SPRINGFIELD — Milton Rivera has seen it with his own eyes, and it’s scary. A man sat down for a meal at the Friends of the Homeless shelter — and suddenly turned white and collapsed. The staff revived him.
Help came too late for another guy Rivera knew who overdosed in the shelter’s bathroom. He was found hours later, dead from the illicit fentanyl that has infiltrated the drug supply throughout the state. “Thank God I stopped,” said the 52-year-old Rivera, who gave up illegal drugs three years ago and now rents a room at the shelter.
Rivera and many others live every day with a reality that became starkly apparent in Department of Public Health statistics released last month, surprising numbers that have brought a moment of reckoning for the state’s third-largest city.
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From 2017 to 2018, the rate of overdose deaths in Springfield roughly doubled — from 35 deaths to 80 among its residents, and from 56 to 108 deaths among those who died while in the city — the most dramatic increases in the state. That happened even though opioid-related overdoses are leveling off statewide and have declined markedly in certain communities, such as Brockton.
What’s going on in Springfield? Officials expressed concern and bafflement but could offer no single explanation.
“It is really a very vexing problem,” which persists “through no shortage of effort,” said Anthony Gulluni, the district attorney for Hampden County, which encompasses Springfield. The county as a whole saw a near-doubling of overdose deaths.
The city’s location plays a role. The New York-to-Hartford-to-Vermont drug trafficking corridor along Interstate 91 slices through Springfield’s heart and floods the city with exceedingly cheap heroin, so cheap that one observer joked that a bag of heroin costs less than a cup of coffee.
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And raw heroin is now being processed at local mills rather than outside the region, Gulluni said.
Some observers say fentanyl arrived here later than it did in the eastern part of the state, which would account for the more recent spike in deaths. Christy O’Brien, director of integrated treatment services at Friends of the Homeless, said the worst of it started two years ago.
“Everyone has seen somebody overdose at this point,” O’Brien said. So far this year shelter staff have revived about 15 people and have seen three die of overdoses.
Helen R. Caulton-Harris, Springfield’s commissioner of health and human services, said she was “very surprised” by the death statistics. She pointed to Springfield’s poverty rate of 27 percent, higher than in Boston or Worcester, as one factor.
Once a manufacturing hub that made washers, dryers, and guns, Springfield now relies on health care and social services for employment, and it has pinned hopes for an economic revival on a casino that opened last year.
Caulton-Harris has identified the neighborhoods where the most overdoses occurred; they’re the same places stricken with gang violence and high rates of chronic illness.
“It’s not just the opioid overdoses,” she said. “It’s neighborhoods that really have pervasive public health challenges.”
A city of 155,000 surrounded by rural areas, Springfield copes with urban problems but lies far from the resources available in Boston.
Police Sergeant Brian Elliott spends a lot of time applying for grants to help the homeless and addicted people in the neighborhood he patrols. “We don’t have any of the money that Boston has,” he said. “We’d love to have those opportunities and the educational horsepower they have out there.”
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Elliott, who has teamed with social workers to reach out to the homeless, has not observed an increase in overdoses of the magnitude suggested by the statistics. He notes that the data go back only a few years. With a longer view, the change might not seem so striking in a city that has always contended with heroin addiction, he said.
Haner Hernández, a consultant and teacher who runs a program that trains Latinos to become alcohol and drug counselors, blames the increase in deaths on what he calls the longstanding neglect of minority communities. Forty-three percent of Springfield residents are Hispanic. With a significant black population as well, Springfield is a “majority minority” city.
“This is called a crisis now because young white kids are dying, affluent kids from the suburbs,” said Hernández, a certified drug counselor who is also in long-term recovery.
The programs developed in response had that population in mind, neglecting the people who have struggled with addiction for decades, he said.
“Most of the services are not designed by and for Latino people,” and it’s “downright impossible” to find treatment services in Spanish, Hernández said. Yet his training program has a waiting list of Latinos who want to be counselors.
Hernández is heartened by some recent developments, such as the needle exchange that opened in January, the Police Department’s decision to carry overdose-reversing naloxone starting in March, and a recovery center that is scheduled to open soon.
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But he notes that these changes are happening long after the opioid crisis first made headlines and later than in many other communities.
At the same time, city officials are fighting an effort to move a methadone clinic that needs to expand from its overcrowded, outdated facility.
The number of clients who came to the Springfield Comprehensive Treatment Center, which is part of Habit Opco, has increased by more than 40 percent since 2017. The clinic now serves about 1,240 people, 64 percent of them Springfield residents, Habit Opco officials said.
Taking the side of neighbors who don’t want such a clinic nearby, Mayor Domenic J. Sarno (who declined a request for an interview) has urged the state Department of Public Health to reject the facility’s license.
Gulluni, the district attorney, rebuffs assertions that the region has been slow to respond to the opioid crisis.
“We’ve devoted an immense amount of time and resources,” he said, mentioning his countywide addiction task force, the establishment of drug courts, and a partnership among his office and local hospitals that provides naloxone to first responders.
That naloxone program started in October. And BayState Health, the city’s largest hospital, is still getting up to speed on coping with addiction in emergency patients.
The hospital is working to get all doctors, nurse practitioners, and physician assistants authorized to prescribe buprenorphine, a drug to treat opioid addiction, and so far about a quarter of them have obtained the necessary credentials, said Dr. Gerald Beltran, chief of pre-hospital and disaster medicine.
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The clinicians can prescribe the medication to people brought to the emergency department after an overdose who are interested in treatment. But a key component of that effort, Beltran said, is still in the works: coordinating with a community agency that can continue treating patients afterwards.
Meanwhile, the Tapestry Health syringe exchange program has opened after years of efforts to locate such a program in the city. Labeled “Harm Reduction Services,” the program occupies a storefront in a strip mall, next to other Tapestry health services.
On a whiteboard near the entrance, clients write down the name of the drugs they took — in this region, drugs are sold in bags stamped with a name — and rate their quality with notes such as “No good!! Danger” or “Good—strong” or “Garbage.”
On a recent morning, Alexander Nuñez wrote on the board that bags labeled “Pride” contain fentanyl. Nuñez, 29, said he’s not quite ready to go back into treatment, but he wants to soon. Meanwhile, he said, “being safe is the main thing.” He has avoided getting HIV, hepatitis C, and skin infections by traveling to another needle exchange, in Holyoke, and he is happy he can now find the service closer to his Springfield home.
“We work with the person to try to improve their health,” explained Liz Whynott, Tapestry’s director of harm reduction. “Abstinence is one goal. There are many people that may not be ready for that. So we work with them within their drug use and figure out ways alongside them to improve health.”
At Tapestry, Nuñez gets not just a needle, but a “safe-injection kit” that includes bleach, water, alcohol pads, cookers, cotton, Band-Aids, and naloxone. He also gets to chat with the staff and knows they will help him find a bed in detox when he’s ready.
Nuñez is still shaken by the death of a high school friend a few months ago. He administered naloxone and frantically performed CPR for eight minutes. But when the ambulance arrived he could tell by the demeanor of the EMTs that his friend was already dead. Now he makes sure not to use too much and to never use alone.
“Every day I’m hearing someone’s OD-ing,” Nuñez said.
Correction: A previous version of this story incorrectly characterized the activity at local heroin mills.
Felice J. Freyer can be reached at felice.freyer@globe.com. Follow her on Twitter @felicejfreyer.