In leggings and a long black hoodie, Ray walked idly up and down Sullivant Avenue in Columbus, Ohio. A block away, an elementary school had let out for the day and students walked home. For Ray, work had just started.
鈥淵ou just walk around until you catch a date,鈥� she said.
Ray is her nickname. She asked she not be identified because she sells sex in order to purchase heroin. At 28, she鈥檚 rail thin and has long black hair.
Ray said she鈥檚 usually able to get work from a group of her regular clients. When that doesn鈥檛 work, she comes out here, where getting in the car with strange men leaves her vulnerable to assault. She said she鈥檚 been raped twice. As she talked, her eyelids slowly fell over her pale blue eyes.
鈥淚 want to quit and go home real bad, but it's just really hard,鈥� she said. 鈥淵ou feel like you're trapped here.鈥�
For some women addicted to opioids, selling sex to buy drugs can become a dangerous way of life. Ray may work for herself now, but like other women interviewed for this story, she could eventually find herself exploited by a pimp or a drug dealer.
In Columbus, law enforcement and anti-human trafficking advocates are seeing an increase in the number of women who are trafficked due to an opioid addiction, meaning they are forced or coerced to engage in sex work.
When these individuals want to seek help, treatment options are not always available quickly enough to provide them a safe path to recovery. And they often need safe housing before they can leave this life behind.
For women seeking help, they can call That call will bring them to the Salvation Army of central Ohio, which has run an anti-human trafficking program for the last ten years. Director Michelle Hannan says opioid addiction now affects nearly all of their cases.
鈥淲e鈥檝e seen a really dramatic increase in how frequently heroin intersects with our cases and the degree to which the drug is being used as a control technique," she said.
When caseworkers come across a survivor with opioid dependency, often their first priority is to get them into detox 鈥� this helps them through the painful drug withdrawals. Hannan said thanks to Ohio鈥檚 Medicaid expansion and their partnership with a local treatment facility, Mary Haven, they鈥檙e often able to get them in immediately. However, there are instances when space fills up and people are turned away.
鈥淭hat鈥檚 the toughest part,鈥� said Hannan. 鈥淚f someone says at this particular moment, 鈥業鈥檓 ready鈥� and we can鈥檛 act in that moment, that鈥檚 when we鈥檙e going to lose that person until the next time that they鈥檙e ready.鈥�
Considering the high rates of overdoses, and other dangers associated with sex trafficking, Hannan said there may not always be a next time. Women in these situations are often victims of violent assault by their pimps, dealers or clients. They also risk diseases such as HIV and potentially fatal infections from dirty syringes.
If a patient makes it through detox and doesn鈥檛 relapse 鈥� as many do 鈥� the next step for the Salvation Army case workers is to help them find long-term addiction treatment. Outpatient care is also an option, but because survivors of human trafficking experience trauma and homelessness, many do best in long-term residential treatment.
These programs last several months to a year and require intense supervision and care from mental health professionals. Julia Gilliam, a coordinator at Mary Haven鈥檚 residential program for women, said it can take six to eight weeks to get in. But she insisted, they never just tell patients to wait.
鈥淭hat鈥檚 not how that works,鈥� she said. 鈥淭here鈥檚 always something that needs to be done.鈥�
Many women who have been trafficked have lost their ID and any vital documentation necessary to apply for Medicaid or health insurance. While women work on gathering identification, they have access outpatient care, such as medications and counseling.
Every so often, a patient will relapse before making it off the waitlist. Gilliam said she wishes that they had more resources.
鈥淏ut with the staff that we have available and the beds and the space that we have available, it works right now,鈥� she said.
For women who are homeless or who live under the control of a trafficker and have nowhere safe to live (as is the situation for many of the women interviewed for this story), six to eight weeks can feel like an eternity. Gilliam says a lack of safe housing could keep many women trapped.
鈥淵ou know that you can run, but there鈥檚 nowhere to run to,鈥� said Gilliam. 鈥淚f there鈥檚 no safe housing for them when they leave, then they can be found very easily.鈥�
Back on Sullivant Avenue, Ray said she recently spent five days in jail where she couldn鈥檛 use drugs.
鈥淲hen you're sober all you do is think,鈥� said Ray. 鈥淪o it's just not worth it really.鈥�
Ray has been thinking of going into treatment. When she is ready, perhaps the resources she needs will be there for her.
This story was produced by , a news collaborative covering public health.
Copyright 2021 Side Effects Public Media. To see more, visit . 9(MDA5NTM4MTIyMDE0MTg3NDc2MTVlZjdmNQ001))
