NEW YORK — Ralph Ortiz loved his family, dancing, freestyle music and handball. He taught his sons basketball and how to navigate the streets of the Bronx. He was a near-constant flirt, sometimes to the embarrassment of his kids. He was strong, prideful and funny.
He was also a heroin addict — and died of an overdose in March 2022.
Ortiz, 60, lived in Mott Haven, a section of the Bronx that has been torn apart by the worsening crisis of overdose deaths and addiction. The crisis has been fueled by fentanyl and the lingering impacts of the COVID-19 pandemic and it’s exploded in New York City and across the nation.
No other neighborhood in New York has lost as many residents to overdoses as Mott Haven.
The numbers starkly tell that story.
As the pandemic ravaged NYC, overdose deaths climbed citywide — from just under 1,500 overdose deaths in 2019 to around 2,670 two years later, according to a recent city report. The pandemic aggravated a problem already on the rise: In 2015, just 942, or 13.8 of every 100,000 city residents, died of an overdose.
The Mott-Haven-Hunts Point area in the Bronx has long struggled with overdose deaths, but in 2021, deaths skyrocketed — by 42.2 per 100,000 residents from the prior year. All in all, the neighborhood saw a staggering 119.3 per 100,000 residents die of an overdose in 2021. That’s up dramatically from 2015, when 18.8 of 100,000 people died of an overdose in the area.
But numbers alone don’t tell the full story of this crisis.
“My heart can’t get used to this,” said Marilyn Reyes, Ortiz’s ex-partner who had two children with him. As the co-director of the Peer Network of New York, Reyes conducts outreach all over the Bronx, helping connect people who use drugs to help.
Their deaths have devastated the neighborhood. Sons mourn their fathers. Volunteers roam the streets to administer lifesaving medicine. Funeral directors stagger at the rising death toll. And overdose deaths are only projected to keep rising.
“It’s the families. It’s the brother, it’s the sister, it’s the best friend. It’s the wife, the husband, the girlfriend, the boyfriend — and the instability that brings that family as a result of an overdose or a fatality from overdose,” Michael Brady, executive director of the Third Avenue BID, said.
“It’s really this concentric circle of impact, but at the heart of it is humanity,” he added. “I think we as a society and we as a community suffer most, because we know there are resources and tools out there and we’re not moving fast enough to deploy them.”
Death comes with the job
Death comes with the job for Joseph J. Balsamo, funeral director of Balsamo Funeral Home, but he’s been stunned by the “massive” rise in overdose deaths he’s seen over the past two to three years.
“There are times that I just have to walk out of this building and clear my head, and I will come back in the middle of the night and sit in the chapel at the loss of a teenager or child,” said Balsamo, who serves many South Bronx residents at his Westchester Avenue funeral home.
“Because I have three boys — of young age, they’re all in their 20s and one is a teenager — I just picture what could have been, how horrible, Thank God it wasn’t me. I’ll sit there with tears rolling down my (face), because I don’t understand. I don’t understand. It takes a mental toll on the funeral directors.”
He’s had friends’ kids die, and others close to him struggle with addiction.
“I bounced their daughter on my knee, and then at 17 years old, placed her in a casket,” he said.
For Ralph Ortiz, drug use and addiction were part of the fabric of his days. Ortiz grappled with drug use and addiction most of his life. His family were users and dealers, and many of his friends were, too. It was inescapable in Mott Haven.
“The first couple weeks after he died, I just kept crying and crying,” his son, Joseph Reyes, 29, said. “I didn’t know where I was. I don’t know why, but it was just a pain in my chest. I don’t know if you ever lost a parent, I never lost a parent, so that was hard. It was like a pain in your chest that you feel. You cannot stop crying. For like two weeks — I was probably in my room and just cried. It was really hard.”
“From my perspective, he was always a great father,” Ralph Ortiz Jr, 30, his other son, said. “ ... He was there for us, always. Always took care of us. Regardless of his doing other things and selling and using — he didn’t let that affect his duties as a father and taking care of the people he loved.”
Ortiz — ironically — died in a rehabilitation and nursing center, where he was doing outpatient treatment after being in a medically induced coma. He struggled with various other health issues, and over his life, spent time in hospitals, different homes, shelters and jail. As he got older, he was no longer able to work, so his income came from dealing and collecting disability.
He had plans to move to New Jersey to live with his son, where his family hoped that he’d have less access to drugs and be able to take care of his health.
“You can give someone all the love you want, but it’s up to them to stop using. Because I tried, I talked to him about it,” Ortiz Jr. said. “But he just never stopped. It’s not, ‘He didn’t care.’ It was just hard for him. I don’t know if he didn’t stop because of his medical conditions, maybe he did it because he was in pain. I don’t know. I never knew why he did it. I just knew he couldn’t stop.”
From bad to worse
Mott Haven and the South Bronx have long suffered under the crush of disproportionately high opiate abuse. In addition to having the highest rate of overdoses in the city, it also has high rates of poverty and unemployment — factors that can drive increased drug use. Large swaths of its population — Black and Latino men — are particularly vulnerable.
The coronavirus pandemic made things worse. Both the acute and long-lasting impacts of COVID-19 — the grief of friends and family members who died, social isolation, jobs and livelihoods lost, community organizations shuttered, clinics short-staffed, the turbulence of social movements — have deeply affected Mott Haven.
With usual supply chains disrupted, fentanyl — which was already increasing in the drug supply — now flooded it. A synthetic opioid, it’s easier to make, cheaper to buy — and very potent. According to the CDC, it’s up to 50 times stronger than heroin.
“The presence of fentanyl in the drug supply is driving the increase in overdose nationally and locally,” Rachel Vick, a Department of Health spokesperson, said. “But so many health inequities we face are driven by systemic racism and historical disinvestment — and overdose rates are tragically no different.”
The synthetic drug has now almost entirely replaced heroin on the streets, Andrew Kolodny, a leading expert on the nation’s opioid crisis at Brandeis University, said. A combination of factors driven by COVID-19 may have led to more frequent, far more deadly, relapses.
“There was more social isolation, less support, and that may have triggered more people with addiction to relapse,” Kolodny said. “Ten years ago, especially for a seasoned user, a relapse might not be the end of the world. But today, there’s such an exceptionally dangerous supply — all it takes is one slip or one short relapse and that’s it.”
That’s likely how Ortiz died. His family found drugs in his room afterward and tested it for fentanyl; it was positive.
“People weren’t getting the services they needed, weren’t getting the connection with other people,” Marilyn Reyes said. “It was really sad. We went out anyway during COVID. But some agencies did not go out during that time. Everything just exacerbated the overdose crisis.”
Years of neglect
City officials admit that to tackle the escalating crisis in NYC and to slow the death toll, more focus is needed on Mott Haven and other high-risk neighborhoods. They say a plan is in the works, but offered few details.
“(W)e are targeting our investments in the most affected communities including the South Bronx,” Vick, the DOH spokesperson said. “The Administration is developing a plan to address overdose and behavioral health needs and is laser focused on these inequities.
The DOH supports seven syringe services programs, which provide Narcan, HIV testing and other medical care in the neighborhood. They’ve distributed more than 2,400 naloxone kits to opioid overdose prevention programs and two dozen pharmacies in the area, and the state’s Office of Addiction Services and Supports licenses 12 treatment programs, including three opioid treatment programs. There are nine sites in the area distributing fentanyl test strips.
But advocates say this isn’t enough to address the years of damage and the mounting problem.
“We are most impacted,” Marilyn Reyes said. “We will always be the most impacted. Our community has always been neglected.”
As the opioid crisis worsened, teams of volunteers and advocates began taking to the streets in the hopes of working against that and preventing more deaths like Ortiz’s. Outreach teams walk and drive the Bronx day and night to distribute Narcan, educate on safe drug use, provide referrals and help get emergency medical treatment.
Although the worst of COVID-19 may be over, fentanyl isn’t going away — and new drugs like xylazine, a dangerous tranquilizer, have entered the drug market. The opioid crisis is projected only to grow. To push against this trend, advocates are pushing for more safe injection sites, known as OPCs, that they say are badly needed in the Bronx.
“We lack resources in this community — hence why we have the Bronx Opioid Collective Impact Project — we’re trying to bring these resources to the community,” Melissa Nieves, who runs the Collective.
It’s been almost a year since Ralph Ortiz died. His son, Joseph Reyes, misses him, a lot. His dad’s death has left a hole in his life — as much as he tries to heal, Reyes can’t help thinking about words left unsaid and what his dad would think of his goals and accomplishments.
Because of his dad, Joseph Reyes has advocated to show that treating the crisis isn’t just about services, but compassion.
“I think we need to stop being judgmental and help our people,” Reyes said. “People are dying at the saddest rate. I experience it on a daily basis. I hear about it, I see it on social media.
“A lot of people are losing. And it’s sad. It hurts.”
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