Homicide Ratchets Up Methadone Clash

Christopher Peak PhotosOn a recent morning in the Hill, dozens of recovering drug addicts waiting for methadone at a clinic spotted a man with purple latex gloves on, waiting with a knife. Days later, the man returned and fatally stabbed his target 16 times.

That homicide on Congress Avenue sparked renewed tension in a longstanding dispute between a methadone clinic with a progressive reputation for treating opioid users spurned elsewhere, and the cops, school parents and neighbors with worries about the crime and homelessness that beset the area.

The problem of drug dealers, prostitutes and recovering users loitering outside the APT Foundation’s central methadone dispensary at 495 Congress Ave. was supposed to be solved by now. State and city officials have been meeting with the not-for-profit clinic’s leadership for months to address the situation, spurred by a greater number of homeless individuals camping out on the Green this summer.

Amidst an opioid crisis that’s expected to kill 1,100 Connecticut residents this year, Hill residents are asking where a life-saving methadone clinic belongs and how it should operate.

Should patients have to live in New Haven to get methadone? Should the clinic reject those who keep coming back with dirty urine, the way clinics in other communities do? Should security guards do more to clear out loiterers?

And should the clinic do more to coordinate with pre-K-8 John C. Daniels School of International Communication right across the street?

If those questions didn’t look pressing before, the fatal stabbing on Saturday, Oct. 7, underlined the urgent need for answers.

Mid-Morning Homicide

FacebookEarlier this month, APT Foundation patients witnessed a spat over a woman turn deadly, after a woman’s current boyfriend slit her ex-boyfriend’s throat.

Daniel Streit, a 33-year-old who goes by “Cracker Jack,” had recently been released from jail, where he was doing a 22-year sentence for four felonies he’d committed during a 2008 crime spree, including second-degree kidnapping, criminal possession of a weapon (with a scratched-off serial number), and first-degree robbery. Streit served only about a third of the time before he was released and moved into an apartment downtown on Chapel Street.

“Fuck the DOC! I’m finally free,” he wrote on Facebook in January.

Streit started dating a 36-year-old West Haven resident, who said she works as a legal secretary and gets treatment at APT Foundation. She claimed she’d been mistreated by her ex-boyfriend, Keith Wylie, a 51-year-old Edgewood resident (who described himself on Facebook as a “Retired PIMP”). She claimed Wylie had been stalking her since their breakup three weeks prior in violation of a restraining order.

A few days before the homicide, Streit confronted Wylie at the APT Foundation, according to several witnesses. They fought, and Wylie knocked him unconscious.

The men ran into each other again on Saturday, Oct. 7, but this time, Streit came armed. Around 10 a.m. that morning, Streit pulled up in front of the APT Foundation, and Wylie arrived in his blue Chrysler 300 down the block. Streit was wearing the same purple latex gloves observers had seen earlier that week; he said they were to protect his hands after the last fight.

By some accounts, Streit flipped into a rage and cursed at Wylie for “messing with [his] girl”; others recall Wylie saying, “We’re going to finish this right now.” They tussled, pushing and grabbing onto one another.

Witness testimony and surveillance footage show that Streit produced a black, five-inch blade from a leather sheath around his waist. He stabbed Wylie in the stomach and arms 16 times, then sliced his neck open. They both fell to the ground, with Wylie on top. Streit yelled out for someone to help pull off Wylie — whom he referred to by the N-word, according to the girlfriend’s report to police. (Streit is white, Wylie black.)

Streit and his girlfriend then both fled on foot. He stripped off his red Spiderman sweatshirt, threw it into some bushes, and put on his girlfriend’s hoodie. He tossed the gloves and the knife’s holster, too.

Police officers arrived around 10:35 a.m. The first responding officer, Vanessa Thompson, described the scene as “total chaos.” A large crowd flagged her down, and she found APT staffers trying to staunch Wylie’s injuries as he bled out onto the sidewalk.

By 11:21 a.m., not long after the ambulance reached the hospital, Wylie was declared dead.

FacebookThe family remembered him as a Navy veteran, a fan of older-model cars, a prankster, and a 20-year volunteer baseball coach for the Walter “Pop” Smith Little League. He was clean at the time of his death, they claimed.

“My brother doesn’t even drink. If he has a beer, that will get him drunk,” said Nadine Wylie Gore. “I don’t know what happened, but he’s never done drugs. He’s helped out a couple of druggies with food and money, but he’s never been a patient. He was too involved with the kids.”

Three cops (including two detectives who’d been posted near APT in an unmarked vehicle) tracked Streit and his girlfriend down York Street, guided by citizens who pointed out where the couple had headed. When they spotted Streit, officers noticed his clothing and bald head were both covered in blood, and his hands were stuffed in his front pockets. Right outside Yale New Haven Hospital, two officers — James Feliciano and Edrick Agosto — unholstered their handguns and put the couple in handcuffs.

In custody, Streit was sobbing and suicidal, according to officers. “Streit repeatedly cried out that [Wylie] ‘got what he deserved’ and that he does not regret what he did,” Officer Paul Prusinski wrote. Another witness reported Streit saying that he was going to get 30 years in prison “because his rap sheet is longer than his dick,” according to a detective’s write-up.

FacebookCharged with first-degree manslaughter, Streit’s being held on $500,000 bond. His next court date, later this month, will be at the state courthouse at 235 Church St., where more serious cases are handled. He has not yet entered a plea. The police report quotes him as saying he “blacked out” during the incident. He claimed Wylie had the knife, which he seized, and then stabbed Wylie in self-defense.

Ashley Stillwell, 29, a friend of Wylie, had been hit hard by the killing. After maintaining sobriety for five years, she recently relapsed. One recent morning, she sat on the ground across the street from APT with her head in her hands. Shortly after noon, she took swigs of cheap vodka. A one-time tenant at a supportive housing complex in the Dwight neighborhood, Stillwell said she has since been forced onto the streets.

“I’m lost right now,” she said.

Cheri Stannard, a 42-year-old with a physical disability who’s watched over Stillwell like a surrogate mom, said she hopes her friend gets back into treatment. She knows from experience that the program works: APT’s methadone personally helped her check her pain and avoid other opiates for over two decades, she explained.

“They help,” Stannard said. “They’re a very good clinic.”

“Life-Saving Care”

Harold Shapiro/Yale Law School

APT’s clinics offer “medication-assisted treatment,” which experts widely accept as the most effective way to treat opioid addiction.

An addiction to opioids, like prescription painkillers, heroin or fentanyl, rewires the brain’s reward circuitry, keeping a person hooked on the drug. Medications like methadone and buprenorphine replicate that effect on the brain chemistry, easing the miserable feelings of withdrawal. They work over a long period, without the quick high.

“What it does is help with some of the craving, so you can focus on other areas of your life,” explained Kathryn Hawk, a Yale assistant professor whose research focuses on connecting overdose survivors to treatment.

There are now over two dozen methadone clinics in Connecticut, five of which are in New Haven, according to state listings. The APT Foundation is one of the biggest providers, serving 7,900 people across all their facilities last year, said Lynn Madden, the executive director. At 495 Congress Ave., APT has 1,900 patients on the rolls.

APT’s main innovation has been reducing wait times. Anyone who shows up before 11 a.m. for a walk-in evaluation — usually at their location on Long Wharf Drive — will usually start medication-assisted treatment the same day.

That’s essential because research has shown that there’s about a 72-hour window after a person expresses a desire to get clean before addiction takes hold again, Madden said. Missing that chance to reach someone with opioid use disorder can be particularly dangerous, since the person will likely get high inconsistently, increasing the risk of an overdose, she added.

In addition to methadone (and, at 1 Long Wharf Dr., buprenorphine), APT offers between 15 to 25 group-counseling sessions daily at each location as well as a suite of other services to help recovering addicts get their lives back on track.

At the 90-day mark, about 80 percent remain in treatment, Madden said.

“Without question, APT’s work has saved lives in our community,” Hawk said.

“They’ve been a leader in expanding access,” added David Fiellin, a Yale professor who’s leading a task force to overhaul the state’s response to the opioid epidemic. “There are few programs that have been able to make the types of strides that they’ve been able to make. It’s the extent to which they’ve expanded their census, the extent to which they integrate medical and psychiatric care within their facility and the extent to which they provide same-day entry into treatment. It’s really very unique, and it shouldn’t be taken for granted. It’s not many programs in the country that have the extensive array of services that they have.”

According to its most recent tax return, APT Foundation pulled in $28.2 million in revenue in 2015. The bulk of that many comes from third-party reimbursements for its services ($20.5 million). The foundation also raises significant funds from government grants ($6.5 million), donations ($760,000) and patient fees ($389,000). About three-fifths of the money goes to employee salaries, including $272,420 for the CEO and $201,968 for a psychiatrist and $189,359 for the medical director.

“We’re not in this business to make money,” Madden said. “We give away treatment — lots of treatment — because it’s life-saving care, and people need it.”

City officials argue that APT could do more, with its multi-million dollar budget, to take some ownership of the surrounding neighborhood.

Prior to the murder, the city held at least three meetings with APT’s staff in recent months, Mayor Toni Harp said on a recent edition of WNHH radio’s Mayor Monday program.

“It’s a really complex issue to try to work out. But we’re working vigorously on this,” Harp explained. “I believe we are beginning to get the ear of the APT Foundation around how critically important it is ... that they treat their patients with more dignity and that they don’t have a lot of people out here on the Green and really out on Congress Avenue menacing the young people who are going to school. It’s a problem, and their practice model has got to be addressed.”

Wider Social Context

How much responsibility does the APT Foundation have for the bloodletting right in front of its property? The not-for-profit’s leadership said that it can’t control the neighborhood outside their facility.

“I don’t think you can lay it at the feet of a substance abuse treatment program. My staff responded, even though they didn’t need to [in order] to try to save this guy’s life,” Madden said. “The media often continues to perpetuate this idea that somehow treatment programs are responsible for all the other social problems in a community.”

She pointed out that methadone clinics are often pushed into neighborhoods where poverty and crime area already pervasive.

“It’s very difficult to locate [methadone clinics] because neighbors don’t want them there. Generally speaking, they end up in not very good neighborhoods, where are you so-called ‘allowed’ to locate,” Madden said. She pointed out that the Hill neighborhood has long been “troubled.” “It’s not about APT Foundation,” she argued. “Identifying every vagrant or person who looks unwell as someone who’s a patient of the APT Foundation, which I know that some people have done in writing, is a ludicrous idea.”

Even if some of APT’s patients do cause problems, denying them care wouldn’t be any better, Madden argued. “The view of a handful of people that, somehow, we should not have any persons in need be seen in New Haven, I think, is discriminatory and unfair,” she said.

The mayor has questioned whether the problems around APT are endemic to the Hill or are being created by APT’s service model.

“So many people come into New Haven to get drug treatment,” she said. “We’ve been working most recently with the APT Foundation to try to figure out what their practice model is and why there are so many people who come here to get methadone from that particular program, hang out on Congress Avenue and then on our Green.”

Madden acknowledged that suburban clients come into the Elm City for treatment. That make sense, she argued, since smaller towns don’t have the capability to provide the same form of speciality care. “There’s no alternative: You’re not going to build a program for five people,” she said.

But Madden also said the not-for-profit is working on redirecting services to satellite facilities. For example, APT opened a West Haven facility this summer. Due to an 18-month hold-up in approving the program’s eligibility for Medicaid reimbursements, however, the clinic has been unable to serve any patients covered by the government, which make up about 60 percent of the usual clientele, Madden said.

Methadone’s Not the Only Drug

Christopher Peak PhotoThe mayor has argued that something else seems to be at work in the APT Foundation’s draw. Harp said she believes the Congress Avenue clinic has an influx of patients traveling from far away because it is more lenient than other clinics. “It looks like they have a harm-reduction model that allows them to use other drugs as well as methadone,” Harp said. “We’ve been very concerned about that.”

APT said it follows the same federal guidelines that all methadone clinics must follow.

According to the feds, an initial medical evaluation must simply confirm a diagnosis of opioid use disorder (through signs like faded needle marks or an eroded septum). That consultation, along with subsequent blood work, a psychosocial assessment, the formation of a treatment plan and a patient orientation, must all be completed within two weeks.

After treatment begins, the patient must submit to at least eight random drug tests a year, the regulations demand. According to the feds, failing piss tests might affect the dosage or take-home privileges, but any one test result should not be the reason for forcing patients out of treatment.

Madden said that the clinic doesn’t kick out patients for relapsing.

“Why would you kick them out for relapsing, when that’s a symptom of the illness in the first place? Where are they if you kick them out of treatment?” she said. “Relapse is normal. We try to help people stay in treatment.” Madden added that those caught committing violence or participating in the drug trade are normally discharged from the program.

Asher Delerme, the executive director of CASA, Inc., another methadone provider in New Haven, said it would be highly unusual if APT deviated from the guidelines. “We’re all pretty much on the same page,” he said. “I would be shocked if they weren’t following protocol on that.”

“Sitting Ducks”

If anything, Madden said, APT’s patients are “sitting ducks” for drug dealers looking to capitalize on their addiction.

Hang outside the APT Foundation for an hour, and you’ll be propositioned anti-anxiety meds (benzodiazepines like Ativan and “sticks” of Xanax) or stimulants (like crack and cocaine). That open-air drug market isn’t helped by a liquor store that opens at 9:30 a.m. every weekday, and even earlier on Sundays, nor a convenience store that cops busted for selling hypodermic needles.

The dealers’ presence turns off some patients. “This block has been really bad. I come here to try to get better, and I hear, ‘You need crack? You need dope?’” said Jennifer, a 44-year-old New Haven resident. “Why would you do that in front of a clinic?”

Lt. Jason Minardi, the district’s top cop, said he has had to post cops to the location near constantly to keep crime under control.

Last year, emergency responders answered a 911 call at APT’s address about 4.6 times every week. That’s 239 calls for service in all: 108 to police and 131 to paramedics, according to numbers provided by Rick Fontana, deputy director of the city’s emergency operations. Those figures don’t include calls to other addresses on the block that would balloon the total, Minardi added.

Due to that volume of crime, Minardi suggested that APT look into other locations that might be better suited for its growing clientele.

“They’re not being good neighbors,” he explained. “I’m not against what they do, but they’ve outgrown that facility. They should find a place where their clients can’t be distracted, like an industrial area where they can come and leave.”

At the very least, the department brass want APT to pay for an extra-duty officer to be stationed out front, as the foundation once did.

Madden said they switched over to an unarmed security force around 2010, after the police union rewrote their contract. Under the old system, the same group of extra-duty cops were assigned to APT, allowing them to get to know the staff and clients, but the change in rules meant that officers would be randomly assigned, “not any regular rotation of people,” Madden explained. The nonprofit would also have to chip in for overtime costs, a figure they estimated would cost an extra $300,000 annually.

“We couldn’t afford that,” she said.

Neighbors Weigh In

While Madden might differentiate the clients from the criminals outside the APT Foundation’s doors, many neighbors view the entire milieu as one and the same. But even then, opinions diverge about how to address the situation. Some neighbors press for the clinic to be booted from the neighborhood; others propose a change in operating hours or the clinic’s programming.

Last week, several local alders voiced their concerns about the stabbing during the Hill North Community Management Team’s meeting in the cafeteria of Career High School.

“The APT Foundation has been a problem for years now,” said Hill Alder Dolores Colon. “And it has escalated into something that is truly unacceptable. We have children in the area who shouldn’t be exposed to this kind of behavior. It’s a really damaging thing to be exposed to this at any age.”

Dave Reyes, another Hill alder, agreed, saying that his constituents have been reaching out to him all week to share their concerns about the fatal incident.

Minardi said he’s most worried about the children next door at John Daniels School, who “have to walk through a maze of drunkards” just to get to class each morning. This summer, kids working in the school’s butterfly garden were rushed inside after someone overdosed right across the street, several parents said.

Madden said APT’s in talks with the school about changing the operating hours to avoid the students’ drop-off and pick-up. Principal Daniel Bonet-Ojeda, a new arrival this year from Puerto Rico, asked for the APT Foundation to hold an open “sit-down” with the community, where “they can explain the project, reiterate their commitment to the community and come up with practical options for everyone.”

In the past, APT’s been reticent about meeting with the school’s parents. A father of two students, Sylvester Salcedo, a veteran of the War on Drugs as a Navy intelligence officer in South America who became convinced that the government should offer heroin at safe injection facilities, said he has tried to get a meeting with Madden four times without luck. Salcedo doesn’t want to see the facility closed down; rather, he wants to talk with her about litter. He envisions a jobs program, where APT patients could clean up wrappers, bottles and cigarette butts that clutter the corner for a small payout. Parent volunteers could even match their workforce.

“I had the idea like a corner patrol group to develop a neighborhood working relationship,” he explained. “But I can’t even get the idea across because I can’t talk to Lynn Madden.”

While he didn’t want to capitalize on a tragedy, he said Wylie’s murder would force uncomfortable conversations — a change he’d welcome. “It will usher in a platform for anyone in the neighborhood to have a true, open, honest dialogue about what’s going on in the neighborhood,” he said.

Thomas Breen and Paul Bass contributed reporting.

Tags: ,

Post a Comment

Commenting has closed for this entry


posted by: DerbyRam54 on October 17, 2017  3:07pm

Quite why APT should be held responsible for what goes on outside its facilities is a mystery. But there is a bigger mystery in the drug treatment world and that is why other options such as Vivitrol (a monthly injection) and the Bridge device are not being studied more aggressively.

Vivitrol requires a patient to be clean before it can be administered, the Bridge device complements it by helping a patient get to the point where they can have a Vivitrol injection (hence the term).

The biggest problem with the Bridge is the lack of a solid study into its efficacy despite growing evidence that it is well-worth such a study.

The two devices together might well reduce the need for daily visits to the methadone clinic. Of course, that would disrupt the revenue streams for an outfit like APT and its suppliers.

posted by: Ben Howell on October 17, 2017  3:59pm

@DerbyRam54 - naltrexone (vivitrol) - a opioid antagonist - has been studied thoroughly and has consistently been shown to be inferior to methadone and buprenorphine (suboxone) - full & partial agonists respectively - for treating opioid use disorder. Frankly, methadone has always & for many years been shown to be best treatment (decreased relapse, decreased death, cost-effective).

Not the main point of the article, but I am concerned with Mayor Harp’s comments included here - she’s trying to have it both ways. Acknowledging that APT has a harm reduction model - which saves lives - but then points to that model being a problem. She also, wants APT to “treat their patients with dignity” but in the same breadth stigmatizes APT’s patients for all the problems on the Green. How’s that for treating them with dignity?

posted by: yim-a on October 17, 2017  8:43pm

suboxone.  Can be prescribed by any MD or NP with a special license (takes about a day to certify) and then prescribed at a regular primary care/internal medicine office.  For many (if not most) works as good if not better than methadone (less sedation).  Once person is on solid ground, they stop by the clinic once a month or even two for a prescription, none of the stigma of waiting outside the APT (or SCRC) clinic for your morning methadone (“the liquid handcuffs”). 

So, a question, how many primary care providers at the outpatient clinics serving the medicaid/uninsured population are licensed to prescribe suboxone and actively accepting and managing patient on suboxone?  How is the city helping to promote this alternative approach to treatment?

posted by: Christopher Peak on October 17, 2017  10:12pm

@yim-a: Good question. There’s a lot of info about buprenorphine, a proven form of medication-assisted treatment, that I didn’t get to include in the story.

APT Foundation does prescribe buprenorphine from their Long Wharf Drive clinic, where patients are directed for their initial assessment, though I’m not sure if its clinicians would write a prescription for Subutex (a single ingredient) or Suboxone (mixed with anti-overdose naloxone). David Fiellin, the Yale professor, said that’s “fairly unique” for a methadone clinic to offer buprenorphine, because others across the country run into difficulties setting up insurance reimbursements. At APT, “It gives the patients a choice,” he said.

How do clinicians choose which drug is right for a patient? There’s not a clear set of criteria, Fiellin said. “My bias, as a clinician, is to start with buprenorphine, because it is a partial agonist,” meaning it has limited effects on the brain’s opioid receptors, compared to heroin, methadone and similar drugs, Fiellin said. “And if they don’t do well, they might need a full agonist, and I’d recommend they move to methadone.”

The state’s task force that Fiellin’s leading is working to increase access to buprenorphine in several ways: (1) They’ve made sure that insurers, including Medicaid, cover medication-assisted treatment, and that they don’t arbitrarily limit the duration or dosage — conditions which other states impose that aren’t based in scientific evidence. (2) They’ve conducted eight-hour trainings in areas with high overdoses death rates to get more physicians and nurses licensed to prescribe buprenorphine. (3) They’ve made mentors available to help answer questions, aimed at older doctors who didn’t learn about treating opioid use disorder back in medical school.

I’m not sure what the city has done, because the mayor’s chief of staff, Tomas Reyes, did not respond to a request for comment.

posted by: THREEFIFTHS on October 18, 2017  5:11am

Methadone is nothing more then a cash cow.My wife uncle who is a doctor in the 70’s own all of the methadone clinics in Harlem and Brooklyn.In the 70’s methadone clinics were big do to the heroin addiction .This greedy Judas Goat made so much money off of those methadone clinics that he has houses in Jamaica Trinidad and Tobago Cayman Islands Barbados and even one in the French Riviera .He told me all Methadone does is keep people dependent on opiates.One time I was at his home in Barbados.This greedy Judas Goat told me that as long as the Government supply the bread.He will supply the soup line.Like I said methadone clinics are noting more then cash cows.

posted by: Acer on October 18, 2017  8:22pm

The “drugs as medicine” business should move away from the school as quickly and as far away as possible.

posted by: Schiavis1959 on October 18, 2017  8:40pm

Educate, offer, and make all 3 MAT’s available and accessible to those wanting recovery.  CT does little to offer Vivitrol and the medical device, The Bridge, which would make it possible to get Vivitrol, without incarceration or treatment.  And btw, do they tell addicts how difficult it is to get off suboxone and methadone once started.  Granted, better than opioids, but provide info and access to all, especially Vivitrol. It is the only medication that worked for my son.  Read personal testimonies on fb, vivitrol treatment group.  It’s not an opioid and allows the brain to heal.

posted by: challenge on October 19, 2017  3:07pm

People want to talk about how effective the drugs . I want to know how a drug treatment program catering primarily to suburban clients continues to operate next door to an elementary school. Suburbs don’t want those programs in their communities and they sure as hell won’t have them next door to their children’s school. The shit New Haven puts up with. Does it take a murder for the mayor to address. Will Madden move her program next door to her grandchildren’s school?

posted by: theNEWnewhaven on October 19, 2017  9:18pm

This clinic has been here longer than the school has been there….

Maybe the school should move.

ALSO, this clinic is a harm reduction program for OUR COMMUNITY.

Imagine what these patients at this MEDICAL CLINIC (they do MUCH more than administer a daily dose of methadone) would be doing to MAKE the money needed to keep their illegal drug use going.

Probably a LOT more than a lover’s quarrel turned violent. Especially MORE for those not involved.

SMH, this is probably the BEST thing that could be happening for the MANY MANY people in NH that are addicted to opioids. New Haven’s overdose deaths are MUCH less that it would be thanks to programs like this.

How about we talk about all the other murders in town made by the drug dealers? Those EVERYDAY New Haven issues, I find, are much scarier are IMPORTANT for the health of this community than a methadone clinic’s neighboring sidewalk.

posted by: challenge on October 20, 2017  8:20am

The first bad idea was to build a school next door to a drug treatment program and a package store. The area was already in decay adding an elementary school in the mix was plain ludicrous. Even as bad as it was it was never as bad as it has been for years with the influx of addicts form neighboring towns filling the area. Early morning and afternoon both sides of the streets are lined with addicts hanging out arguing, using profanity, buying and selling drugs and just being downright obnoxious and many don’t live in New Haven. The program is a privilege that predominately whites receive rather than face a jail cell. The New Haven green is another hot spot. The murder simply forced the mayor to talk about it. As I said the talks will disappear into the night as quickly as they started. One might argue how beneficial is the program when you see the condition of those who exit the program and pour onto Congress Ave. West Haven where many of the addicts live fought to keep it out of their town. Even though they lost the battle they are not serving addicts there. Why? Because people don’t want that in their towns and cities. They choose to send everyone to New Haven where the people’s voice is ignored. Same issue with the gun firing range. No one wants one in their town and so it sits in New Haven where black and brown children live and attend school because although residents have begged for years to move the range their voices are ignored. And yes let’s deal with drug dealers. Will that include the ones in white coats who prescribe addictive drugs like candy? I didn’t think so. In response to the stream of addicts lining Congress Ave can we move the program next door to an elementary school in Westville, Amity, Whitney, Prospect, East Shore or East Rock area or where Madden or you live? I think not. Black lives matter too.