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Every day, drug users check themselves into detox programs determined to fight their addiction.
After the ravages of withdrawal, some will rely on willpower and a 12-step program to help them stay away from heroin. Others will move on to a residential or outpatient program where they’ll get counseling and medication to help curb cravings. The next stage might be a halfway house or a group home dedicated to sober living.
When there are gaps between any of these stages, patients often relapse.
Steve Fox, who leads a group of South End neighborhood associations, has been watching this cycle of addiction, treatment and relapse in his community for years.
"Somebody goes into detox, they’re back in 30 days at Mass and Cass," he says, referencing the area around the intersection of Massachusetts Avenue and Melnea Cass Boulevard where on any given day you might see dozens of people high or passed out in door jambs or on sidewalks.
"We need to dedicate ourselves to not just managing this problem, but getting ahead of it," Fox says. "It’s time for us to recognize that this crisis is going to require a major investment in a mothership."
"It’s time for us to recognize that this crisis is going to require a major investment in a mothership."Steve Fox
By mothership, Fox and Sue Sullivan, who represent 235 area companies through the Newmarket Business Association, envision an addiction treatment and research campus. There would be one in Boston, and others around the state.
On these campuses, patients would find everything they need to manage their addiction, including detox to get them through withdrawal, all varieties of 12-step programs, all types of medication treatment, inpatient facilities, outpatient care and mental health services.
The campus would offer transitional housing, maybe a sober home, assistance finding a more permanent residence, career counseling and job placement. There'd be a research wing to collect data on what's working and what's not.
"We're talking soup to nuts," Sullivan says. She's optimistic. "We have the best minds in the world in Boston. If we can't figure this out, who can?"
Sullivan and Fox are shopping their idea, trying to persuade city and state leaders to sign on, figure out who would run the campus or campuses, and who would fund the plan.
"We need money and dedication," Fox says.
"And political will," Sullivan adds.
Their message is beginning to take hold.
"The campus idea is great," says Boston Mayor Marty Walsh, noting he isn't sure how the project would be funded. He suggested that perhaps a for-profit business could help.
Walsh, who speaks often about his own recovery, likes the continuum of care the campus would provide.
"You’re talking somebody that could have a year sobriety in a clean environment. That’s almost a recipe for success," Walsh says.
There are residential addiction treatment programs on Cape Cod, in Worcester and on the North Shore that keep patients through many stages of recovery. But Dr. Andrew Kolodny, co-director of the opioid policy research collaborative at Brandeis University's Heller School, says he hasn’t heard of any facilities with the scope of services proposed in this case. He suggests the state seek funding from pharmaceutical firms who marketed opioids as a non-addictive cure-all for every kind of pain and "created this mess."
"If this is a community recognizing that it’s got a public health crisis and they’re stepping up to the plate, I think that’s great," Kolodny says. "On the other hand, if what’s driving this is an effort to further marginalize or segregate people suffering from opioid addiction, that does concern me."
Fox and Sullivan say their plan is not an out-of-sight, out-of-mind approach. But they do call the campus idea "Long Island 2.0." Some of the proposed campus services were available on Long Island before the bridge that connected it to the mainland was condemned in 2014.
They have a suggested site for the campus: Lemuel Shattuck Hospital, a high-rise brick facility on the edge of Franklin Park that's run by the state. It houses prisoners who need health care, some state mental health and public health programs, and a methadone clinic. Pine Street Inn runs a men's shelter on the property. Part of the facility is not in use because it's not up to code. The Baker administration is reviewing its capacity and use.
As is, Shattuck is not a particularly appealing place.
"We need to think: Would we be comfortable having our loved ones served in that type of institutionalized setting, especially over an extended period of time?" asks Vic DiGravio, president and CEO of the Association for Behavioral Health Care, a trade group of more than 80 addiction and mental health treatment programs.
DiGravio says there’s no question the city needs more treatment options. But if there's going to be a major investment, the money might be better spent on programs in communities.
"Recovery is a lifelong process," DiGravio says. "We need to make sure there are services available where people live and work."
Kolodny, with Brandeis, says it's critically important that we make addiction treatment drugs, especially Suboxone, also known as buprenorphine, more widely available.
"If we’re going to see overdose deaths start to come down, and they're still soaring, it has to become easier to access buprenorphine than it is to access pills, heroin or fentanyl," Kolodny says.
Fox and Sullivan say addiction campuses would be the hub of wheels, with spokes connecting patients to ongoing care in their community.
The idea of an addiction recovery campus gets mixed reviews among drug users. Some are skeptical about entering a large institutional space. Others not interested in discussing treatment shrug. One man is enthusiastic.
"If this program's available I would want to be one of the first ones to get in it," says Jose, who’s 45 and lives out of his car. We aren't using Jose's full name because his drug use is illegal.
Jose has been through detox and treatment four times. Once he got kicked out because a urine test showed drugs. Another time, Jose says his doctor tried to wean him off buprenorphine too quickly and he relapsed. But these days Jose is terrified every time he buys a bag of dope: Will this one contain enough fentanyl to kill him? So he's ready to try treatment again. But he's also hesitant.
"I’m willing to go into a program, but I need to be 100 percent sure that I’m going to be good when I get out, because it’s hard. Trust me, it’s hard to get away from this," Jose says.
There are, of course, no guarantees that treatment will work on a campus or anywhere else.
The next stop for Fox and Sullivan and their "mothership" proposal is the Baker administration, which controls use of Shattuck and would have to get on board if there’s to be a major investment in an addiction recovery campus in Boston.
Share your experiences, and follow along with our reporters as they cover opioid use and treatment, by joining our Facebook group, "Living The Opioid Epidemic."
This segment aired on July 17, 2017.
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