Geographies of Overdose Response: Spaces of Care and Fear in Kensington, Philadelphia

Abstract

In 2019, Philadelphia Mayor James Kenney declared Philadelphia’s opioid epidemic a national emergency. The city’s large, open-air heroin and fentanyl market is situated in the Kensington neighborhood – its zip code, 19134, has the most fatal overdoses per year of any in the city (Philadelphia Department of Health, 2020). Many people from the city and the whole of the east coast who use drugs make their way to Kensington because of how cheap and readily available heroin and fentanyl are. Many of these people end up living and using on the streets, as there are few shelter beds available in the city that will accommodate substance use. Because of the dispersed, public, and widespread nature of substance use in the neighborhood, community members and social services providers in the neighborhood are often the first and only people able to respond to an overdose that happens in public space at any given time. As the city struggles to implement an overdose prevention site –a place where people can bring in, test, and use substances in a safe, medically regulated environment – an informal network of these social service providers and neighbors have developed strategies to reverse overdoses and provide street-level medical care to people who inject and use drugs. This thesis looks at how these networks may operate as informal, geographically disbursed overdose prevention sites. It examines how the current arrangement functions as a space of care and asks how a formalized site may contribute to governmentality, evaluating the benefits and drawbacks of the current informal network. It studies the impact that the informal, and sometimes dangerous, nature of overdose reversal has on those who are tasked with being first responders. It discusses how working within the uneven geographies of Kensington’s substance market changes these responders’ experiences of public space and contributes to geographies of fear. It analyzes some Kensington residents’ practices in relation to people who use drugs in the neighborhood and asks how these practices impact overdose response. Key words: substance use, overdose prevention sites, Philadelphia, revanchism, geographies of fear