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

Jen Nagel and Miles Hoffman, staff members of MoNetwork, distribute harm reduction kits they hope will keep people alive.

THEO WELLING

Jen Nagel and Miles Hoffman, staff members of MoNetwork, distribute harm reduction kits they hope will keep people alive.

The men head toward the big white van almost as soon as it rolls to a stop in front of Russell Park.

It's just after 3 p.m. on a Tuesday. The park, which stands at the corner of Cabanne Avenue and Goodfellow Boulevard in the West End neighborhood of north St. Louis, consists of a small patch of grass surrounding a large playground in a neighborhood marked by vacant buildings.

Some of the men move with the stiff-legged gait of those who spend their nights sleeping rough, stretched out on concrete or grass.

A tall man nicknamed "Swoop," his hair held together in a series of cascading braids, approaches the van tentatively, his movements halting and cautious as the latest hit of heroin crawls through his veins.

Swoop, 43, says he's been homeless for about nineteen months, and that he uses heroin to self-medicate for chronic depression.

"The depression makes you want to get high," he says. "You have no job. Nobody wants to give you a job because of your appearance and what you're doing."

Occasionally, Swoop earns money from odd jobs in the neighborhood. But when he gets home, it's still the same story, he says.

"We still sitting around," he says. "We get to come back to an abandoned building. We look around, and it's depressing as soon as you walk in the door. So the first thing we do, we got money in our pockets, we get high."

As far as COVID-19, Swoop says he's not worried.

"I'm not really around that many people," he says. "I think God is good. I don't know. I'm just not that concerned about it."

Swoop grabs a brown paper bag from a cardboard box piled high with lunches, then a bottled water from one of the cases left on the sidewalk. He joins the line of other men inching forward to the van.

Standing at the front of the line are Miles Hoffman and Jen Nagel, staff members of the Missouri Network for Opiate Reform and Recovery, or MoNetwork, located at 4022 South Broadway in south St. Louis. MoNetwork owns and operates the van and collects the items it hands out.

Hoffman and Nagel eagerly engage with the men, smoothly reaching for simple black backpacks, known as Harm Reduction Kits, which they fill with a long list of items calculated to keep their customers alive for another week. Alcohol-soaked swabs. Hypodermic needle disposal kits. Small plastic tubes of Naloxone, also known as Narcan, which can be squirted up the nose to reverse a drug overdose.

In recent months, because of the threat posed by COVID-19, other essentials have been added to the bags: hand sanitizer, disposable gloves, face masks.

Tourniquets, cotton pellets and single-use cookers are part of the harm reduction supplies. - THEO WELLING
  • THEO WELLING
  • Tourniquets, cotton pellets and single-use cookers are part of the harm reduction supplies.

Hoffman, himself a recovering opiate user, says he wants to bring more resources to north St. Louis residents struggling with drug dependance and homelessness. Which is why he takes the MoNetwork van to the spots around St. Louis where he knows they're likely to find unhoused people.

About the time he went into recovery a couple years ago, Hoffman says, the market for illegal opiates went from prescription painkillers to much more powerful opiates, such as heroin and fentanyl.

"Things have kind of changed ... the supply had changed, and the drugs had changed, but the people hadn't," Hoffman says. "And being able to give people the supplies they need, like Naloxone, to reverse overdoses for their friends and loved ones, to keep people safe and to keep people out of hospitals and to keep people informed, is something I'm really passionate about."

It's impossible to understand homelessness and drug use in isolation from other big-picture issues, such as access to health care and how people interact with police, Hoffman notes.

"And COVID has made that much clearer," he says. "Now we're seeing these issues are being amplified. So people are saying we need to change things and work within the system."

To Nagel, who is also in recovery, the pandemic's impact on drug abuse is a brutal stew that mixes the results of the United States' war on drugs, the lack of resources for treatment and society's efforts to penalize and moralize away addiction.

"And then you get a worldwide epidemic that's showing glaringly, obviously, that our social structure, our social services, our health services, housing, health care — it's glaringly obvious how disproportionate it is, and how it is not a good system," she says.

The thing of it is, Hoffman says, the system is doing what it's designed to do.

"Which is to keep people in their place," he explains. "And for right now, what we're doing is just trying to directly help people who are most impacted by this."

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

Miles Hoffman, street outreach coordinator for MoNetwork. - THEO WELLING
  • THEO WELLING
  • Miles Hoffman, street outreach coordinator for MoNetwork.

Hoffman has been working for MoNetwork since July 2018. Before that he worked in the restaurant industry.

"My thing is, I had a really difficult time being in and out of recovery," he says.

A man drives up in a car, pauses, interrupting Hoffman.

"You giving this stuff away?" the man asks.

"Yeah," Hoffman says. "I got Narcan, sandwiches, bottled water, that kind of stuff."

The man nods and drives off.

Hoffman says he wants to take the MoNetwork van on more routes across north St. Louis.

"At this point I feel there are a lot of resources that are available for people who are living in south St. Louis, and a lot of people north of Delmar don't know about them," he says.

For his part, Hoffman says he began abusing opiates through prescription pills.

"I was just a curious kid," he says.

"A lot of it was trauma-based. Opiates are a painkiller," he adds. "And it's not just a physical painkiller, but it kills all kinds of pain. It does its job, and it does it really well. And I was the typical white kid from the suburbs, with the story of prescription pills and other drugs and stuff like that."

Hoffman says he was really drunk the first time he tried heroin.

"It wasn't like anything had happened," he says. "And so when I first used heroin intravenously I looked at my friend and I started laughing. 'This is going to ruin my life.' And I was joking at the time. But I was also 100 percent serious."

Tyrone, who says he's been homeless for more than three years, credits MoNetwork with literally keeping him alive.

"It's hard to be homeless and sober," he says. "If I had some place to stay, I can actually deal with my addiction. I try to work and hustle, but it's hard."

Tyrone says he isn't afraid of the coronavirus so much as he's afraid of dying alone.

"Being homeless and dying without nowhere to stay and nowhere to live with my kids," he says.

Tyrone says MoNetwork has saved his life. - THEO WELLING
  • THEO WELLING
  • Tyrone says MoNetwork has saved his life.

An hour has passed since the MoNetwork van glided to a stop in front of Russell Park. Now, with the backpacks and supplies nearly gone, Hoffman and Nagel start packing up and prepare to leave.

For an hour, the van provides an island of decency and compassion in a place and time that often seem as if they lack both. And being part of that means a lot according to Nagel, who used to work in the Madison County, Illinois, drug court.

"To be able to have a connection because I'm in recovery myself and knowing what it was like out there," she says. "That little bit of connection. And so many people who suffer from this disorder are ostracized, you know."

A back injury led her to become addicted to prescription pain pills, and then a painful journey into recovery brought her to MoNetwork as a volunteer. That led to her to working full time for the organization.

Nagel says she sees reason for optimism, regardless of how long the pandemic lasts.

"Because if we can live through something like this and muddle our way through and navigate it ourselves," she says, "if it lasts for two or three years or even forever, we're going to get used to that new normal. Because people that use drugs and people who are in recovery are super resourceful. And we're very resilient, and we're all able to adapt to crises."

Jena Nagel, peer coordinator for employment, MoNetwork. - THEO WELLING
  • THEO WELLING
  • Jena Nagel, peer coordinator for employment, MoNetwork.

She adds: "My life experience, my experience in active addiction, it has given me a purpose. And now I love to get up and go to work every day. And that sense of purpose is keeping me healthy and keeping me in recovery."

Hoffman slides behind the van's wheel, and Nagel climbs into the seat next to him. They buckle their seatbelts. A moment later the MoNetwork van pulls away, en route to the MoNetwork headquarters in south city.

There they will stock up, recharge and prepare for the next day's stop, where their customers will greet them like a lifeline.

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