Michael Cain's face is creased with sorrow. The Charlestown man buried his 24-year-old son five months ago after a heroin overdose, a high-school football hero who became yet another casualty of generations of self-destructive addiction.
"I was a sick kid from a sick family growing up in a sick neighborhood," Cain said last week. "Now, my son is a statistic.''
Cain and other Charlestown residents who are working to curb opioid addiction fear that many more are at risk of suffering the same fate.
Charlestown has been hit hard by the opioid epidemic. Cain, a 51-year-old recovering addict who is active in drug-prevention work, estimates that nearly every family in the neighborhood has been affected by addiction either directly or indirectly.
Help is on the way. A second health clinic opened in the neighborhood last week to provide comprehensive care to a population whose struggles with drugs often have gone unnoticed and untreated.
The crisis has permeated each of Charlestown's three main segments, activists said — the sprawling Bunker Hill public housing development, with mostly minority residents; the Irish-Catholics who long dominated the neighborhood; and the condos and townhouses where affluent newcomers have settled.
According to the latest comparable data from city and state agencies, the annual rate of deaths related to substance abuse in Charlestown was nearly twice the Massachusetts number and outpaced Boston as a whole by 22 percent.
Boston police have responded to 25 nonfatal overdoses in Charlestown this year, but the total is much higher partly because many go unreported, according to an activist who works in drug prevention. Three Charlestown residents had died of overdoses through mid-August, the activist said.
In addition, the prevalence of hepatitis C in Charlestown — an indicator of intravenous drug use — has been the worst of any Boston neighborhood and nearly six times the city average, according to Boston Public Health Commission data.
But with a famously insular culture and only one health clinic until last week, the neighborhood's 17,000 residents have had limited treatment options and not much interest in venturing for help outside Charlestown's congested square mile, activists said.
The recently opened clinic, called NEW Health Charlestown, will operate behind the weathered walls of the former St. Catherine of Siena school, which taught the children of Charlestown's blue-collar families for 104 years. The facility will join an existing clinic in the neighborhood run by Massachusetts General Hospital.
The new, independent facility, located in the midst of the housing development, will have a staff of 26 ranging from primary-care physicians to dentists to substance-abuse counselors. It's a holistic approach that aims to prevent problems before they start and treat the bodies and minds of patients who otherwise might not seek help, according to chief executive officer James Luisi.
"This is one of Boston's forgotten neighborhoods," Luisi said of the area around the housing development. "I want this to be really life-changing."
Dr. Monica Bharel, state Department of Public Health commissioner, cited Charlestown's outsize drug problem when she spoke recently at a celebration for the new clinic. And Dr. Sarah Wakeman, who practices at MGH's Charlestown HealthCare Center, said she believes the crisis is worsening there.
Compounding the challenge is this: Unlike much of the state, where the epidemic burst into broad public view two years ago, opioid addiction has been a serious problem in Charlestown for at least a decade. Overdoses plummeted in the neighborhood after the Charlestown Substance Abuse Coalition launched a counteroffensive beginning in 2004, but the problem has grown again.
During that time, activists said, the same culture that spawned Charlestown's "code of silence" after high-profile crimes has stifled discussion about drug dependence .
"You know what we've had? We've had ignorant parents who just couldn't or wouldn't acknowledge it. We hide behind our secrets," said Cain, who has been sober for five years.
As a result, most people outside "the town" did not know the extent of its tightening grip.
"I think, outside of Charlestown, not many people are necessarily aware of it," said Wakeman, medical director of MGH'S substance-abuse disorder initiative. In Charlestown, its services include substance-abuse counseling, hepatitis C prevention, and referrals to other resources. MGH officials said the clinic expects to start accepting new patients in 2016.
Jack Kelly, a Charlestown resident who served on Mayor Martin J. Walsh's substance-abuse task force, said the problems have not received the attention directed at hard-hit but more politically connected areas such as South Boston.
Kelly and others now are spreading the anti-opioid message on Charlestown's streets, in its schools, and at community forums. The effort is led by the Substance Abuse Coalition, a who's who of neighborhood players that is candidly discussing the severity of the problem and working to detour the next generation from addiction.
Sarah Coughlin, coalition director, constantly sees the fallout of the epidemic. Her office, based in the Boys & Girls Club, is notified of every neighborhood overdose. Although the drug-prevention message is louder than ever in Charlestown, the sense that better days are close is elusive.
"It's hard to say we've turned the corner when we're burying people constantly," she said.
One person who has turned the corner is Candice Centola, who "graduated" from the Charlestown drug-court program recently. After 58 appearances in court — more than two years of drug tests and counseling — she basked in applause from a courtroom packed with recovering addicts and well-wishers, including First Justice Lawrence E. McCormick.
She dabbed a tissue to her eyes. "It's been a long, long time," she said, "since I've actually been happy."