APT In The Crosshairs

Move the entire operation away from homes and schools deep into the heart of Yale’s medical district.

Fix the broken, under-funded Medicaid transportation system that’s supposed to serve those in recovery.

Have a private van service escort clients in and out.

Maybe even form a drug users’ union so they can have their own voice.

Operate in all of Connecticut’s 169 towns, and do it 24/7, if you must, but find ways to relieve the stress on an already deeply stressed Hill neighborhood.

Those were some of the ideas and plain cris de coeur framed by remarks about compassion, cautions about stigmatizing drug users, and the perils of NIMBY-ism that emerged from a four and a half hour marathon of listening and venting Wednesday night at City Hall.

The subject: the APT Foundation and the behaviors of its clients at its Congress Avenue methadone clinic.

The participants: nearly 100 who attended the meeting of the Board of Alders’ Human Services Committee in the aldermanic chamber.

After engaging about 20 speakers including APT docs and staff and besieged neighbors, alders voted not to take any specific action on APT itself. Instead, the committee voted to approve an resolution offered by Westville Alder Richard Furlow. It calls on the city officially to term drug addiction a “chronic medical condition.” And with that as a model, the resolution charged the city to develop an action plan to deal with the crisis.

The resolution, which next goes before the full board, passed unanimously.

It was the first time, said committee Chair Darryl Brackeeen, Jr., that APT had spoken directly to alders, explaining who they are, what they do, and how addiction is often a life-long struggle, with relapse as a regular feature of the arc of cure. CEO Dr. Lynn Madden and staff doc Mary Ellen Savage stayed the whole session

Under pressure from constituents following a killing near the site on Congress, the mass overdoses on the Green, and the daily dealing with APT clients wandering the streets after exiting APT, alders also wanted to address APT staff directly. (Click here for a story exploring the pros and cons of APT’s unique methadone model.)

They beseeched APT, an independent entity founded in 1970 and staffed primarily by Yale physicians, to help solve the growing drug-use-and-treatment crisis in New Haven, whose epicenter is the area from the Green to Congress Avenue.

Passions Voiced

A sampling of Wednesday night’s back-and-forth:

Hill Alder Evelyn Rodriguez: Patients are leaving ill, woozy from the [APT] facility. You state you’ve been meeting with the city since 2014. How can we still have this?

APT’s Lynn Madden: It is not my experience they’re leaving ill from our treatment. But we treat a wide age-range of people. Older people are on other medications [as well as methodone]. We treat very ill people.

Wooster Square Alder Abby Roth: Could APT set up private van rides?

Madden: That’s expensive, and we don’t have the money. Medicaid people are eligible for [free, or subsidized public] transportation. But a pass, for example, that might have been given for a month is now for two days only. It’s complex, it’s gotten worse. We’re in conversation about transportation every day.

Yale School of Public Health Professor Greg Gonsalves: We need more services like APT, not less. Do not surrender to NIMBY-ism and misinformation. Build out from APT’s success. I love this city. People who use drugs are not ‘them.’ They’re our brothers and sisters. It’s shocking to me to hear myths perpetrated.

Yale School of Medicine Psychiatrist Declan Barry:  APT’s model is unique: You can enter treatment on the same day [which is critical]. There’s confusion and stigma with this disorder. It is no different than diabetes. That you entertain the idea that it is different is absurd.”

Anonymous shouting audience member: “You don’t live in New Haven!”

Committee Vice Chair Richard Furlow: “This is in no way to stigmatize. I have drug addiction in my family. This committee wants to help.”

Hill Alder Rodriquez: “None of my colleagues view this as NIMBY. It’s about engagement. Shouldn’t what they [APT clients] do when they leave [the facility] matter” to APT?

Roth: Everyone believes it’s a disease. My concern is transit.

Hill North Management Team Chair Howard Boyd; “We’re not against treatment, but the safety and health of the community. The loitering, the foot traffic, what the kids see, [the effect on] local business. It’s an ugly look out there. We want APT to sit with us, the community.”

 

Congress Avenue resident Jose DeJesus: “I think APT is terrific. I think they should increase hours to 24/7. I think they should open in all 169 towns. Just not in a residential neighborhood. I’m all about access. We just need to be cognizant that one neighborhood cannot bear it all. Other places have to pick up the slack.”

Longtime Arch Street resident Lynda Faye Wilson: “It’s about littering, loitering, and disrespect. APT needs to come up with something with their clients. It makes me sick to see them [post-treatment clients] gathering in our green space.

Downtown resident Jacob Remes: “I work in New York but live in New Haven because I’m fiercly proud of New Haven, of [immigration] sanctuary, and of APT. A caring city. We need to see our neighbors not as problems but as people to help.”

Yale School of Public Health’s Jeannia Fu: “Recall the AIDS epidemic. Had we heeded NIMBY instincts, we would not have solved that epidemic. When we turn away, when we don’t look, when we deny housing due to addiction, which happens in New Haven, that’s when people die. The solution is not to ‘control’ these people but include their voices. They’re not ‘zombies.’ We’re missing a big piece of the solution” from drug users.

Longtime Hill resident Abdias Rodriguez: “They come to your porch to defecate! In the green space they’re not just hanging out, they’re cooking drugs. We ripped out 300 families to put in a school [John C. Daniels]. and now look what the kids see! Five hundred yards from school there’s active [drug] distribution. Our people did that illegally. It shouldn’t be legal now. We sacrificed a lot to keep the little we got.”

Family and addiction physician Dr. Curtis Bone: “Addiction is like obesity, but addiction [by contrast] has an effective drug [methodone]. Seven out of ten people on methadone return to work. This [New Haven] is a beautiful city due to its sense of community, with caring institutions like Cornell Scott and APT. I feel the tenor of conversation [tonight] has shifted from finger-pointing to partnering.”

Resolved: Show Resolve

After the vote on the resolution, Hill Alder Evelyn Rodriguez, who holds a master’s degree in public health, pointed out to Furlow: “There is already federal law that supports drug addiction as a medical condition.”

Furlow said the resolution is still important because it could change the culture of how we deal with the opioid crisis and set New Haven up as an important municipal model.

Other alders chimed in that the resolution might also open doors to additional state and federal funding support.

However, as the clock neared 30 minutes to midnight, no further details were offered.

Brackeen said that for months City Hall’s Community Services Administration other staff have been looking into this problem. APT, and other “stakeholders” will be part of a workshop, scheduled in the next few weeks, as part of the run-up to create a city action plan mandated by the Furlow resolution.

The resolution now moves to the full Board of Alders for approval.

Also voted on Wednesday night was approval for the city’s health department to accept a $25,000 grant, over a five year period, to provide preventive medicine education, from Griffin Hospital.

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Comments

posted by: Patricia Kane on September 13, 2018  12:32pm

Considering the complexity of the problems, I feel unqualified to vote.
Addiction is a public health problem of crisis proportions. Treatment is necessary, but the funding is not in place to do it sufficiently.
Housing is also a pressing need.
I am proud to live in a city with caring political leaders and dedicated medical professionals.
One day we will spend time on the underlying causes of this epidemic.

posted by: wendy1 on September 13, 2018  6:25pm

Addiction is an illness not a crime.  We need addiction services in the center of the city.

posted by: Sylvester L. Salcedo on September 14, 2018  8:46am

Patricia Kane and wendy 1, it’s great that you are keeping informed and engaging in the community dialogue about the current heroin/opioid epidemic.  here’s my offered solution as one of many possible paths, but one that has not been considered seriously by decision makers in any quarter in a serious way in New Haven, CT or nationwide…see: five steps in http://www.whoischuu.com.  We are in a heroin epidemic. There is not enough money, public or private, to support the type of treatment and rehab effort that everyone talks about.  We need to change course drastically and our policy, IF THE GOAL IS ZERO HEROIN/OPIOID DEATHS.  We have accepted about 300 in 2012, and progressively upwards to 1,000+ last year, and there has no movement in the sense of urgency at all.  Narcan has been promoted, and the current effort to load up every first responder or good samaritan with a dose of narcan (at $20 or $94(CT state rate) or ($95/$135 my local pharmacies) is wasteful, a “feel good/bandaid solution” and frankly, stupid.  There are about 105,000 CT individuals affected by a heroin/opioid dependence, let’s say 1/3 are sober and clean, 1/3 are in treatment or rehab, and 1/3 are active users…for 30,000 active users spending/ wasting $10/$100 per day for something that may be contaminated (fentanyl, baby formula, powered sugar, etc) which really has a $0.10/per bag actual value is about $300,000-$3million per day, or $9-$90 million per month, or $$108million-1.08 billion per year going to the blackmarket tax-free, and when the heroin/opioid consumers get sick or overdose, the taxpayers pay even more for emergency and medical expenses.  Every overdose death and incident is 100% preventable!  Get the active users under a safe and medically supervised situation.  Temporarily suspend laws against heroin and stabilize this population with a sensible and effective path to sobriety or a safe use maintenance program.  Let the heroin/opioid addicted be heard. No BS: no blame, no shame.

posted by: Patricia Kane on September 14, 2018  9:55am

@Sylvester Salcedo: You make a compelling case for doing the logical thing, but I don’t need persuading based on numbers. So often I see civil rights issues, public health issues, argued on a numbers/ financial basis. I guess it’s the game you have to play for funding.
  Addiction is a health issue. Wendy was a nurse at YNHH for years and both of us believe in science and good medical advice.
  The US has fallen into a pattern of blaming the poor, the sick, homeless and any one who is vulnerable.
  It was not always this way, but if the political agenda is to dismantle the reforms of FDR - the “traitor to his class” who “saved capitalism”, then we have to invent “welfare queens” to justify depriving children, the largest group of recipients, from having a decent standard of living.
    The corporations have won. The current administration is repealing protections for air, water, public lands, women’s health, etc. and reducing its tax rates. The middle class is becoming a memory.
    My point is that our collective wealth should be used to reduce human suffering, not maximize it.
    What kind of society ignores illness and refuses to treat it?
    Why is the Zika virus respectable, but HIV was not?
    We have to resist politicizing health issues (lock ‘em up) and demand humane approaches to our problems.
    Wasn’t it Eugene Debs who said, “There are more of us than there are of them”.

posted by: Sylvester L. Salcedo on September 14, 2018  11:24am

Patricia and Wendy, are we fired up and ready to go?  Let’s do it!  working with the 105,000 heroin/opioid addicted/affected individuals across connecticut plus their moms and dads, or brothers/sisters, cousins, best pals, and others who could form a core group of about 500,000 eligible/registered voters and even if only 1-2% of that group joined the CHUU (CT Heroin Users Union…www.whoischuu.com) just for election day, and assembled as a voting block (even though I’m a committed Democrat) this fall, I’m willing to vote as a block with all registered, voting members of the CHUU and we vote in unity (in Solidarity/Solidaridad) for the gubernatorial candidate who will commit (and a signed pledge, a la Republicans’ no new taxes pledge type of “dog and pony” show)  to do the right thing for the heroin/opioid population of CT.  In the past, when all the CT Republicans and all the CT Democrats voted along party lines, as they did in 2012 between Malloy and Foley, the difference was only 5,000 votes…from a practical, political point of view…This is an achievable goal.  Who’s fired up for change? real change?  this year.  On November 6, 2018.
In the beginning, there were three….

posted by: Patricia Kane on September 14, 2018  1:31pm

Sign me up, Sylvester, but the real resistance is the small town legislators who are unfamiliar with city problems and more resistant to information that might change their minds. Josh Elliott in Hamden has written about this.
  Change is coming, but in the meantime, people suffer.

posted by: wendy1 on September 14, 2018  1:50pm

I agree with S.S. there is no real solution…people will die.

posted by: robn on September 15, 2018  2:51pm

Its hard to imagine having less than zero respect for Alder Furlow already but he’s expanding my imagination. This was the same guy that simultaneously passed an 11% tax increase on residents while complaining about not being able to purchase property because of the tax increase. And now Hill residents want action but instead get his sponsorship of a statement stating the obvious and doing nothing. He should be thrown out of chambers for his lack of competence.

posted by: robn on September 15, 2018  2:57pm

Did a licensed physician just say in a public forum that drug addiction is the same things as diabetes?
Drug addiction is a willful, self induced process of slowly creating physical and mental dependency upon a foreign chemical.
Diabetes is a random, naturally induced lack of a chemical that regulates your bodies ability to process sugar (which we need to ingest if we want to live).
WTF!?! This is an insult to Hill residents that have to put up with this stuff and to all people who suffer from the disease of diabetes (that they didn’t choose).

posted by: Patricia Kane on September 15, 2018  8:35pm

@Robn: while diabetes may not be a perfect analogy, an excellent report on NPR attributed the initial clusters of opioid addiction reports to injured rust belt workers who were prescribed opioids for their chronic pain and got hooked. The same has happened to high school athletes and people on meds post-surgery.
  The truth is, many people were hooked without their knowledge or consent. The role of the Sackler family and Purdue Pharma in concealing the risk of addiction (claimed it was “rare” and “low) is now the subject of government scrutiny.
  We have to move away from the blame game and deal with the reality of a disease, the same way we did with AIDS.
    If you want to focus on blame, focus on the “incentives” offered doctors and staff who prescribed these potent pain killers and the greed that sacrificed the health of our fellow human beings to the relentless drive for profits.
    This is our collective problem to solve now.
    This was not a matter of choice for millions of people.

posted by: Sylvester L. Salcedo on September 15, 2018  8:53pm

Robn, the CHUU has a no B.S. (No Blame, No Shame) outlook.  It does not matter how one becomes dependent on/or addicted to heroin/opioids…you partied/you willfully ingested heroin or innocently had a painful toothache or back surgery and your doctors prescribed you opioid-laden medicines and you got hooked/addicted… whatever the circumstance, I believe there is universal acceptance that we are in an emergency/epidemic situation.  So, now…what to do?  To get to “Zero heroin/opioid-related deaths” immediately should be our community goal.  And I believe it is achievable for almost no extra cost, but emergency policies need to be implemented.  A good comparison is the recent hurricane in the Carolinas…when you have to evacuate areas in a hurry/an emergency, you suspend “traffic laws” and close off beach/shore-bound lanes and allow everyone to travel on all roads and highways away from the pending storm/danger in one safe direction.  Likewise, in a heroin/opioid emergency/epidemic, changing drug laws or temporarily suspending current drug laws may be necessary to stem the tide of the danger (that is, the 100% preventable heroin/opioid- related deaths) via immediate changes in the drug laws or suspending them for a period of time (short - 3 months or long - 3 year term ) to resolve the emergency which is the rising 1,000+ per year heroin-opioid related deaths to get it down to ZERO, immediately!
That emergency change may mean expanded MAT’s all the way to safe injection/consumption clinics-facilities, and even, actual heroin (clean, pharmaceutical grade, not street heroin) for a maintenance program, no different from methadone or other MAT’s (medically assisted treatment) programs….ask the heroin/opioid dependent individual what it will take to stabilize their lives from day one.  Not a prescriptive or punitive policy, not mandatory rehab or treatment order, but a complete “thinking out of the box” outlook to get to ZERO heroin/opioid overdose death status.

posted by: robn on September 16, 2018  6:07am

Hill residents (or any other neighborhood) shouldn’t be forced to host a large portion of Connecticut’s addicts in their neighborhood.

And Drug addiction may be pitiable but is not even close to being the same as diabetes. A licensed physician should not be spreading such a hyperbolic lie. This quote speaks loudly to a sad fact. You can talk all you want about the welfare of addicts but the fact is this is a lot about money…these doctors are milking a fat eds&meds; cash cow at the expense of residents.

posted by: Sylvester L. Salcedo on September 16, 2018  9:49pm

Robn, again…I agree with you completely that the Hill neighborhood should not have to bear the brunt of the burden, disproportionate burden, regarding the current statewide heroin/opioid epidemic.  Every city should have adequate clinics to serve their residents, and every cluster of smaller towns, such as Orange, Woodbridge and Bethany that share a district high school, likewise, should be able to share a clinic dedicated to serving their residents who are affected by a heroin/opioid dependence.  This will only happen when the Hill community organizes and rejects the disrespect and unfair treatment by others.