On a chilly Monday afternoon in the West Side neighborhoods of Austin and West Garfield Park, the streets are quiet.
“Need rigs? Need rigs?” Vincent Lee, an outreach worker with the Chicago Outreach Intervention Projects (COIP), a program run by the University of Illinois at Chicago School of Public Health, calls out the window of COIP’s mobile services van to one of his regular clients.
“Rigs” are hypodermic needles used to shoot heroin — the group’s mission, which it takes on the road to various areas of the city five days a week, is to get users into treatment and help prevent the spread of HIV, Hepatitis C and other infectious diseases.
The outreach workers find their clients by cruising popular spots where heroin is sold, putting them in the middle of some of the most dangerous parts of the city.
About three years ago, the COIP van pulled into an area just minutes after a gang-related shooting left one dead, four injured and a vehicle full of bullet holes, according to Lee.
He said Monday was a slow day because of the weather.
Their first client of the day steps into the van asking for rigs and for Narcan, a drug used to rapidly reverse the effects of opioids if a user overdoses.
Lee said the mobile services unit and the brick-and-mortar sites COIP runs in Austin, Humboldt Park, West Englewood, South Chicago, and Uptown, began handing out Narcan a couple of years ago.
The client is one of more than 7,000 that COIP provides with services.
Lee said most of their clients are on the West Side, and over the last five years, he’s seen the problem grow into an epidemic.
Although he’s spent years witnessing the destruction heroin has caused in communities, Lee said it still hurts him to see it. He said he recently had a client he was urging to get into treatment for her addiction — a young woman.
“I said, ‘I’ll get you into treatment,’ but she said, ‘I’m not ready for treatment,'” he recalled.
“You’re living in an abandoned building,” he reasoned. “When are you going to be ready for treatment?”
The demographics of clients are changing, too — more young users from the suburbs are getting hooked and ending up in the city, Lee said.
Working the frontlines of the opioid crisis, he’s seen increased use by clients of prescription medications like Xanax, a Benzodiazepine — known on the street as “benzos” — used to treat anxiety disorders.
And over the last several years, there has been ever-increasing circulation of heroin cut with Fentanyl, an opioid-based pharmaceutical pain reliever that is 50 to 100 times more potent than morphine, according to the Centers for Disease Control and Prevention.
Vincent Palacios, who has been a COIP regular for about 15 years, is the second client of the day. He tells Lee there’s a batch of Fentanyl on the streets circulating now.
“But whoever’s doing it knows what they’re doing,” Palacios assured Lee. “It’s a good mix. It’s definitely a good mix.”
“How it cook up?” Lee asks, fishing for more information about whether a bad batch is on the streets.
“Like a light purple-ish,” Palacios explains.
“It clog the syringe up?” Lee asks.
“Uh, uh. No,” Palacios said. “That’s what I’m saying. It’s actually a good mix.”
He tells Lee that two bags of the Fentanyl-laced heroin will keep him high for 14 hours.
Lee continues questioning Palacios about withdrawal symptoms and whether he’s using the drug with methadone — Palacios is currently in a treatment program that provides methadone as an alternative to heroin.
Asked if he sees Fentanyl frequently, Palacios said he first came across the high-powered opioid in 2009; he said the drug hits the street in waves.
“It’s weird. Sometimes like when you see it, it’s everywhere, but then when it’s gone it’s hard to find,” Palacios said. “When they get it, it seems like they flood the damn streets with it and then, you know, when it’s gone you’ve got to wait until it comes back.
“Fentanyl is stronger than heroin, and me personally, I prefer the Fentanyl because, I think, it holds longer than the heroin.”
He admitted that he’s overdosed more times than he can count.
“Right now at this point in my life, I’m damn near 40 years old, I’ve been going to this [methadone] clinic for about roughly a year, and it does get tiring,” Palacios said. “I don’t need to come out here, obviously, because I go to the clinic. It’s not like I’m sick or anything like that. It’s just … I like the taste.”
At COIP’s West Side office, 4756 W. Madison St., intervention workers see as many as three dozen clients like Palacios every day, according to Julio Garcia, COIP’s site study coordinator.
The majority of clients are residents in the neighborhood and white kids and Latinos in their 20s and 30s.
Garcia said young, once-affluent users from the suburbs are harder to reach because they often go untreated in the early stages of their addiction. When the sale of small quantities of needles was legalized in the late 2000s, it made it easier for young, affluent users to get, he said.
“Now, in a weird way, it’s made it a little bit harder to reach these folks because problem with the suburban folks now is … they’re going to the pharmacy to get the stuff and going home,” he said. “They’re not hearing the harm-reduction part, they’re not hearing a referral for treatment and service and things like that.”
Those users eventually find themselves in the city, ill-equipped for the hard streets of Chicago, according to Garcia.
Suburban kids often start out using heroin with a small group of friends, which reduces their chances of getting an infectious disease. Once they reach the city, they begin sharing needles with strangers, which increases the odds of contracting HIV and Hepatitis C, he said.
“There hasn’t been that much of a focus on the young suburban groups and what they’re doing in terms of harm reduction and stuff because, of course, the suburbs says, ‘Not in our backyard,’ in terms of treatment centers and that kind of stuff,” Garcia said. “So we’re kind of carrying the burden of the suburbs on us, and we don’t know how to really relate to them, in a sense, because they’re having a different experience than an inner-city black kid or an inner-city Latino kid.”
Over a decade ago, he noted, COIP was providing mobile services to places like Oak Park and Forest Park, but budget cuts at the state level have limited their ability to go beyond the western border of Chicago.
“That’s why we have the burden of the suburbs,” he said.
He noted that it can be difficult for users to get fresh needles in some suburbs because pharmacies charge more and require identification to purchase.
COIP is working to develop strategies to reach this population of suburban youth before they become heavily addicted.
“I think now [the heroin epidemic has] taken a second wave because of the ubiquity of opiates available,” he said. “Some of these kids that got injured, athletes that got injured in high school playing football or whatever, they gave them an opiate and then all of a sudden they get a habit.”
Once those users realize it is cheaper to get heroin in the city, they get exposed to harder drugs like heroin cut with Fentanyl.
“Those two combinations have really kind of like skyrocketed the young kids using even more,” he said.