Juan sleeps on the streets and keeps his possessions in a shopping cart with an ominous mask tied to the front. He stands gaunt and his hands are ashen, thick with muscle.
When Mott Haven’s out-of-sight drug den, The Hole, closed in May, Juan found his way, along with many others, to St. Mary’s Park.
Juan—who didn’t want to use his last name for fear of retaliation from his community—wants to quit using heroin. In early December, he saw a familiar face in St. Mary’s Park‚ a reporter from the Herald. He asked the reporter to make some calls to detox centers, believing that his own requests wouldn’t be taken seriously because he doesn’t have medical insurance.
After several calls to multiple organizations, it became clear that uninsured drug users like Juan fight an uphill battle navigating the bureaucratic medical system alone.
Despite years of drug use, Juan’s had mixed results trying to kick his addiction. He says his most recent relapse was in May 2017—around Mother’s Day. He was 11 years sober before this incident.
To receive detox treatment, Juan considered that he could fake being “crazy” or claim to be suicidal for admission at Lincoln Hospital, but he didn’t want to take away from patients in genuine need of those services.
So, Juan and the reporter started down a rabbit hole together in search of help. The reporter first called New York City Relief, an organization that, among other services, helps drug users access detox centers.
He rang the general line of the nonprofit, which makes available a list of groups that provide detox resources for those without insurance. A man answered and gave the reporter another name and number.
The reporter called the new number, but it went straight to voicemail.
He then dialed the number of a different harm reduction clinic only to be transferred to another voicemail.
On the third try, the direct line of an employee at yet another harm reduction clinic went to voicemail. A man answered a call to the main line and offered the number of someone who would pick up Juan in a van and take him to a health clinic to detox.
The man on the line asked if Juan had insurance. Hearing “no,” he directed Juan to St. Barnabas—a Bronx hospital that takes everyone regardless of insurance status.
On the second call to St. Barnabas, the operator confirmed the hospital would take Juan, and she offered directions to the site. Go to 4487 Third Ave., Room 138. This room was 3.1 miles away from Juan—roughly an hour’s walk with his shopping cart full of belongings through December’s biting breeze. In the cold, alone, with all his belongings, the task seemed daunting.
“If you have insurance you can get help no problem,” said Juan. “If you don’t, it’s hard to find help.”
There is help out there for people who want to detox yet don’t have insurance, but Juan’s journey illustrates a breakdown in the line of communication from the offices where help is born to the streets where people need it.
Brett Hartford from New York City Relief said the phone tag with the reporter was an anomaly. The organization does have an extensive list of treatment locations available and brings a bus to Mott Haven on Saturday mornings and early afternoons for anyone who wants a ride to detox. Juan vaguely placed the Relief Bus after the reporter mentioned it to him.
Despite popular belief, the NYC Department of Health and Mental Hygiene says detoxification is not the safest response to addiction, citing scientific research that shows the risk of overdose increases following detox. Instead, it recommends medication, such as buprenorphine or methadone for addiction treatment on an ongoing basis.
The department funds several Federally Qualified Health Centers tailored to serve high-need populations, including housing-insecure individuals.