Miles to go…

“I wish they wouldn’t call it methadone mile,” says the security guard, “there’s more going on around here than that.”

Methadone Mile. That is what some call the area around the intersection of Melnea Cass Boulevard and Massachusetts Avenue. Within a few short blocks of the intersection there are many social service agencies, including a methadone clinic. The area has been chronicled, in both words and pictures, by the Boston Globe and WCVB, and from what I can tell during a nearly three hour walk there last Saturday morning, it is still struggling both as the center of, and as a path from, the opioid epidemic that continues to sweep across Boston and all Massachusetts.

The security guard tells me that he has worked four years in the area, and has “pretty much seen it all.” He finds discarded needles often, and has administered narcan. When I ask what he thinks about what he sees daily, he shrugs his shoulders and says, “Not sure. Part of me thinks we coddle them, making it too easy. Part of me knows it a disease.”

Some believe programs such as the observation room, called SPOT – Supportive Place for Observation and Treatment, run by Boston Health Care for the Homeless, is an example of coddling. It is a place where drug users can go after using and be watched to ensure their safety. However, others see it as a part of harm reduction programming, protecting against overdose deaths by ensuring that those who find themselves near overdose can be medically monitored and offered access to more comprehensive health care and treatment.

As for treatment options, nearby on Topeka Street there is a methadone clinic, which is relatively quiet at 9:00 a.m. on Saturday. As its 11:00 a.m. closing approaches, there is a steady stream of clients, arriving on foot, on bikes, and in cars. People of all ages. There is the middle-aged woman walking her little dog, holding the leash with an arm that bears the evidence of many needles over many years. A group of men chats nearby, laughing in the morning sun. There’s an older man in a shiny blue car, waiting for his daughter while a little child sits in the rear seat. A young man standing at the edge of the parking lot looks at me suspiciously, so I approach him and strike up a conversation. Monitoring the outside of the facility has been his job for the last year. “One year seems like four,” he says, and offers that while he does not have a solution to the opioid epidemic, he believes the methadone clinic plays a vital role. “I guess it’s better here, otherwise they end up in there,” he says pointing to the walls of the South Bay Correctional Facility, “and that’s a lot more expensive.”

I walk from the clinic with a young woman who tells me that she has been on the methadone program for four years. She is making progress, her dosage has been reduced, but she does not want to be taking it for life. “I started on pills when I was younger, Percocet, you know, and then went to heroin, but I’m lucky, I don’t have Hepatitis C or anything like that.” What she does have is a five-year old boy, “He’s doing okay,” she tells me. “He started school, but he’s the youngest in the class, so I think I’m going to keep him back a year.” A single mother, she awakes at 5:30 a.m. every day, takes a medical ride to the clinic, and then returns home in time to get her son off to school and herself to work. She has heard that Mass Health may no longer pay for the clinic rides, and she worries that without them she, and others like her, will not be able to keep up with the program.

A block away, I walk past the Southampton Street Shelter, and stop to talk with two women who are checking the area for discarded needles and weapons hidden by the shelter’s clients. They find more needles than weapons, about ten needles this morning. They find them behind cars, next to buildings, and see them in places they cannot reach. I ask how many at the shelter, knowing it is a wet shelter, are active drug users. One says 90%, the other says all. “That’s why they’re in their situation. Drugs. It’s so sad.” Their empathy is genuine, and they express that they wish they had a solution, but they do not.

At the intersection of Albany Street and Massachusetts Avenue, I linger as I pass through for the second time, appearing to wait for a pedestrian light. Pills are sold openly, poured from pill bottles into waiting hands in exchange for cash. An elderly woman exclaims loudly to a gathering group of men, “These are from my own stash”. A man yells, “Hey, you gotta take care of her,” as he sends a young woman across the busy street. Another woman, better dressed, her eyes lacking the darting movements of one seeking drugs, appears to have just finished her business of selling. She is counting her money as she walks away, empty pill bottle in hand.

On the embankment adjacent to the Massachusetts Avenue Connector, a man and woman sit next to each other, leaning against a fence. About ten feet away a man is nodding off. The woman gets up, approaches him, leans down, and appears to check on him. Further up the embankment someone lies in the fetal position. Cars come off the expressway, stop as the traffic light turns red, and their occupants seem not to notice the scene around them. The light turns green, and they travel through.

Down the street, I walk through the McDonald’s restaurant parking lot. There are people everywhere. Sitting on walkways, curbs, and standing. Inside, the booths are full. I watch as a new model SUV with an out of state license plate begins to make a turn into the parking lot, and then quickly turns back onto the street. I see the looks on the faces of the driver and passengers as they realize they would rather get their coffee elsewhere. On the sidewalk next to the entrance is a baby carriage, surrounded by at least eight adults, huddled, thinking about what’s next. Inside is a baby girl, dressed in a bright pink, clean outfit. As I walk further, I see another team from the Southampton shelter looking for needles, just before I come across one discarded under a nearby bridge.

While I head back towards my car parked at the South Bay Mall, thoughts race through my mind. I saw many discarded pill bottles, and cannot help but think that there are just too many pills. Each one I saw sold or handed off was one that should not have been prescribed, for it was not used for its intended purpose of treating pain. We have so much more work to do to curb excessive prescribing.

I think too about the disease of addiction. I think about how with most diseases we turn to medications for cures, however in the case of addiction, medications – painkillers – often lead to the disease. But I also think that given the extent of the epidemic, and our inability to meet the demand for detox, clinical stabilization and transitional support services, for a while we may have to rely on medications – medication assisted treatment – to keep people alive. Our goal should be though, as the young woman with the five-year old son hoped for herself, not to have people relying on those medications for life. Life, if possible, should be lived without the long-term leash of medication-assisted treatment.

My thoughts turn to the many faces I saw during my walk. There were old and young, black, white and gray, and male and female faces. There were the faces of mothers and fathers, sisters and brothers. Many faces were tired and worn, marked with shallow, empty eyes. And then there was the face of the precious baby wrapped in pink, reminding me that we have a responsibility to give everybody a chance for a better life.

Like the security guard I first encountered, I too wish they would not call it methadone mile. There is more going on than that. I realize that for every face of addiction, there is the face of someone working at a shelter or clinic. And, for every trade of pills, heroin and fentanyl, there is a transaction of kindness by those willing to help. But, to paraphrase, yes we have miles to go.