Passing through a metal detector, Kenneth Towler made his way into the lobby of the Center for Community Health on Los Angeles' Skid Row. Towler, 47, is no stranger to the clinic's chaotic waiting room, so he quietly took his place against the back wall as various patients filtered through the clinic. The smell of urine and smoke clung to some visitors, many of whom, like Towler, are homeless.
These visits to the clinic had become routine, but now, the 47-year-old was noticeably worried. His mind rewinded to two weeks earlier when he claims the few possessions he had were stolen, including medication for his bipolar disorder and a new prepaid cell phone. "And as soon as I turned my back they just took everything," he said. "It was the phone they were really after."
The incident meant he would have to request a refill on his medication before its scheduled date, which can be nearly impossible for patients like Towler, who has a history of drug abuse. So now he was here, anxiously waiting to be called in to see the doctor.
Towler's situation is common in Los Angeles, which has about 44,359 homeless individuals at any given time, according to 2015 figures from the Los Angeles Homeless Services Authority. For those who are mentally ill—a group that accounts for nearly one-third of the county's homeless population—receiving and keeping prescription medication can be a daily struggle.
Stealing and selling are both problems: Many prescription drugs have high street value, and homeless populations are vulnerable to theft. And because so many homeless individuals also have a history of drug abuse—about 50 percent of homeless people with mental health conditions have co-occurring substance abuse problems, according to the Substance Abuse and Mental Health Services Administration—it can be difficult to find a clinic that will refill stolen prescriptions.
"Before I was diagnosed with bipolar disorder, I was already using drugs. I did cocaine in high school and then harder drugs as I grew up," Towler said. "It wasn't until I was diagnosed with bipolar disorder that I realized that I was using the drugs to deal with everything."
The CCH clinic, run by the private non-profit health agency JWCH Institute Inc., tries to fill the gaps in access to mental health care for the city's homeless. Past and even ongoing drug abuse doesn't prevent clients from receiving mental and health care services at the clinic, a sign of recognition that, especially for homeless people living on Skid Row, getting necessary medication can be challenging, in part because of substance abuse problems.
"This isn't about getting to the bottom of things or catching them in a lie," said Jordan Allan, a clinical medical social worker at CCH. "The doctor goes by what they see and what the client relays to them."
Theft, Allan said, only makes the problem worse. "One of my clients had a container of medication. He's in a wheelchair, and he can't fend for himself, so people would steal his medication," she recalled. "I ended up putting a sticker on it saying 'Laxative: Will give you diarrhea' because otherwise people would steal it."
Allan noted that anti-depressants, some of which are used to treat schizophrenia, are often sold on the street. "I know painkillers go for like $4 a piece, so do some of the larger dosages of the anti-anxiety medication," she said. She added that the clinic's pharmacy no longer fills prescriptions for painkillers because of the high abuse rate.
Allan refers people who need an emergency refill to Exodus, a mental health urgent care clinic about three miles east of Skid Row, sending them with a note describing the patient's mental condition, and, with the patient's consent, information on their progress in the clinic's program. "They'll give them enough medication for the end of the month because I always write in the email [when] their next refill will be ready," she said.
But not all of the physicians at CHS take this approach. In many cases, clinicians will deny a refill if they suspect the client could be selling or abusing their medication. Without receiving the medication, those patients are left to cope with their illness on their own or pay out of pocket at another clinic.
That was the case for Towler who, after waiting for more than an hour, returned to the lobby defeated. Like many others before him, he had been denied a refill on his meds. "He told me no because I was just going to sell it," he said, dejected. "Now I really don't know what I'm going to do the rest of this month."
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