Addicted to drugs, with (almost) nowhere to go: Life for New York City’s poorest addicts

I met Manny eight years ago when he tried to rob a friend of mine. He showed up at a peer-supported recovery meeting we both attended. I’d see him periodically on the street, always worse for wear, banged up, losing teeth and clearly still in active addiction. As we do in my recovery group, I’d offer to help him get clean whenever I saw him. He’d wave me off.

“I’m good,” he’d say. But he was far from good. In fact, I am pretty sure there were many times he was actively dying, and yet there was no agency in the city geared to help him. If this were a post-mortem account of Manny’s life and times on the street, it would be fair to say he died of neglect.

That neglect was probably always the case, but it became institutional neglect when Manny entered the public school system, and no one intervened on his behalf. He was clearly bright and clearly troubled — a description that fits many kids in what was then a working-class neighborhood with a gang problem.

More than half of the mentally ill in the United States go untreated, posing a danger to both themselves and to others. Of that population, roughly half suffer from chronic substance abuse. The presence of both addiction and mental illness, or comorbidity, is common among our homeless population.

The systems in place to help are limited. “We can help you with X problem, but only if Y” is a more common situation than “we can help you with that and any related issue.” Getting access to publicly available services is an unwieldy process for the most competent among us. For those in trouble, the system is unnavigable.

For the past 40 years, the city’s primary answer for a problem like Manny has been the golden hammer of incarceration. That’s changing, but far too slowly given the depth of the problem. Now, to compound matters, NYC Health + Hospitals, the city’s public hospital network, quietly announced in December the closure of all its 11 detoxes — places where the city’s comorbid population could sometimes find access to the help they needed.

Back to Manny; he was a fixture in the Williamsburg. While it is essentially an urban mall now, Manny grew up in a Williamsburg with empty storefronts, crack addicts, street prostitution and stray dogs.

When I met him, he had two spots — one outside the Duane Reade across from the Apple Store on Bedford Ave. and the other a few blocks north at the L train station. When he wasn’t nodding out, his nose was often buried in a book. His cardboard sign said, “Need a Miracle” or made a generic plea for kindness.

My daughters perked up when I told them that a friend and I were helping Manny. “I give him food sometimes,” Ella said. “He’s really nice.”

Two area pastors declared themselves fans. One is an FDNY chaplain. “You do realize that his IQ is higher than both of ours put together?” she texted from her family vacation.

Here’s what I know of Manny’s story, as he has told it to me. Now 35, he started using heroin intravenously at the age of 12 when a woman offered it to him in exchange for helping her get home safe from a strip club where she worked on Queens Blvd. He grew up in a rent-stabilized tenement in the heart of what is now prime real estate.

His Colombia-born mother was an alcoholic. In and out of mental institutions, she eventually returned to Colombia, where she died a few years ago. He met his father only once. His forearms are scarred from cigar burns (his now-deceased stepfather was abusive) and dark track marks that start on the tops of his hands and trace the veins up his arms. He showed me two scars from bullet wounds. With no siblings and an extended family that gave up years ago, it was a miracle Manny was still around.

I’ve been in recovery for more than a minute, and I have only seen a person of Manny’s description get clean a few times. He had no home, no financial resources, no family, no HR department, no health insurance and none of the ID required to get it.

Manny was an overdose waiting to happen. Many overdoses later, Manny was sick and tired of being sick and tired, and he wandered into the same peer-support recovery meeting.

Except as luck would have it, I wasn’t working the day after Christmas and decided to hit that meeting. It was in the basement of Our Lady of Mount Carmel a half block from the tenement where he grew up. I didn’t do anything heroic. If anything, I was circumspect, assuming he might try to rob me. I had some time to help. Another guy from the meeting offered to help, too.

We immediately got a crash course on what the city won’t do for people like him. It began at Woodhull Hospital at the now-shuttered detox unit there.

We learned about the detox situation in passing when the attending physician told us Manny wouldn’t have been admitted anyway because he was on methadone, something Rikers Island — another city-run facility — got him hooked on while he did time for selling drugs and burglary.

Detoxes provide a five-day medically supervised place for patients to go through withdrawal. Methadone patients are technically already detoxed from heroin — therefore, the theory goes, no need for detox.

“If your friend were addicted to alcohol and showed signs of physical withdrawal from it,” said the attending physician at Woodhull’s detox, “We could take him, because alcohol withdrawal can be fatal and requires medical intervention. If he were high, okay. But no methadone here. He needs a rehab.”

It didn’t matter that Manny’s skin looked like rubber and he was sweating through a puffy jacket. It didn’t matter that he shot heroin while taking methadone because the clinic where he got it terminated him for bad behavior and tapered his dose too fast. It didn’t matter that he shot 35 bags a day before he got locked up, sometimes mixing it with cocaine, or that he used crystal meth, or that he popped Xanax like Tic Tacs.

Methadone was a part of the picture, and that disqualified him, as it does at many rehabs. A city rehab could help, but it would take a while and, as anyone in recovery knows, willingness is a wasting asset among active addicts.

Testing positive for alcohol withdrawal, Manny was admitted for five days. Matt and I used that time to sort out his Medicare and find a rehab that incorporated methadone treatment. We spent at least 40 hours as a tag-team taking him to recovery meetings, answering questions on the phone while Manny was in heavy withdrawal, Matt driving to Riker’s to get the discharge papers Manny had lost, and several more trips to the Department of Social Services in Chinatown to sort out his insurance issues.

We had considerable out-of-pocket expenses. We put together a collection and raised a few hundred dollars that paid for a motel on Queens Blvd. not far from the strip club where he got hooked on heroin 23 years earlier. Having somewhere safe to stay was crucial for Manny. Showers helped him get through withdrawal, but more important was having people there to care for him.

Eventually, we got everything in order and dropped Manny off at a rehab upstate. As I write this, Manny has been 61 days sober. He ran the spirituality meeting at the rehab where he was for the first month, and is now living at a long-term facility in the Bronx. He looks and sounds like a different person.

And while that’s reward enough, what happened was a fluke. Everything we did during the holiday break (including the kindness part) should have been provided by the city, not strangers. Any other time of year and I wouldn’t have been able to help. Survival should not require so much luck.