One place where the Massachusetts opioid crisis comes starkly into view is inside a brightly lit room on Albany Street in Boston that houses the AHOPE — Addicts Health Opportunity Prevention Education -- needle exchange program.
Inside, a wall is covered with the obituaries of those who've recently died of drug overdoses.
“Most of those are our loved ones, our friends," says Nicole Oakes, a health advocate with the Boston Public Health Commission, which runs the program. "We've got a family of three siblings - two boys are up there, so the mom has lost two out of three children in the last year and a half."
She breaks down as she points to the obituary of her 8-year-old son’s father, who she says was carrying the overdose reversal drug Narcan when he died.
“He died with Narcan in his bag. This is just incredibly devastating. It seems like it's going to completely wipe out my generation."
Oakes does everything from helping to get people into drug treatment, to training people how to use Narcan, to trying to make sure that if people are going to use drugs, they do so as safely as possible.
The AHOPE program used to be mobile — it was run out of a van that distributed clean needles for free in various parts of Boston. But once the program started operating in the South End two years ago, they’ve seen a 300-percent increase in the number of people accessing their services.
Sarah Mackin, the program manager, says most clients come to the center for clean injecting equipment.
“They can get clean needles, clean ancillary injecting supplies, which is aimed primarily at preventing HIV and hepatitis C transmission," Mackin says. "They can come and get a referral, treatment, coffee, food, clean socks. Anything that you can think of, we'll try to do here."
The ultimate objective, says Mackin, is saving lives. The program gives out about 200 Narcan kits a month, and, last year, AHOPE distributed more than 150,000 clean needles. Mackin says many of the clients are desperate for treatment.
"I can't even tell you how many times a day - not a week or a month - that someone comes in here and says, 'If I don't get into treatment, I'm going to die.'"
So referring people to treatment has become a big part of AHOPE's focus. The agency sends clients across their hallway to the PAATHS program, where a case worker will make what are often repeated calls to find a bed.
PAATHS program manager Yailka Cardenas says that one reason Massachusetts had more than 1,000 opioid overdose deaths last year is the state's fragmented treatment system. Many people come to her after a non-fatal overdose. She says the hospital often releases patients with a list of places to call for treatment, and many don’t understand or have the wherewithal to navigate what can sometimes seem to be an arbitrary treatment system.
"This week alone, I know of three clients who had overdoses this week, and it was partly because they were not able to find a detox bed," Cardenas said. "So they came in and asked us to make the call, because a lot of people find that if one of us makes the call, one of the staff, people have a higher chance of getting in."
Cardenas says people coming out of detox have an even harder time finding long-term treatment, and many end up back in homeless shelters.
"They got me into a detox program, and from there, it just took. It was just the time. I was ready to get sober."
That’s exactly what happened to 28-year-old Benjamin, from Waltham, who didn't want his last name used because of the stigma of drug addiction. He said he went to three detoxes and was then sent to what is called a holding — a typically state-funded facility where patients stay while waiting for treatment. The problem, Benjamin says, is that many of these holdings run very differently from each other, and they often kick people out who don't immediately comply with their rules, so people often return to shelters.
“And the next thing you know, you're sleeping at night, and some guy is shooting up next to you and offers you a shot," Benjamin says. "You're like, 'Well, I can't get into a program, so why not get high?'"
After Benjamin was arrested for stealing to support his $300-a-day heroin habit, he realized that his life was out of control. Although he graduated from college, he no longer had a job, and he had lost contact with his family. He knew the staff at the needle exchange program as he had been getting clean needles there, and so he asked for help.
“They got me into a detox program, and from there, it just took," he says. "It was just the time. I was ready to get sober."
When Benjamin now comes to 774 Albany St. to get his daily methadone dose, he also volunteers at AHOPE for about an hour a day, which he says is what helps keep him sober. He credits AHOPE with saving his life.
"It saves a lot of people. It saves me, because I get to see it every day. It might not be just the staff people that save me, but other people who come in through here. Because I don't want to do some of the things that these people have done for drugs - and that's what saves me every day."
Benjamin hopes that when the state opioid task force releases its report Monday, it will include recommendations on ways to improve treatment and boost access to treatment.
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