Substance use disorders involving illicit and highly addictive drugs — such as heroin and other opioids, methamphetamines, and cocaine — take a high toll on the individuals who use the drugs, their families and communities, and the health care system. In addition to facing higher risks for serious diseases, chronic users of illicit drugs are more likely to delay seeking care for their health needs and to rely on hospital emergency rooms when their needs become pressing, both of which contribute to poor health outcomes and high health care costs. A recent analysis suggests that a large share of the health care costs related to the opioid crisis in the last two decades stemmed from emergency room visits to treat patients after overdoses, along with costs associated with the health complications of opioid use.

In New York City, deaths related to unintentional drug overdoses rose continuously between 2010 and 2017, before declining slightly from 2017 to 2018. However, rates of overdose deaths continued to increase in the Bronx, which lost more residents to drug overdoses in 2018 than any other New York City borough. Overdose deaths among Bronx residents increased by more than 200 percent between 2010 and 2018, and a majority of those deaths involved heroin or fentanyl, which are types of opioids.

Bridging Access to Benefits and Care (BABC) — an innovative collaboration among three nonprofit organizations that serve low-income and vulnerable communities — was designed to improve connections to public benefits and health care services for people dependent on opioids and intravenous drugs in the Bronx. The pilot program sought to address challenges related to social determinants of health for low-income drug users — challenges such as housing instability, food insecurity, and lack of health coverage — by helping them make use of benefits and services. The primary goals of the BABC pilot program were to:

• Engage high-risk, high-need intravenous drug users and other opioid-dependent users through compassionate, community-based outreach in the Bronx
• Increase their awareness of and enrollment in public benefits
• Improve their access to and use of health care

Increasing outreach, benefits assistance, and direct connections to health services is expected to improve long-term health outcomes for people who use drugs. It is also expected to increase their use of preventive and mental health care and decrease their reliance on emergency rooms.

BABC was supported by the OneCity Health Innovation Fund, an initiative designed to promote new ideas in New York City that could reduce avoidable hospitalizations, improve community health outcomes, and address social determinants of health such as food security and economic stability.

This brief presents findings from an MDRC study of the implementation of BABC between September 2018 and June 2019, and offers a few lessons for serving a traditionally high-need population with serious health issues.