PLYMOUTH — David McKinley had drifted in and out of rehab for years, but his recovery never lasted long.
Desperate, he asked his mother to have a judge commit him to a drug treatment center. He knew that would likely be the Plymouth center run by the Massachusetts state prison system, but he saw no other choice. A secure, locked facility was the only way he believed he could finally break free from heroin. He had been addicted for six years, since his father died.
Twice before, McKinley had received court-mandated treatment at the Massachusetts Alcohol and Substance Abuse Center, part of a minimum-security prison complex in the middle of Myles Standish State Forest, surrounded by a tall fence and razor wire. Each time, he went back to using almost immediately after he was released.
This time, he believed, would be different. A friend had lined up a job for him when he got out. His mother was already looking for sober houses. He felt he was finally on the path to long-term sobriety, his mother said.
The path ran through Plymouth, he knew. Still, McKinley, 29, dreaded going back.
Patients there wear orange uniforms, carry a laminated badge that says “inmate,” and are monitored by corrections officers — although none was there because of a criminal charge. The toilets overflow and the food was hardly edible, he told his mother, Michelle Wiley. Unlike the small group of actual inmates who are held in a separate part of the complex, patients are not even allowed to have visitors.
“They treat you like you’re a criminal,” she recalled him saying.
On Sept. 29, three days after he arrived at the treatment center, McKinley was found hanging from the top bunk bed in his room, a sheet around his neck.
Prison rules and regulations
McKinley’s suicide, the first ever at the facility, remains under investigation and state officials declined to discuss it. But his death has put renewed focus on the controversial practice of placing those struggling with addiction in a prison-like setting.
For the past 15 years, people committed for drug and alcohol treatment had been sent to a barracks-style facility in Bridgewater, part of a sprawling prison campus that includes the state’s psychiatric hospital.
In May, as the opioid crisis worsened and the need for beds increased, the addiction treatment center was moved to Plymouth, a serene wooded setting that was seen as more therapeutic.
It was a well-intentioned shift, but one that left unaddressed what critics see as the addiction center’s fundamental flaw — that it is governed by prison rules and regulations that can make treatment feel like punishment, or worse.
The Globe interviewed seven former Plymouth patients and three parents of patients who all gave nearly identical accounts of unsanitary conditions, verbally abusive correction officers, and short, perfunctory meetings with counselors who provided little to no therapy. Some patients said that when they complained about the conditions they were moved into isolation cells without toilets or running water.
There are also safety concerns. At least one rape and one serious assault have occurred at the Plymouth facility in its first half-year in operation, court documents show.
State officials said patients are placed in isolation only when their behavior poses a significant risk, and they maintained that the facility is regularly cleaned by prison staff and inmates.
But corrections officials did not dispute that the suicide, rape, and assault occurred on their watch, although they said they could not discuss them because they remain under investigation. Three other men have attempted suicide since the move to Plymouth, officials said.
Officials defended the prison-like setting as one of the center’s biggest advantages.
Christopher Fallon, a spokesman for the Massachusetts Department of Correction, said that illegal drugs have never been smuggled into the Plymouth center, and no one has overdosed in the facility. The razor wire prevents patients from running away, while the orange uniforms make it easy for officials to locate those who do.
“It’s restrictive because it has to be,” Fallon said.
Fallon said he often hears from parents who say they can sleep only when their children are at the secure facility, unable to walk away from the center to use drugs again. In 2009, when the state considered shutting down the program, then housed at Bridgewater, parents of patients gathered at the State House with signs that said their children would die without it.
Surge in Section 35 requests
In recent years, as the opioid crisis has deepened, the number of people who have turned to the court system for help has skyrocketed. Under a state law known as Section 35, a judge may commit into treatment anyone with an addiction whom family, police, or other law enforcement deem a danger to themselves or others. Some people contest their commitment, but others go without protest, seeing it as their best — even last — hope for recovery.
People who are committed can be held for up to 90 days, but usually stay for shorter periods.
Between July 1, 2016, and June 30, 2017, there were nearly 11,000 requests for forced commitment, an 85 percent increase from seven years earlier, according to court officials. Of those 11,000 requests, judges approved nearly 6,400, according to state figures.
The surge is a side effect of an addiction epidemic that shows little sign of abating and a chronic shortage of affordable places to help those in its throes. Many people, like McKinley, will “self-commit” by asking someone they know to file a petition for them so they can receive free, immediate treatment.
Of the 4,031 men ordered to receive drug treatment in Massachusetts between July 1, 2016, and June 30, 2017, more than half — 2,266 — were sent into the custody of the Department of Correction. Advocates say a prison-run program inevitably treats men more like inmates than patients.
“Theoretically, it should be just like a hospital. You go in, you’re given the full spectrum of care,” said Leo Beletsky, a Northeastern University law and health sciences professor. “Instead, it’s just like a warehouse.”
Massachusetts appears to stand alone in sending some of its civilly committed patients into the care of the penal system. Thirty-three states have laws that allow forced commitment for substance users, but only 14 regularly do so. In 2009, a Department of Correction survey found that no other state sent patients seeking recovery into prison settings.
Even within the state, the Plymouth center is unique. The state’s four other facilities that accept Section 35 patients are run by hospitals or treatment programs, and they provide the standard treatments for withdrawal and addiction — using medications to ease withdrawal and support recovery that are not provided at the Plymouth center.
Asked why Plymouth eschews these medications, officials said they can be abused or sold among patients. But they said they are not opposed to such treatments if the drugs can be administered in a more controlled fashion, such as through injections. (On Thursday, the Food and Drug Administration approved one such medication.)
Proposed legislation would require the Plymouth center to begin offering medications for addiction treatment next year.
Maggie Filler, a lawyer with Prisoners’ Legal Services, a nonprofit group that represents people in state prisons and has interviewed patients about the conditions at Plymouth, said the Department of Correction is profoundly ill-equipped to handle patients with chronic addiction.
“This is a fundamental betrayal of the state’s mandate to provide appropriate care when a parent or a loved one says, ‘My son is really at risk,’ ” she said.
Living conditions decried
Patients and parents of patients interviewed by the Globe described often filthy conditions at Plymouth: soap in short supply; showers rarely cleaned.
Patients said they saw men with serious mental health problems that went untreated. One man with schizophrenia screamed and threw furniture. Another man was incontinent and often covered in his own filth, according to a former patient.
Patients also said they were served tasteless meals so small they were often hungry throughout the day.
Many also complained of abusive correction officers. One inmate told lawyers from Prisoners’ Legal Services that as patients lined up at mealtimes, some officers yelled out “Beans for Fiends!” Another patient said an officer told him “to overdose already.”
In interviews, former patients also said they had witnessed correction officers assaulting patients. James Garrett, a 24-year-old former patient who finished a 30-day stay in September, said he saw a corrections officer grab a young man by the neck and throw him against a wall.
“That place is brutal,” Garrett said. “People don’t understand. That place is literally a prison. They treat us worse than they treat the inmates.”
Thomas N. Neville, superintendent of the Plymouth facility, denied that the facility was unclean, and said he had not received any reports of officers assaulting or insulting patients. Patients have been solely responsible for any violence in the facility, he said.
Since May, when the program moved from Bridgewater to Plymouth, 15 patients have been attacked by other patients, three correction officers have been assaulted, and prison officials have broken up two dozen fights, Neville said.
Officials said that patients at Plymouth are required to take 20 hours of group and individual counseling each week. But former patients described lengthy delays before meeting with counselors or being assigned to a group. After the Globe’s inquiries, the program instituted a policy to require that counselors see patients within three days of their arrival.
Rules changes for women
From the start, those committed under Section 35 are treated like criminal defendants. Once a request is filed in district court, local police are sent to apprehend the person, often at their home or place of work.
The person is brought into court in handcuffs and put into a holding dock, often alongside defendants charged with crimes. A clinician assigned to the courthouse makes an evaluation to determine the likelihood of self-harm or danger to others, then makes a recommendation to the judge. Defense lawyers are appointed to represent those facing possible commitment.
Women who are committed must be sent to one of three treatment facilities. Until last year, many women had been placed in MCI-Framingham, a women’s prison, but Governor Charlie Baker and legislators agreed to end the practice after it was challenged in court.
State law now requires that women be treated only at facilities licensed by the mental health or public health departments. But that provision of the law does not apply to men, an exception advocates find confounding.
Last year, Baker celebrated the opening of a new treatment program at Taunton State Hospital for civilly committed women. But his administration has had little to say about the treatment of civilly committed men.
Asked whether health officials had any concerns about the Plymouth facility or about the differential treatment of men, Sharon Torgerson, spokeswoman for the Department of Health and Human Services, e-mailed a statement supporting “safe, effective treatment.” She did not reply when asked whether health officials consider the Plymouth program safe and effective.
Men who are civilly committed in Massachusetts are sent to one of two places: the Plymouth center, which has 251 beds, or the 108-bed Men’s Addiction Treatment Center in Brockton, run by the High Point Treatment Center, a nonprofit agency. The much smaller Brockton center is often full.
In Brockton, the costs of treatment are covered by a combination of Medicaid reimbursements and funding from the state Department of Public Health. The Department of Correction pays for the Plymouth program, spending $73,000 a year per bed.
Patients in the Brockton program who are addicted to opioids receive tapered doses of methadone, buprenorphine, and other medications to ease withdrawal symptoms. Then they enter a rehab program that offers medications to treat addiction, as well as individual and group counseling, said CEO Daniel S. Mumbauer.
The Brockton facility is not locked, but if patients attempt to open a door, an alarm sounds, giving staff a chance to talk them into staying. The vast majority of patients choose to stay, Mumbauer said. Over the past four years, the percentage who walked away before completing treatment ranged from 3.6 percent to 6.6 percent.
People fare better when they feel they have a choice to leave or stay, Mumbauer said.
“When you lock somebody up, it changes the way people look at their treatment,” he said.
Site once a forestry camp
The Plymouth facility, a cluster of cinderblock buildings reached by a long, winding drive into a pine forest, was originally a forestry camp for prisoners nearing release.
Unlike other treatment programs in the state, the Plymouth center is not licensed. The Department of Public Health inspects the building and monitors food safety, but does not evaluate the treatment program or field complaints about it.
Patients spend their first few days in detox. During that time, officials said they receive some medication for withdrawal symptoms, which includes days of nausea, diarrhea, body aches, and sleeplessness. But unlike High Point and most detoxification programs, they do not use methadone or buprenorphine.
When patients leave the detox ward, they move into one of two “dormitories,” two to a room. The rooms are unlocked, and men can linger in the hallways. They have some access to an outdoor recreational area.
The facility is staffed by a mental health director, 16 substance abuse counselors, and four mental health clinicians. A psychiatrist comes once a week. On a recent day, five classes were being held in different buildings, filled with men discussing their road to recovery.
As with the treatment of withdrawal, Plymouth does not provide methadone or buprenorphine to treat the underlying addiction. Those medications, both opioids, ease cravings and help people move toward sustained recovery, but can be diverted for illicit use.
The facility does not even provide Vivitrol, a shot that blocks the effect of opioids and has no street value. Although not available at the Plymouth treatment center, Vivitrol is routinely offered to state prison inmates before leaving custody.
Instead, Plymouth officials said, they connect each departing patient with such services in the community.
“We do our best to support him medically, emotionally, and psychologically,” said Michael Henry, regional administrator for mental health at the Department of Correction. “We don’t ever imagine that the treatment here is more than just really getting him ready for his step in addressing his problem.”
Daniel Bennett, the state’s top public safety official, said the move to Plymouth was meant to provide patients with a “secure and therapeutic environment.” Meeting that goal requires tight security, officials say. When the program moved to Plymouth, patients would occasionally flee into the woods. In response, the center installed fences with razor wire to prevent their departure.
For judges deciding between Brockton and Plymouth, that difference is critical.
“A lot of them see that there’s a fence and they can’t leave,” said Daniel F. Calis Jr., assistant deputy commissioner at the Department of Correction. “That’s what judges know.”
Sexual assault allegation
In August, Joe, 55, begged a judge in a Western Massachusetts district court to have his 21-year-old son committed. He was terrified that his son’s heroin addiction would kill him. His son, Nicholas, did not fight the commitment.
“The court assured me he was going to the best program” in the state, Joe said.
Less than a week later, Joe said he got a call from a Plymouth official telling him his son had been sexually assaulted by his roommate.
“ ‘Oh my God,’ ” Joe recalled thinking. “ ‘I sent my son to a place where he got raped.’ ”
Nicholas was removed the next day, after Joe called the court that had him committed and told officials what happened. Nicholas later went to a drug recovery treatment program in Florida.
The allegation of sexual assault remains under investigation, said Neville, the Plymouth superintendent.
Judge Mark S. Coven of Quincy District Court, who receives commitment petitions daily, said he sends men to Plymouth when they have fled treatment in the past, or when there are no beds at the smaller Brockton facility, as is often the case. Coven said he believes patients at Plymouth are generally safe.
“I have no reason to doubt they’re providing good and beneficial treatment,” he said.
Coven said concerns about the prison-like conditions at Plymouth are misplaced, given the scope of the crisis.
“What’s the alternative? Just letting people overdose on fentanyl and die? What you really need to do is look at the families who are terrified. Their kid has now overdosed five times in the last month,” Coven said. “They find their kid on the floor with a needle in the arm . . . The families are desperate.”
Those battling addiction are often desperate, too. After a relapse into heroin use that led to two overdoses, Jim Hiland repeatedly went to hospital emergency rooms hoping doctors would find him a bed at a treatment center. They never did.
So he was happy when a judge ordered him committed on Sept. 9. But in the Plymouth detox unit, he was forced into a cold-turkey withdrawal, receiving only Librium for two days, he said.
“It was horrible,” he said.
Although he was assigned a counselor, he said, “she stopped by for two seconds on the second week. And then ran off.” He said he saw her for another brief meeting, and only started attending twice-a-day classes more than halfway through his stay, he said.
Another patient, Justin Bigos, said he waited until his 26th day to see a counselor, just nine days before leaving.
“It’s just forced abstinence,” he said of the program. “That’s all it is.”
On Oct. 10, the day he left, Bigos said he was hoping to get into a program, but had no specific plans.
“I honestly don’t know what I’m going to do,” he said. “They didn’t help me at all.”
Fallon, the DOC spokesman, said a review of Bigos’s schedule showed he saw his counselor within a week of being committed. He said the records did not show how long the meeting lasted.
A final phone call
Two nights before he took his life, David McKinley called his mother from the pay phone at the Plymouth center.
“ ‘I’ll just do what I have to do,’ ” he told her. “ ‘And hopefully, I’ll get out of here soon.’ ”
State officials have declined to say whether McKinley left a note, citing the ongoing investigation. Wiley said the lack of information has left her desperate for answers.
She has taken comfort in stories his friends have told her about his humor and his kindness. One story was especially moving.
In July, a man named Michael was sent to the Plymouth facility against his will. There he found McKinley, whom he had grown up with in Mansfield.
Michael, who asked that his last name be withheld because his employers do not know he was in recovery, recalled how McKinley brought him a cup of instant coffee and a peanut butter sandwich from the canteen. McKinley put his arm around him and reminded him of their childhood days, when the world seemed easier.
“He made me feel human again,” Michael said.
Maria Cramer can be reached at email@example.com. Follow her on Twitter @globemcramer. Felice J. Freyer can be reached at firstname.lastname@example.org. Follow her on Twitter @felicejfreyer