QUINCY — This parking lot behind a Southern Artery gas station doesn’t look much like a doctor’s office, but every morning about 25o people make their way to this dead-end street to take their medicine.
In Quincy, a city hit hard by the opioid epidemic, the only legal place for many patients to take anti-addiction medications that have helped them reclaim their lives is an old conversion van parked near a homeless shelter, not far from Mount Wollaston Cemetery.
But not on weekends anymore.
Habit Opco, a private health care provider that runs several methadone clinics in Massachusetts, late last year stopped offering its mobile service — the van — on Saturdays and Sundays.
The company says it hopes to build a permanent facility in Quincy, across the street from where the van now parks five days a week. But for now, patients must make their way to clinics in Brockton or Boston for their daily dose of medication every weekend morning — a logistical roadblock that some say jeopardizes their recoveries and their lives.
“It’s just getting ridiculous with the van,” said one patient, who said she has stayed off heroin for over 10 years and, like many in recovery, takes her daily dose of methadone before heading off to work. “You’re telling me that you really don’t give [expletive] about people in recovery.”
Extensive research has shown that methadone and similar medications like buprenorphine are the most effective current treatment for opioid addiction. But because methadone itself is highly addictive, missing doses can lead directly to relapse as users try to stave off brutal withdrawals. Any roadblock to getting daily medication — a trip to a distant, unfamiliar clinic, for example — can be deadly.
The van was taken offline on weekends because it’s in poor condition, and Habit Opco, fearing it will break down, has tried to limit its use, a company spokesman confirmed. A new van would cost about $80,000 and take months to get outfitted and approved.
“They’re too cheap to buy one after all these years?” the patient wondered. Indeed, Habit Opco’s parent company, Acadia Healthcare, in financial results announced in November estimated that its 2018 revenue would be about $3 billion, with earnings of $600 million.
But vans are less than ideal, a company spokesman said, particularly compared to a permanent facility.
Habit Opco e-mailed a statement that did not address the decision to take the van off the road twice a week, and pointed to its nascent plans for a clinic in Quincy.
“Habit Opco has been committed to providing these critical services in Quincy for 30 years, long before the current opioid crisis,” the statement read in part. “We are excited that we are now very close to submitting a formal application to the city for a new facility at which we can provide all the critical services our clients need under one roof.”
The company operates 12 methadone clinics in Massachusetts.
But Chris Walker, a spokesman for Mayor Thomas Koch of Quincy, said the city was only made aware of those plans for the first time last week, after I’d started asking around about the van.
Walker declined to comment on the proposal until more details are available. But winning city and neighborhood approval for a clinic will take considerable time — many months at least — and may never come to fruition.
I asked Walker whether a city the size of Quincy ought to have a permanent facility for medication-assisted addiction treatment (Habit Opco has a facility on Hancock Street where it offers counseling and other services, but not methadone; company officials said those services would move to the new proposed facility.)
“From a 30,000-foot perspective, we feel pretty strongly that Quincy has a great deal of services to provide patients, whether it be this or traditional treatment,” Walker said.
But when you’re one of the 250 people waiting for the van every morning, the 30,000-foot perspective doesn’t matter much. In a city where 40 people died of overdoses in 2017, according to the latest available state figures, a permanent clinic would save lives.
For the foreseeable future, though, Habit Opco appears to be shifting at least some of its costs onto the state, rather than repairing or replacing its van. Some Quincy patients who have insurance through MassHealth and meet certain qualifications now make the weekend journeys to the Brockton or Boston clinics via state-paid transportation. That increases some costs for MassHealth, though at least some of those patients already were using the same service to get to the Quincy van on weekdays.
State officials said they were recently made aware of the schedule changes in Quincy, and had been told adequate provisions for patients there had been made. Those trips must be preapproved, which is another potential stumbling block for someone trying to stay clean.
“I’m not out there shooting dope; I go to work,” said the patient, who spoke on the condition of anonymity because of the stigma surrounding addiction, and for fear of retribution. For her, stopping at the Habit Opco clinic on Topeka Street in Boston on the way to work on weekends makes more sense than traveling to Brockton.
But that presents its own problems. Topeka Street, a short stretch of pavement in the shadow of the jail, is in a section of Boston known both for its constellation of recovery services and its near-constant open-air drug trade.
Another patient, who has a take-home prescription for methadone that allows her to visit the van only four times a week instead of seven, feared that a weekend trip would be impossible because of her three children.
The woman said she’d been clean for seven years thanks to methadone. “I’ve been clean the whole time. It’s really worked for me and I’ve been really thankful,” she said. Getting to the van in Quincy, where she lives, is simple; but on weekends, when her children are out of school, she can’t bring them to the clinic in Brockton.
“I don’t know why they don’t have a building,” she said. “They’re getting all this money, I don’t know why they can’t find one.”
In its statement, Habit Opco acknowledged the challenges associated with opening a methadone clinic, even as the opioid crisis rages: “We have been forced, because of the competitive commercial real estate market in Quincy and the real challenges associated with siting facilities like ours, to physically separate the counseling we provide clients from the dosing that many need.”
Neighborhood and municipal opposition to methadone clinics has indeed made proposals challenging all over the state and country — a vicious cycle that leads to long lines and chaotic scenes at those that do exist, and in turn reinforces stigma that drives local objections to more clinics.
But saying we are in the midst of an opioid crisis isn’t enough. We need to act like it.
A building makes a lot of sense, and Habit Opco’s efforts to build one in a corner of the city with few neighbors will hopefully meet minimal resistance.
But until it’s built, their patients deserve better.