Osiris Mercado was one of the lucky ones. He made it into the Phoenix House rehabilitation center just a week before they closed their doors to new clients in March. When the coronavirus first hit the city, no one, except staff, was allowed in and out of the drug and alcohol rehabilitation center.
“If I would have been out there, the chances are really high that I would have been probably dead,” Mercado said.
Mercado started selling drugs when he was a teenager and eventually started using the products himself, he said. The drugs evolved from marijuana to cocaine and eventually to heroin. It spiraled until he was no longer a dealer—only a customer.
He overdosed about six to seven times before his most recent stay at Phoenix House, he said. And with the risk of taking heroin laced with unpredictable amounts of fentanyl bought illicitly on the streets, he’s nearly certain about what would’ve come next.
“I don't think I had an eighth one in me,” he said. “I'm not a cat. I don't think I have nine lives.”
The impact of the global pandemic has touched nearly every aspect of life, including recovery from substance abuse. More than 40 states have reported increases in opioid-related mortality, according to the American Medical Association. Drug deaths have risen an average of 13 percent so far this year over last year, according to a report by the New York Times that looked at mortality data from local and state governments. If the trend continues, this year will see the sharpest increase in annual drug deaths since 2016.
At a time when it seems people need their services more than ever, recovery providers feel restrained in their work. Recovery centers across the country, including in New York City, have had to cut back the number of people they serve and are feeling unsure about their future.
“If anyone’s saying they're not worried, they're not being honest,” said Saeeda Dunston, executive director at Elmcor Youth and Services Activities. “This is concerning.”
Elmcor is a non-profit and drug rehabilitation center named after the two neighborhoods that the center is located in—Elmhurst and Corona. It’s the area that Dunston calls “the epicenter of the epicenter” of the city’s coronavirus outbreak.
The 51-bed intensive residential inpatient facility is currently at about 55% capacity, according to Dunston. While their state funding hasn’t been cut, their revenue has declined by 62%. That loss of income can set off a cycle that further exacerbates revenue issues down the line.
“Census equals revenue,” said Ann-Marie Foster, president and CEO of Phoenix House. “And if you don't have the numbers in your program, it's very possible that programs will fold and not survive.”
The Phoenix House, which has served thousands of people in New York since 1967, had state funds withheld in the third quarter of this year, according to Foster. And while she hopes that that funding is eventually restored, her center still faces a stark loss in occupancy due to social distancing requirements. Right before COVID-19 hit, they were at 86% occupancy of their 416 beds, she said. Now they’re at about 60% but went as low as 48% earlier this year.
For people like Dunston at Elmcor, the social distancing requirements meant making difficult decisions about who should be sent home.
“We had to start to weigh which one was worse—them getting COVID or us not being sure if they were able to pull the recovery together,” she said.
While the city’s health department has made efforts to ensure outreach and resources are still accessible for people struggling with substance abuse, including a methadone home delivery program and allowing doctors to prescribe buprenorphine through telemedicine appointments, people on the frontlines say far too many people are falling through the cracks.
One of the biggest contributors to that has been the pivot to virtual meetings, which raises the issue of access and literacy.
“We saw a lot of our participants pass away who were really not technology people,” said Patricia Woolridge, director of the Brooklyn Recovery Center at Phoenix House. “Zoom wasn't for them. They didn't know how to use it, didn't have access to it. And coming to the center was their life. Every other day, you heard or got a phone call that so-and-so had passed away. It's just been unbelievable.”
The intangible benefits of supporting each other in person was also lost in the switch to virtual meetings.
“One addict is the best help for another addict—somebody that understands them,” said Mercado. “When we weren't allowed to gather in groups and go to our meetings, I know for a fact that there's a lot of people that relapsed and are probably still out there from people that had years [of recovery] under their belt to people that just came out a couple months.”
While there’s no data available yet on the number of overdose deaths in New York City this year, a report by the Overdose Detection Mapping Application Program found that suspected overdoses increased by about 20% on average compared to the same period in 2019.
“This pandemic has just exacerbated and exposed the cracks that were already in the system,” said Dunston. “We still moralize the disease of addiction. It's always the stepchild [of the healthcare system] because there's a belief that people do this to themselves.”
Whether it’s not having enough beds or the lack of funding for social services that address the entirety of a person’s issues like housing and employment, recovery providers say their struggles before the pandemic were made more apparent this year and highlight the need for their work to be part of the continuum of healthcare.
“We felt very forgotten in March and April,” said Foster. “I remember being in touch with the Department of Health and clamoring for PPE and sanitizer. We're making a lot of noise to say we cannot afford any cuts to our facilities, just like how hospitals can't because we care for a very vulnerable population.”
For now, people on the frontlines of this work are continuing to use this moment to speak up about the difficulties of their mission and what needs to change.
“These issues that we're discussing are issues that hopefully we’ll discuss past the pandemic,” said Dunston, “because they will still be issues after the pandemic.”