One in a series of occasional articles about opiate abuse and its consequences.
It took multiple applications of the overdose-reversing drug naloxone, Paul Hachey of Plymouth recalled, to revive him in late September. The 38-year-old was “dead” from an OxyContin overdose for three minutes before he slipped back to life, he said.
The next day, after a short stay at Beth Israel Deaconess Hospital-Plymouth, Hachey was sitting on the couch, unsure what his next steps should be. Then he heard a knock on the door.
It was a Plymouth police officer in plainclothes, along with a recovery specialist from the Gosnold on Cape Cod treatment organization. Hachey’s father arrived soon after.
“Before I know it, there was some kind of intervention going on,” Hachey said in an interview. In 20 minutes, he said, the trio convinced him to accept inpatient treatment for his addiction.
The visit was a part of Project Outreach, a program that links police departments, treatment providers, and other organizations in 14 Plymouth County towns in the fight against the opioid abuse problem in the region by proactively offering treatment for addicts. The program launched in December 2015 following meetings between Plymouth Police Chief Michael Botieri and officials from substance-abuse treatment centers in the area.
Like in many places across the country, opioid overdoses had been climbing in Plymouth. Botieri said local police responded to 120 overdoses in 2014, with 15 resulting in deaths. The introduction in January 2015 of naloxone for emergency treatment of an overdose did not stem the tide of opioid deaths that year. While the antidote was used more than 90 times, Botieri said, there were still 23 deaths from 202 overdoses in 2015.
Initially limited to Plymouth, Project Outreach has since expanded to include Carver, Duxbury, Hanover, Kingston, Lakeville, Marion, Marshfield, Mattapoisett, Middleborough, Pembroke, Plympton, Rochester, and Wareham. Botieri estimated that some 200 people have received follow-up visits like Hachey’s, and plans are in place to have the entirety of Plymouth County included by February or March.
The outreach process kicks in when there’s an overdose resulting in hospitalization in a participating community. If the person who overdosed doesn’t accept treatment, a police officer in plainclothes and a clinician from a treatment facility will follow up with a visit within 24 hours of the overdose -- even if they’re not wanted.
“We’ve had a half-dozen people go to the emergency room and say, ‘Don’t come to my house tomorrow. Don’t send that outreach program.’ And we went anyway,” Botieri said.
Before the visit, the officer will check for outstanding warrants. If there is any, the wanted person is arrested by a uniformed officer and enters the criminal justice system, through which he or she might receive addiction treatment. Project Outreach is reinitiatied if the person is released.
Each visit is unique, said Sarah Cloud, director of social work at Beth Israel Deaconess Hospital-Plymouth.
“There are occasions in which we can’t locate the individual. [That] happens about 14 percent of the time in Plymouth. Other times we’re encountering a family member who may or may not have known that their loved one almost died the night before of an overdose,” she said.
Those approached are not legally required to accept treatment, but if they do they may be on the hook for at least part of the cost, depending on the treatment plan and their insurance coverage. As opposed to a “one size fits all” solution, officers and clinicians work with patients on a case-by-case basis to find a preferable treatment option.
About 85 percent of those visited will accept treatment, Botieri said. Treatment does not necessarily have to come from the employer of the specialist who was part of the visit.
For various reasons -- a need for childcare, fear of losing a job, even a previous bad experience in recovery -- many patients don’t like the first treatment option proposed to them, said Peter Monaghan, director of community development for CleanSlate treatment centers in Massachusetts.
“Being able to have a Plan B, C, and D in your back pocket is huge,” said Monaghan, who is heavily involved with Project Outreach.
The program also enables addicts and their loved ones to get help themselves from weekly “drop-in centers” at alternating locations in East Bridgewater and Plymouth. There, treatment providers and support groups set up stations to dispense information and aid.
“They come into a very welcoming environment,” said Neil Eaton, pastor of New Hope Chapel in Plymouth, which hosts drop-in centers every month. “There’s a place just to kind of sign in, and then they can kind of meander about without any pressure.”
Visitors are treated on a case-by-case basis. Meanwhile, the drop-in centers have fostered relationships among those working against the opioid scourge.
“Before this, none of us really knew each other. We’re kind of building bridges with each other, so we can help the community,” Eaton said.
But despite the gains, those involved with Project Outreach concede opioid abuse may be an intractable problem.
“It’s going to take time to stem a tide like this. It’s like a tsunami. The problem has increased so rapidly and exponentially, a few drop-in centers are not going to turn it around on their own,” said Paul Jehle, who heads the New Testament Church of Cedarville, the other location for Plymouth’s drop-in center.
A year after Project Outreach’s launch, the frequency of opioid overdoses and deaths in Plymouth has not decreased significantly. There were 211 overdoses in the town in 2016, 19 of them fatal. Naloxone was administered 120 times in Plymouth last year, some repeatedly to the same person, Botieri said.
“We’re measuring our success in small doses,” he said.
For those brought into treatment through the program, there is always the chance of relapse. In September, a Duxbury police officer working with the program managed to convince Jennifer Bylo’s 22-year-old son to accept inpatient treatment.
But Bylo said it was only a few weeks later, after a stint at a treatment facility, that he suffered a heroin overdose while living in a sober home. Naloxone saved his life, she said.
“What they should be watching is what happens after [patients] get into treatment. Where do they land after the 30 days” of in-patient treatment? Bylo said.
Hachey said he plans to stay in his Falmouth sober home for a few more months. He’s had help compiling his resume and hopes to start working -- he specializes in flooring -- again soon. And he has a goal in mind -- to take college classes and eventually get a job helping others recover from substance abuse.
“For once,” he said, “I’m actually looking forward to the future.”
For Hachey, who says he was sober for six years before the end of a relationship triggered his relapse in September, Project Outreach “was like a godsend.”
“I had barely had time to consider what to do next when they were there” to offer treatment options, he said.