Did APT Help?

Christopher Peak PhotoA woman arrested for shoplifting told the cops she travels to New Haven from Waterbury each day to get methadone. And she feels she’s not getting the help she needs to wean herself off it.

Her story sounded familiar.

So a top cop, with the woman’s permission, began recording what she had to say.

“When I signed up for the clinic,” the woman told him, “I thought that it would be more than just getting your methadone and leaving.”

The conversation took place last week. Assistant Police Chief Otoniel Reyes had arrived at the Yale Bookstore on Broadway to help with the arrest of two people, a man and a woman, on shoplifting charges. Reyes struck up a conversation with the woman. He found her story interesting for several reasons. He used to work as a substance abuse counselor before becoming a cop. Now, as assistant chief overseeing patrol, he’s tackling the increase of people, many from out of town, using drugs and often overdosing on the Green. In that quest, he has found himself frustrated by the policies of the clinic the woman attends, run by the APT Foundation.

With the woman’s permission, and a promise to keep her identity private, Reyes shared the audio recording of their discussion in the interest of highlighting those concerns. He said her story matched those of many out-of-town substance abusers his officers encounter in and around the Green.

And he felt it gets to the heart of New Haven’s current debate over how best to address a drug crisis that has exploded into public view.

“It was alarming,” Reyes said of the discussion. He argued that it points out how APT’s unique policies — allowing clients to obtain methadone even if they test positive for using some other drugs — have made the city a magnet for people struggling with addiction from all over the state, without necessarily helping them get better. Other public officials, including Mayor Toni Harp, have raised similar concerns about APT as the drug crisis has spawned a public safety and health crisis on the New Haven Green. (Click here and here to read about some of that debate.)

Asked about the episode, APT CEO Lynn Madden expressed regret for the story about the woman’s experiences, but defended APT’s overall policies, which differ from those of other clinics and which she said the public often misunderstands.

“Think You’re Ready?”

 

The arrest at the Yale Bookstore occurred Aug. 30. In the beginning of the recording Reyes states that the woman wanted to “go on record to talk about some of the issues we’re dealing with here in New Haven from her perspective. We want her voice to be heard. She’s someone that wants to get help. She’s someone that’s trying to fight her addiction.”

A transcript of the subsequent conversation follows. (Click on the above audio file to listen to it.)

Asst. Chief Reyes: Where are you from?

Arrestee: Waterbury.

Why are you here in New Haven today?

I come to New Haven to go to the APT Foundation

How often do you come?

Monday through Saturday?

Can’t you get services in Waterbury? Why don’t you go to Waterbury?

Initially, I did go to Waterbury. But Waterbury is stricter in terms of their tox screens. If you’re positive for anything outside methadone, they detox you. You’re no longer able to [get methadone]. Whereas APT doesn’t.

They do use screens. But regardless of what you’re positive for, they really barely have a conversation with you. “You’re positive? OK. Bye, bye.” You can still get doses. No kind of disciplinary …

Or restrictions?

Or restrictions.

I imagine that if you’re coming here, you feel like you’re getting adequate help from the APT Foundation here in New Haven?

No, I don’t feel that way. In fact, I am not getting adequate help. As a result of that, I made appointments with a psychiatrist and a doctor. You’re not even assigned a counselor at APT Foundation. You used to be assigned a counselor for each client. Now if you go in, and for some reason you have to meet with a counselor, you just kind of wait for whoever is available. There’s no one-on-one sessions.

So when was the last time that you spoke with someone to talk about the progress of your addiction and how you’re doing?

I initiated a conversation last week to let them know I was making an appointment outside of APT Foundation because I wasn’t getting the services I needed there.

How long have you been coming here to New Haven to get services from the APT Foundation?

Oh, for a long time. I signed back up in November. Prior to that, I was on a year, then off. On for a year, then off…

Has that helped you in your addiction?

I think it has, because I’m not using heroin anymore. I’m not on the streets having to buy heroin and be in that situation. So in that regard, yes.

But when I signed up for the clinic I thought that it would be more than just getting your methadone and leaving.

Are you using any other substances now?

Right now? No. I feel I need to be on something for, like, anxiety.

They’re not providing you that?

No.

They’re not providing you any counseling, any case management, to see what your progress is, to help you wean off that particular drug ...?

If you try to wean off a drug, let’s say you want to detox, they try to convince you not to.

What do you mean?

Like, let’s say I go in and say, “I’d like to start detoxing.” They will say, “Do you think you’re ready? Have you been on it long enough?”

How long have you been on it?

Since November.

But they’re really not monitoring you in any way to determine if you’re ready for it?

Yeah.

What happened here today? Why did you come into contact with us?

The person I was with was stealing out of the Yale Bookstore. I separated from him.

Where is he from?

I think he’s from New Haven. I’m not sure.

Do you know if he goes to the APT Foundation?

I don’t think he’s on methadone. I happened to run into him on the Green. He knows my husband …

Well thank you. I appreciate your candor and your receptiveness. I wish you well with your addiction.

Thank you.

Hopefully you get on the path and you get the services you need.

I’m trying to.

How Best To Help?

Paul Bass PhotoThe arrested woman, who was born in 1974, was charged with sixth-degree larceny, a misdemeanor. Her arraignment is scheduled for Friday. She also faces larceny and failure to appear charges in pending cases in Waterbury, according to the state judicial website.

“We have heard this time and time again from our officers who come into contact with these individuals every single day and are told the same thing,” Reyes said in a subsequent interview about the conversation and why he wants New Haveners to hear it.

Reyes said the police have been working with others in government and with community organizations on a plan to respond to the disorder on the Green — with daily overdoses involving the use of both opiates and, in the case of more than 100 over a couple of days last month, a synthetic cannabinoid called K2. With an increased police presence, Reyes hopes his cops can arrest more dealers who “prey on these people.”

But he doesn’t want to focus on arresting the users themselves, he said. Rather he wants, with service providers, to identify who they are and what problems have sent them to the streets, then steer them to help.

“We don’t want to criminalize homelessness,” Reyes said. “We don’t want to criminalize drug addiction.”

To succeed, the effort needs community organizations to help solve rather than worsen the problem, he said. He questioned whether — as in cases like that of the arrested shoplifter — APT Foundation is keeping people on methadone longer than they need to be, attracting a regional crowd to the city that becomes a prime market for dealers, and even standing in the way of self-sufficiency.

“You have individuals like this individual that is in a certain place in her sobriety where she feels she would benefit more form psychotherapy, which is the cause of her problem, and wants to wean off the drugs,” Reyes said. “We have an epidemic right now in New Haven. They are contributing to this epidemic.”

Behavioral Health

Markeshia Ricks PhotoAPT CEO Madden responded that APT does have counselors onsite to help clients. But like other agencies, it doesn’t have money for all the psychiatrists it needs. So sometimes that means waiting for an appointment with the first available person. She added that some clinics don’t have any psychiatrists at all. APT also runs group psychotherapy sessions.

Mayor Toni Harp argued that counseling should be available immediately, especially for methadone users whose urine tests positive for other drugs. She cited the interview with the accused shoplifter, to which she has listened, as an example.

“The arrestee basically was saying, ‘I’m depressed. I need something else.’ That’s why she was saying she is taking those other drugs,” Harp argued during her latest appearance on WNHH FM’s “Mayor Monday” program. “People become addicted because they’re trying to self-medicate around behavioral issues they have. If all you’re doing is giving them methadone, you’re not addressing the underlying problems. It could be depression. It could be anxiety. It seems that where you go to get your methadone should be the place” to get that help.

Cornell Scott Hill Health Center immediately assigns a counselor to new clients to whom it distributes methadone at a clinic it runs at the South Central Rehabilitation Center (SCRC) on Cedar Street.

The idea is to focus on the root psychological as well as the physical challenges the clients face. Doctors consider that as an essential part of drug treatment. They emphasize the importance of having each patient assigned a licensed therapist, who can build a therapeutic rapport and employ evidence-based practices like motivational interviewing and cognitive behavioral therapy.

“You can’t just give somebody medication and expect them to get clean and sober. A lot of other things need to be addressed,” said Ben Metcalf, who directs SCRC.

In surveys, APT clients have generally reported being pleased with the care they get, APT’s Madden said. She said APT, like clinics such as SCRC, also monitors patients’ use of other drugs to determine how best to help them get better.

“I’m sorry if she’s not having a positive experience,” Madden said of the interviewed woman. “It sounds like if she’s come out of treatment more than one time. It sounds like somethings she’s committed to.” She urged the woman to “make her concerns known and we will try to address” them.

Encourage Or Discourage Weaning?

APT does often assess whether people are ready to stop receiving methadone treatment, Madden said. Sometimes a client might be motivated by the difficulty of traveling from, say, Waterbury every day to get doses, which may not be the best reason to stop.

Madden cautioned against “hasty” decisions.

“We are reluctant sometimes to discharge someone from treatment for opioid treatment disorder if that treatment is working,” she said. “Opioid disorders are life-threatening. ... When a person requests to taper, we talk with them about what we understand best practice to be. How long one should stay on a medication. How the length of time on a medication affects your long-term wellness.” She said that peer-reviewed literature on the subject concludes that staying on methadone a minimum of three to five years “is a predictor of longer-term abstention from misuse.”

Harp agreed that many methadone clients benefit from remaining on the drug for years. “That’s fine if that works for them,” Harp said. “I know it doesn’t work for the people that hang out on the Green and the people that have dirty urines. I think they ought to have different practice models for them.”

“The idea that you have to be on methadone the rest of your life may seem depressing, but lifelong treatment is not necessary in all cases,” said Ece Tek, chief of behavioral health at Hill Health and assistant clinical professor at Yale.

Tek and SCRC’s Metcalf went on to state that each patient’s needs have to be individualized, and depending on the patients circumstances the length of time in treatment can vary. The overall goal is to prevent relapse, overdose, and death while simultaneously promoting recovery and wellness.

She and Metcalf agreed that in some cases patients need to take methadone for many years, especially if they have already struggled with addiction for that long. Young people in particular may be able to cross the “bridge” from methadone to suboxone and recovery, Metcalf said. If a client expresses a desire to move from methadone to more counseling, that would fit into what Tek called Hill Health’s behaviorally focused “holistic approach.”

“Benzos” & The Dirty Urine Dilemma

 

One big difference between APT and other methadone clinics, and the main reason people fighting addiction come to New Haven from throughout the state: They report that APT is far more likely to distribute methadone to clients whose urine tests positive for use of other drugs.

Madden defended the decision to administer methadone to some clients who test positive for other drugs. Methadone works specifically on opiates. And opiates like fentanyl can kill. So methadone can keep a user alive, even as that user is battling with other substances, she noted.

“We really try to make sure that people live to make decisions another day,” APT’s Madden said.

“This is really that urgent.”

APT and Madden have been pioneers in pursuing a “open access” model that seeks to reach more people who may be kicked out of other programs with counterproductive strict rules. This recent article in a Yale publication notes how the “open access” model helped APT’s patient census grow 183 percent, from 1,431 to 4,051, in nine years. Madden reported in a research paper that the model helped APT increase its operating margin from 2 to 10 percent at a time when it lost 14 percent of its government block-grant funding.

At Hill Health, clinicians seek to avoid distributing methadone to clients whose urine tests positive for other drugs, especially benzodiazepines, or “benzos.” The term refers to medications like Xanax, Klonopin, Ativan, and Valium.

For starters, people sometimes accidentally overdose and stop breathing if they have both methadone and benzodiazepine in their system, Tek said. “They may die in their sleep.”

If SCRC discovers that a patient has been on benzos while receiving methadone, Metcalf said, it will work with them for a “short period of time, while they taper off of that medication. Any patient being prescribed benzodiazepines has to sign a release of information, and allow for SCRC staff to communicate with their prescribers.  All methadone patients are monitored by SCRC staff using the Prescription Monitoring Program website. Patient’s prescriptions for controlled substances are recorded there per state law. Any individual patient who is found to be pursuing benzodiazepines from other providers and purposefully not reporting it must discontinue this practice in order to remain in good standing with the treatment program.

Metcalf said the policy has succeeded in reducing multiple-substance abuse and improved patients’ outcomes.

Metcalf and Tek made a point of not criticizing APT for the widespread misuse of benzos. Rather, they said, the fault largely lies in overprescription of benzos by practitioners in the community.

They said they make a point of reaching out to prescribers to tackle the problem. Often, prescribers just don’t have the information about their clients because prescriptions of methadone, unlike that of other drugs, are not included on the shared prescription monitoring website. The intent of keeping that information secret is to de-stigmatize methadone use. But it has the unintended consequence of failing to inform some prescribers that patients are using multiple drugs that can conflict your recovery.

“That’s actually the crux of a lot of what’s going on,” Metcalf said.

“This is a giant public health issue,” APT’s Madden remarked. “Citizens and community members wishing it would not be as big an issue as it is —  that doesn’t help things very much. We’re going to continue to do our part in terms of providing good information, providing treatment, and really optimizing care.”

Reyes called APT’s arguments “convenient.” He questioned whether “monetary gain” influences decisions more than “the individual progress of their clients.”

“I know they get paid every time they dose,” Harp added. “If they’re saying that they can show that the amount that they get paid per dose per visit is not adequate for there to be case management, they should be going to the legislature asking to get an added payment for behavioral health intervention. During the years I was in the legislature, I don’t remember them ever coming to ask for that.”

Madden said APT does regularly ask DMHAS for more funding.

The state monitors methadone clinics to ensure they follow these federal regulations. If they do, then they are free to pursue different policies based on what they consider the most effective approach. Mary Mason, a spokeswoman for the Department of Mental Health and Addiction, compared the process to the way doctors treat cancer. Some will advise chemotherapy or radiation more readily than other doctors will, for instance. As long as they follow the rules, as with clinics that distribute methadone, it’s up to members of the public to decide which approach makes sense for them.

Click on the video to watch the full episode of “Mayor Monday” on WNHH FM.

This episode of “Mayor Monday” was made possible with the support of Gateway Community College and Berchem Moses P.C.

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posted by: WakeUPNewHayHay on September 7, 2018  3:01pm

This seems more of a smear piece, on?

Plus, that methadone patient was seeking BENZOS, a DEADLY combo!

The clinics in others towns say NO to patients regularly, kick them out and back on the street.

They, in return, come to NEW HAVEN and APT BECAUSE of the their “harm reduction” model.

HARM REDUCING measures means you don’t just kick a patient out because they’re actively using.

APT is STABILIZING the community at large, taking on MANY MORE patients that others deny!

APT has multiple locations: North Haven and West Haven run VERY SMOOTHLY and almost every patient is SATISFIED!

The Legion and Long Wharf spaces are inner - city clinics with…. INNER CITY ISSUES!!

What don’t we get about this? There is a NEED for them within the community.

APT has a VOCATIONAL program, a walk-in clinic, psych services, an IOP,  and runs THE most diverse group therapy sessions of any clinic in the state.

APT also hosts MANY research studies that connect patients/staff to CURRENT theory and practices.

AKA: They’re ACADEMIC vs TOTALITARIAN - A proven success in the field!

The minimum standard is to medicate the population daily (to reduce harm in both withdrawal symptoms,  illicit use, theft to purchase illicit drugs) and to focus on a LONG TERM PLAN to walk off OR lower to a maintenance dose.

Coming off methadone too quickly can be terrible for a patient. Coming off too soon may also result in a relapse.

Why not talk with APT patients who AREN’T breaking the law? Those that take daily methadone but are also PRODUCTIVE members of society? The mothers, the teachers, the bank tellers.

That non-profit has saved MANY LIVES! They have also been a HOME BASE for a large number in OUR COMMUNITY that has NOWHERE ELSE LEFT TO TURN.

Yes bad eggs exist in the bubble in the Hill. But the HILL also has BAD EGGS NOT ON METHADONE.

Should we talk about the gun violence and the gang issue there too? No, not today? fine.

Thank you APT! Some of us know your worth!

posted by: clarkringone on September 7, 2018  3:40pm

Add that to the fact that the APT Foundation execs had to pay back a lot of $$ for double billing insurance providers. The drug use, prostitution and violence in the area of the APT foundation which is right next to an elementary school. The APT foundation is a magnet for crime.

posted by: AverageTaxpayer on September 7, 2018  4:26pm

If Waterbury’s drug users are coming to New Haven for more lenient access to methadone, something is really wrong with the picture.

Is APT going against the grain with their protocols because they have the addicts best interests at heart, or because they need the special human guinea pigs for the research they are conducting?

In any case, the externalities APT is generating is causing damage to New Haven’s social fabric. I mean why not open a satellite clinic in Waterbury, or better yet relocate there entirely? (In which case our multiple drug-using methadone patients could hang out and of drugs in downtown Waterbury!)

These APT patients aren’t being preyed upon by drug dealers. They are coming to New Haven not for drugs, (which sadly are available everywhere), but instead for the ability to get methadone despite dirty urine tests.

Regardless, the City needs to say “No!” to drug use on the Green. Instead the powers that be have allowed it to become normalized! And can I point out that allowing this population to congregate in one place isn’t helping anyone.

Good if the City is taking a hard look at the status quo. I would still like the Mayor and/or the Proprietors to tell us what changes are going to actually take place.

posted by: Patricia Kane on September 7, 2018  6:38pm

Where is the City’s LEAD program in all this?
I have no connection whatsoever to the APT Foundation, but I did spend time learning about new approaches to people with health issues, especially addictios, and the harm reduction model is the progressive model. Criminalizing and forcing people with health problems into the criminal justice system was a colossal failure.
Is it possible that every institution dealing with vulnerable people might be shown to have holes in their programs if we checked them one at a time?
Could we spare a few billion from our bloated military budget and have a Marshall Plan for our cities to set up housing, treatment programs, etc. and hire all the medical personnel to get the job done?
There are solutions, but the people in need are not the best advocates.

posted by: NHPLEB on September 7, 2018  6:44pm

All this drug addict wants is the methadone.  She uses other drugs and comes to NH because Waterbury won’t stand for it.  NH is the dumping ground for addicts.  We have to face facts.

Give them the methadone and send them home ; no loitering in NH—- ......Don’t bother with the excuses of not getting more “help”;  it’s cheaper to supply them than trying and failing to rehabilitate them.  They don’t really have the ability to stop so why torment them?
Maintain them till their lives end by natural causes.

posted by: 1644 on September 7, 2018  8:14pm

Wake:  Why not talk with APT patients who AREN’T breaking the law? Those that take daily methadone but are also PRODUCTIVE members of society? The mothers, the teachers, the bank tellers.

Those patients don’t need APT’s indulgent policies, because, being law abiding, their urine will be clean.  It the law-breaking patients that APT attracts.  Moreover, while the Hill certainly has its share of “bad eggs”, it doesn’t need more traveling in from Waterbury or other towns.  The basic question here is whose interests are paramount:  those of addicts, or those of the law-abiding population?  Both APT and NHPD are indulgent of lawbreakers.  I suspect North Haven does not suffer from the problems New Haven does in part because the people of North Haven would not have its police force take a hands-off attitude toward the problems addicts bring when they linger.

posted by: TheMadcap on September 7, 2018  9:03pm

“Give them the methadone and send them home ; no loitering in NH”

Okay, this is New Haven in 2018, not the Stalin era in the Soviet Union.

posted by: mmrmike1 on September 8, 2018  8:28am

@clarkringone, where were these concerns about an elementary school is next store when the BOE decided to build there. APT Foundation was there long before the school.
And to all who want APT to move, where should they put it? How about in your backyard? Maybe they should move to 165 Church St. so the mayor and her cronies can have a front row seat and see how all there wonderful ideas are going.

posted by: LEDGERDEMAIN on September 8, 2018  9:30am

@WakeUPNewHayHay “THE most diverse group therapy sessions of any clinic in the state.”  What do you mean by this and how does it help?

I have a family member who is a long term client of APT who is also addicted to benzos.  APT refuses to taper him. As I was reading this, I was thinking how his woes are identical to this woman’s.

posted by: yim-a on September 8, 2018  10:11am

No easy answers here.  As a nurse practitioner prescribing suboxone (another opioid replacement therapy) at a community health center (not in New Haven), I’m familiar with the dilemnas, ethical and otherwise, of the harm reduction model.

Some people cruise through the program. They have family and jobs that keep them occupied and engaged with the world.  Opioid addiction was a bump in the road (addiction after injury/illness) that methadone/suboxone helps to overcome.  Their urine drug screens are negative and soon we see them once every 1 or 2 months for a med check.

Many others are in way deeper than that.  Herion/opiate abuse is just the tip of the iceberg.  They struggle to provide a clean urine (without alcohol, benzos, cocaine) and need weekly med checks and counseling/psychiatric care.  Given the dangers of opiate use on the street, what competent clinician could conclude that discharging them from the program for consistently “dirty” urines (cocaine, alcohol, benzos) is a better option than continuing to engage them in the program? 

So, do we cherry pick the “easy” patients and then let programs like APT take the “bad apples”, the ones truly in need of harm reduction?  It’s not an easy decision, as the tough patients can take up alot of time and resources.  But absolute abstinence from all drugs is honestly an unrealistic goal for many, and so the worse of 2 evils is to engage in treatment while pushing for closer supervision and higher levels of psychiatric care.

posted by: NH06515 on September 8, 2018  10:13am

APT provides an essential service for the region and does a great job with a difficult population. It’s a full service operation providing full medical care, psychiatric, employment, and much more. A few points:

The women clearly has no ambition to remain clean if she has to visit the clinic 6 days per week. After 90 days with no dirty urines you can get your first take home bottle and within a year many patients visit the clinic once a week. Clinicians, in my experience, are always available. Also, they care. An appointment with a doctor is never more than a week away if you need it. By saying that she felt anxious she was probably hoping to get benzodiazepines, which are a class of drugs that can actually kill during withdrawal. They’re not an appropriate choice for most people on methadone. Not something you want to start taking if you are testing dirty.

Patients must typically do one meeting a month. This might not sound like much but there is a large cohort of patients who are stable, working, and have no immediate need for an intervention.

New haven is the logical choice for the hub in the treatment process but many patients then go to North Haven or West Haven (the spokes).

The big problem is that so many patients are “disabled” and don’t work. I don’t know how they live off of $700 a month but they find ways to supplement their disability payment; some legal some not. Where the client population is largely employed, like North Haven, there is no issue with people hanging around. And please remember that the North Haven clinic serves people from all over the state so it’s not just the “cream of the crop” white middle class working patients. It’s the same demographic mix as New Haven.

Bashing APT is unfortunate. The Mayor clearly doesn’t understand the addiction epidemic and neither do the cops. APT offers a lifeline off of heroin addiction that can be accomplished in one day. No red tape. And that is a huge asset to our community when it’s needed.

posted by: Ben Howell on September 8, 2018  1:58pm

Hey Paul Bass, APT is saving lives on a daily basis. There are several mis-statements and misconceptions about opioid use disorder, addiction, APT and medications for addiction treatment (like methadone & buprenorphine) in this piece. Feel free to reach out to people who are addiction experts at Yale and in your own backyard to accurately represent the evidence and addiction. Or interview more people (and not use NHPD/cop recordings) who get treatment. I would be happy to talk to you about the mistakes you make in this piece. I do not work at APT but a I am a physician who provides care to this population and do health policy research in this area.

1) Kicking people off methadone for other substances in their urine leads to an increase risk for fatal overdose and relapse.
2) Kicking people off methadone for benzodiazepines is the same. Yes, people should be tapered to a lower dose and have a discussion, but the alternative - using heroin and/or fentanyl from illicit market leads to fatal overdoses.
3) APT offers primary care, psychiatric services, group therapy, drug counseling. Your article implies that they do not which is inaccurate. 
4) The language of “dirty urine” reflects stigma towards people who use drugs and a fundamental misunderstanding of addiction and addiction treatment.
5) Long term opiate treatment with methadone is not a *failure.* It is the equivalent as telling a diabetic that staying on insulin is a *failure.* It is what works for many people.
6) Tapering people of methadone, especially within a year of starting treatment, is dangerous and should not be done cavalierly. Yes, all treatment decisions should be shared & led by patients, but the evidence is clear - tapering people off early leads to high risk of overdose death and relapse.

I am disappointed by Toni Harp’s lack of leadership, stigmatizing language and lack of understanding of the addiction treatment. I am also disappointed by the NHPD use of this tape recording.

posted by: NHPLEB on September 8, 2018  2:32pm

@ Madcap—-  Stopping people from loitering, buying drugs, urinating/defecating on streets,  begging,  fighting, overdosing is not a sign of Soviet -style dictatorship.  It is obeying our own laws.  Your reply makes no sense.  But let them come piss/crap by your house and call the police off if they come to help.  YOu like that in our city?!?!?! What are you thinking?!?!?!

posted by: Bumbershoot on September 8, 2018  11:15pm

APT is putting the priority on keeping people from overdosing and dying from heroin. 

That seems to be a good priority.

posted by: 1644 on September 9, 2018  8:56am

Stigma,  aka societal peer pressure, can be an effective deterrent.  We have reduced the stigma, and societal penalties for many behaviors which harm society, including illegal drug use, as well as “non-violent” crime.  This reduction may be good for the individuals who engage in these behaviors, but the resultant increase in the behaviors has been bad for society. As John Major said, “Society needs to condemn a little more and understand a little less.”  (Also from John Major:“It is time to return to those core values, time to get back to basics: to self-discipline and respect for the law, to consideration for others, to accepting responsibility for yourself and your family, and not shuffling it off on other people and the state.”)

posted by: NHPLEB on September 9, 2018  10:21am

Thank you 1644;  Adams was right and so are you!

posted by: TheMadcap on September 9, 2018  11:02am

How do you stop people from loitering in a city? I can’t wait for this answer


For the record, I have a good friend who like ledgerdemanin’s relative was told not to taper when he wanted to come off suboxone(after reachig that point from methadone), so he just did it himself anyways, and surprise, he got off. He had a full time job, was/is young, and ample family support, basically the ideal person not running risk of relapse, and was basically told, “no, you’re clearly very sick in the head and we need more of your time and money”(Disclaimer: i am not sure of which clinic he went to, but i believe it was in North Haven, which points towards APT)

posted by: NH06515 on September 9, 2018  11:58am

@1644

Stigma and norms of behavior evolve over time. Just because addiction has gone from a closeted issue that families struggle with and conceal, to a medically recognized illness, doesn’t speak to a decline in society’s moral fiber. It’s just no longer acceptable to deny the huge toll that addiction takes of families, employers, the government and the individual. It impacts every facet of life. Literally. Just like any other illness. And saying that an addict needs to take some responsibility just misses the point entirely. Most addicts desperately want to stop the chaos of addiction. They can’t. Methadone, wether temporary or permanent, offers that break so the addict can reassess and make better choices.

I don’t think that reducing the penalty by taking away criminal sanctions and stigma has any impact on an addicts behavior. And the removal of such sanctions has thus far been limited to marijuana at the state level. Countries that have experimented with decriminalization across the board for all drugs can plow the criminal justice money straight into treatment and housing and vocational services. Sounds reasonable to me. Our 100+ years of criminalization seem to have failed in every way and ruined so many lives.

More importantly, your post neglects that ideas, values, approaches and science evolve and change over time. Our ideas about race, gender, equality, tolerance, and a million other topics are constantly evolving. I continue to learn and see things far differently than I did even 10 years ago. And it’s ok for views to change over time. It’s a maturation process to be able to reconsider deeply held beliefs and reassess your position instead of staying wedded to concepts that may have no justifiable underpinning other than that they were widely held beliefs at some previous point in time.


Personally, taking a compassionate approach to addiction (up to a point) makes sense from every perspective.

posted by: EarlyBird on September 9, 2018  2:07pm

It would be instructive for a member of the NHPD to board the J Bus from Waterbury some weekday morning. Open your ears for just a minute, and you’ll find out who’s holding, what they’re holding, and where to find them after you get your methadone. I feel for those coming to APT genuinely seeking to end their addiction, but a good portion of them are career dealers and life-long substance abusers. Something needs to be done.

posted by: narcan on September 9, 2018  2:18pm

APT can’t afford counselors? It doesn’t sound like they can afford to provide the services they offer then. If they are just going to recklessly provide drugs to addicts without the accompanying services necessary to actually quit, then perhaps a state law or city ordinance mandating full spectrum services is needed.

Maybe they should disclose their finances so the public being impacted by their policies can be assured they are providing the best care possible for their clients and the community at large.

posted by: 1644 on September 9, 2018  4:09pm

NH06515:  I would agree that stigma will not change an addict’s behavior, although incarceration will stop the addict from preying on the general population to support his addiction.  Stigmatizing and punishing drug use, however, can and has reduced the number of those who become addicts.  By lessening the consequences for bad behavior, we increase the number who will engage in it. 
  I, also, agree that societal norms and stigma change, but assert that not all of these changes have benefited greater society.

posted by: Politics 101 on September 10, 2018  12:08pm

Ben Howell: I appreciate your input. It seems to be well-informed and grounded in science. It ignores, however, a basic component of the equity conversation here in CT. The APT Foundation has an impact on the surrounding neighborhood. Folks from the suburbs and other CT cities come to New Haven for their methadone. Afterwards, they don’t exactly stop by Zinc for dinner. To the extent that they engage in criminal and nuisance behavior (and by all accounts some of them do), the brunt of that falls on a disproportionately poor, disproportionately minority city. I am sympathetic to the voices who ask why we in New Haven are paying to clean up after people who live in Wallingford but take their methadone in New Haven. And if the APT Foundation’s policies, whether or not they’re grounded in science, cause North Haven addicts to wave goodbye to Len Fasano for the day and take the bus to New Haven, then I’m not sure what to make of those policies. Something tells me that neither you nor the APT Foundation execs who make six figures live on Congress Ave. Maybe if they did they’d find some money for some counselors and additional security guards.

posted by: challenge on September 10, 2018  3:23pm

Wake up: Thanks for the morning humor. It doesn’t take rocket scientists to figure out why people with addiction problems from across the state come to New Haven. They come because they can continue to use and actually obtain another drug in the process when programs in their own community refuse to enable them. Many towns and cities won’t even have these programs in their community normalizing drug use. The only people who support APT services are those receiving a paycheck to keep this ferris wheel going. Anyone who doesn’t see problem with APT being located right next door to an elementary school I suggest they move it next to their children’s schools. Unfortunately too many decisions made at City Hall are made without community input and so by the time the community realizes what’s coming to their community the contracts have already been signed.

posted by: Ben Howell on September 10, 2018  3:53pm

Politics 101: I agree and sympathetic to the concerns of residents in Hill North. And you are right, I do not live on Congress Ave (I do live in New Haven & pass through downtown/the green on a daily basis). There is a problem but scape-goating addiction providers and all the clients they serve is not the answer.

I would argue that current policies that concentrate safety net services & especially drug treatment programs in lower-rent neighborhoods are the larger problem and our ire should be directed accordingly. Federal regulations on addiction providers/opioid treatment programs that restrict the types of care they can provide. Lack of leadership from DHMAS and the state on increasing MAT services. Lack of leadership from the city in conjunction with stigma, attitudes & NIMBYism that keeps clinics out of well-to do neighborhoods & towns.

Did you know that in other countries (Canada & UK for example) methadone for addiction can be dispensed at pharmacies and/or out of primary care offices? Also, many methadone providers through out the US are situated in neighborhoods without problem. It’s the concentration of services that’s the problem.

The state and our country are in the midst of opioid use and opioid overdose epidemic & the numbers in Connecticut are going in the wrong direction. Our neighboring states that have expanded methadone & buprenorphine services (VT, MA, RI) have had decreasing overdose deaths in the last year. Connecticut (& New Haven) needs to follow.

posted by: opin1 on September 10, 2018  11:24pm

APT and other treatment providers need to standardize the treatments at each of their locations.  If the services provided in New Haven are what they deem best practice then they need to do the same in all the other towns. It shouldn’t be easier to get methadone in New Haven than in Waterbury or anywhere else; the treatment should be consistent between different providers.

Its absurd to think that the best thing for the woman arrested is to spend, what, 3 hours of her day sitting on/waiting for buses to get to New Haven for a treatment SIX days a week for muliple years!  What kind of life is that?  How could she ever get a job if she has to spend 3 hours traveling to and from New Haven everyday for her fix?  How could a person ever overcome depression having to do that every day for such an extended period of time?

posted by: NH06515 on September 11, 2018  12:13am

APT Foundation’s locations make sense.I can remember buildings on Legion/Frontage, Boulevard, Congress, and Long Wharf. All were on bus routes. Legion and Congress have easy access to supplemental medical services (specialists, research facilities, hospital, etc). Boulevard had easy access for the homeless shelter and proximity to West Haven. Long Wharf, the base of operations, has similar ease of access for all transportation and is close to the Yale medical campus.

If anything, APT should be growing. I can’t imagine that anyone is getting rich providing these services to the population it serves. And it’s totally inappropriate to ask a business to open its books to the public so someone can see if enough money is being spent on one item or another. There are strict regulations ( federal and state) that dictate every aspect of a methadone clinics programming. Sure there will be variation from operator to operator, but the basics are the same. I’m sure that staff, rent, and legal compliance eat up a huge proportion of APT’s operating budget and that every year is a budgeting challenge for the company.

Addiction treatment is an essential service now. The opioid crisis and the overdose crisis requires the presence of a treatment modality that is local and easy to transition to. Anyone who thinks methadone is just substituting one addiction for another doesn’t know the first thing about addiction. Sure, abstinence may be a goal for some, but it’s not realistic for all people. Over the years, I have known lawyers, doctors, fireman, and a myriad of other educated, decent people who have chosen methadone maintenance over active addiction. And it’s the right choice for them. And for many others. Far better than continuing with active addiction.

I wish there was more compassion. No one minimizes the impact on the neighborhoods that house the clinics but work together for solutions.

posted by: Politics 101 on September 11, 2018  9:08am

NH06515: According to the 2017 990, three APT Foundation staff members make more than $200,000/year, not including compensation from other sources. Yes, that’s rich. In any event, I think everyone on this thread is trying to work together towards solutions—what makes you think they’re not?

posted by: Patricia Kane on September 12, 2018  12:38pm

Portugal decriminalized all its drugs and both crime and drug use went down. People who cannot end their addictions are put on maintenance doses. Treating addiction as the public health problem it is (first popped up in towns whose industries had moved to cheaper out of country labor), is the only approach that works, but those making money off incarceration and forced labor of prisoners won’t tell you that.
  APT appears to be on the right track, but one agency can’t provide the housing and other health services this needy population requires. That is a societal problem and we have not committed sufficient resources to people, but to weapons and a bloated military budget.
  What we see on the streets of New Haven is a failed political commitment at the highest levels of government to dealing with the economic damage that only briefly touched Wall St, but resulted in job losses, foreclosures and evictions while the stock market boomed.
  Stop blaming an agency that understands the “harm reduction” approach.
  Start asking officials what is happening with LEAD?
  Before you vote, ask the candidates whether they see addiction as a public health issue and are they prepared to seek funding to provide housing and treatment.
  Stop blaming the victims.