Fighting Addiction and a Pandemic to Keep St. Louis' Unhoused Alive

May 27, 2020 at 6:10 am
Jen Nagel and Miles Hoffman, staff members of MoNetwork, distribute harm reduction kits they hope will keep people alive.
Jen Nagel and Miles Hoffman, staff members of MoNetwork, distribute harm reduction kits they hope will keep people alive. THEO WELLING

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The MoNetwork van makes the rounds through the city. - THEO WELLING
The MoNetwork van makes the rounds through the city.

For more than two decades before the COVID-19 pandemic hit America, the nation was coming to grips with another public health menace: the opioid crisis, a human catastrophe centered in the United States that accounted for the bulk of the nearly 71,000 drug overdose deaths reported nationwide in 2017. On average, 130 Americans each day die from opioid overdoses, according to federal figures.

But thanks to an array of strategies — increased access to treatment, government prescription monitoring, a national education campaign to dissuade doctors from overprescribing opiates — overdose fatalities have started to drop nationwide.

In 2018, slightly more than 67,000 Americans died from drug overdoses — a decline of 5.6 percent from the previous year after more than twenty years of escalating mortality statistics, according to the National Institute on Drug Abuse.

But the progress being made nationally in fighting opioid abuse is not matched in the St. Louis region.

Opioid overdose deaths in St. Louis rose 200 percent across the region between 2012 and 2019, according to the NCADA, a local organization originally known as the National Council on Alcoholism and Drug Abuse.

Between 2017 and 2018, opioid overdose deaths in St. Louis went up 23 percent. In St. Louis County fatalities climbed even higher — by 30 percent.

Now, because the COVID-19 pandemic is amplifying the interlocking factors behind overdoses, drug mortality rates are likely to climb even higher, according to Brandon Costerison, an NCADA policy analyst.

A key reason is the prolonged social isolation for many people caused by the COVID pandemic — a major driver behind drug relapses.

"People are bored, they have time on their hands, they want something to do," Costerison says. "But on the other hand, they have less money to spend. That kind of combination can be particularly harmful."

In addition, many people are having a difficult time accessing drugs, Costerison says.

"Some people might go several days or a week without getting in touch with a dealer to get their drugs," he says. "And so when they do get their heroin or fentanyl, their tolerance has dropped as a result of their period of sobriety."

MoNetwork's staff takes extra precautions because of the pandemic. - THEO WELLING
MoNetwork's staff takes extra precautions because of the pandemic.

Chad Sabora, co-founder of MoNetwork, says security measures to control America's borders because of the pandemic have had a big impact among opiate users.

"Our drug supply, it's always been inconsistent because it's an unregulated market," Sabora says. "Now it's even more inconsistent."

Another new consequence of isolating in place is the fact that more drug overdoses are occurring at home, and concerned family members are now more likely to seek help for loved ones with a suspected drug problem, Costerison says.

"Because it used to be, people were able to hide their use by using with a friend," he explains. "But now that they are quarantined at home and in more contact with family, people are starting to see these things that are odd or coming across as concerning a lot more commonly. Family and friends are starting to see, 'Oh, this person might have a problem with substance abuse.'"

Since COVID-19 is a respiratory disease, it is particularly dangerous for people with compromised immune systems and who are prone to respiratory tract infections — especially the unhoused population, according to Costerison.

Unhoused people are exposed to the elements on a consistent basis and thus "they're more likely to have some type of respiratory infection," he says. "Right now a sinus infection could be enough to cause an overdose, because the person's already having a hard time breathing."

Sabora criticized the City of St. Louis' decision in early May to take down two homeless tent cities in downtown St. Louis between City Hall and the Soldiers Memorial.

ArchCity Defenders, a public interest law firm, had filed a lawsuit to prevent the closure of the encampments in response to a city order to vacate. The group, through its lawsuit, argued the city did not have "enough shelter beds, motel rooms, and temporary housing for people to move into." The lawsuit also alleged that there was a waiting list of nearly 100 people for shelter beds.

Mayor Lyda Krewson said the order was issued out of concern that the encampments' residents could spread COVID-19.

The problem with that, according to Sabora, is that closing the tent cities scattered the residents, making it harder to track down unhoused people who need help to survive.

"We knew where everybody was," Sabora says about the tent cities. "All those encampments had a 'mayor.'"

Many of the people who had lived in the homeless encampments were taken to live either in a shuttered retirement center for Catholic nuns called The Little Sisters of the Poor or one of several motels under contract to the city.

But a large number of those unhoused people have since left the facilities, according to Sabora.

"There was no food at the hotels that they sent people to, like, literally," he says. "People didn't have enough to eat. And they still don't."

Stephen Conway, Krewson's chief of staff, defends the encampment closures on the grounds that they were dirty, overcrowded and a magnet for drug dealing and drug overdoses. "Twenty people shoulder to shoulder throughout the day," Conway says. "Some of the other conditions were the rotten food, the needles in the tents."

Conway denied that any of the people moved to the Little Sisters site or the three hotels lack access to food.

One man at an encampment had walked all the way from Wentzville, while other people had come from Valley Park and Effingham, Illinois, according to Conway.

Stephen Conway talks to Capt. Renee Kriesmann at the edge a homeless camp before it was cleared away. - DOYLE MURPHY
Stephen Conway talks to Capt. Renee Kriesmann at the edge a homeless camp before it was cleared away.

"We were attracting people from throughout the region and even further," he says.

The city is spending about $250,000 per month to house 232 residents at the Little Sisters facility and the three hotels, and to provide counseling and training services for the dozens of people moved from the encampments, according to Conway.

Eventually, the city hopes to be reimbursed by the federal government for its costs, he says.

"Our goal, it was a great opportunity to introduce some of these people to a fresh start, besides being an incredible health hazard," Conway says of the tent city closures. "We've gotten a tremendous number of people off the streets. We've gotten them into conditions where they have a hot shower, a laundry and three meals a day and wraparound services."