One Woman’s Journey From Drug Use and Life on the Streets to Stability
She credits a Pew grantee with showing up for her when she ‘didn’t want to show up for [herself]’
Like many who’ve struggled with opioid use disorder (OUD), Randi Giammona remembers the day when she decided enough was enough—and made it stick.
It was July 25, 2023. After more than two decades of periodic drug use, homelessness, prostitution, repeated trips to emergency rooms, having a son and losing custody of him, she was hospitalized yet again. But this time it felt different.
“With all the crazy things that had happened to me, now I really thought I was going to die, that this was my last chance,” she said. “I knew if I didn’t fight as hard as I could for my son, that if I lost him, even if I survived, I’d also lose myself.”
Today, at age 39, Giammona is in a much better place, physically and emotionally, thanks in part to years of help she received from Pathways to Housing PA, which received a five-year growth grant from the Pew Fund for Health and Human Services in Philadelphia in 2024.
She has her 10-year-old son back. They share a house in the Grays Ferry section of Philadelphia with her elderly mother. Medicare pays Giammona to be her caretaker.
She is not substance-free; she takes a long-term injectable form of buprenorphine that reduces her cravings and allows her to “show up for daily life without feeling sick, anxious, depressed, out of my mind,” as she put it.
For Giammona, that feels like real success. And it feels that way for staff members at Pathways as well.
This recovery journey includes many of the elements that Pathways counselors often see as they try to help people on the streets who suffer with OUD.
Giammona’s journey was long, uneven, and unpredictable, filled with fits, starts, reversals, and dead ends; she had started and stopped methadone treatment five times. But along the way, she had the ongoing assistance of a steadfast partner, Pathways in this case, that provided her with basic health care, housing, and a wide range of other services—and stuck with her for years.
“A lot of personal rebuilding has to happen,” said Christine Simiriglia, Pathways’ president and CEO, of working with the roughly 225 individuals dealing with OUD that her organization serves annually. “And a lot of hand-holding in some cases. You have to let people express whatever they need to express. And you have to listen, because it’s real.”
Giammona’s drug use began in high school in suburban Bucks County. At age 16, she had surgery on her sinuses, and doctors prescribed opioids, Percocet, and Vicodin for her post-operative pain. From there, she moved on to Oxycontin, which she got from friends. While still in high school, she remembers being involved in “drug-seeking, drug-selling, and various shady avenues of business.” Eventually, she moved on to heroin.
In her 20s, she had a reasonably typical young adult life, finding work, living with her great-grandmother, and giving birth to her son. Then, her great-grandmother died, and the family lost the house. Suddenly Giammona was living on the street, and her son, who was 18 months old at the time, was taken in by her mother.
“I had been sober before all of that happened, but I didn’t know how to be homeless sober,” she said, adding that she resorted to prostitution to pay for her continued opioid use. “I felt like I couldn’t find my way out.”
A year or so later, she was contacted by Pathways, which learned about her through Prevention Point Philadelphia, a nonprofit in the Kensington neighborhood that provides medical, behavioral health, and substance use prevention and treatment services. She had gone to that organization for buprenorphine treatment.
To get her off the street, Pathways first put her in an apartment in Torresdale, where she felt desperately lonely. Then, in a unit in Frankford with a different problem: proximity to drug dealers. A third site was better. By then, though, her mother had lost custody of her son, who was placed in foster care.
And Giammona herself had moved on to xylazine, a dangerous veterinary sedative. Also known as “tranq,” it’s become a commonly abused street drug that can lead to necrotic skin wounds, life-threatening infections, and limb amputations. Among other things, it caused her to lose a toe.
Finally came the epiphany in 2023 and her decision to move forward, with the help of Pathways and the long-term injectable buprenorphine, a treatment option that Pathways clinicians and some of its partners believe holds great promise. “People start to stabilize. People go back to work. People reconnect with their families much quicker and better than with other treatment options,” Simiriglia said.
Giammona credits Pathways for “showing up for you, even when you don’t want to show up for yourself, reminding you why you don’t deserve what you’ve been going through.” Her message to others grappling with OUD is simple and direct:
“Don’t be scared to trust. If you ask for help, let them help you.”
Jessica Gillespie is a senior officer with the Pew Fund for Health and Human Services. Larry Eichel is a senior adviser with The Pew Charitable Trusts’ Philadelphia research and policy initiative.
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