At drug treatment centers on Staten Island, the calls disturb the daily routine. The solicitations interrupt meals, counseling sessions and support groups.
Sometimes, staff members say, the callers make explicit offers: thousands of dollars to refer a person with a heroin or pain-pill addiction and good insurance. Other offers are more subtle — a recurring donation or a contract.
The callers are recruiters working for treatment centers as far away as Arizona, California or Florida, or as close as Long Island or upstate New York, all angling to fill their beds with patients from Staten Island.
“They are opportunistic people or organizations who are preying on people of vulnerability at a time of high stress,” said Luke Nasta, director of the addiction treatment center Camelot of Staten Island, which has been there for 45 years. “It’s unethical. It’s borderline criminal.”
The calls began years ago, Mr. Nasta said, but they have become far more frequent as Staten Island’s opioid addiction rate has soared and brought the borough some notoriety. An episode of the National Geographic series “Drugs, Inc.” last year described it as “Heroin Island.”
“If you’re in the business you say, ‘Oh, well this is a fertile ground,’” Mr. Nasta said. “So they come here and they solicit.”
Even if the solicitations do not cross a legal line, people in the treatment community say they do cross an ethical line.
“There are enough people doing it who seem to think it’s O.K., or know that it’s not and don’t care,” said Marvin Ventrell, the executive director of theNational Association of Addiction Treatment Providers, which has about 550 members.
Some people end up in drug treatment by court order; others at the urging of family or friends. In New York, some treatment programs are for-profit. Most, like Camelot’s 45-bed residential center for men, are nonprofit.
“If a person comes to this door, the last thing I want to talk to him about is what kind of insurance he’s got,” John Coleman, the director of operations at Camelot, said. “I’m not saying that’s not important or doesn’t play a part in getting help, but I don’t care. I want them in the doors and off the street.”
In 2015, Staten Island recorded the highest rate of overdose deathsinvolving prescription painkillers in New York City and had the second highest rate of overdose deaths involving heroin, after the Bronx, according to the city’s Department of Mental Health and Hygiene.
The Staten Island district attorney’s office is investigating 59 suspected overdoses this year. In February, the office started an initiative to treat every overdose like a crime scene.
Nationwide, more money has been flowing into addiction treatment over the last several years, due in part to two laws, one passed in 2008 — the Mental Health Parity and Addiction Equity Act — that ensured equal coverage of mental health care; and in 2010, the Affordable Care Act. The money has drawn new entrants to the treatment industry, often private, for-profit providers.
“It began to change the game significantly,” Mr. Ventrell said. “The money is now there.”
Particularly when profit is part of the equation, he said, pressure to fill beds could lead to unethical efforts to recruit patients. That possibility prompted the treatment providers association to create an ethics code two years ago.
“The addiction industry was no longer a small collegial group that was carefully working together and trying to do the best thing for clients,” Mr. Ventrell said. “Rather, it had become a very competitive business.”
The code specifically addresses remuneration: “No financial rewards or substantive gifts are offered for patient referrals.”
In February, Mr. Ventrell put in place a system for filing complaints about member organizations.
The system is too new and the data too sparse to draw conclusions yet, he said; so far, of the 10 complaints filed, four related to payments for patient referrals.
In New York City, 346 treatment programs — including residential and outpatient — are certified by the New York State Office of Alcoholism and Substance Abuse Services; 22 of them are on Staten Island.