In the throes of addiction, people congregate around Penn Station and the Port Authority Bus Terminal.
A couple from Ohio pushed a shopping cart filled with their tattered belongings toward West 34th Street as tourists crowded beside them. An older man from Massachusetts nodded off outside Pennsylvania Station, which 600,000 people pass through daily. Nearby, a woman from North Carolina crouched next to a cardboard sign.
New York's transit hubs welcome millions of tourists and commuters every year. But in recent years, the hubs have also increasingly become a destination for people with opioid and other drug addictions, many of whom arrive from parts of the country that have seen soaring rates of drug use and fatal overdoses.
New York has its own drug crisis: Overdose deaths rose sharply in 2016 with the arrival of fentanyl, and authorities say the city has become a centre for the illegal synthetic opioid. But other than in pockets of the Bronx and Staten Island, the opioid crisis tends to be largely hidden from public view.
That is not so at Penn Station and the Port Authority Bus Terminal in Midtown Manhattan, Jamaica Station in Queens and other transit centres. There, people in the throes of addiction line sidewalks, waiting to score, asking for money and even sleeping in makeshift camps. Their numbers swell as the weather grows warmer, their presence recalling a grittier era in New York.
"They're dope refugees," said Dimitri Mugianis, a counsellor at New York Harm Reduction Educators, a nonprofit that works with users and their families to promote safe drug use. "They're looking for a better life."
Mugianis said opioid users come to New York for drugs, but also because they can find more tolerance and support here than in their hometowns, and greater access to services such as syringe exchanges.
Rebecca Conklin of Thomasville, North Carolina, one of nearly three dozen people living on the streets near the city's transit hubs who were interviewed by The New York Times, said outside Penn Station that she became addicted to prescription painkillers after studying to be a nurse. She and her husband came to the city about two years ago, destitute and in need of medical care and a fresh start.
"My husband told me New York takes care of its people," Conklin, 40, said.
City officials said this population is transient and does not represent an overall increase in the ranks of the city's homeless. Still, their growing presence has been hard to ignore.
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Barbara A. Blair, president of the Garment District Alliance, which represents businesses and property owners in the area between Penn Station and the Port Authority, said that starting last summer, significantly more people arrived who appeared to be using drugs.
"They're back this year," Blair said. "They're there with their cardboard signs. They're passed out."
Many people living on the streets said they are more able to find shelter and treatment in New York. But some also come to the city because of the availability of drugs.
Drugs such as fentanyl, which can be 50 times stronger than heroin, are more abundant and typically cheaper in New York than in small cities and towns, according to several drug users and harm reduction advocates.
The drugs, which also include prescription pills, crack cocaine and methamphetamines, arrive at transit hubs from around the city and New Jersey, often shuttled in by low-level dealers who are selling to those who live on the street — and to commuters — to support their own habits.
The New York Police Department, whose Transit Bureau patrols the subway system, said arrests for drug-related offenses were up 55 per cent as of June at the subway stations connected to Penn Station, Port Authority and Jamaica Station in Queens — where drug buyers come in on the Long Island Rail Road — compared with the same period last year. Across the system the numbers remained roughly even.
Certainly, people have come to New York to buy drugs for decades. But in the past, they typically made a U-turn toward home once they made a purchase.
Now more are staying. The first wave came to the city from Long Island, New Jersey and Connecticut about five years ago, according to several interviews. Many said they had first become addicted to prescription opioids, but had progressed to street drugs and were battling heroin addictions when they arrived.
Jay, a 39-year-old former house painter from Long Island, said he had weaned himself off heroin by visiting a methadone clinic in Manhattan. He said there were more barriers to treatment on Long Island, such as long waiting lists.
"Here, you get on a methadone program that day," said Jay, who asked that only his first name be used to avoid embarrassing his family. Still homeless, he earns money handing out flyers and doing odd jobs.
In recent years, people have followed from more far-flung places.
Grace Cohen, who is from a suburb of Atlanta, said she and her boyfriend came to the city last fall after struggling with opioid addiction in the past and ending up homeless together.
"There's more resources for us here," said Cohen, 19, who spoke outside a subway entrance on West 42nd Street on a recent afternoon. She sat on a crate holding a sign that said she was homeless and three months pregnant. She and her boyfriend were trying to get into a nearby family shelter, she said, but their application had not yet been approved.
Several people who have lived on Midtown's streets for years said they could no longer make enough money by panhandling because of increased competition from these newcomers.
Yolanda Rodriguez of the Bronx said she had spent several years around West 40th Street, struggling with mental illness and substance use. She said she now gets by thanks to food truck workers, who provide most of her meals, and handouts from commuters who recognise her.
The reason for the growth in the population, she said, is obvious. "Drugs," Rodriguez, 30, said. "Look around. They're everywhere."
In addition to tourist dollars, Midtown Manhattan has clinics, syringe exchanges and outpatient programs — infrastructure from earlier waves of drug use in the city.
Blair, the president of the Garment District Alliance, said the newcomers have taken over LinkNYC screens, which offer free Wi-Fi and charging stations, and block foot traffic with luggage and mattresses in one of the busiest parts of the city.
More troubling, Blair said, is their precarious health. "These people are in critical condition," she said, noting the authorities cannot force people to accept help. "There has to be a new model for what is essentially a crisis."
Denise Paone, senior director of research and surveillance in the city's Bureau of Alcohol and Drug Use Prevention, said mortality data did not show that the crisis was worse in transit hubs than elsewhere in the city. Of the 1,487 fatal overdoses in New York in 2017, 14, or 1%, occurred in Penn Station, Port Authority or Jamaica Station.
But the issue is undeniably more visible there.
"I see more ambulances than ever," said Darryl Grisham, 59, who earns tips for helping tourists get cabs outside Penn Station.
"You've got the fentanyl. You've got the K2," he said, referring to synthetic marijuana. "You have people walking around here like zombies."
Inside the station, Sonia Parven, a supervisor at a Hudson News and Dunkin' Donuts, pointed to a busy corridor outside the shop. "There was one guy who overdosed right here, near the trash can," she said.
At one time, Parven said, she and her employees knew the faces of the people who hung around Penn Station. But now, she said, "New, new, new faces. Every day, two or three new faces."
Max Sepulveda, managing director for harm reduction services at a syringe exchange on West 37th Street, which is run by Housing Works, said the number of people seeking drug supplies had steadily climbed to about 50 a day, and they are "a hefty mix" of area residents and people from outside the city.
Overdoses around the exchange have not increased, he said, because of naloxone, the overdose antidote, and prevention education. Still, such incidents are not infrequent. On a recent afternoon, two ambulances were outside the unmarked building that houses the exchange. Medics tried to coax a man who had overdosed to go to the hospital.
One of the medics said that he was called to the area so frequently, he had gotten to know many of the users — "kids from around the country," he said, who were typically mixing drugs. He recalled, for example, administering naloxone to one redheaded man five times.
On a recent afternoon, Conklin, of North Carolina, sat outside Penn Station finishing a donated salad. She and her husband had parted ways, she said, and she had been sleeping on the subway and asking passersby for change. She had been robbed of four cellphones and narrowly escaped sexual assault.
"The hard part is going from a life of normality to this," Conklin said.
Yet she had no plans, she said, to go home.
Written by: Annie Correal
Photographs by: Sarah Blesener
© 2019 THE NEW YORK TIMES