Coronavirus creates new layer of risk for opioid addicts

Chris Knutson couldn't stop fidgeting with his mask. After a few more tugs, he gave up and went back to passing out the overdose antidote naloxone at a homeless encampment on Minneapolis' South Side.

He hadn't set out to do drug intervention work. After joining St. Stephen's Human Services, a local housing advocacy group, he'd mostly sat behind the desk the past few years, helping people through the tedious process of applying for affordable housing.

Then COVID-19 struck. Almost overnight, the problem for many people of finding a roof to sleep under was overtaken by other anxieties.

"The whole goal of outreach has shifted, where it used to be building relationships with people," he said. "Now, we're trying to keep people safe."

Knutson and others from St. Stephen's outreach team spend their days handing out vials of naloxone and clean syringes, as well as food, toiletries and other necessities. Though the agency is still working to end homelessness, Knutson said it also saw a chance to help those caught between the pandemic and the ongoing opioid crisis.

The new focus on drug outreach reflects COVID-19's devastating impact on the city's unsheltered population. St. Stephen's is part of a grassroots movement taking shape in long-neglected parts of the city where a lack of access to health care, jobs and adequate housing made residents vulnerable even before the pandemic.

"The permanent solutions that people need are just not there," says Knutson. "It doesn't have to be this way — this is a job that will turn you against capitalism."

He continued, growing frustrated: "There's tents everywhere, there's luxury condos everywhere, and we're just going around looking at both every day."

After watching as heroin and prescription drug abuse ravaged the Rust Belt and Appalachia for much of the past decade, Minneapolis is now feeling the full brunt of the opioid epidemic. Things have only gotten worse with COVID-19. The city has recorded more suspected drug overdoses since the pandemic arrived here in late March than compared to the same period last year. Even before then, the city was already on pace to easily surpass 2019's tally of 1,499.

Fran Evenson, another St. Stephen's worker, said that their work has taken on new importance during the pandemic, which health officials worry may lead to an increase in addiction rates, as more people find themselves overwhelmed with taking care of their households and earning a living while struggling with feelings of isolation.

As a result, St. Stephen's and other outreach groups like Southside Harm Reduction are making renewed efforts to slow the opioid epidemic's spread in some of the city's most disadvantaged neighborhoods. There are also increasing efforts to bring medical care to the poor, rather than make them travel to the already overburdened treatment facilities. In Phillips and other neighborhoods hit hard by the epidemic, advocates aren't waiting for help from the city. They have formed an underground supply network to help people struggling with addiction but who don't have access to drug treatment. Some of these outreach workers are finding that they must contend with City Hall and the police, who are wary of their harm reduction approach.

Evenson, who started at St. Stephen's after Knutson, said the program largely relies on donations, but that they pay for some supplies out of their own pockets. They buy plastic spray bottles from a dollar store and fill them with hand sanitizer, telling everyone who gets one to hang on to the bottles.

Knutson says their outreach focuses on two causes that have always been intertwined: homelessness and substance abuse.

"If you're using, it's going to be hard for you to maintain your housing and to keep your job and all that," Knutson said.

A recent afternoon found the pair visiting a ramshackle encampment across the street from the former Navigation Center. They announce themselves before poking their heads into one of the tents. A woman emerges, and they ask whether she needs clean needles. "No," she responded while sizing them up. Too often the needles end up in the grass, creating a safety hazard for children. The pair make their rounds about three days of the week. Some faces they recognize from their housing-assistance work, and they try to learn the names and needs of newcomers as a way of establishing trust.

Some of the people they encounter have cycled in and out of treatment programs. Many also struggle with mental health. Besides doing outreach, Evenson says, the job is also about educating people who have gotten used to living largely disconnected from the world. But word about the dangers of the virus seems to be getting out. People huddle around Evenson and Knutson, asking for hand sanitizer, disinfectant wipes and masks. They shout their gratitude and promise to share the supplies.

Complicating matters is the added threat of contracting the virus, says Knutson, who wears masks and gloves and wipes down the SUV with Clorox wipes before and after every shift.

"You just have to tell people to back up, and how interested people are in that varies," Knutson says later. "We're also wearing the masks now, which can be very alienating."

Besides growing social isolation, the coronavirus epidemic has cut off users from treatment programs. Some are being turned away from hospitals and clinics already suffering from a shortage of beds. Others are avoiding medical settings altogether out of fear of getting infected. But the encampments themselves are vulnerable to an outbreak, with people packed together with not enough masks, soap or hand sanitizer.

"Can you keep back six feet?" Knutson asks, to little avail. Some residents scramble to get out of the way as a backhoe rumbles past. A man, wearing a white thermal shirt and a thin beard, wanders over and sheepishly asks for "rigs," as clean needles are called. Evenson responds that they're out but will return the following day with more, and asks the man whether he needed any naloxone.

Since the pandemic started, a certain "compassion fatigue" has set in, says Evenson, with more people focusing inward, on their own families: "We're not seeing the same level of donations."

He sees the work as offering a lifeline to communities still facing steep disparities in access to health care, jobs and adequate housing. Many have cycled in and out of homeless shelters and treatment facilities. Because of COVID-19, there's a "growing aversion" to shelters, he said.

Knutson moved to the Twin Cities from Cincinnati with no clear idea of what he wanted to do, taking a job at Half Price Books and delivering newspapers on the weekends. Then he applied at St. Stephen's.Evenson also felt drawn to social issues. He lost his job in 2008 during the financial crisis and was homeless for six months before enrolling in Metropolitan State University, where he studied sociology. Knutson sees their work as important, but ultimately as a Band-Aid. He hopes to soon get back to doing his previous work of getting unsheltered people into permanent housing.

"That would be very depressing if our job was no longer as housing focused as it was in the past," Knutson said. "This was already a problem; it's not like homelessness changed for the better with what's going on."

Libor Jany • 612-673-4064 • @StribJany