Third in an occasional series on breaking the grip of opioid addiction. Read the other stories in the series here.
Dawn Marie Dingee feared, and halfway knew, what she would find when she kicked open the bathroom door in a panic: her second-born son slumped over, already blue.
Her Stevie — the mama’s boy, the ladies’ man, the one who “had a lot of love in his heart” — was dead from a heroin overdose at age 27.
Stephen Gonzalez had survived many overdoses. But this one, in April, was different. A few hours earlier, Gonzalez had left the South Bay House of Correction in Boston, where he’d been forced off the methadone he was taking to combat his addiction. So his body had little tolerance for the heroin he injected at his mother’s Jamaica Plain apartment.
“I don’t think anybody should be denied medication, and that is a medication,” Dingee said, referring to methadone. She is hoping her son’s story will change prison treatment policies, not just here but around the country.
“If it can help save one person, I’d be happy,” she said, breaking into tears, “because no mother should have to go through that.”
But many mothers have.
One out of every 11 people who died of overdoses in Massachusetts had been incarcerated recently, according to a state analysis of data from 2011 to 2015. Half of all deaths among former inmates were opioid-related.
Most jails and all prisons in the state deny inmates access to methadone and buprenorphine, the main drugs used to treat opioid addiction, even if inmates arrive with a legal prescription. (An exception is made for pregnant women.)
As the death toll mounts, efforts to change these policies are gaining momentum — but slowly.
In Massachusetts, 26 advocacy and health care groups, including the Massachusetts Medical Society and Massachusetts Health and Hospital Association, have joined a coalition pushing the Legislature to require jails and prisons to provide the medications for opioid addiction to inmates. These medications ease cravings, prevent overdoses, and help people stay in treatment.
But so far there is no bill containing such a requirement, just a proposal to create a commission to study the question.
Vic DiGravio, chief executive of the Association for Behavioral Healthcare, a trade group for Massachusetts mental health and addiction-treatment providers, said there’s no need for further study.
“The science and the research on this is clear. To wait any longer to do this is just going to result in needless loss of life,” he said.
‘The worst thing in the world’
Dingee (pronounced “don-zhay”) was surprised that her son got involved with drugs, starting at age 19 with illicit pain pills and progressing quickly to heroin. She thought he would be scared away by what he had seen in his own family. Dingee herself had long struggled with heroin addiction, and that’s why Stephen was raised mostly by her relatives in South Boston.
Still, mother and son maintained a strong bond. As soon as Stevie and his older brother were old enough to take the bus, they would come visit her in her apartment; she also lived in South Boston at the time.
“They wanted their mother,” Dingee said. “Especially Stevie, he was a mama’s boy.”
Dingee, who has been in recovery for the past five years with the help of methadone, saw her son struggle as she had. He sought treatment for his addiction numerous times, and had several periods of sobriety, but could never sustain his recovery or hold a steady job.
In late 2016, Gonzalez started on methadone, according to Dingee. But that didn’t stop him from using tranquilizers and cocaine, she said.
On Feb. 9, his 27th birthday, Gonzalez was arrested in Boston and charged with possession of heroin with intent to sell. With no access to methadone at South Bay, where he was awaiting trial because the Nashua Street Jail was full, he went into a painful withdrawal.
Methadone, an opioid, creates physical dependence. Getting off it with minimal discomfort requires reducing the dosage by tiny amounts over months. Stopping methadone suddenly, as the jail required, catapults a person into what Dingee described as unbearable pain.
“He said, ‘Ma, it’s the worst thing in the world. . . . If I could just end it all, I would,’ ” she said.
Dingee understood. She had had to kick methadone in jail years ago and the experience made her feel suicidal, too.
“You just want to end it, the physical pain,” she said. “Your whole body feels like you’re on fire and then you start hallucinating because you haven’t slept in six days. I don’t wish it on my worst enemy.”
As awful as it is, opioid withdrawal is typically not deadly. But a failure to provide effective treatment for addiction can be. Without medication, such inmates as Gonzalez often return to the streets still needing to get high — and with their tolerance to heroin reduced.
Dingee said she knows people who walked out of jail and within hours died of an overdose in the bathroom of the nearest McDonald’s.
Gonzalez was freed on Friday, April 6, with a monitoring bracelet, to await his trial date. His release was timed to enable him to attend the funeral of his stepfather, who had died of cancer. He first headed to his mother’s apartment in Jamaica Plain. After she was asleep, he slipped out to meet a friend.
And when the sound of the shower running nonstop awakened her later that night, Dingee learned she would have to bury her husband and her son in the same week.
Addiction and incarceration
The correctional system is a critical player in the opioid crisis. A high percentage of people suffering from addiction end up incarcerated, and about two thirds of inmates have a substance use disorder.
But with the exception of two houses of correction in Western Massachusetts, correctional officials in the state object to methadone and buprenorphine (often referred to by a trade name, Suboxone) because the drugs are opioids that can be diverted for illicit use.
Inmates around the country “have developed a host of ingenious methods” to smuggle buprenorphine behind bars, said Peter Van Delft, spokesman for Suffolk County Sheriff Steven W. Tompkins, in an e-mail response to the Globe’s questions.
Vivitrol, a once-a-month shot that blocks the opioid high, has won favor with correctional officials because it is not an opioid and has no street value. With the first dose provided free by the manufacturer, the state’s prisons and several jails offer inmates a Vivitrol shot shortly before they are released.
In addition to Vivitrol, Suffolk County, where Gonzalez was jailed, offers counseling and 12-step support groups for addicted inmates and discharge planning that connects them with treatment programs in the community.
It’s not clear whether Gonzalez took part in any of the programs or had declined a Vivitrol shot. But his mother is convinced that if her son had been allowed to stay on methadone, he would still be alive.
Dr. Alexander Y. Walley, an addiction specialist at Boston Medical Center, agrees that newly released inmates are unlikely to fatally overdose if they can stay on their medication while behind bars — even those who, like Gonzalez, had also been using illicit drugs on the street.
The medications available to treat addiction address only opioids. For some people, Walley said, these drugs prevent the opioid high but don’t eliminate the need to take something to feel better, to salve physical or psychological pain.
“What they need is more care, not less care,” he said.
Walley has seen jail policies derail his patients’ recovery. Sometimes patients in stable recovery get arrested on warrants for crimes committed while they were using illicit drugs. Suddenly, a jail stint interrupts their hard work at sobriety. Some find withdrawal so horrible they are unwilling to resume medication upon release.
The Association for Behavioral Healthcare estimates it would cost Massachusetts jails and prisons $20 million a year to provide inmates with medications to treat opioid addiction.
Buprenorphine and methadone are inexpensive, but administering them behind bars poses logistical challenges that can be costly. For example, additional security and clinical staff are needed to ensure that inmates ingest their medication fully and don’t take it away to sell.
Two adjacent states have overcome these obstacles.
Officials in both states say that providing the drugs legitimately, with proper supervision, can reduce the demand for contraband because inmates get needed treatment.
Around the country, a growing number of localities also provide buprenorphine or methadone to inmates, and several states are considering legislation to require it, said Sally Friedman, legal director of the Legal Action Center, a New York-based nonprofit that advocates for people with addiction.
Meanwhile, the US Department of Justice is investigating whether Massachusetts prisons are violating the Americans with Disabilities Act when they stop prescribed medications that addicted inmates had been taking before incarceration.
The ADA is also the basis of a suit filed last month by the American Civil Liberties Union against a county jail in Washington state that denies medication for opioid addiction.
Change is starting to happen, Friedman said, “but very slowly and not nearly enough.”
A final visit to the jail
These days, the tears come often for Dawn Dingee. Thinking of Stevie and his years struggling with drugs, she remembers him as a young man who was just “looking for love wherever he could get it.”
Dingee, who is 48, said she was finally able to sustain her own recovery when, five years ago, someone gave her a job driving people to medical appointments. Gonzalez never got that far. The treatment he received could not quiet a nagging need.
“Just to be sitting with yourself, 100 percent clean . . . he couldn’t do it,” his mother said.
The other day, Dingee went to South Bay to pick up the belongings Gonzalez had left behind. But because more than 30 days had passed, the jail had gotten rid of them and replaced them with a payment.
The tears started flowing again as Dingee emerged from the building, holding what was left of her son’s short life: a check for $82.71.