Heroin, U.S.A.
Addiction to opioids — both prescription pills and illegal narcotics — is devastating the U.S. Northeast. It is also changing the way people think about the war on drugs
A juror overdoses in the courtroom. A grandmother overdoses babysitting her grandchildren. How middle-class Massachusetts wound up addicted, and how it’s radically changing the war on drugs.
BROCKTON, MASS.— Not long into the meeting, a mother began to cry. She had been diligent, doting. She had not come to terms with how her son’s life turned out.
“I worked so hard,” she said. “And this is where it ended.”
It was a summer Monday night. Three dozen people were sitting in chairs scattered around the bluewalled “multi-purpose room” of a high school in a Boston suburb. In their khaki shorts and golf shirts, they looked like nothing so much as a parent-teacher association.
This was the weekly Brockton gathering of Learn to Cope, a booming 20-chapter support group for the families of heroin addicts. This is how the families of heroin addicts look.
“Sometimes people have walked into a meeting and thought they were at the wrong meeting,” said Joanne Peterson, Learn to Cope’s founder. “Because we all look so normal.”
Teachers, nurses, cops, at least one judge. Jack Reilly is a lawyer and former human resources executive. Before he became chairman of the Learn to Cope board, he was another dad sobbing through a session.
“The stereotype is not that you are the daughter of a lawyer in an upper-middle-class town outside of Boston who goes to a great school district,” Reilly said. “This isn’t bad kids. These are good kids. This is a disease. But you tell your story and it’s not like people receive you, necessarily, like you’re talking about pediatric cancer. It’s just got a lot of stigma and stuff attached to it.”
The good news is that the stigma is fading. The bad news is that it is fading because so many kids are dying.
More than 1,200 people in Massachusetts died from overdoses of heroin or prescription opioids last year. That is double the number who died four years ago, four times the number who died in car crashes.
The picture is just as ugly in the postcard towns of Maine, New Hampshire and Vermont. The killer drug once associated with urban poverty is more popular in the United States than ever before — especially among white people, women and the middle class, especially in the suburbs and the country, especially in the Midwest and northeast.
A weeklong tour of the Massachusetts wreckage revealed glimmers of hope: families starting to speak out without shame, once-oblivious political and medical leaders innovating to save lives, a small-town police chief putting addicts in treatment rather than handcuffs.
But the body count is staggering and rising. Haverhill, an unremarkable town of 60,000, had three overdose deaths in 2011, more than 20 deaths in 2014. In most of the state, this year will be just as bad as last. Thousands of families, many of them prosperous, have been left to puzzle out how they ended up here. Heroin. “This was not something we foresaw would be a problem with our kids,” said Mickey Gys, a corporate procurement manager.
His son Zachary, funny and fashionable and babyfaced, was a high-scoring high school hockey forward in the city of Lowell. He sprained his ankle during his junior year. A teammate offered him a Percocet for the pain.
“Before we knew it, he was headfirst in it,” Mickey Gys said. “He couldn’t stop.”
The heroin crisis is intimately connected to a crisis in prescription pill abuse. During the epidemic of the 1970s, heroin was usually the first opioid a heroin addict had tried. More than two-thirds of today’s heroin addicts, studies suggest, started with legal drugs like Percocet, OxyContin and Vicodin, often prescribed by a doctor after an injury or illness.
The issue is money. Dealers can sell hits of heroin for $10 or less, pills for $50 or more. When addicts run out of cash for the pricey painkillers, some turn to the cheaper stuff. Government crackdowns on the availability of pills, and a 2010 change that made OxyContin harder to abuse, have inadvertently strengthened heroin’s competitive advantage.
Zachary Gys progressed from Percocet to OxyContin to heroin, stealing anything he could sell. His parents spent “tens of thousands,” Mickey Gys said, on treatment programs. In 2013, he celebrated 60 days of sobriety at a sober-living house in Florida. He relapsed and died on Day 61. He was 21.
Jack Reilly’s family suffered from alcoholism for generations. He took deliberate steps to shield his daughters: a move to a high-income town populated by “intact families,” honest talks about addiction, active childhoods filled with Girl Scouts and soccer and vacations.
His daughter Becca began abusing Percocet at 17. By 18, she was a heroin addict.
She had never felt quite comfortable in her own skin, she said, and heroin gave her an escape. It was available. That was it.
“If a psychiatrist heard about my childhood and my life, there’s nothing that would make them be like, ‘Oh, that makes sense then,’” said Becca, 22, now
Billy Pfaff, an intense, muscular tattoo artist in Billerica, a small town northwest of Boston, carries two cellphones. The Samsung is for people who want tattoos. The iPhone is for desperate addicts. The iPhone rings more often. On a sunny weekday morning in July, the caller was a young woman addicted to pills. Pfaff had persuaded her to go to rehab, but she was getting cold feet. Her father said he was too busy to talk to her.
“No one’s going to hurt you,” Pfaff said tenderly. “No one’s going to harm you. I know you’re scared, but I have your back.”
They spoke for two minutes. When Pfaff hung up, he told the story to an anxious woman sitting in the shop: Joan Todisco, the mother of three sons, all heroin addicts, one dead. His tone changed.
“He won’t be busy when she’s dead, right?” Pfaff said. “We’re not dealing with you making money. We’re dealing with your f----n’ child dying. What don’t you get?”
“He’s probably not going to get it,” said Todisco. “Unless you’ve done it or been through it . . .”
Pfaff, 46, wears white tank tops and a black “Pay It Forward” baseball cap turned backward. After a friend died of a heroin overdose last year, he started a Facebook group he called “Heroin is Killing My Town.” He used the group to post improvised video monologues that were at once profane and compassionate.
Addicts and their families began messaging him. With no training, a once-homeless man best known as “Billy Inkslinger” became a sought-after addiction counsellor — a testament both to the force of his personality and the despair and confusion of parents and spouses unequipped to deal with a problem they had never contemplated.
“I never thought about talking to my kids about heroin,” said Todisco, 53. “Heroin, I thought it was gone. I really thought it was over.”
In 2013, Todisco’s youngest son found her eldest son dead of an overdose on the floor of their father’s apartment. Tony was 25, a union roofer with steady work, a nice car and two children. She is now trying to save his two brothers, Nicholas, 24, and Jake, 22.
She works in a hospital kitchen. When her sons stole all of her savings, she lost her house of 17 years. Nicholas asked her this summer if she would cover a $7,000 treatment program. It might as well have cost $700,000.
“You have to have money to win this,” she said. “And we don’t have money.”
The crisis has exposed the woeful inadequacy of the U.S. treatment system. Lowell, a hard-hit city of 105,000, has a single 19bed residential rehab facility.
The wait for a Lowell House bed is two to four months. For a heroin addict, even a 24-hour wait can be deadly. Heroin is purer now than ever before. With increasing frequency, it is laced with fentanyl, a synthetic drug even more powerful and deadly.
“Our beds just are constantly full,” said Lowell House chief program officer Maria Lucci. A “huge” risk, she said: “If they can’t get a bed, that means they’re probably going to use that day, and they could die that day.”
Once shamed into silence, families of addicts have become outspoken in pleading for help. The political tide appears to be turning in favour of treating heroin addiction like a public health problem rather than a crime wave. Democratic presidential candidate Hillary Clinton has proposed a $10-billion treatment initiative; in a remarkable break from elections past, Republican candidates have competed to sounded most treatment-friendly.
The response may have been influenced by the race, class and clout of the victims. Marc Mauer, executive director of the Washington, D.C.-based Sentencing Project, noted that people who used crack cocaine during the epidemic of the 1980s, most of them poor and black, were punished as serious offenders.
“The difference is so dramatic in terms of the approaches that are being laid out,” Mauer said, “and the crack stuff was not all that long ago.”
Not everyone has softened this time. The right-wing governor of New Hampshire has emphasized enforcement over treatment. Massachusetts has been far more thoughtful. But the state still does not spend nearly enough to handle the overwhelming demand.
State-funded Lowell House is free. Other facilities are not. Even if addicts can find a bed, they might not be able to pay for it: insurance companies rarely cover longterm treatment, the only kind of treatment most heroin addicts find effective. They also put strict limits on short-term treatment.
“If it was heart disease, and someone had a heart attack, they wouldn’t say, ‘You were just here with a heart attack last week, we’re not going to cover it this week,’” said Learn to Cope’s Peterson. “They need to treat it as a medical condition, the insurance companies, and stop stigmatizing addiction.”
Todisco spent her summer making desperate phone calls, pleading for a break from a program or an insurer, getting “denial after denial.” In between, she said, she waited for a call telling her it was time to bury another child. “It’s hell,” she said. Jake sat morosely beside her in a Celtics T-shirt, sedated by the legal drug he takes to control his heroin cravings. She cradled a photo of Tony.
“I could not go through it again,” she said. “I made it through this, but I won’t make it through these two. I know that as long as I fight, maybe they’ll fight.”
All day, every day, Edward Bradley, the fire chief of the town of Plymouth, carries bottles of Narcan, the nasal spray that reverses heroin overdoses. Even to his grandson’s T-ball games.
“You just never know where or when you’re going to run into a need for it,” Bradley said. “It’s become that crazy.”
A juror overdosed in the local courtroom. A driver overdosed while stopped at a red light. A grandmother overdosed babysitting her grandchildren during a blizzard.
Plymouth, the charming seaside town where the Pilgrims settled, bills itself as “America’s hometown.” Aside from its history, there is nothing exceptional about it. Before 2013, Bradley’s fire department responded to 40 to 60 overdoses per year.
There were 313 overdoses in 2014. Fifteen people died. This year has been worse.
“Anyone who thinks it’s not going on on their street isn’t paying attention,” said Peter Holden, chief executive officer of Plymouth’s Beth Israel Deaconess hospital. “And that’s the polite version of what I think. The honest version is: get your head out of your ass. It’s everywhere. I can’t talk to one family that doesn’t have a story about losing somebody somehow.”
Before 2013, Bradley thought of heroin as the domain of homeless people living under bridges. He has been disabused of this notion by a steady stream of 911 calls from the homes of Plymouth professionals.
“A lot of these people, they’re collegeeducated,” he said. “They’re professional people. They have good jobs. They’re grandmothers.”
Plymouth has 60,000 residents. One Monday night in July, four people overdosed in four hours. The exact same thing happened one Friday night in August.
Last year, Bradley had all of his crews armed with Narcan. Every crew has now used it at least once. “It’s a regular occurrence now,” Bradley said. “To them it’s just like grabbing the nozzle and the hose off the truck.”
Plymouth’s police chief, Michael Botieri, initially responded to the crisis with a traditional get-tough approach: a plainclothes Street Crimes Unit to arrest drug dealers and unruly addicts. Six months later, after Plymouth had three overdose deaths over two weeks, he had his epiphany: arrests were not going to make a meaningful difference. He threw himself into prevention and treatment initiatives he had previously dismissed as “social work.”
“I had a little revelation that these are our neighbours, these are our relatives, these are regular people, these are regular families,” Botieri said. “And we realize we have to change our focus.”
Holden’s “slap in the face” came courtesy of students at the high school across the street. In a segment for their amateur newscast, they quoted a local drug dealer who said he had obtained pills from a friend who stole doctors’ prescription forms from the hospital.
Holden showed the video to dozens of other hospital executives. He soon became an outspoken crusader for painkiller reform, using his perch as chair of the state hospital association to push for standards to limit the use of narcotics.
“Hospitals and physicians are part of the problem,” Holden said. “Any pill on the street from a prescription that was not appropriately utilized? Well, as far as I’m concerned we have some measure of culpability for that pill being on the street.”
James Brown Jr. lay flat on his back outside the headquarters of the Gloucester Police Department. Brown, a sweet 21- year-old, had managed to avoid heroin for two days. He ached too much to sit.
Addicts like Brown haunt the state’s police stations and courthouses, hauled in by local cops for drug possession, theft or erratic behaviour. Brown, though, had not been arrested. He found a ride to Gloucester from Lowell. He came to ask the cops for help.
“Yesterday I tried to get into a place,” he said. “And then my sister called me up and said all you’ve got to do is show up here and they’ll help you.”
Gloucester, pop. 29,000, has a 60-officer police force based in a seaside building stained with the waste of squawking seagulls. Since June, the force has running an experiment that appears unprecedented in America. Its architect is a former undercover drug cop.
Chief Leonard Campanello revealed his “Gloucester Initiative” on the department’s Facebook page in May. To Massachusetts addicts and their families, his post was nothing short of astonishing.
“We are poised to make revolutionary changes in the way we treat this DISEASE,” Campanello wrote.
Any addict who wanted to get clean would be invited to show up at headquarters. The Gloucester PD would work the phones to get them into treatment — “not in hours or days, but on the spot.” A volunteer “angel” would support them through the process. Even if they brought drugs with them, they would not be charged.
“I’ve never arrested a tobacco addict, nor have I ever seen one turned down for help when they develop lung cancer, whether or not they have insurance,” he wrote. “The reasons for the difference in care between a tobacco addict and an opiate addict are stigma and money. Petty reasons to lose a life.”
Campanello’s program officially started on June 1. Campanello thought it was possible nobody would show up. The first addict walked in on June 2.
He was from California. Someone who loved him had seen the Facebook post and bought him a plane ticket across the country.
Over the next four months, 210 others followed him into the tiny headquarters lobby. The Gloucester PD found beds for all of them, often within three hours. Campanello has been inundated with gratitude.
Much of it is tinged with amazement. Wrote one man: “Is this even a real police department?”
Campanello goes by Lenny. A burly, blunt 47-year-old with sombre eyes and an affinity for Springsteen, he can pass for an oldtime Boston cop out of a Dennis Lehane novel. He also holds a master’s degree in criminal justice.
Gloucester is America’s oldest seaport, a gritty town dominated for two centuries by the fishing industry you can still smell on the streets. Campanello became chief in 2012. Earlier, he served seven years on the narcotics beat in a town nearby, arresting “everybody,” achieving not much. For every dealer he put behind bars, he said, another popped up.
He was at home on a Friday night in March when he got the call that angered him into boldness. Another overdose death, Gloucester’s fourth in three months.
“I just said, ‘I’m sick of this,’” he said. “Just tired about hearing about these people who could be saved. What can we be doing different? What can we do that shakes the conversation?”
He had come to believe the war on drugs — the war on the supply of drugs — was a failure. He decided his little department would target the demand for drugs.
“A drug dealer with no customers is an out-of-work drug dealer,” he said.
The program is even more untraditional than he explained in the initial post. He is using assets seized from drug dealers to help pay for treatment and to buy Narcan for uninsured families. He is lobbying insurance companies and pharmaceutical companies. And with a prominent developer who lives in Gloucester, he has created a non-profit to help other police departments start similar programs.
“We have to have a very honest conversation,” said John Rosenthal, the developer, who has two addicts in his family. “Lo and behold, we’ve got one chief in a small town called Gloucester who is willing to start the conversation.”
The man from California walked in at 3:30 a.m., suffering through withdrawal. An officer took him to the hospital. He was on his way to a treatment facility by the afternoon. As of late September, Campanello said, he was still clean and sober.
Campanello knows this because they speak all the time. Two or three times a week, the heroin addict sends the police chief a text message.
“I had a little revelation that these are our neighbours, these are our relatives, these are regular people, these are regular families.”
MICHAEL BOTIERI PLYMOUTH POLICE CHIEF