Life And Loss On Methadone Mile – Boston Globe

I found the following article in the Boston Globe – it is a powerful description of what addiction is truly about.  The lives it takes hostage and the unbelievable pain and suffering of those addicted. And of those who love them.

You will read about men and women,  who would do anything to be free,  but the all consuming life of addiction keeps them chained.

This article follows one area of horrific pain.  But truth be told,   this story could be about many communities – Vancouver’s Downtown East Side, Surrey’s Whalley Strip, Edmonton, Calgary, Winnipeg, Toronto, Halifax , Los Angeles, Miami, – this health crisis has taken lives hostage across all boundary lines.

For twenty-three years my son was one of those hostages.  He tried dozens of times to walk away.  Detox, treatment, harm reduction.  A family who loved him deeply and would have done anything, given anything, to help him.  Each and every time he said he had enough, he meant it.  Everytime he said he wanted help, he meant it.  I never doubted that for a moment.  That is what he wanted.  His addiction had other plans.

This article by Nestor Ramos and Evan Allen is a real depiction of addiction, loss, lives devastated and surviving one day at a time.  It is worth reading.

 
LIFE AND LOSS ON METHADONE MILE a section of Massachusetts Avenue known as Methadone Mile.
BY NESTOR RAMOS AND EVAN ALLEN
PHOTOS BY KEITH BEDFORD

Last night’s needles line the sidewalks at dawn along the blighted blocks where Massachusetts Avenue and Southampton Street meet. People emerge from shelters and halfway houses and trudge toward the methadone clinics that lend this place its ugly nickname.

An open-air drug market is in full swing on the corner outside a convenience store, where offers of drugs trill like music. “Clonidines-Clonidines-Clonidines-Clonidines!” “Does anybody need Xani Bars?” Phenergans, Pins, Johnnies? A man grimaces one chilly morning, unsteady on his feet. He opens his mouth to reveal a knotted bag of heroin, double-wrapped and ready to be swallowed should police wade into the crowd. “This is all I have left,” he says.

Some come to this sad section of the city to get high, slumped on street corners and shooting up between parked cars. Some come to get clean, ducking into low-slung clinics where they swallow the fuchsia medicine, sweet and bitter at once, that frees them from heroin’s grasp. The people here call it Methadone Mile, and it is the congested heart of Massachusetts’ raging opioid crisis.

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Those working toward recovery at the many clinics and services here try to steel themselves against the streets outside. On the mornings when she must brave the chaos, Alyssa Bowman swallows her 80 milligrams of methadone and walks to work quickly, eyes on the ground and earphones stuffed in her ears.

Like many of the others who populate this place, Bowman, 35, is passing through on her way to somewhere else: A life with her children, a return to her career as a dental assistant.

Clean at 23 thanks to daily methadone treatments, she relapsed about a year ago with a seven-month binge of alcohol and benzodiazepines, a type of tranquilizer, that destroyed her life and her liver. By March, she was living in a nearby halfway house where the other women called her “mom,” and brought her their broken necklaces and eyeglasses to fix. She collects heads-up pennies for luck and gives them to women having rough days on the road to recovery. Now, she lives in her own apartment; she walks through Methadone Mile some days on her way to her job doing merchandising and marketing for a retail service company.

The sing-song offers of pills and dope make her stomach turn.

“That road,” she said, “leads to nothing.”

But these streets were paved with suffering long before today’s drug epidemic earned much notice. And in the wake of the closing of the Long Island Shelter, the chronically homeless mingle with a new generation caught in addiction’s grip, parading this most confounding of problems out before an audience at a busy Boston intersection.

Even as a rising death toll stokes compassion and newfound resolve, gaping holes remain in the systems set up to combat the crisis — nowhere more visible than here. As more and more people stumble along the sidewalks of Methadone Mile each morning, those holes seem harder than ever to patch.

Lexi sits in the median as she takes a break from panhandling along a stretch of Massachusetts Avenue nicknamed Methadone Mile. Lexi, who had been an opioid user, has been homeless for nearly nine years. (Keith Bedford/Globe Staff)   Lexi reaches out from the blankets to take her coffee at the place she sleeps under a highway near a stretch of Massachusetts Avenue. (Keith Bedford/Globe Staff) Lexi has been homeless for nearly nine years. A former heroin user, she spends her days panhandling along Methadone Mile. At night she sleeps on sidewalks and under bridges in the neighborhood.
Recovery and relapse jockey for space in the same few blocks. A constellation of services for those suffering from homelessness, mental illness, and drug and alcohol addiction line the streets near Boston Medical Center, compressed into one of the only corners of the city where such facilities can exist without uproar from nervous neighbors.

The Woods-Mullen and Southampton Street shelters, for women and men respectively, house hundreds every night, a few blocks apart. The headquarters of Boston Health Care for the Homeless, a 30-year-old program dedicated to the city’s most vulnerable patients, occupies part of the building next to Woods-Mullen. The same building is home to several Boston Public Health programs — among them one that distributes clean needles and another, PAATHS, that helps coordinate services for people making their way through a thicket of acute, residential and outpatient care for drug addiction. In the middle of it all is Boston Medical Center.

In the battle against substance abuse, these are the front lines. For some, access to so many services in such close quarters is a boon. People who live in one of the shelters can make it to therapy groups, see their primary care doctors at BMC, and visit a recovery center without commuting all over the city. And service providers here, many say, show their patients a respect they rarely find elsewhere.

Jennifer Tracey, head of the city’s Office of Recovery Services, says there is “probably nowhere else in New England if not the country where you find . . . . the level of services that you’re finding here.”

But the challenges of the area are obvious. Despite a heavy police presence, low-level dealers work the streets, harassing and baiting those clinging to sobriety, and selling to those who have lost their grip.

By dawn, people are already beating a path toward the methadone clinics. Dozens make their way down Southampton to the clinic on Topeka Street, a shabby one-block roadway flanked by industrial businesses and a fenced, inactive construction site that signs warn is an environmental hazard. People sleep there anyway, bedding down behind a concrete structure that’s either half-built or half-demolished.

Couples walk by holding hands. Women push strollers. Yesterday’s panhandling signs sit discarded along the chain-link fence. A billboard rises over the run-down gas station on the corner, where Michael McCarthy and Rachelle Bond, charged in the killing last summer of Bond’s daughter Bella, used to sit in the dirt. The billboard faces the other way; the side overlooking Topeka Street is blank.

Some drive to the two methadone clinics here and duck inside for a few minutes to take their dose before driving away. Others walk in and out quickly, dressed in the uniforms they’ll wear at the jobs they’re bound for. But many — those with nowhere else to be — linger outside, crouching on the dusty roadside.

Methadone, an opioid that wards off withdrawal symptoms while blocking the chemical craving associated with heroin, is one of the most effective treatments against opioid addiction, along with Suboxone, a similar drug that can be taken at home. That’s why this area’s derisive nickname infuriates many who have spent years working in the treatment programs here: It stigmatizes the people whose pain and suffering is very public and mocks their efforts to get clean. They wish it were known instead as Recovery Road.

But methadone itself can be extremely addictive, and some take it indefinitely for years, trading one addiction for another that allows them to go to work and lead less fractured lives. Others, still active drug users, take it to ward off withdrawal symptoms for the days or hours until they cobble together enough money to buy heroin from one of the dealers on Massachusetts Avenue.

Even the combination of pills the dealers sell in their looping cadence — a specially tailored mix of seemingly random medications called “the cocktail” — is designed to intensify heroin’s potency or amplify the pain-relieving effects of methadone into a powerful high.

Users swallow a benzodiazepine like Klonopin or Xanax, the blood pressure medication Clonidine, and the seizure medication Neurontin or Gabapentin. An antinausea drug, Phenergan, completes the blend.

Then they drift away. The people piling the pills on top of their methadone doses are easy to spot: Some, overcome, stoop so low that their hair and hands scrape the sidewalk.

One woman, a regular on the sidewalks and under the bridges here who studied toward a master’s degree in health education before her life fell apart, likened the layering of pills atop an opioid to Maslow’s hierarchy of needs, the theory in psychology that basic physical needs must first be met before a person can seek safety, love, or esteem.

In the cocktail — and for many on the Mile — opioids come first.

Shaun kisses his wife, Donna, as they sit in the parking lot of a mall near Mass. Ave. Both have been homeless opioid abusers for several years. (Keith Bedford/Globe Staff) Shaun and his wife, Donna, have been homeless opioid abusers for several years. They kiss in the parking lot of a mall near Methadone Mile.
Shaun stands shivering in front of the Cumberland Farms store on Mass. Ave. and does the math: A week, maybe more, before he can get on Suboxone after being kicked out of his methadone clinic. Two hours before he’ll be dopesick. Less than $20 needed to buy a quarter-gram of heroin.

His stomach is cramping. He is nauseated, and he is anxious: Soon, the diarrhea and vomiting will start, and pain so complete he’ll be able to feel it in his hair.

The tall and skinny 45-year-old from Lynn has been clean for several months, he says, and so has his wife, Donna. Among his prison tattoos, he has her name inked across his chest and her initials on his wrist. They always promised each other: We’ll quit this together. For years, they said, they have lived in shelters, rooming houses, and on the streets; using, detoxing, relapsing, getting arrested — always together.

Shaun and his wife, Donna, look for warm-weather clothing in their storage unit in Boston. (Keith Bedford/Globe Staff)    Shaun counts the change he made panhandling while waiting to board a van that takes homeless men to a shelter. (Keith Bedford/Globe Staff) Shaun and Donna look for warm-weather clothing in their storage unit. A few days later, Shaun counts the change he made panhandling while waiting to board a van that takes homeless men to a shelter.
Now, in early May, Donna is living in a halfway house, looking for a job. He is staying in a homeless shelter, and wakes up at night reaching for her. He walks her down Southampton Street every morning so she can get her methadone without succumbing to the temptation of the dealers she passes on the way.

He’s too old to go through withdrawal, he says. He doesn’t have it in him anymore. He decides: He’ll use heroin, just for a week. Then, Suboxone.

Shaun, who goes by the nickname “BonZ” (pronounced Bone-zee), panhandles $17, and vanishes into the stir of people in front of Cumberland Farms, looking for his dealer. He emerges moments later, smiling.

“It’s as easy as that,” he says.

Like many others here, Shaun’s addiction predates the current opioid crisis. For him, heroin serves as a refuge from a lifetime of traumas — some self-inflicted. Even with the wealth of treatment options he is surrounded by every day, a remedy has been elusive, the damage that deep. Court papers document a tumultuous childhood, hospitalizations for mental health issues, and repeated arrests. He started drinking at 8, the documents show, and by 13 he was smoking angel dust, snorting cocaine, and using LSD; he started using Oxycontin in the late ’90s, he said, before switching to heroin. He served time for a failed robbery at a McDonald’s. His brother died of an overdose in 2012.

“I love heroin. I live it. The first time I ever did it I fell in love with it,” he says. “But you hate it. You want to kill it. But you can’t. It always wins. It’s the biggest lie.”

Shaun holds a needle in his teeth before shooting up heroin. (Keith Bedford/Globe Staff) Shaun holds a needle in his teeth before shooting up heroin.
He lopes over to a low orange box of a building at the edge of Mass. Ave., The Universal Church, and squats down on blacktop wet with rain. He opens a water bottle, takes out a clean syringe, and squeezes a few drops of water into the upturned bottle cap on his knee. Then he unwraps the folded Keno ticket that holds his heroin.

It is too windy to cook, so he stirs it up in the bottle cap and draws the amber liquid up into the syringe through a makeshift filter, a cotton pad he found discarded on the ground. He rolls up his sleeve, revealing dark blue veins he calls “ropes,” and plunges the needle in, waiting for the eddy of blood called the “red flag” that means it is safe to inject.

The red swirl beckons, and he presses the plunger.

His shoulders relax, no longer sharp points under his jacket. He is not thinking about the hours and days that will follow this one perfect moment of relief: That his plan to use just once every day will fail by the afternoon; that he will begin missing his morning walks with Donna to panhandle for more dope; that he will spend two days trying to raise enough money to take her to see “Captain America: Civil War,” only to spend it on heroin instead; that he will fail to get into a Suboxone clinic, try detox, then return to the streets and to heroin, then detox again. In this moment, there is only the pain leaving his body.

Boston Police officers and a security guard chase an alleged drug dealer after he ran while being questioned in front of the Cumberland Farms store on Mass. Ave. (Keith Bedford/Globe Staff)   Officers handcuff the alleged drug dealer as the security officer stands by.  (Keith Bedford/Globe Staff) On Methadone Mile, Boston police officers chase an alleged drug dealer after he ran while being questioned.
In many ways, the center of this teeming neighborhood — the hub of the Mile — is not a shelter or a clinic. It’s a convenience store.

The Cumberland Farms on the corner of Massachusetts Avenue and Albany Street was the company’s first foray into an “urban location” in Boston since 1981, and a month-long fund-raiser for Boston Medical Center accompanied the store’s opening in November 2013 — a nod to their new neighbors.

“With our brand new look and store concept, we felt the timing was right for us to provide this vibrant neighborhood with a convenient, affordable option for freshly prepared food and our everyday convenience items,” Cumberland Farms president Ari Haseotes said in a news release at the time.

The firm couldn’t have known what was coming. Less than a year after the store opened, in October 2014, the condemnation of the bridge to Long Island shuttered the shelter there and tossed the city’s already overburdened support systems into chaos. It also resettled hundreds of Boston’s homeless here.

Almost overnight, the number of homeless, drug- and alcohol-dependent people crowding around Cumby’s appeared to double. Shoving matches block the doorway. People mill around inside indefinitely, buying nothing. The bathrooms stay locked, to keep people from shooting up heroin inside. One night, a pair of men’s dress shoes sat abandoned in front of the register; a woman with a black eye and a metal bar slid through the belt loops of her jeans added packet after packet of sugar to a yogurt she brought from outside.

Many of the people out front are simply having a cup of coffee with their friends outside the local shop — they’re living in the shelters and spend their days outside, said Tracey, whom Mayor Martin J. Walsh appointed in 2015 to head the city office charged with addressing substance abuse. But others are nodding off on their feet, conked out by the cocktail.

“It’s scary for people to see people that sick and unaware,” Tracey said.

Service providers in the area meet with one another and with police and neighborhood and business groups regularly, addressing problems as they arise — harassment outside methadone clinics, or parked cars being used as cover for injection drug use. But the daily responsibility for reining in the chaos often falls to the Boston Police Department.

“Gotta go, gotta go,” say the police officers who show up every hour or so to sweep away the restive crowd, pointing down the sidewalk. But no one here has anywhere to go. Everything they own, they carry in backpacks and plastic bags. They grumble and swear, walk grudgingly 20 or 30 feet, stop. A skinny man spreads his arms wide, gesturing to the public sidewalk. “They always say that this is theirs, but what’s ours out here?”

Cumberland Farms, in a prepared statement, said it appreciates the efforts by police, but the company worries that the concentration of troubles is overmatching city efforts, forcing reconsideration of the store location. “We at Cumberland Farms have tremendous compassion for the homeless and people affected by drug and alcohol addiction . . . It’s a difficult situation for everyone. Cumberland Farms is unwaveringly committed to keeping our customers and employees safe.”

Police are trying. Officers can often be seen searching backpacks or questioning loiterers, and they arrested more than 200 people within a quarter-mile of the Melnea Cass Boulevard and Mass. Ave. intersection in a nine-month period ending in June alone, according to department statistics. But the most common charges are low-level possession or distribution of drugs, and people are often back on the corner within days or hours. Many need help, police and health officials say, more than they need jail time.

Officers patrol on bikes, in cruisers, and on walking beats, and some hand out postcards filled with information about how to get clean. Just last week, Boston Police launched a pilot program designed to refer people who are summonsed to court on drug charges in South Boston and the South End into treatment at PAATHS while they wait for their court hearings, which can often take weeks.

“The problem is, you’ve got so many public health resources to help the people that need help, but then you’ve got the people who want to take advantage of people down on their luck,” said Lieutenant Detective Brian J. Larkin, commander of the Boston Police Drug Control Unit. “The shelters open up in the morning, and they flood the streets.”

When the cops leave, the Cumberland crowd inches back. Jae Cleva reclaims his spot in front of the store selling synthetic marijuana joints and dreaming of becoming a rap star: “I own this galaxy,” he spits out in one of his favorite verses, “I burn you like a calorie.” He darts away to deal with his customers.

Robert, who at 39 has been using heroin since he was 17, wobbles on the corner. “I have no one except for my sister,” he says. “She begs me to come home. For some reason, I don’t.”

He’s high on heroin and Xanax. Cars whip past. He feels like he’s flying.

Sherry, a homeless woman, leans against a street post in front of the Cumberland Farms store on Massachusetts Avenue and Albany Street. The location is a place where homeless people and those struggling with addictions gather near the Boston Health Care for the Homeless facility. (Keith Bedford/Globe Staff)    Shirley pushes her shopping cart across a parking lot. Shirley, who is homeless, says she uses a variety of drugs. (Keith Bedford/Globe Staff)   Ramon Perez picks up discarded drug paraphernalia near a section referred to as Methadone Mile in Boston. Perez, whose wife works with homeless people, decided on his own to help clean up the neighborhood. (Keith Bedford/Globe Staff)    Robert Morgan hands out clothes, food, and toiletries to members of the homeless community on Massachusetts Avenue. Morgan and his wife, Chrissy Joubert, live nearby and hand out donations twice a week as concerned citizens. (Keith Bedford/Globe Staff) Sherry, a homeless woman, leans against a street post in front of the Cumberland Farms store on Massachusetts Avenue and Albany Street. Nearby, Shirley pushes her shopping cart across a parking lot. Ramon Perez, whose wife works with homeless people in the area, picks up discarded drug paraphernalia and Robert Morgan, who lives nearby, hands out clothes, food, and toiletries to members of the homeless community.
These streets were paved with suffering and struggle decades before the bridge to Long Island came down.

Boston City Hospital, which merged with Boston University’s hospital in 1996 to become Boston Medical Center, has served the city’s “worthy poor” at this site since 1864, according to a city-published history of the hospital.

About a century later, the boulevard that now bisects the neighborhood was slated to become an interstate — an inner beltway through the city. But the project was canceled in 1971, and instead of Interstate 695 racing past these blighted blocks, a new surface road was named for Roxbury civil rights leader Melnea Cass.

In the refashioned cityscape, cars and trucks cluster as they enter or exit Interstate 93, cut across Roxbury toward Fenway Park on game night, or head home to the South Shore after a downtown workday. The traffic islands on Mass. Ave. and Melnea Cass quickly became an ideal spot for panhandling, with beggars accosting drivers waiting two or three light cycles to turn through the busy intersection. Some hold signs, but many simply walk down the dotted lines separating lanes, peering into window after window, cup in hand.

By the time Mayor Thomas M. Menino said in 2007 that some homeless people “had become problems on the street,” the intersection of Massachusetts Avenue and Melnea Cass Boulevard was the most obvious example. Panhandlers crowded the streets right outside the Woods-Mullen Shelter even then — an intersection a Globe columnist called “the crossroads of all cadgers” in 2008.

“This is a neighborhood that has for a very long time been a place where poor people in Boston receive services,” said Dr. Jessie Gaeta, medical director of Health Care for the Homeless, which has been on the corner of Massachusetts and Albany for 30 years.

Some of the homeless people they try to help have been here nearly as long. Craig, a 61-year-old husk of a man missing most of his teeth, said he has been out panhandling on Methadone Mile for nearly 20 years. He spends his nights shuffling through traffic, leaning on his cane with his cup outstretched, alongside the men in reflective vests selling $10 roses on the median.

Gradually, more services set up shop in one of the few parts of the city where it was possible to open new recovery centers and methadone clinics. As Boston’s real estate market exploded, the notion of opening more facilities elsewhere started to feel like a fantasy.

“There are pros and cons to having things clustered this way,” said Gaeta. “If we were doing urban planning today, would we do it this way? I have no idea.”

The area, which spans corners of four neighborhoods — Roxbury, Dorchester, the South End and South Boston — has always accepted the burden graciously, Gaeta said. But the influx of people displaced by the Long Island closure, which came as the opioid crisis was reaching new heights, pushed the concentration to a new and concerning level, and brought addiction — and all the eyesores that accompany it — into plain view.

At the same time, the crisis outside of the city has grown, a wave that many leading the fight against substance abuse saw coming a decade ago but were powerless to stop.

People from the suburbs show up in larger numbers now, said Devin Larkin, director of the Recovery Services Bureau at the Boston Public Health Commission, who is not related to Lieutenant Detective Brian Larkin. Once they’re downtown, they “pick up a case” — slang for an arrest — or become regulars at one of the methadone clinics here. They sleep in shelters, or under the highway overpass. Their families won’t let them come home, or they stay away out of shame.

This new generation of those from outside the city, for whom homelessness is relatively new, add to the already overburdened shelter and recovery systems. They stumble side-by-side with those who have spent decades on the street.

Andrew sits with his girlfriend Briana after getting high on marijuana at Ames Nowell State Park in Abington. The two have struggled with alcohol and drug addiction for several years and are trying to stay sober. They spent several months living in a tent and buying heroin on the streets near Methadone Mile. (Keith Bedford/Globe Staff)   Andrew hugs his mother, Barbara, in the kitchen of her home in Abington. Andrew has spent time off and on living on the streets. (Keith Bedford/Globe Staff) Andrew and his girlfriend, Briana, have struggled with alcohol and drug addiction for several years and are trying to stay sober. They spent several months living in a tent and buying heroin on the streets near Methadone Mile. Now he’s living with his mother in Abington.
Huddled on a fire escape above Massachusetts Avenue on a soggy Saturday morning, Andrew, 31, reaches the same conclusion he’s come to again and again during a 15-year battle with addiction: “I’m ready for this to be over.”

He’d spent Friday night high, bouncing on the balls of his feet as if an electric current was coursing through him. A small crowd writhed nearby: A wild-eyed man with a scraggly beard grabbed a woman by both shoulders and shook her; another, barely conscious, stood hunched on the sidewalk, staring vacantly into the middle distance.

“It looks like a scene out of ‘The Walking Dead,’ ” Andrew says. Late at night it can seem just as dangerous.

When a handful of men threatened him with a knife late that rainy Friday night, he fled and hid on a fire escape, still and silent and too scared to sleep.

He’s been done with heroin a hundred times before, promising himself and his family that he was finally committed to getting clean. And again and again he’s relapsed — bolting from his mother’s house in Abington, drawn inexorably to drugs and sometimes to the Mile, where they are cheap and plentiful.

Each time he promises he’s done, he says his mother asks a question he can’t answer: “What’s different this time?”

Like many of the other men and women who parachute in from the suburbs, Andrew can leave the Mile whenever he pleases. He looks young for his age. He’s long-armed and thick-shouldered like a welterweight fighter. A warm bed awaits back in Abington; a well-connected uncle will help him get into recovery beds that are always scarce.

But the cycle keeps repeating: He’s been through detox 15 or 16 times, he thinks; six or seven ‘Section 35’ commitments, named for the statute that allows his mother to force him into rehab without his consent; a long record of arrests for minor crimes, nearly all of which he beat.

Andrew cools his head off in the sink, feeling feverish as he tries to reduce his heroin usage. (Keith Bedford/Globe Staff) Andrew cools his head off in the sink after feeling hot as he tries to reduce his heroin usage in his home in Abington.
He’s been to Florida for treatment. He’s stayed in one of the sober homes his family operates — that lasted only a few days. He’s even detoxed right here on the Mile, at CAB Boston, where he remembers looking out over the chaotic scene.

“You can literally see your drug dealer,” he says. “He’s waving to you.”

Now, the men he calls the walking dead look frighteningly like his future.

“My next step is washing my hands,” says Barbara, his mother.

Andrew isn’t a bad guy, says his uncle, who operates several sober homes and recently retired from a job with the Boston Public Health Commission — “he’s not a criminal element.” But this has gone on for more than a decade now, and the family is waiting for a call from police to tell them he’s dead.

But the call Barbara gets that morning is from Andrew. From the fire escape, he begs her to rescue him.

At home in Abington, where Barbara makes chili and a shiba inu dog trots around the yard, the madness of the Mile feels very far away. Andrew heads to one doctor’s appointment after another, hoping to try a relatively new medication called Vivitrol that’s said to mute the effects of opioids so thoroughly that shooting up is pointless. In a few days, driving back from a job interview, he passes exit 18 on Interstate 93 — the highway entrance to the Mile — and doesn’t turn off, grateful for once to be carrying an empty wallet.

Within days, the cycle starts again: Barbara finds Andrew passed out on the couch, overdosed on a bag of pills his friend said were Xanax. A dose of Narcan at the hospital revives him, but within hours he’s lying shoeless under a highway overpass in Quincy.

He’s ready for this to be over. Again. But what’s different this time?

He finds a bed at a detox facility on the Cape, but they can’t take him for a few days — long enough to go into withdrawal. So Barbara drives him to his dealer in the city to get heroin to hold him over. Taking her money, he shoots up while she waits in the car — a new low, he says.

As she drives him to the Cape, to a detox facility far from the Mile, Andrew says he’s grateful that she hasn’t given up on him, and hopeful for a happy ending. He’ll get clean and look for a bed in a nice sober home on the South Shore, far from the fire escape and the grim glimpse of where his life is leading him.

“I don’t want to be one of these 40-, 50-year-old guys still going to detox,” he says. So he keeps fighting for sobriety, hoping each time that something will be different.

Homeless men board a van bound for a shelter near Methadone Mile. (Keith Bedford/Globe Staff) Men wait to board a van that will take them to a homeless shelter.
There are dozens of programs for combating addiction, but a typical path to recovery is supposed to look like this: Determined to get clean, a drug user walks into an emergency room. Users are admitted to whichever Boston-area detox program has an available bed, and — prescribed methadone or Suboxone — they spend up to two weeks under medical supervision.

Once the heroin is out of their system, they move for a month into a transitional program somewhere, where the work of treating addiction begins in group or individual therapy sessions.

Finally, they move into a halfway house, from which they can go back to work or hunt for a new job. They can visit drop-in centers and attend group meetings, which are typically a requirement for methadone therapy. Slowly, sober days pile up; lost lives are reclaimed.

But the system is fractured and inadequate, said Gaeta.

Detox — the first step — is generally available on the Mile and elsewhere, though that varies some by time of year and even time of day. But after that, the obstacles to recovery mount.

“Getting into detox is a four lane highway. Coming out of detox is a one-lane country road,” said Vic DiGravio, president of the Massachusetts-based Association for Behavioral Healthcare.

Critical post-detox programs such as transitional support and clinical stabilization services are in short supply around Boston, and the 40 beds at Boston Public Health’s only facility — Transitions, in Mattapan — are typically full. Beds are so scarce that agencies here put patients onto trains or in taxis with instructions not to stop until they reach facilities in Tewksbury or Worcester.

While some agree to go, many are not comfortable leaving their lives behind. Discharged from detox and back on the street, people who have spent a week or more getting clean make their way back to the Mile to wait. Relapse is almost inevitable.

That problem was compounded when the Long Island closure eliminated more than half of the city’s post-detox addiction recovery beds.

Even those who navigate the gantlet that far can find themselves back on the street, because beds in halfway houses are also hard to find, said Andrew’s uncle Charlie, whose sober homes are typically full. After several drug overdoses, he got clean in 1989 and became an addiction counselor.

“The whole system is short on beds,” Charlie said. “There’s no place where you can just knock on the door and get in.”

But many on the Mile aren’t ready to knock on those doors anyway — they are still deep in the throes of addiction.

That, says Drug Control Unit commander Brian Larkin, is the most difficult part of policing the area.

“You can arrest people all day long, but you dump them in jail for 30 days, and what happens then?” he said. “People who are addicted have to want the help. There are plenty of people offering it.”

Solutions for those who aren’t looking for help have always been harder to come by. Boston Public Health’s AHOPE needle exchange program and Healthcare for the Homeless’s SPOT (Supportive Place for Observation and Treatment) target those who aren’t yet in recovery, seeking to reduce the health risks and steer people toward treatment. And the city plans to hire a street worker focused on substance abuse — something once supported by the state but cut during recession-era budgets, Devin Larkin said.

State funding for substance abuse treatment has climbed in recent years after stagnating from 2007 through 2014, according to statistics provided by the Association for Behavioral Healthcare, which represents mental health and addiction treatment organizations. But even a dramatic ramp-up in spending in recent years could not keep pace with demand, said DiGravio.

More frustrating for many who have long worked in drug treatment was how long help was in coming, and how slow sympathy for addiction was to arrive.

“It’s tough to argue that there’s more attention on this epidemic because it’s reaching into suburbs,” DiGravio said. “I think there’s resentment . . . It took this spreading to Wellesley and Needham and Milton for people to sit up and take notice.”

Shaun (right) watches as his friend Chris shoots heroin behind a building in Boston. After a night in a homeless shelter, both were feeling the symptoms of withdrawal from heroin. (Keith Bedford/Globe Staff)   Boston, MA – 05/05/2016 – A homeless man holds his prosthetic leg in his wheelchair in front of the Cumberland Farms store on Mass. Ave. (Keith Bedford/Globe Staff)  People sleep wrapped in blankets on Malnea Cass Boulevard. (Keith Bedford/Globe Staff)   Chris gives Diane a hug after getting high on a synthetic marijuana cigarette in front of a gas station on Mass. Ave. Keith Bedford/Globe Staff) Suffering and struggle take many forms. Shaun and his friend Chris felt the symptoms of heroin withdrawal after spending the night in a shelter. Shaun watched the next morning as Chris shot up. A homeless man holds his prosthetic leg close in his wheelchair, afraid it will be stolen while he rests. Others sleep on the streets. Chris gives Diane a hug after getting high on a synthetic marijuana cigarette.
Sleep will not come for Terrance tonight. The 21-year-old homeless man is restless, lonely, and afraid of his dreams, so he paces Mass. Ave., waiting for something to happen. Around him, headlights illuminate the nighttime panhandlers, and a sinewy man with his hair in his eyes tries to hawk a television set he pushes in a shopping cart. Terrance, who goes by “Delicious,” is less than 24 hours removed from a stint in the hospital, where he was admitted after threatening to kill himself.

“All I could ask for was to be loved,” he says. “And I could never get it.”

He grew up in foster care, residential homes, and psychiatric hospitals, he says, and has been living on Methadone Mile for two or three years. In a year or two, he says, he imagines he will be dead.

He’s not afraid. He’s waiting.

Kenny, who has been homeless off and on over the years, walks while wrapped in a blanket on Mass. Ave. (Keith Bedford/Globe Staff) Kenny, who has been homeless off and on over the years, walks Methadone Mile wrapped in a blanket.
Behind him, Mass. Ave. stretches into Back Bay, the grit and construction giving way to brownstones and gardens. But his world is small. He has no one, owns nothing but what is in his pockets: a photographer’s business card, a lighter, and two pictures he drew while hospitalized. One depicts the apocalypse, and the other, the beaked beast that stalks his dreams, poisonous sulfur pouring from its mouth.

“This is not a life I would wish on anyone,” he says, his voice slow and clear. “This is just a death sentence waiting to be carried out.”

But people understand him here. And besides: Where else would he go?

The cacophonous dirge of the morning drug market is just hours away, but the streets are never fully quiet. People huddle in tight groups, passing K2 joints back and forth. A drunk man in a loose business suit slurs his way through a story about his dead parents. A woman pulls off her hat to show an open head wound.

Sleeping here is dangerous: Thieves snatch bags and rifle through pockets. Some people bed down together on patches of grass, parking their shopping carts like circled wagons.

Others hover just above slumber. White sheets draped across their shoulders, they shuffle under the streetlights like ghosts.

This story was reported and photographed from April to July 2016. Produced by Jennifer Peter, William Greene, Mark Morrow, Laura Amico and Michael Workman. Maps by David M. Butler.

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