The opioid crisis inflicts such cruelty on millions of American families every day. Philadelphia families endure more than their share. “We had an estimated 1,200 overdose deaths in Philly in 2017,” said Tom Farley, the health commissioner. “To put that in perspective, AIDS deaths at the worst of the epidemic were 935. We have the highest overdose rate by far of any of the 10 biggest cities in America.”

Like most places, Philadelphia is arresting drug dealers, reducing opioid pain prescriptions, running ads about the dangers of opioid abuse and distributing naloxone. Many cities and towns struggle to increase the number of doctors qualified to offer opioid substitution therapy with buprenorphine, or with Suboxone, which contains buprenorphine and naloxone.

For people with substance use disorder, Garcés said, there are two gateways into official Philadelphia: the criminal justice process and the emergency room. These also could be gateways to drug treatment, but cities uniformly fumble both opportunities.