Finding help for addicted fishermen
NEW BEDFORD — It hurts to be a fisherman.
Tyler Miranda found that out when he started working on a scallop boat at age 18. The son of a lobsterman and nephew of a scalloper, he was prepared for long days of heavy, repetitive work. But he didn’t anticipate how much his back would hurt after hours of shucking scallops, hauling buckets, and shoveling debris.
Nor did he foresee the remedy his boatmates would offer: Percocets.
“ ‘Try one of these. This takes away the pain,’ ” Miranda, now 33, recalls them saying. He took the opioid pills; they worked.
Then one day, Miranda said, he felt ill when he got home because he had stopped taking them. So he bought painkillers on the street, and in time the pills took over his life.
It’s not an unusual story among the men who perform some of the world’s most dangerous and physically demanding work. Fishermen are five times more likely to die of opioid overdoses than other Massachusetts workers, according to a state Department of Public Health analysis released in August.
But addressing the addiction problem among fishermen poses unique challenges. The workplace demands that lead to addiction also can thwart efforts to treat it.
Most treatment programs require regular doctor’s visits and support-group attendance, something clients can’t do if they are out on a scallop boat for 10 or 12 days. For people who rely on seasonal, intermittent work, missing even a single trip will cost them a significant share of their annual income.
Dr. Arnold Hill understood the culture when, two years ago, he took a job as medical director of the New Bedford office of CleanSlate, a national chain of addiction-treatment centers offering outpatient care. He’d grown up in Yarmouth, Nova Scotia, another busy fishing port.
Hill says he immediately saw an unmet need among fishermen in New Bedford, the country’s most profitable fishing port, with $1 billion in annual revenue.
He began working with CleanSlate to design a program to accommodate the fishermen’s schedules while also enforcing accountability. Inspired by a program for airline pilots, Hill came up with a regimen dubbed the Poseidon Project, after the Greek god of the sea.
It works like this: In the first 10 days or two weeks, participants start taking Suboxone, a drug that controls cravings and prevents relapse; they also attend groups and undergo counseling. Then, when it’s time to go to sea, they take a lockbox containing their Suboxone doses for the trip.
When they return, they must report to CleanSlate within 24 to 36 hours, for a urine test and a count of the wrappers from each Suboxone dose — measures to ensure the medication was taken. Then they participate in an intense schedule of counseling and support groups before they ship out again.
Hill said he faced an immediate obstacle when he asked clients to have their captains alert the program when the boat returns. No one wanted captains to know they were in treatment.
Instead, the program consults a public database that tracks every boat, to find out when their clients are back on shore. That can be a risky moment for relapse, because the fishermen leave the boat with thousands of dollars in earnings.
“People have told me, ‘Having money right there in my hand often drives me to relapse,’ ” Hill said.
Those who don’t meet the terms of the program can still enroll in treatment at CleanSlate, but they will not be part of Poseidon and its special accommodations for fishermen, Hill said. The program, he emphasized, is for people strongly motivated to overcome their addiction.
“You can only be in the Poseidon program if you’re going to adhere to the simple rules,” he said. “You have to be really serious: ‘I want to be sober.’ ”
Introduced in June 2017, the Poseidon Project has had a very slow launch. Currently, only six people are participating. None of the six participants wanted to discuss their experiences with a reporter.
Hill attributes the low participation with difficulty getting the word out about the program, a problem fed by the stigma surrounding substance-use disorders, especially on the waterfront. Boat owners have shown no interest in marketing it to their employees, according to Hill.
J.J. Bartlett, president of Fishing Partnership Support Services, a social service organization for New England fishermen and their families, confirmed the problem.
“If you’re a boat owner or captain, you don’t want to be known as a vessel that allows drug use,” Bartlett said. “If you’re a crew member, you don’t want to be seen as someone who uses drugs.”
But the Fishing Partnership has been working to fight stigma on the wharves, as well as training people in the overdose-reversing drug naloxone, often known by the trade name Narcan.
“We have been including opioid awareness any time we have a gathering of fishermen,” Bartlett said. “Any CPR or first-aid program that we run, we include Narcan training and send the fishermen home with Narcan.” The partnership has also distributed Narcan kits to more than 80 vessels.
Debra Kelsey, a community health worker employed by the Fishing Partnership, said the Poseidon Project is the only addiction program she knows of that is geared toward the needs of fishermen.
“Medication-assisted treatment has not been an option if you’re a fisherman,” she said. “CleanSlate has tailored the meetings around how a fisherman works.”
Tyler Miranda started on his road to recovery long before the Poseidon Project was launched, spurred by a stint in prison (for a domestic incident that Miranda blames on drug use) and a desire to be a good father to his young daughter.
After prison, Miranda started working with a counselor and attending Narcotics Anonymous meetings. Miranda said he’s been drug-free since February 2017. At work he has learned to pace himself, working “smarter, not harder,” and at home he eases his pains with yoga.
Now, Miranda is training to become a recovery coach — a peer counselor. He said he speaks openly about addiction to friends and acquaintances on the waterfront, where he sees a unique opportunity to make a difference.
“Because I’m a fisherman and I’ve lived that life, fishermen will be more open to taking suggestions and guidance,” he said. “I understand because I’ve been there.”