Latonia Easter, forty-six, waits in line to receive food and harm reduction supplies provided by a Chicago Recovery Alliance (CRA) truck parked at the corner of 68th and South Halsted. Easter has been homeless for more than ten years and struggles with chronic opioid use. The coronavirus pandemic has only reinforced her reluctance to seek shelter and resources from local health care and homeless support service providers. She worries about contracting the virus at shelters and instead chooses to stay in a few abandoned buildings in Englewood.
Because Easter prefers to be on her own, she uses drugs in private, meaning that her chances of a fatal overdose drastically increase. When CRA staff offered her Naloxone—an injectable medication designed to rapidly reverse opioid overdose—Easter declined.
The United States experienced a record of nearly 72,000 overdose deaths in 2019, according to the Centers for Disease Control and Prevention (CDC). Other preliminary reports suggest that 2020 has the potential to be deadlier. The Overdose Detection Mapping Application Program (ODMAP), which tracks emergency calls responding to suspected overdoses, found that sixty-two percent of counties in the United States indicated increases after COVID-19-related lockdowns began. Illinois is one of those states.
The Cook County Medical Examiner’s Office confirmed 1,267 opioid overdose deaths in 2019, and ongoing analysis suggests that Cook County is projected to double the number of opioid-related overdoses this year.
Research shows that drug use often increases during times of economic distress, and data from the Illinois Department of Employment Security showed the statewide unemployment rate tripled in 2020, with 10.2 percent in September compared to 3.7 percent last year.
Although national data on overdoses remains incomplete, frontline preventive health care specialists and homeless service providers have seen notable upticks in substance misuse and housing insecurity throughout their service populations across Chicago.
Anthony Strong, a community health worker at Heartland Alliance, said that while driving across the city he has seen a proliferation of homeless encampments—more than he has ever seen in his five years with the organization.
When asked if a rise in new homeless persons and overdoses have occurred compared to pre-pandemic conditions, Strong said, “All of the above. It used to be an older crowd and it is slowly getting to be a younger crowd, where you are having, at one point, very able-bodied twenty-year-olds that could go get a job unable to because of this addiction, which leads to, at a faster track, homelessness.”
He frequents the West and South Side to provide outreach services to individuals struggling with addiction and homelessness. “Over the past three months, I’ve seen maybe fifteen overdoses with my own eyes, and all of them have been in a four- or five-block radius on the West Side, near Chicago Avenue and Kedzie Street,” he said.
Clifton Sanchez, an outreach specialist and director of human resources at CRA, concurred that a notable increase in homeless individuals has taken place since the pandemic began. “I pass 51st right off of State Street, between State and the Dan Ryan, there is a viaduct right there, that viaduct is totally full with homeless [people],” said Sanchez.
“In January or February of this year, when we drove by there, there was no one in that viaduct … the increase was substantial to the point where I told a couple of pastors that do a lot of outreach—giving out food and such—and they went over there to bring food for the folks,” he said.
Based on the harm-reduction materials that Sanchez distributes at his five sites across the South Side, he has been able to note the differences of the drug supply in certain areas. CRA currently has eighteen locations across the city that their mobile units travel to to provide harm reduction materials and health care services.
“The majority of the people we are serving are addicted to crack cocaine, ten to one,” said Sanchez. “[They] are coming for the safe snort and smoke kits—we’ve seen a super uptick at all the sites.”
Sanchez said that the majority of illicit opiates on the street contain fentanyl, a powerful synesthetic opioid analgesic that is fifty to one hundred times more potent than morphine, which has been an all-too familiar culprit of the overdose epidemic.
A lack of donations and supplies during the COVID-19 pandemic has hindered CRA’s ability to consistently provide personal protective equipment (PPE) to their clients. “We try to give them hygiene kits when we have them,” said Sanchez. “We try to give them food and snacks when we have it. We literally save this stuff just for our homeless population because we don’t have enough to give it to everybody. You got to ration it out.”
Sanchez estimated that about a quarter of CRA’s total client population is unsheltered homeless. “When folks come to the truck, their masks are dirty, they got food on them, and they have been wearing those masks for a few days, because that’s the same mask we gave them last week,” said Sanchez. “So, there is no intervention between the times that we see these folks. What we give them is what they have until we see them again.”
Throughout 2018, an estimated 76,998 people experienced homelessness in Chicago, 18,126—about twenty-four percent—of whom lived in the streets or shelters, according to a report released by the Chicago Coalition for the Homeless.
These numbers do not account for the tens of thousands of individuals in Chicago that currently live paycheck-to-paycheck and are one financial setback away from eviction or homelessness, nor do they account for the expected climb as the economic downturn continues to worsen the financial stability of Americans.
An analysis conducted by Dr. Brendan O’Flaherty, a professor of urban economics at Columbia University, estimates that there will be a forty to forty-five percent increase in homelessness nationally by the end of 2020.
The majority of open-space congregate shelters in Chicago were forced to reduce the number of available beds in an effort to abide by CDC social distancing guidelines and other preventive measures to combat infection rates from climbing. “We cut our population in half,” said La Forice Nealy, president and CEO of the Olive Branch Mission, a long-time social and homeless service provider on the South Side.
In March, local health care and homeless service providers formed a cross-sector partnership innovative called the Chicago Homelessness and Health Response Group for Equity (CHHRGE), to address and combat the devastating impact the COVID-19 health crisis has had on Chicago’s most vulnerable communities. As of June 5, the group was comprised of more than thirty organizations, including A Safe Haven, All Chicago, Chicago Coalition for the Homeless, and Cook County Health (CCH), among others.
“We knew that the homeless checked all the boxes in terms of underlying conditions that made them the most vulnerable, the most susceptible to getting the disease, getting sick from it, and dying from it,” said Neli Vasquez Rowland, president of A Safe Haven and a founder of CHHRGE.
Working in tandem with the City of Chicago Department of Public Health and Rush University Medical Center, in April A Safe Haven opened a medical respite isolation space to serve unsheltered COVID-19 positive patients in their headquarters in Tri-Taylor, where the organization dedicated a wing to house 100 beds for homeless persons diagnosed with the virus.
Unfortunately, the majority of homeless and transitional living shelters are unable to create isolation areas for COVID-19 patients or accommodate the expected increase in demand during Chicago’s coldest months. Pre-pandemic, the Olive Branch Mission had 350 beds split between two locations—now they hover around 170.
Andrew Wodja, a substance use advocate with The Night Ministry, has seen how harmful the pandemic can be to homeless persons, especially affecting how they obtain money, resources, and basic health care services. The Night Ministry, a homeless service provider located on the North Side, operates a street medicine team that provides free healthcare, survival and harm reduction supplies, and direct support to Chicago’s underserved population.
“Just a couple months ago, if you were in the Loop at any given time of the week, you’d see how drastic the change was,” said Wodja, commenting on how some homeless individuals he works with subsist on money from panhandling in the central business district of the city.
“A lot of these folks make money down there because that’s where all the foot traffic is, and if there is no foot traffic down there, there is no money to be made,” he said. “If you mess with their money, you are messing with their habit, a habit that is down to a science at this point, and when you mess with that science, people die.”
The Night Ministry works with UI Health to onboard clients on a Suboxone treatment program to help homeless persons detox and break their dependency.
“Of the individuals that are interested in Suboxone, we don’t have success with all of them,” said Wodja. Over the last few months, Wodja and his street medicine team members have surpassed over fifty participants in the Suboxone treatment program. There are many challenges when it comes to tracking the progress of participants, including locating the individuals to make sure they are following the regimen protocols, said Wodja.
Stephan Koruba, a senior nurse practitioner with the street medicine team, estimates that about twenty percent of the Suboxone program participants see it through to the end. But Koruba said that COVID-19 has pushed many to turn to the program, as resources and certain drug supply chains are inconsistent due to the limiting nature of the pandemic.
Matthew, forty-nine, who lives in a tent under a viaduct near West Chicago Avenue and North Sacramento Avenue, was on Suboxone for four months before turning back to his daily opiate use. He said the Suboxone manifested in intense gastrointestinal discomfort and being “dope sick,” which led him to back to opiate use, despite the fact that he’s known of four individuals close to his friends and him who fatally overdosed over this past year. Since the pandemic began in March, Matthew, who has been on the streets for years, said he has seen more homeless people turning up and that it has been much harder to obtain resources and supplies.
Dr. Jeffrey Watts, a board-certified psychiatrist and addiction medicine physician at CCH, said that the greatest risk of overdose is when the drug supply chain is intermittent. There has been a dramatic increase in fentanyl-laced drugs during COVID-19 because the synthetic opioids are easier to come by as compared to the naturally occurring drugs, Watts said.
“During COVID-19, the supply has been inconsistent, and when people are able to get something, they are not aware of what they are purchasing,” he said.
When asked if there is a correlation between substance-use disorders and homelessness, Watts said absolutely. “They are affecting how we feel, how we think, the decisions that we make and sometimes that ends up with a person losing their housing, or not being able to pay their rent, maybe their behaviors lead them to not be able to go back to the place where they were staying before. All of these things are tied together very closely.”
Watts said that telehealth practices and loosened regulations on prescription-filling protocols could be a useful tool to combat the opioid epidemic during the coronavirus pandemic and thereafter.
“We were granted, through the DEA and through the federal government, the ability to prescribe treatments, whether that be methadone or buprenorphine, without directly seeing the patient, which had been a barrier in the past,” Watts said. “We have been able to engage patients on the street, either through telehealth, telephone, tele-video, or having them come into a clinic that might be near a homeless shelter. We’ve actually seen an increase and I think it’s an opportunity to engage patients.”
Some patients may only need to go once every two weeks or once every month, versus six days a week. “We’ve been able to use centralized appointment sites and bring the patient where we have tele-video capability,” said Watts. “And even if the provider isn’t there, we are able to provide them services and send their prescriptions.”
Telehealth technology has the potential to reach underserved populations and strengthen preventive care capabilities for outreach specialists and homeless service providers, but a buffer period exists in terms of widespread availability of these technologies.
Ideally, those in recovery would “be in a detox center and under medical supervision, away from being triggered by people shooting up around them,” said Wodja. “We accept it as part of the struggle … they are their own doctors, they are good at surviving for the most part.”
Peter Winslow is a first-time contributor for the Weekly. He is a reporter for Gazette Chicago Newspaper and a freelance writer.