One Year Inside a Radical New Approach to America’s Overdose Crisis.
By The New York Times / Jeneen Interlandi
I. ‘Let’s not crowd her right out the gate.’
It was late summer, and the sun was high over East Harlem. Terrell Jones stepped out of a large black van that advertised help with detox and free hepatitis C testing and scanned the homeless encampment beneath the elevated train tracks across the intersection from where he stood. He was looking for a specific inhabitant, a white woman in her late 20s or early 30s whom he and his colleagues had heard about for weeks but had yet to meet. Like many of the women Mr. Jones encountered in his work, this one was unhoused, was attached to a possibly abusive man and was using hard drugs (crack, in this case). Unlike the others, though, she was also about five months pregnant…
II. ‘There’s still deep hatred in this country for people who use drugs.’
The American approach to addiction and overdose needs, desperately, to change. The nation’s half-century war on drugs has failed: We are being pummeled by the third wave of a multigenerational opioid crisis that was triggered by our legal drug industry and our faulty regulatory apparatus. We spend roughly five times as much incarcerating people with substance use disorders as it would cost us to treat them, and the return on that expenditure has been meager at best. Drug use is soaring, and drug overdoses are killing more than 100,000 people a year — more than at any other point in modern history. Life expectancy is declining in the United States for the first time in generations largely as a result. The economy is losing a trillion or so dollars — equal to about 5 percent of its G.D.P. — every year in productivity, health care costs and criminal justice expenditures, among other things…
III. ‘Look at all you beautiful people.’
The new center had been open for just shy of two months when George Cosme first visited in late February 2022 to inject heroin with a friend. It normally takes several minutes for an excess of opioids to trigger the kind of respiratory crisis that can kill a person, but Mr. Cosme’s overdose was almost instantaneous. His face turned bright purple just moments after the heroin entered his bloodstream. His body went almost rigid with clenching. He lost consciousness and then, in a matter of seconds, stopped breathing…
IV. ‘I pay more taxes than you.’
The tide of needle litter came in heavy at the start of every month, when benefit checks arrived and people were briefly flush. They took their used syringes to the van to exchange, sometimes by the bucket or bagful, and Mr. Jones and his colleagues collected so many from beneath parked cars, along littered sidewalks and near schoolyards, where they took extra care, that their hands sometimes ached from the effort. There were far fewer by month’s end, but when the first of the month came again, a fresh swell always followed. That tide would turn even more decisively after winter came and folks headed down into the subways or ducked into whatever shelter they could find. But it was late October now, and the days were still mostly warm…
V. ‘A cocktail waitress who serves mental health.’
OnPoint’s headquarters consists of a four-story brick building near the intersection of East 126th Street and Park Avenue. Its nearest neighbors include a bodega, a locked Department of Transportation garage, a public housing complex and, directly across the street, a preschool. From a distance, the area can look chaotic. Dealers and program participants regularly clog the sidewalk out front, and drama from the street periodically spills into the building. But Anthony Santiago, the manager of the front room, is a master of de-escalation, and any chaos inside is well controlled as a result…
VI. ‘This was somebody’s brother right here.’
It was late fall — freezing out and not yet 6 a.m. — and Mr. Jones and Mr. Roman had not been at East 116th and Lexington for more than two minutes when someone ran over screaming. A man was unconscious, appeared to have overdosed and needed help immediately. They found him quickly a few feet from where they had parked. He was upright, leaning against an ice machine in front of a bodega, but stiff, bluish and ice-cold. Mr. Jones called 911 while Mr. Roman shot four milligrams of naloxone up his nostrils then laid him flat on the ground and started him on an Ambu bag: in and out, slow and steady, breathe breathe breathe. It had been raining. The man was soaking wet and reeked of urine…
VII. ‘Whose houses are they breaking into?’
Not all the news was bad. As fall yielded to winter, Mr. Cosme was alive and abstaining from heroin. He was off parole, too, no longer state property for the first time in years. To his great pride, he had reversed an overdose himself, out on the streets, one early evening in late fall. He was still meeting with Ms. Corso regularly, and if he had not found his way into stable housing or gainful employment, he had developed at least some insight into the forces that motivated him. “I don’t want to care about anyone because I don’t want to lose anyone,” he told me in early December. “And I don’t want anyone to care about me because maybe I don’t think I deserve that.” He was still using some drugs; he had never really known a life without them, he said. But for the first time in forever, he felt his future was speckled with hope…
VIII. ‘The science doesn’t really matter.’
In its first year of operation, OnPoint welcomed more than 2,000 people into its program — at least half of whom became regular participants. It’s too early to say whether the program’s efforts will translate into better long-term outcomes for them. Opioid addiction, in particular, can take years to recover from, even in the best of circumstances, and the people who go to OnPoint seeking help tend not to be in the best of circumstances…
IX. ‘Community is like the antidote to stigma.’
The sun had not yet risen, but the people standing near the intersection of 116th and Lexington were visible by the light spilling out of a bodega and a sign offering cash loans in electric red. Some folks bounced with stories and jokes, but most leaned quietly against the gates of closed shops. They surrounded the OnPoint van as soon as it parked. Winter had come. The cold was biting, and their needs were voracious. They wanted needles and cookers, warm clothes and breakfast. They wanted naloxone, too, but not fentanyl test strips because, in truth, they wanted fentanyl. Heroin without it was considered old man junk.
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