There were nearly four times as many opioid-related deaths — 712, according to the NCADA — last year than homicides in the St. Louis area. Overdose deaths hit individuals who are homeless especially hard. A 2013 paper in the Journal of the American Medical Association called it an emerging epidemic among the population.
Most of the social service agencies in the St. Louis area offer drug treatment programs, but advocates contend treatment isn’t always available when people in need are ready to accept the help.
The Rev. Ken McKoy has watched the trend play out locally. In the past three years, McKoy provided ministry to homeless individuals living on the old streetcar tracks north of the Central West End. Felicia Nash was one of them.
“One night, Felicia said she was going to get clean and she and I were going to get married,” McKoy said. “I probably would have married her. She’s a smart girl. Everyone has a vice.”
Nash was 48, and like many residents of the tracks, had been dealing with a heroin addiction for years. But one rainy night in November, she decided it was time to get clean.
Nash packed her bags. Her friends on the tracks threw her a little going away party. And though it was after hours, McKoy drove her to the Salvation Army treatment center on Washington Avenue.
But there were no beds available, McKoy said. He had no choice but to bring her back.
“I had to let her out of my car, in the rain, with her bags, her crying, and all this disappointment,” McKoy said. “And I think that broke Felicia. I really do.”
A few days later, Nash fatally overdosed on heroin. McKoy and some of her friends from the tracks went to her funeral on Dec. 15. That night, he did what he always does on a Friday — offer them food and comfort.
“Can I have some potato chips?” a woman named Frieda asked, when McKoy approached. “I’m a potato chip freak.” McKoy gave her a few bags of Doritos.
“I’m just tired,” Frieda told McKoy, her voice breaking. “I know you’re tired baby,” he said as he handed her more chips and a mandarin orange.
Frieda told McKoy she was planning to head to her uncle’s house. “I’m going to call you in an hour, okay?” McKoy said. Freida, her voice barely audible, agreed.
McKoy watched her walk away.
“If there was a facility that I could have took her, she could have got some methadone, she would have gone tonight,” he said. “Hopefully, when we come out tomorrow night, Frieda will still be alive.”
“It’s a crater.”
McKoy has encountered dozens of Felicias and Friedas in three years — people who want to stop using drugs but can’t get treatment at the moment they’re ready.
“Probably the best a homeless addict feels is at night,” he said. “There are fewer eyes on them, so they don’t have to wrestle with the guilt and the humiliation and the shame. And I’ve seen with my own eyes, as people get to that place of clarity, it’s usually late-night hours.”
But very few agencies prescribe the drugs to treat opioid addiction, and none are open when McKoy is doing his outreach. “I was calling it a gap, but it’s really a gaping hole. It’s a crater,” he said.
McKoy doesn’t disparage the local social services agencies like the Salvation Army and the St. Patrick Center. Both have helped thousands of people get clean, including Danny Prowell.
Prowell had been struggling with addiction and was on the streets for years. He returned to St. Louis in 2010 to spend time with his mother, who had been diagnosed with cancer.
“I had wanted to stop,” he said. “I was tired of being on the streets. When my mother passed, that kind of really threw me. It’s a life-changing thing, and I thought, ‘I’ve got to change.’”
Prowell had heard about the St. Patrick Center in downtown from other homeless individuals. One day, he wandered in to get a hot meal, and struck up a conversation with a few guys in the room.
"Basically, it was like, ‘hey man, you ain’t gotta walk the streets. At least you can sit here here and sit and watch TV 'til like 3:00,’” he said. “I came here to get warm, and stayed.”
Prowell beat his addiction with the help of near-daily meetings. St. Patrick staff helped him get a house and a job. He married a woman he met during treatment.
“It’s a beautiful program,” Prowell, now 60, said. “I recommend it for anyone looking for a way out.”
“I feel like I let her down.”
St. Patrick Center treats drug addiction through a clubhouse model, said Walter Kozuszek, its senior manager of behavioral health programs. Participants like Prowell have to attend a certain number of meetings a week, which are offered 365 days a year, but only between 8 a.m. and 3 p.m.
Kozuszek said he’s never heard about the schedule being an issue. “The barriers typically are more internal rather than external,” he said. “They’re not barriers that necessarily exist because the services aren’t available. The services are available.”
But other providers agree with McKoy.
“In terms of having a 24/7 place that’s safe for these people, we absolutely need that,” said Meredith Throop, the medical director at Places for People. “People are dying, a lot.”
Places for People serves a lot of individuals who are homeless, many of whom are also struggling with mental illness and addiction. It’s one of the few agencies that prescribes drugs like methadone and suboxone to uninsured individuals. Throop wants more providers to consider medication-assisted treatment. She also wants to expand the availability of nalaxone. The drug can reverse opioid overdoses, but has to be given within three hours to be effective.
“We have lots of grants, a lot of money coming in the direction of helping these folks, Throop said. “It has yet to be determined where this money will go and how that will work.”
For his part, McKoy plans to ask the owners of agas station near the tracks if they would stock nalaxone. The drug could have saved Felicia Nash’s life, and given her a second chance to get clean.
Her death still weighs on him heavily.
“The thing that really bothered me about Felicia is I gave her hope,” he said. “I had gotten a few people into treatment, and she saw me as that person who could help me, and to a large extent I feel like I let her down.”
That’s why he’ll continue to keep advocating for her friends who are still trying to survive on the tracks.
Follow Rachel on Twitter: @rlippmann