The Growing Crisis of Addiction

At BRC, we realized simply detoxing those addicted to opioids and linking them to treatment wasn’t good enough.

This year in our city, more people will die from drug overdoses than will be murdered. As the growing crisis of addiction – especially to heroin and other opioids – garners ever more attention, BRC realized we needed not only to ask those struggling with addiction to change their habits, but that for them to survive, we needed to change ours.

You know BRC as a leading provider of shelter and services to homeless New Yorkers. And you know that to be effective, we take a holistic approach to serving the men and women who come to BRC seeking not just shelter, but the opportunity to transform their lives.

What you may not know is that to be the provider our clients need us to be, BRC provides the highest quality addiction services – to both the homeless and housed – and has been for 40 years.

Our original name was the Social Rehabilitation Club for Public Inebriates, which then became the Bowery Residents’ Committee, reflecting our founders, men like Clyde Burton, Fred Cooper and Jack Ryan, for whom BRC programs are named. They were recovering alcoholics and addicts who resided in the infamous flophouses that once dominated the Bowery. And BRC’s caring, effective and innovative work in the field of addiction is so strong that in 2014, BRC’s Chief Medical Officer, Dr. Angela Kedzior, was named by Governor Andrew Cuomo as New York’s Addiction Physician of the Year.

Addiction has long been recognized by the medical profession as a disease, yet there are many who scorn those who use drugs, seeing them as weak or lacking in motivation, often pointing to the frequency of their relapses as evidence, and questioning the value of investing in their treatment. Even some of those who acknowledge addiction as the disease it is, wonder whether this pattern can change, and addicts can get better.

THE ANSWER IS YES, BUT IT’S NOT EASY;

Especially if you’re poor and homeless, and you lack a support system. The first challenge is to find a detox that will take you. Even though addiction is lethal (remember, people are dying at twice the murder rate), many community-based detoxes don't admit individuals who lack insurance or have a mental health diagnosis. For those who are admitted and complete detox, a process that takes a few days, the next challenge becomes getting into a treatment program that will support your efforts to remain substance free. Yet there is routinely no coordinated support between leaving detox and entering treatment. And often it can take days, weeks or months to find a rehab bed or outpatient program, a story told sadly and powerfully recently on NPR.

Often, addicts who have completed detox find themselves back where they came from, to fend for themselves. Many are homeless, or live among friends or relatives who are active users, where drugs are impossible to avoid, hard to resist and easy to buy. Relapse is common.

At BRC, we have historically taken a more caring and effective approach, perhaps because our founders knew all too well what the stakes were…and still are.

BRC serves over 10,000 individuals annually; over half have a history of addiction, many using drugs and alcohol to self-medicate a mental health disorder. Last year, our Chemical Dependency Crisis Center (CDCC), a 32-bed inpatient detox, had over 2,000 admissions. We welcome those who others don't, including the mentally ill and the uninsured. And believing firmly that an ounce of prevention – or preventing a 40-ounce relapse – is worth a pound of cure, we do what most don’t: we admit individuals who are about to relapse…just before they do. Even more compelling than the number of people we welcome and serve, is that 87% left with a treatment plan. That’s significant. Why? In part, because – unlike most detox programs – we don’t require clients to leave when they are sober; they can stay at BRC until they have a place to go where their treatment can continue. Getting people sober and getting them to treatment; that’s been the BRC approach for decades.

Now our beds are being filled at ever increasing rates by those addicted to opioids (heroin, oxycodone, etc.) Because of how opioids interact chemically with the brain, the usual course of treatment is to substitute a safer opioid for the more debilitating one. This is known as opioid replacement therapy (ORT) or medication-assisted treatment (MAT), and for years the standard option was methadone. Recently, an alternative option, a drug known as buprenorphine (or Suboxone), has proven to be similarly effective and easier to administer.

At BRC we realized simply detoxing those addicted to opioids and linking them to treatment wasn’t good enough, as in the weeks, days, or even hours between their becoming clean and the start of their treatment, they are at great risk of relapse. We needed to change the way we worked, and change the way the treatment system works, if we were to save the lives of the addicts we serve. Because BRC also operates an outpatient treatment program, we have doctors licensed to prescribe buprenorphine.

And so we began last year to prescribe it to our opioid addicted clients, as they detoxed from heroin, and as they waited for a treatment slot to open. This raised new challenges, as we asked the treatment programs we work with, and their professional staff, to do something they had never done: accept clients even though they had already begun treatment under our supervision. While there’s been some resistance to this new approach, there’s been enough cooperation and collaboration for us to stay the course, and for our clients to succeed. Indeed, over the past several months, 42% of all opioid addicts who come to CDCC -- and 91% of those who come in need of our highest level of care -- are beginning treatment on buprenorphine before they are discharged.

Finally, and importantly, given the history our clients have – most are homeless and come to CDCC from the subways, streets and transit hubs – it just makes sense to use this moment to address the many chronic health and mental health needs our clients have, and have been avoiding or ignoring: diabetes, heart disease, hepatitis, even cancer, just to name a few. Thus, unlike many other detox programs, CDCC provides seamless access within our program to a range of physical and mental health services, with assistance from our medical partner, NYU-Lutheran. And yet this approach to treating the whole person and not just their addiction, is the exception, not the norm. Perhaps this helps explain why so many addicts don’t seek sobriety, or relapse after having gotten sober. Simply put, we believe if we treat the person, we improve the odds of solving the problem.

This is the caring, effective and innovative work we strive to do every day at BRC. And in doing so, we save lives. So what better way to conclude this month than to introduce you to Vandrina and Charles; they came to BRC because of their addiction, and because they want to change their life. You’ll meet them in the less than 5 minute video below.

And while we do receive generous government funding to support CDCC, it doesn’t fully cover our costs. So after watching, if you want to make a meaningful impact in the life of someone challenged by addiction, please donate to BRC and the life-saving work we do at CDCC.

Sincerely,

Muzzy Rosenblatt, President & CEO

Charles' and Vandrina's Stories

BRC Addiction Treatment Innovation