Can Philadelphia Fix One of the Most Drug-Plagued Neighborhoods in the Country?

The vow was unequivocal: The city of Philadelphia was finally going to root out the drug trade that has long monopolized the streets of Kensington.

Around the neighborhood, where scores of people languish in the shadows of the elevated train, injecting, smoking and nodding in and out of consciousness, the expectations were far more tempered.

Antonio Alvarez, 58, surrounded by grandchildren on his porch, believed the drug market would go quiet, temporarily, and then return as it always had. Harris Steinberg, 57, standing at the counter of his auto parts shop, said that everything along Kensington Avenue — the tents, dealers and stray needles — was already moving to the neighborhood’s back streets. Elizabeth, 29, who was sitting on a mattress on the sidewalk — and, like many of those using drugs on the street, declined to give her last name — heard that mass arrests were coming for those like her. But, she said, she was stuck on a waiting list for a shelter bed.

No one except the drug dealers said that they were happy with how things were in Kensington, one of the most sprawling areas of open drug use and dealing on the East Coast. And almost no one expected things to really change.

Mayor Cherelle Parker, who took office in January, insists that this time is different. She campaigned on restoring “lawfulness,” and no neighborhood has come to symbolize disorder like Kensington, highlighted by candidates for national office as evidence of the country’s “depraved reality.”

Ms. Parker, a Democrat, talked of bringing in the National Guard (Gov. Josh Shapiro, also a Democrat and the person who would have to authorize such a deployment, was against the idea). And last month her administration released a highly-anticipated plan to “eliminate Kensington as the narcotics destination of Philadelphia.”

The effort is heavy on ambition and light on specifics, particularly how the city will address the long-term needs of the hundreds of people suffering from addiction and now living on the sidewalks. Officials have told the City Council that they are creating a “medium- to long-term system and structures for care, treatment, housing, jobs” — a system, they acknowledge, that does not currently exist.

Central to the initiative is heavier law enforcement in the neighborhood, and, though this phase has yet to formally begin, the police are clearing a large homeless encampment this week.

Much of this has troubled some public health experts. The city’s aim, said Scott Burris, who directs the Center for Public Health Law Research at Temple University, is to “exercise pressure on people to get treatment services.”

But this would not solve the fundamental challenge of Kensington, he said, where large numbers of people need wound care, treatment for infectious disease, counseling, short- and long-term housing and jobs, even as they struggle to recover from an ever-changing mix of new and devastating drugs. “That’s always been our problem,” he said. “We don’t have the actual services available.”

The drug trade moved into Kensington in the 1970s, setting up in empty warehouses and eventually creating what Mr. Shapiro, then the state’s attorney general, described as a nearly “billion-dollar enterprise” in a neighborhood where the median household income is below $30,000. Known for the purity of its heroin, the market drew people from all over the Northeast. The market also brought the rampant gun violence, turning local blocks into some of the most dangerous in the country.

Still, the death toll from guns in Philadelphia, even at its worst, is far below the toll from overdoses. In recent years, the market in Kensington shifted from heroin to more lethal and destructive synthetic drugs like fentanyl, which can brings swift, severe withdrawals, and xylazine, which leaves festering wounds that can lead to amputations. The city’s fragmented treatment services have struggled to handle these compounding miseries.

Years of police operations and encampment sweeps failed to fundamentally change the neighborhood. Mayor Parker’s predecessor, Jim Kenney, moved the city’s strategy decidedly away from law enforcement and toward “harm reduction,” aimed at keeping drug users alive while coaxing them into recovery.

Many residents insist this strategy made things worse. “It seems like people are being coddled!” Crystal Anderson, 52, declared at a recent meeting of the Harrowgate Civic Association. “We are tired!”

Quetcy Lozada, a City Council member whose district includes much of Kensington, said that the previous approach would never have been tolerated in a wealthier neighborhood. “They basically sent a message that there was not going to be policing,” she said.

Under the city’s new approach, she said, people would be offered the services they need. The city is already expanding on the treatment and shelter options that are available, but on the street, she said, “business as usual will no longer be tolerated.”

Outreach teams have been telling people what is coming and offering to connect them with available treatment. The eventual aim is to direct people to “wellness facilities” that city officials say they are planning, though it’s unclear when the facilities will open and what specific services they will provide. Those who are found committing quality-of-life offenses will be offered treatment and shelter. If they refuse, they could face arrest.

What this new strategy will not entail are some of the key elements of harm reduction.

The city effectively banned supervised injection sites, and in February a harm-reduction nonprofit was kicked out of its building. The mayor, as she had pledged to do, proposed cutting all city funding for the needle exchange program run by Prevention Point Philadelphia, an organization based in a church on Kensington Avenue.

Though it now offers a range of services, including a shelter, Prevention Point began 33 years ago with the needle exchange. One study found that this program very likely prevented more than 10,000 H.I.V. cases and saved the city hundreds of millions of dollars. Mayor Parker said that the exchange could still operate, just not with city money. Responding to questions about the funding cuts, officials from the Parker administration told the City Council that they were preparing for an increase in H.I.V. cases.

The turn away from harm reduction is by design: With fewer day-to-day resources and more rigorous law enforcement, the plan’s supporters argue, drug users would be more likely to seek help.

“The Police Department is going to have to reset the norms,” Police Commissioner Kevin J. Bethel said in an interview, insisting that the neighborhood had become too much of “a place of comfort” for people using drugs. With a more “stringent” approach, he said, “hopefully we’ll be pushing more people to treatment.”

Among some workers in public health, and people on the street — many of whom say they have been in rehab multiple times — this has drawn skepticism and apprehension. The prospect of discomfort, even the threat of a stay in Philadelphia’s troubled jails, would mean little to those who have lost limbs to a drug they are still injecting. Addiction is a chronic disorder, they point out, which functionally changes the brain’s circuitry.

“About a year ago they said, ‘We’re going to try a pilot,’” said David Malloy, director of mobile services at Merakey Parkside Recovery, a treatment program that operates in Kensington. The plan was to offer a choice between jail or treatment to a few in the neighborhood facing low-level charges. Six people took up the offer, he said. On the way to treatment facilities, he said, “three of them literally jumped out of moving vehicles.”

Mr. Malloy, who years ago was using drugs and living on the streets of Kensington himself, believed that change in the neighborhood was possible. But he said it would require better cooperation between harm-reduction advocates and those who believe in more policing, and “an understanding that all of this fits together.” Coercion won’t work, he said.

Still, some believe that there could be more dramatic changes coming to the neighborhood than many realize.

Just a few blocks south of Kensington Avenue, large residential buildings are rising, a new frontier in the ongoing development of North Philadelphia. More than 4,000 units have recently been built or proposed in the area, according to the New Kensington Community Development Corporation, a nonprofit that has been in the neighborhood since the 1980s.

That interest from the real estate industry was hardly there during past efforts to clean up the neighborhood, said Bill McKinney, executive director of the development corporation and a resident of the neighborhood for 20 years. Now, with developers on the doorstep, he said, a cleaner Kensington, long sought by many of the neighborhood’s working-class residents, could bring far more disruptive consequences to their lives than they had anticipated.

“We’re actually celebrating our own demise,” he said. “Because folks here are going to get pushed out in a heartbeat.”