Pieces of the Puzzle to Recovery

By: Ashley Barrow

Every day more than 130 people die in the United States from an overdose. The opioid crisis is a public health crisis and a national emergency. Massachusetts ranked among the top ten states with the highest rates of drug overdose deaths involving opioids.

From left to right: Michelle Barrows, Christine Cuccinello, Katie Humphrey holding up signs of those they lost to overdoses during a rally to end fentanyl overdoses on April 16; photo taken by Ashley Barrow

Massachusetts is considering legalizing “safe injection” sites, a controversial proposal to allow addicts to safely use drugs while encouraging them to quit. But interviews of some people who have recovered from addiction, people who are still in recovery, and family members who have lost someone to addiction suggest there is no one silver bullet.

There is not one single way each person interviewed describes their relationship with addiction, relapse, and recovery.

Claire Schmidt is the program coordinator at AHOPE Needle Exchange in Boston, Massachusetts. She works directly with those dealing with addiction and recovery daily. “I think people who use drugs are the kindest, most resourceful, brilliant, resilient people, you would ever meet,” said Schmidt at a panel discussion at Boston University on Feb. 25.

Greater access to naloxone, the use of needle exchanges, safe injection sites in the United States, investing in more long-term treatment methods, and recovery houses are a few methods of recovery. Others are successful in recovery through support from family members, attending rallies and recovery events, having faith and practicing a religion, or having the willpower to quit using substances abruptly.

group of harm reduction and safe injection site supporters at The Massachusetts State House; photo taken by Ashley Barrow

The one common point that each interviewee made is that individuals, community members, and policymakers need to do more to help alleviate the crisis.

Boston Medical Center has received an $89 million federal grant to participate in a nationwide research study addressing the opioid crisis. The goal of this study is to decrease opioid-related deaths in Massachusetts by 40 percent. BMC’s Grayken Center for Addiction will implement the research.

Michael Botticelli is the executive director of the Grayken Center for Addiction. He is also one of the nation’s leading addiction experts and served as the director of National Drug Control Policy at the White House under President Obama.

Botticelli was a panelist at the Massachusetts State House on March 13 after The NOVA Addiction film screening. He announced to the audience that he has been in long-term recovery from a substance use disorder for more than 28 years.

“We apply the principle that we know people with addiction intersect with our healthcare system and those are often missed opportunities to really engage certain people in treatment. I think we have taken the opposite approach. How do we do a better job of engaging people in care as well as addressing their specific substance determinates whether that is housing, food insecurity, etc.,” said, Botticelli.

Diane Hurley is concerned that we should be holding those who accompany someone using opioids accountable for another individual overdosing. Her son, Sean Hurley passed away of an overdose on Jan. 6 after leaving a rehabilitation center with another person to do heroin. Hurley said that he never called home to say he was leaving the program. She said, “He never did that in 13 years. He never left a program before. Everything that happened was out of the norm for him, and he died.”

Hurley is the co-founder of Black Balloon Day. She started this day of remembrance in honor of her son-in-law, Greg Tremblay who also passed away from an overdose.

Brian Downes has been in recovery for about 14 months. He contributes his recovery to finding multiple solutions over the years such as attending narcotics anonymous meetings and surrounding himself with other people who are also in recovery.

Downes was petting his puppy, Vladimir and handing out flyers about Rising Above Addiction, Inc. to pedestrians walking past the Massachusetts State House at a Rally to End Fentanyl Overdoses. Vladimir lives with Downes, and his fiancé in a recovery house that they run in Dorchester called Steps to Solutions with 23 other people in recovery. Downes said, “He’s helping my fiancé and me with our dreams in the end. He gives us hope that if we can take care of him, then we can take care of ourselves.”

Brian Downes petting his puppy, Vladimir; photo taken by Ashley Barrow

Feb. 2, 2018, is his clean date. He said, “I’ve tried methadone, suboxone, and therapy. That never worked for me because you’re still surrounding yourself with people who are using. You have to get yourself into a program such as Narcotics Anonymous.”

Christine Cuccinelli is the founder and executive director of Rising Above Addiction, Inc. and she was present at the rally on Apr. 16. She is a recovery coach who is waiting to get certified and a domestic violence advocate. Through her nonprofit she empowers individuals to overcome substance use disorder.

Cuccinelli is ten years clean from heroin after using the opioid for 13 years. “I can’t explain this disease. It’s going to hit the next two generations and wipe out the whole country,” she said.

Cuccinelli advocates for other individuals in recovery through this nonprofit which in return helps her in her long-term recovery.

Theresa Harmon is also someone who practices advocacy and educates those about addiction. She and her husband, Andy Harmon run a nonprofit called To the Moon and Back, Incorporated. The organization supports children born substance exposed and their caregivers — her son was born with Neonatal Abstinence Syndrome. A child is born with withdraw symptoms every 15 minutes.

In a phone interview with Harmon in Plymouth, Massachusetts, she said, “We can’t forget about the kids.”

Harmon meets with legislators throughout Massachusetts and middle schools and high schools to help educate those who might not be familiar with what Neonatal Abstinence Syndrome is. NAS is a group of problems that occur in a newborn who was exposed to addictive opiate drugs while in the mother’s womb. She believes that educating people as much as possible is part of the solution to the opioid epidemic.

Tyshaun Perryman, who is also in long-term recovery and a recovery coach in Massachusetts said that going to meetings, rehabilitation, and having a sponsor helps with the recovery process. He was a panelist at a discussion about solutions to opioid use on Feb. 25. He said, “Once you see the fruit of your labor and see someone from ground zero and watch their life change, there’s no greater feeling in the world for me.”

Downes introduced himself as an addict on camera. “Addicts are everywhere. You can’t even tell who an addict is anymore. I know doctors, I know of a lawyer,” said Downes.

A report by The Massachusetts Department of Public Health revealed in August 2018 that construction and fishing industries have the highest opioid overdose death rates in Massachusetts. Stephen Ashman worked at Miller and Long Concrete Construction as a field layout engineer at the age of 22 when he suffered an accident on the job. He was 75 feet above the street level when a bulldozer backed into him while on the job. It crushed him into a wall. He had a burst fracture of his T12 vertebrae, he fractured every rib, he had a punctured lung, and a broken back.

“This was when I was seriously introduced to painkillers,” said Ashman.

Ashman has been in out of rehabilitation centers in Maryland and Washington D.C. He also attended a rehabilitation center in Massachusetts once. Ashman does not want the name of the rehabilitation centers to be disclosed.

“No one that I know enjoys doing it, but it has such a strong hold on people that you end up doing it anyway. A lot of that is the withdraw part of the drug. Everyone that I know says the same thing,” said Ashman.

Ashman has been on suboxone for nearly nine years which has helped him with his withdrawal symptoms.  Suboxone is a combination of buprenorphine and naloxone. Buprenorphine is an opioid medication, sometimes called a narcotic. Naloxone blocks the effects of opioid medication, including pain relief or feelings of well-being that can lead to opioid abuse.

Cuccinelli heard that there might be a limitation to suboxone soon in Massachusetts. “I heard that they might be taking it away. I don’t think that is a good idea at all. I think it’s part of the solution. It saved my life”, said Cuccinelli.

A significant amount of support from family members helped Ashman get into recovery. His mother, Chance Ashman- Galliker mentioned in a phone interview that she texts him every day saying, “I love you” and he texts her back saying “I know.”

Ashman has lost about 30 friends to overdoses. He said, “You might die, but it’s the people you leave behind who have to pay for it.”

Chance Ashman-Galliker is also a recovery coach and an advocate at Magnolia New Beginnings. In a phone interview with Galliker, she said, “His addiction was killing me. You have to learn how to parent a different way.”

Michelle Barrows lost her husband to an overdose in December 2018. Barrows thinks that part of the solution would be to make it a law that spouses and other family members need to be alerted when their loved one is leaving a rehabilitation facility.

One of the employees of a rehabilitation center found him outside unresponsive. Barrows said he was left outside for half an hour without being administered Narcan. The FDA approved the first generic naloxone nasal spray to treat opioid overdose on Apr. 19, 2019.

Barrows said that she believes he was robbed based off of his autopsy report. The pictures of the final report will be released in May. She believes her husband had a “hotshot” which is a term used by people who use drugs which means a lethal dose of drugs and opioids. She thinks someone gave her husband a mix of antidepressants, cocaine, and fentanyl.

Among the 1,445 opioid-related deaths in 2018 where a toxicology screen was also available, 1,292 of the 89 percent had a positive screen result for fentanyl.

Devin Reaves was a panelist at a House Democratic Policy Committee hearing hosted by Rep. Joe Hohenstein in Philadelphia, Pennsylvania on March 6, 2018. The overdose rate is very high in Philadelphia.  Reaves is co-founder and executive director of the Pennsylvania Harm Reduction Coalition. Reaves has been in long-term recovery since 2007.

At the panel, he held up a packet of fentanyl testing strips and asked Rep. Hohenstein why he could not have made the testing strips legal earlier.

Devin Reaves holding up fentanyl testing strips at The Democratic House Committee Meeting in Philadelphia, PA on March 6; photo taken by Ashley Barrow

When asked how in an interview after the event how he began abusing drugs he said, “I don’t really think it matters where it starts. I think it’s how we treat people who use drugs that matters. We shouldn’t incarcerate them. Having a substance use disorder shouldn’t be a death sentence.”

People walking outside of Friends Hospital – one of America’s oldest mental hospitals where gaps in mental health and substance use disorders were discussed at The Democratic House Committee Meeting on March 6; photo taken by Ashley Barrow

Drug offenses account for 45.4 percent of incarcerations.

Loui Diaz has also spent time in prison. He is a substance abuse counselor and re-entry specialist with the Middlesex County Sheriff’s Office in Massachusetts. When he was younger, he sold drugs and stolen jewelry and became involved in a car theft ring. During his struggles with heroin addiction, he received a ten-year prison sentence for stabbing a police officer while trying to flee a crime scene.

Diaz was able to quit heroin use without any substances such as suboxone or methadone. He was able to end his habit “cold turkey.” He described how he has noticed everyone has different solutions to combat their addiction. “I understand we’re all different. That’s what worked for me – it might not work for everybody. The NA meetings and detox work but it’s not for everyone. I know guys who died, and they tried so much with the program because that’s what they were taught. I think that’s the worst mistake you can make.”

When asking Diaz in an in-person interview after the event about what he thinks of safe injection sites, he said, “I’m all for harm reduction and safe injection sites if they can help someone in their recovery.”

Safe injection sites provide medical supervision for people who want to inject pre-obtained drugs. Insite is the first safe injection site to open in North America in Vancouver, Canada. There are approximately 120 safe injection sites currently operating in twelve countries around the world (Australia, Canada, Denmark, Germany, Luxembourg, the Netherlands, Norway, Spain, and Switzerland) – but none in the U.S.

There is currently an underground safe injection site in Massachusetts but, Jess Tilley, the facilitator of the site, did not give very much information about it and its location. She said, “As far as I know, ours is the only one running on a consistent basis. It’s totally against the “rules” to give the address out. It is strictly word of mouth, and no one is allowed in unless they are a PWID.” The acronym PWID stands for a person who injects drugs.

Angela Mae Ni Mhaille uses drugs on occasion and has been in active recovery from heroin for nearly a year. Mhaille thinks that for most people it’s easy to be a functioning person who uses drugs and it’s easy to quit with some willpower.

“The reason why we often think of substances as very addictive or that there’s a large quantity of people with problematic relationships is because those are the drug users that you see,” said Mhaille.

Mhaille is a harm reduction specialist in Gloucester, Massachusetts and interacts with those in recovery every day. “I don’t think that a lot of people that consume the amount of substances that I did, in the way that I did, with the particular features with the relationships with substances that I did have that easy of a time ceasing but I think there are a lot of us like that but I don’t think that it’s a grand quantity.”

Mae said that she encounters people of all ages, backgrounds, and genders who come into the needle exchange. “I see soccer moms, and I see businesses men who just want to have a weekend.”

Mae is part of the transgender community and has faced some backlash. She thinks we need to be looking at the whole picture and recognize all aspects of a person and not stigmatize them because they have a drug problem. “I often think that we look at situations like here’s the person, here’s the drug, and we don’t look at anything around the person. We look at this person consuming drugs and say that you have a disease, or you’re broken, or you’re morally unsound…and when we do that and ignore all the other things we ignore the needs of this person that aren’t being met by society.”

Working on accepting herself and not turning to a drug for relief has been a solution to Mae’s recovery.

Dec. 23, 1993, was when it came to an end for Diaz. Recovery for him has been a combination of quitting on his own, practicing his faith, and surrounding himself with the right people. In a speaker event at Learn to Cope in Cambridge, Massachusetts on Mar. 11 he said, “I didn’t see a voice. I didn’t hear a light.” He was arrested and held in Cambridge, Massachusetts without any bail. He was told that he would not win a trial.

“The best thing that ever happened to me was getting arrested. I didn’t get arrested. I got rescued,” said Diaz.

Massachusetts is now placing persons who are involuntarily committed to treatment – the section 35 process – in jail or prison even though no charges have been levied against them.

Ashman described his time while in prison in Washington D.C. He did not want to disclose the name of the prison. “It was such a joke. Everyone was just getting high.”

Everyone spoken to in recovery and their family members have a different opinion as to how to combat the opioid crisis. Each person described how their addiction started, how it progressed, and how it ended or how they are still fighting it differently.

Hurley said, “I don’t know what the solution is. The time when my son was successful was when he stayed with the plan. He did the detox. He did the aftercare, but it was going to the meetings and staying there with people who were sober and were all doing the right thing. Once you think you’re okay – I don’t need to go today. I’m tired. I’m busy. You can slowly see the whole mental attitude changing, and I think that’s the answer.”

The U.S. Department of Health and Human Services is focusing its efforts on five major priorities: improving access to treatment and recovery services, promoting use of overdose-reversing drugs, strengthening the understanding of the epidemic through better public health surveillance, providing support for cutting-edge research on pain and addiction, and advancing better practices for pain management.

“You need to be active in your recovery and save yourself,” said Downes.