Poverty, Addiction, and Medicaid Cuts: A Former Addict's Call to Occupy Wall St.

This week the City of Philadelphia was awarded the dubious distinction of the nation’s "poorest large city," with one quarter of the adult population and one third of children living below the poverty line. Philly’s been big and poor for a long time now, but this is a significant uptick from previous census numbers, and the total economic impact of the ongoing Great Recession has probably not yet been felt. While attempts to de-stigmatize addiction by painting it as a disease that doesn’t discriminate by race, class or gender are well intentioned, the fact is that while addiction may not discriminate it certainly does tend to cluster geographically, and there is a correlation between urban poverty and elevated levels of addiction.

Philadelphia is also the nation’s ninth most segregated city, so the scope of its addiction crises is generally left to the imaginations of the city’s professional class, who stick mostly to the Center City district and a handful of low crime, comparatively high-income neighborhoods. When you step outside this tight circle of comfort and privilege, the drop off is steep and the neighborhoods plagued by addiction—and the violent crime that comes along with our prolonged and pointless War on Drugs—stretch out like a vast plain, dotted with tens of thousands of abandoned properties and vacant lots. In recent year, efforts by the police to flood high drug and crime neighborhoods (Operations Sunrise and its sequels, such as Pressure Point) with boots on the ground and crush the drug trade have only served to disperse it further. Now drug commerce has spread its net over the newly impoverished neighborhoods abandoned by the remnants of what was once the city’s massive working class whose lives were consumed, generation after generation, by jobs in the city’s equally massive manufacturing sector. But the plants have long fled south or overseas, and the working families fled too. 

To call this blasted landscape “vast” is no exaggeration; I am talking about literally miles of land inhabited by families surviving below the poverty level and whose only realistic hope is, not surprisingly, not to end up on the street. As a social worker I have traveled through these neighborhoods routinely for years and can tell you that once you step outside the sharply defined circle of race and class that encloses the city’s professionals, the conversation focuses obsessively on one topic and one topic only: drugs. Who’s taking them, who’s quitting them, who’s selling them, who got killed over them; these are the day-to-day events that guide hundreds of thousands of lives in Philadelphia’s poorest neighborhoods—which is to say in the vast majority of Philadelphia outside Center City. It’s impossible to ride a public bus through this city and not come away with the impression that addiction and its associated social costs are not the most pressing issue of our time. I guess it all depends on where you live, though; the big houses of the Main Line still sustain their expensive upkeep, becoming more and more like gated communities every decade.

What’s most maddening is that while the city’s most vulnerable populations are trapped in a cycle of poverty and addiction that the recession has only aggravated, the state of Pennsylvania is moving to make devastating cuts to Medicaid, the primary source of funding for addiction treatment for the urban poor. Dope addicts in North Philly don’t go to cushy seaside dry-out resorts when they decide to kick; they go wherever the state is willing to pay to send them. Many of these treatment facilities are already in ailing physical condition, understaffed by undertrained professionals and so crowded that a free bed is like hitting the lottery. Deeper cuts to this particular section of our nation’s vanishing safety net could have a profoundly negative impact, pushing addicts who are already at the fringes and dire states of homelessness and incarceration.