Inside an addiction-treatment clinic where walk-ins are welcome
Fourth in an occasional series about breaking the grip of opioid addiction. Read the other stories here.
FALL RIVER — At a wooden table still damp from the previous night’s rain, Adam Carreira smokes a cigarette and talks about how he’s breaking his mother’s heart.
His story will sound familiar to anyone aware of the opioid crisis gripping New England and the nation: He sniffed painkillers with his friends as a teenager, got hooked, and moved on to injecting heroin.
Carreira is 22, with a young man’s wispy beard, and he says he doesn’t want to become like some of the people he’s met in detox, still struggling in their 40s. He wants to achieve a better life while his mother is still around to witness it.
So he’s here, at 7 a.m. on this blazing June morning, pursuing his fifth detox, in the hope that this time recovery will last. Carreira has come to this particular picnic table because it’s outside the Open Access Center of the SSTAR treatment center, where he knows that if he shows up, he can always get in the door.
The center is one of three “opioid urgent care clinics” financed by the state (the others are in Boston and Worcester) that have opened over the past couple of years in a pilot program. Each person who walks in the door undergoes an immediate assessment and receives help locating and getting to an appropriate placement, if one can be found.
The decision to seek help for addiction can be fleeting. Yet often the crucial moment passes as phone call after phone call to treatment centers yield only a request to call back tomorrow. The opioid urgent care clinics aim to embrace patients as soon as they request help, in the hope people will start treatment when they’re ripe for success, open to change, perhaps ready to stop breaking their mothers’ hearts.
SSTAR chief executive Nancy E. Paull invited a Globe reporter and photographer to see this process in action, and several patients agreed to participate.
Carreira is lucky on this day: Only one other client is waiting when the Open Access Center opens its doors at 7:30 a.m. On many days, SSTAR staffers say, there’s a long line.
As he heads into the building, Carreira reveals some ambivalence: “It’s like I have a split personality. I tell myself I want to get clean. I tell myself I want to get high.”
Coaxing out his story
Inside, the young man is greeted by Kathy Belanger, a 66-year-old clinician trained in counseling; she is one of three clinicians who interview clients to assess their needs and determine the best place for them.
Belanger leads Carreira into a windowless office and they get to work. The form on the computer in front of her demands a lot of answers, and Belanger elicits them with efficiency and kindness, probing yet nonjudgmental. She asks what drugs he has taken, how much, and how often.
“Any clean time?”
“A few months back, I had two months clean,” he says. “That was with the assistance of Suboxone.”
But Carreira gradually started selling and trading the medication — which stops withdrawal symptoms, controls cravings, and prevents overdoses — and resumed heroin use.
“Yeah,” Belanger says, dragging out the word with a sympathetic lilt.
Belanger’s sympathy has roots in her own family. Her nephew is Chris Herren, the Fall River basketball star who became a mover and shaker in the world of addiction recovery. But his mother, Belanger’s identical twin sister, Cynthia Herren, never saw her son’s final success: She died in 2004, when Chris was still in the throes of addiction to cocaine and heroin.
Belanger had worked 34 years as a counselor for people with multiple handicaps, when two years ago SSTAR recruited her into the recovery business.
Now she turns to Carreira, in the chair next to her desk. He says he walked away from a SSTAR treatment program earlier this year. “What do you want to do this time that’s going to be different?” she asks.
“I don’t know. It’s so hard. I tell myself the same thing and then I go back into it.”
Answering questions about his upbringing, Carreira says he was diagnosed with hyperactivity and anxiety as a child. His father was in prison for most of his childhood, rejoining the family for only a couple of years before dying of an overdose.
Carreira was 15 when he found his father’s body. “He was ice cold.”
“You must have some post-traumatic stress from that. That’s so sad,” Belanger says.
“Possibly. I feel it doesn’t affect me. But probably it does subconsciously.”
Carreira acknowledges that he suffers from anxiety and depression and assents to a referral to a psychiatrist, although there’s a six-week wait.
“Have you had any thoughts to hurt yourself?” Belanger asks.
A brief pause. “I say I want to kill myself sometimes, but I know I would never be able to do it, probably.”
“When was the last time you said that?”
“I don’t know, probably last week, but that’s just to get a reaction from people, to have people feel bad for me. . . . I really don’t want to die.”
“You never had a plan?”
Next: date of birth? Address? The questions whipsaw from fervent to functional.
After an hour of information-gathering, Belanger declares, “I think you’re appropriate for detox level of care. . . . You’ll see the nurse and then we’ll make plans to see if there is a bed for you.”
If there’s a detox bed available at SSTAR, he will get an escort across the parking lot to the treatment facility. If not, a recovery coach will sit with him and call around looking for a spot elsewhere in the state.
More often than not, Belanger says, a number of patients leave without finding a bed, although many come back to try again. “There definitely is a lack of beds in the state,” she said. It’s a shortcoming an urgent care clinic cannot address.
‘Temptation got to me’
Belanger’s next client is pacing in the waiting room. With dark stubble on a sunburned face, Scott has sleepy, half-closed eyes, yet he seems unable to sit still.
Back in the same dimly lit office, Belanger peppers Scott with the same questions, and bit by bit his story emerges.
He was recently in jail and has been out on bail. His plan was to go to a shelter, but it was full and he ended up on the street. He’s injecting heroin, drinking a pint of vodka, and downing two or three 24-ounce beers each day, as well as popping Klonopins and smoking cocaine.
“My intentions weren’t to come out, start using drugs and stuff like that. But I spent a couple of days on the street” — he sighs — “and it got to me. Temptation got to me. I didn’t have too many resources, or too many places to turn to.”
“Are you homeless now?”
“Yeah. I have nothing now. I have no clothes, I have no socks, no boxes. One outfit and a backpack. Starting from scratch.”
“Ever diagnosed with a mental illness?”
“Yeah, of course. Anxiety, depression, PTSD.”
Scott leans back, closes his eyes, and presses his palms against his forehead. Sensing his agitation, Belanger hastens to move through the questions.
“I hope they can get me a bed today,” he says. He speaks in a nasal monotone, but his words sound frantic.
“I don’t want to spend any more time on the street. I’m not going to make it. . . . Is there a place where I could get some T-shirts? I’ve got one outfit. I need a shower. I need to clean up.”
“We will certainly work on trying to get you something.”
As Belanger leaves the room to see whether there’s a detox bed for him, Scott says, “I’m ready, I know I’m ready. I don’t want to go back to jail. I’m not young anymore, I’m 33. . . . I’m tired, I’m friggin’ exhausted, I’m mentally run down.
“It could be worse,” he adds. “I could be dead.”
‘I had him arrested on Friday’
Michael Wahl walks into Belanger’s office with his mother.
At 28, he is tall and lanky, sporting a loose tank top that reveals elaborate tattoos. His mom is wearing blue scrubs, about to head to her job as a nursing home aide, and has a Bluetooth device clipped to her ear. For much of the interview she sits quietly.
But not until she speaks up, with sudden fervor, does the full story become clear. Michael suffered multiple injuries in a car crash in 2015, leaving him with nerve damage, constant pain, and a toolbox of screws and pins in his ankle, Dawn Wahl explains.
Before this, Michael had used various drugs recreationally. But when his doctor stopped prescribing painkillers, he turned to heroin and got hooked. He also started regular cocaine use.
When a squabble led to him losing contact with his daughters, he fell into a depression, and his drug use spun out of control. That was about 18 months ago.
For the past two months, Michael Wahl says, he’s been taking methadone and has avoided heroin most days. But the previous Friday, he overslept, missed his methadone dose, and to avoid withdrawal he stole from his mother to buy heroin. She called the police.
“I had him arrested on Friday,” she tells Belanger, “because I didn’t know what else do to. He’d take off for days on end. I’m calling the hospital, the police station, nobody has record of him. I don’t want to be somewhere and the police tell me, ‘We just found your son dead from an overdose.’
“He’s my only son,” Dawn continues. “If something happens to him, I don’t know where I go from there. . . . It’s a gamble every time he takes off. It just, it rips my heart out.”
Belanger asks Michael to rate his anxiety on a scale of 1 to 10. He says it’s a 7 or 8.
“Do you have low motivation, low energy, to the point of feeling helpless and hopeless?”
“How’s your sleep?”
“Crappy. There are days I can’t sleep, days when I fall asleep in the early morning and sleep the day away.”
“How’s your appetite?
“There are days when I’m hungry all the time and days when I don’t want to eat.”
“Who’s your support system?”
“Who do you confide in when you have a problem?”
Belanger tells Wahl that she thinks he needs treatment for mental illness as well as addiction. But there are very few “dual diagnosis” beds in the state. SSTAR has a 17-bed dual unit, but on this day — as is often the case — it’s full.
So Wahl gets a spot on the waiting list. Belanger says he probably will get a bed by the end of the week, provided he calls every day.
The idea for the opioid urgent care centers emerged from the pleas of families that had dealt with addiction. Again and again, people in community forums told state officials in 2015 that it’s just too difficult to find and start treatment.
So state health officials decided to mimic the walk-in clinics that people visit to get sore throats evaluated or cuts stitched up. That way, people who decide they want addiction treatment will at least find an open door and some immediate attention, even if they can’t always find a bed.
The state selected SSTAR, Boston Medical Center, and Community Healthlink in Worcester to test out the “opioid urgent care” concept, at a cost of $2 million a year for four years ending in June 2020. By March 31 of this year, the three centers had assessed some 19,000 walk-ins.
The state will measure the pilot’s success based on how many people got access to treatment, and how quickly. If the pilot is deemed successful, advocates hope to expand the concept statewide.
The three men who agreed to have their stories told here eventually received at least some treatment. But each met a different fate.
Michael Wahl never got his dual-diagnosis bed, his mother, Dawn, said in an interview a few weeks after his June visit to SSTAR.
Michael, she said, diligently called SSTAR every day for two weeks but never found an opening. During that time, he continued visiting a methadone clinic every day. Then he stopped the methadone — suddenly, which threw him into severe withdrawal pains. He went back to SSTAR, where he enrolled in an outpatient addiction program.
Michael did well for a while, Dawn Wahl said. But she grew frustrated at him lying around the house, so she took his house key and told him to get a job. Instead, he disappeared.
“Now my kid’s out there somewhere. I don’t know if he’s dead or alive,” Dawn said, her voice taut.
A few days later, she told the Globe that Michael was in jail and wanting to get into rehab.
Scott, the 33-year-old recently out of jail, might be heading toward a happier place. He secured a bed in detox the day he came to the SSTAR clinic.
Scott couldn’t be reached afterward. A woman who said she was his mother answered the phone number he had provided. She said Scott had completed detox and entered long-term residential treatment. As part of this program, he’s working long hours in a restaurant, and he doesn’t have a phone, she said. He did not reply to a message left at the treatment program or to messages his mother relayed.
Scott’s mother also said he told her he did not recall having spoken to the Globe, most likely because he was so high at the time. For this reason, the Globe is not providing his last name.
And Adam Carreira, the 22-year-old who worried about his mother’s broken heart? He, too, got a bed in detox the day he came to the Fall River clinic.
But he didn’t follow through with the plan to continue treatment after detox, he said in a recent phone conversation. He stayed five or six days in detox, started to feel better, and got restless. So he went home to the New Bedford apartment he shares with his girlfriend.
He’s not getting counseling, taking medication for addiction, or attending groups. He never got an appointment with a psychiatrist. His mother has moved to Kentucky.
Carreira said he’s sniffing heroin and fentanyl from time to time but no longer injecting.
“I wouldn’t say I’m in a habit,” he said. “I can go days without it. Before, I was doing it every day. I don’t want it to run my life again.”
Asked what he would do if that started to happen, Carreira didn’t have an answer.