Smiling On The Outside, Crying On The Inside

So often those of true heartbreak survive simply by putting on a brave face and sending that message out to the world “I’m strong.  I’m okay. I am handling this. Things are fine.” And while we learn to do that simply as a survival technique and because sadly we may be the only one pulling on that end of the tug-of-war rope trying to rescue our loved one, inside we feel broken.

I call that “smiling on the outside, crying on the inside”.  I think as parents with loved ones addicted we can all relate to that.

This is something we have learned to do. Perhaps you grew up in a home where there was domestic violence. Perhaps you yourself grew up in a home where alcohol or drugs were an issue. You learned at a young age to put on “a brave face” for the outside world.

Maybe you were fortunate to be raised in a loving home with none of those issues and that happy face was just that, “happy”. It was real. There were no fears to deal with. But as a parent you have found yourself in the throws of your children’s struggle with drug or alcohol misuse.

You are trying everything you can to hold onto that lifeline, trying to pull your loved one back.

I think of people as a beautiful heavy yet fragile ceramic vase – if every time you walked by a beautiful vase and banged it with a parcel or your keys or your purse, eventually it starts to break down.  At first it is little scratches on the surface, eventually the vase starts to crack.  And then crumble.  We are like that.  Physically, emotionally, we need someone to “help us move that vase”, if that makes sense.

If it were a beautiful vase, we would ask a friend to come and help us move the vase to a place where it wouldn’t get so damaged.

We need to reach out as hurting people as well, to those we feel safe with.  To someone we trust. As a parent who is watching your teen or adult child struggling with addiction you have tried everything you possibly could. Yet often it feels like there is nothing you can do.  You have no power or control to change their behavior or circumstances.  And so we build these walls around us, those walls being the face others see, “I am just fine”, because we believe those walls can keep us safe where in reality those walls keep us trapped.

I don’t know if that makes sense to you but I think it probably does.  I hope it does.

We have to know who it is safe to “let down those walls” with.   One of the most important steps to take if someone you love is struggling with addiction is to find yourself a support system. A safe place to go where others understand your journey because they too have a loved one struggling. A place that validates your feelings.

Remember, what you are going through is not your fault. Often as Moms we feel “Mom guilt”. If you are a mother you know exactly what I mean. If our children are hurting or something has gone terribly wrong, like the rise of addiction, we blame ourselves. What did I do wrong? We have to remember we did not cause the addiction. We are not to blame. Addiction is a disease and unfortunately our loved ones took that initial step to try a substance never believing they would be held hostage to it. And that ultimately, that decision would hold you hostage. Your loved one hostage to the substance. You hostage to their behavior.  And sadly, our loved ones behaviors or decisions are not changed by our time frame!!

Your “vase” is full and it is heavy – but know you are not alone. Join a support network such as Parent’s Forever or find a NarAnon Support Group in your community. Or reach out to a friend who understands your journey because they to have walked it with a loved one.   Or feel free to get in touch with me anytime.  Even if it is just to vent about your day.  We all need someone to feel “safe” with.

Just remember you are not alone – even if you feel like you are, especially when you have no family around to help and support you.  When that load feel too heavy, that is when you reach out to those who truly care.  Put me on that list!!

Take care and be kind to yourself,

June

Those Suffering With Addiction And Homelessness And Their Treatment Within The Healthcare System

For all of us who have loved ones struggling with drug addiction or chronic alcoholism, as well as those of you who may work in the field of addiction, we are acutely aware that the treatment of those we love and care deeply for is not always the level of compassionate care we would hope our loved ones would receive.

Too often society looks at the behaviors related to one’s addiction instead of looking at the person suffering and struggling with that addiction.

My son recently recorded a presentation I gave to a group of first responders and ER nurses and I want to share that video with you.  (He probably should have edited out the part where I needed to find my glasses!! )   What can I say, it is organic, it is real!!

I believe many of you will relate to what I am saying in this video.  If you think it may help others better understand I hope you will consider sharing it with friends and family.  It is only when we let people “see” the person struggling, consider why, use compassion and kindness instead or vitriol, hear stories, can we hope to ease the stigma around addiction.  Erase the shame so often felt by those struggling.  Together we can – we are stronger together,

We are making progress but we have a very long way yet to go.  We cannot slow down.

You can watch this presentation on YouTube:

I hope each of you are taking the time to look after yourselves.  I know when those we love are suffering it is easy to get lost, putting yourself last.  Remember taking care of you is not a luxury, it is a necessity.

I hope this video will re-enforce what you already know.  That it will validate what you know to be true.

Take care and please keep in touch.  I truly care.

 

Much love,

June

Ask Why? There is Always A Reason

Through all the years of living, volunteering and working in the world of addiction, I have come to realize, there are only two reasons people try drugs.

  • Curiosity
  • Pain

Curiosity – that is easy to understand. We are naturally curious beings. We think we are invincible. Who ever thought curiosity could have such devastating consequences?

Physical pain. We all can identify with that. Sports injuries, motor vehicle accidents, surgeries, falls, wisdom teeth being removed. A doctor prescribes medication for pain. Sadly, for many, that initial treatment for pain, going unchecked, leads to a debilitating addiction to narcotics.

Emotional pain. Emotional pain is much more complex. Perhaps you are living in a home with domestic violence.   Husband/wife/parent comes home after work and starts drinking. The more he (she) drinks, the meaner he gets. Mom gets hit. The children stay in their bedroom scared. Feeling helpless.

Perhaps that emotional pain is the result of being sexually abused as a child. Or a sexual assault. Bullying. Being yelled at. Being made to feel you are not good enough or a disappointment. Loneliness. Isolation. Abandonment.

The reasons for emotional pain are vast. And emotional pain is generally created by someone you should have been able to feel safe with.

Young males, middle-aged men make up a hugely disproportionate percentage of the population struggling with addiction, untreated mental illness, depression, anxiety, alcoholism, drug addiction, death due to overdose and suicide.

The disparity in numbers is staggering. Men are not reaching out for the help they so desperately need and deserve. For too long we have heard the comments, “Be a big boy”. “Big boys don’t cry”. “Act like a man”. Far to many sons have been made to feel they are a disappointment to their fathers.

And what has been the result? They don’t talk. They bottle up the hurts, the fears, the abuses, the terror, the bullying, the sadness. But those feelings of despair don’t just disappear. They fill that child or young person with feelings of self-loathing, shame, guilt.

Men don’t share their feelings in the same way women do. As a man, when was the last time you told a friend or co-worker, you felt sad? You were depressed? You were struggling? Probably never.

So what happens all too frequently? Men self-medicate with alcohol or drugs and for a short period of time they feel better. The problems don’t go away though, they are just masked for a brief while. So men drink a little more, or use a little more and before long, they have completely lost control.

And that is a tragedy. We need to create an environment where men can feel safe being vulnerable. It is only when men begin to reach out and say, “I need help” can we hope to reduce the pain and trauma caused in childhood or in the teen/young adult years.

If we are to save the lives of those struggling, we have to ensure they feel heard. That their fears and trauma are validated. Where they are made to feel safe and cared about in a compassionate setting.

We are loosing far to many loved ones because of feelings of shame and the stigmas we place on abuses. We have to pull back the shades and treat the causes. We will continue to lose sons, brothers, fathers, friends to drug and alcohol abuse, to overdose and to suicide.

Show respect, kindness and compassion to everyone you meet. You walk in no one elses shoes. You do not know their story.

Just know, that behind every single person struggling with addiction, overdose, suicidal thoughts, there is a reason. And that reason is untreated pain. Pain that has never been exposed. As a society we must care enough to reach out and take that hand. See the person, not just the addiction. Listen to their story. They have one.

Be that person to someone, you wish someone had been for you.

Remember to take care of yourselves.

The Face In The Mirror

The past is the past – time to let it go!!

Far to often we stay stuck in the past.  What we did.   What we regret.  What we wish we had done differently.  We constantly beat ourselves up with “what if I had only….”.

That is a sentiment what keeps us stuck.  It keeps us regretting.  It keeps us in pain.  It keeps us in “blame” mode.

I know as parents our actions are with the very best of intentions.  We make decisions based on the information we have at that time.  We always have our loved ones best interests at heart.

And every decision you make as a parent is based on the deep unconditional love you have.  Whether that decision is to help, assist, enable, show frustration or anger.  Whether you say, “yes you can come back home”, or whether you say, “you have to leave” or “you can’t stay here because of your actions but when you are ready for help, I will always be here”.

Every decision you made, you made with the very best of intentions in mind.  Whether it was to help your adult child who is addicted with a place to stay or help protect your other children from the kayos of their siblings addiction and have to say,  “you can’t be here right now”.

Your decisions have always been based on the love you have and the information you had at that particular time.  Your decisions were also based on what was known about addiction at that particular time.

If your loved one was struggling when tough love was suggested and that is what you tried, you were trying your best.

If your loved one was struggling when drug use was considered a moral choice and you treated it as such, don’t blame yourself.  You were trying your best.

If your loved one was struggling with the concept of ‘they have to hit rock bottom’ and you thought that was the right thing to do, don’t blame yourself.  You were only trying whatever you thought could help get your loved one out of the bowels of addiction.

Today we have scientific and medical proof that addiction is a disease.  It is often a disease that runs in families – so there is a genetic component.  We also know that addiction can raise its ugly head when there is no family history.  No one can look at someone and say, “this person will become addicted”.   One day, and hopefully not far off, science and medicine will allow that awareness long before it can become an issue and hopefully be halted.  But that time is not yet here.  Soon hopefully.  But not today.

We know that the brains of those addicted are altered.  The damage is there. The part of the brain – the frontal lobe, responsible for decision making, choices, is the part of the brain deeply affected and permanently altered.  It has been compromised.

In my book Addiction: A Mother’s Story I quote Glenn A Hascall who brilliantly said, “The me in the mirror is not what I once was.  The me in the mirror is not the final word on who I will become.  The me in the mirror is simply a reflection of today”.

Whether you are the parent of a teen or adult child struggling with addiction.  Whether you are the person who is struggling with an addiction.  Whether you are a person who is in recovery.  Whether you are a sibling.  Whoever you are, however you reacted, whatever you did, this is a message for you.

Please go and get a mirror.  A handheld mirror if you have one and find a quiet place to sit.  Away from noise, bright lights, anything that might affect your peace and quiet time.  This will only take a few minutes.  Put everything else aside.  Just take a few minutes to spend with yourself.  And this is what I want you to do ……..

Sit quietly.  Hold up your mirror. You are not going to be checking your makeup or your hair.  You are not going to be checking for blemishes.  What I want you to do is look at your eyes.  Just your eyes.

Now say to yourself – whatever I have done in the past, whether is was with the best of intentions or not; whether it hurt or helped; whether decisions I made caused suffering unintentionally. All that is in the past.  I cannot change my decisions of the past.  They are past.  I have to live with those decisions and so do those who were affected.  But I will stop blaming myself, because that “me in the mirror is not who I once was”.  Everything I did was with the best of intentions.  If it was you  trying to help the child you loved so deeply or if you are  that person who struggled with that addiction.  Or if you continue to struggle.

Just remember, everything up to this very moment is in the past.  You can’t change a single thing.  It happened.  You felt the pain.  You suffered.  Perhaps you caused the pain.  None of that really matters any more.  Its done.  That  person is gone.  Stop obsessing because that will only lead to continued suffering, pain, sadness, depression.

Keep looking in the mirror.  But don’t think about tomorrow.  Tomorrow hasn’t come yet.  You will deal with tomorrow, tomorrow.  Don’t ruin today, worrying about tomorrow.  Tomorrow will come tomorrow and whatever happens you will deal with it then.  Remember, today is not “the final word on who you will become”.  If you get too far ahead of yourself,  you only create anxiety.

Stay in the moment.  Stay in this moment.  Because this moment is who you are today.  Right now.  The “me in the mirror is a reflection of who I am today”.  And you can decide who that person will be.  And you can decide how you will act or react to anything today that comes up based on what you now know.

Whoever you decide “the me in the mirror” is today, let it be that person with information you maybe didn’t have before.  Let it be the person you are going to be kind to.  We have to be kind to ourselves.  When addiction has taken over the life of someone we love, we often blame ourselves. “Why didn’t I see this coming”? “What did I do wrong”?  Don’t go there.

And if you are the person who has struggled with addiction, be kind to yourself.  You have beat yourself up long enough.  The past is the past.  You aren’t there anymore.  The you “in the mirror” is who you are today.  And it is not “the final word on who you will become”.  You deserve help.  You deserve understanding.  You deserve treatment.  Reach out and get the help you need for this horrific disease that is holding you hostage so you are able to live the best life you can.

Remember – we all deserve peace in our lives.  But when we have someone we love addicted, peace is a distant memory and it is not something we can see ahead when right now everything is dark.

So look in that mirror and say to yourself, “The me in the mirror is not what I once was.  The me in the mirror is not the final word on who I will become.  The me in the mirror is simply a reflection of today”.

I wish you peace today.  Take care of yourself and remember you are not alone.  I truly care.

 

 

Mother’s Day ~ What Does It Mean To You

Mother’s Day has always been the most important day of the year to me.  Nothing in my life is more important than being a Mom.  Nothing ever has or ever will be.  That is who I am.  I am a Mom.

One thing Mother’s Day most certainly is, is an emotional day for everyone who is a Mom, has stepped up to be the Mom, is a Grandmother or aunt who stepped up to fill the Mom roll,  is a son or daughter who grieves for the Mom who has passed away or the son or daughter whose Mom simply walked away one day and never returned,  who is struggling with a severe addiction or mental illness and is just not able to be a presence in your life. 

You may be the Mom whose child for reasons you may never understand, choose to walk away.  Is not in your life. 

You may be the Mom whose son or daughter is struggling with the horrific disease of addiction and you are praying you will hear from him or her today.  At least you will know, this person you love so completely is still alive and there is still hope that change will happen.

You may be that Mom who is sitting by your child’s bedside in the ER because of an overdose last night, or visiting at a correctional institution because that is where your teen or adult child currently is.

You may be that Mom whose adult children are hundreds or thousands of miles away.

You may be that Mom who has tragically lost the child they so deeply love to drug or alcohol abuse.  Or to suicide because they could see no other way out.

Mother’s Day can bring the joy it was meant to bring – celebrating your Mom and being celebrated as someone’s Mom.

Sadly Mother’s Day is not a happy day for far to many people.

Mother’s Day can bring up memories you sometimes wish you could forget.  But memories don’t work that way.  That is why we call them memories.  The person grappling with the feelings of having been abandoned. “If she loved me why didn’t she just quit using heroin”?  “She cared more about the next fix than she cared about me”.

Sometimes we get another chance to make things right.  Sometimes we don’t.  Sometimes tomorrow is a good day and for far to many tomorrow just doesn’t come. And when you have a loved one who is in the depth of their addiction, that is always your greatest fear.

But one thing I know for sure, in spite of all the fears, all the kayos, all the drama, all the pain and all the heartbreak, the broken promises, the years and years of crying ourselves to sleep at night, one thing is certain: of all the hats we wear, the most important one of all is the Mom hat.

Nothing and no one will ever be able to remove that hat.  That is who I am.  That is who you are.  We are Moms.  Those old wedding vows, “for better or worse, for richer or poorer, in sickness and in health, to death do us part”,  I think that should be the “Mom vow”.

As painful as a divorce can be, we can and do walk away.  I have.  But I would never, will never, ever walk away from my children.  Our children may for whatever reason make that choice, but I know that as Moms, nothing is more important than our children and their well-being.

To all the amazing women out there, the Moms, the Moms by choice, all those women who reach out and touch the lives of others, to my eldest daughter Kare,  who I swear was my Mom in another life because she has always looked out for me and had my back, even if she didn’t always agree with me, she has always been “My Person”.  I could not “do life” without her. To my daughters JJ and Bean who are Moms themselves, to my Mom who passed on to her next chapter on Boxing Day 1996 after struggling with ALS for two years.   I wish you all a Happy Mother’s Day.

To all the Moms whose children continue the struggle with the disease of addiction and to those Moms who have so tragically lost their children to his horrific disease, I hope you are somehow able to find a peaceful place to go if even for awhile.

Last evening my youngest son Michael took me out for dinner.  He jokingly called me his “MAD” Mom And Dad.  Because for many of us Moms we have been in this struggle alone.  To all those Moms who do the impossible every single day I celebrate you. And to those men who have become the “MAD” to their children – “Happy MAD Day” to you as well. Sadly you are too frequently the exception not the norm.  Thank you.

To those of you who may question their  absentee mother’s reasons – just know it was never about you not being “good enough”.  You were perfect.  It was your Mom who was feeling broken and just unable to be there.  Know that.  Say it and remind yourself of that daily. You were perfect.

As women, as Mothers, together we are the change makers.  We must never stop standing up and speaking out to change laws and end the stigma around drug addiction, alcohol addiction and mental illness.

To you all may your Mother’s Day be whatever you need it to be.  Always remember, you are not alone. We Moms are in this together.

 

 

To All Mothers Who Have A Teen Or Adult Child Struggling With Drug Addiction

Every single Mom I have ever met who has a child struggling with the disease of addiction,  will be able to relate to this powerful testimonial by Former WWE Westler, Marc Mero.  It is a powerful, honest and love filled testament to a mother’s love.   My grandson’s Mom came across it and sent it to me.  I know it will touch your heart as profoundly as it did mine.

This is a powerful story of unconditional love.

My son Nathan once said to me, “Mom you can’t understand me, just love me”.  The love I had for my son when he was deep in his addiction or taking a brief break over 23 years of hardcore heroin, cocaine, crack cocaine and meth addiction, was always the same.  It was unconditional.  Of course he was more “likeable”  when he was not using, but my love for him never waivered.  It was constant.  It was real.  It was deep.  It was an unbreakable bond.

Extended family all to often completely walk away.  Siblings, who are so profoundly affected often say, “enough”.  Sibling truly are the “unseen” victims of a brother or sisters addiction.  And tragically, fathers all to often give up.  From my experience, it is the Moms who keep trying.  It is the Moms who never give up.  It is the Moms who maintain that unbreakable bond.  It is the Moms who keep encouraging and believing and loving, even when their child’s behavior is most unlovable.

This testimonial  could be for any one of the Mom’s who never gave up.  Who continue to love.  Whose love is unconditional always.

When our child is deep in their addiction, they have no idea of the co-lateral damage caused by their addiction.  They truly believe they are the only one who is being affected.  That is one of the false realities they live with.  But as we who love them know, our devastation is raw.  It is not until the drug use ends that the person who struggled with the addiction gains clarity.

Please watch this story and warning:  You will need a tissue.  This will touch your heart profoundly

 

As Moms, as parents, as families we must continue to stand up, speak out and advocate to end the stigma and shame around addiction, so those living in the shadows of addiction will reach out for help.  We have lost far to many to this horrific disease.  Thousands of lives lost every year.  Families completely devastated.  Societal  resources and first responders stretched to the max.

Take care of yourself and remember you are not alone, I truly care.

Is Harm Reduction The Same As Enabling?

There are many who believe that harm reduction is really just enabling.  To many they are adamant.  To others they see harm reduction as a absolute requirement in treating the disease of addiction.

After 27 years of experience, having a son who battled severe addiction to heroin, crack and meth, volunteering more than 12,000 hours in the Whalley area of Surrey with those struggling with addiction, homelessness and violence as well as working many years in a shelter in Whalley,  I have cared for, loved and lost far, far, far to many people who battled the disease of addiction.  And so, I have my own opinion on that.

I give approximately 60 presentations each year on addiction, homelessness and gang violence. All part of raising awareness.  Society looks at statistics and while these numbers are vitally important to know, what we must never forget, is statistics are far more than just a number.  They are lives.  Lives of sons and daughters, mothers and fathers, sisters and brothers, friends,  lost because they battled an unforgiving disease.  The statistics represent lives of people who were deeply loved.  Who are mourned for everyday. Whose families are left devastated because that candle of hope has blown out.

And we can not forget those who are suffering every single day.  Those battling the disease of addiction are truly suffering.  The ‘party’ ended for them a long time ago.  They are not using for the “high” or the “low” – they are now using to just get through the hour, the day, the night. To stop the incredible pain. The nausea. The vomiting. The involuntary leg movements. The cold. The cramps. They feel isolated. Broken. Shame. They are lonely.

Are they responsible for where they are at?  Did they ultimately cause where their lives are at?  Yes, they made a choice.  Unfortunately many choices we make in life are made in the teen years and early twenties.  During a period when people take the most risks.

What no one ever thought was that choice would awaken a beast that would hold them hostage. That would devastate their lives.  That would devastate the lives of every person who loves them.

Addiction is a chronic and often terminal disease.  When addiction raises its ugly head it takes control and for far too many people suffering with the disease of addiction, they are not able to break free.  This is where harm reduction is paramount.

Harm reduction can take many forms – from needle exchanges to prevent the spread of disease, to overdose prevention sites and consumption sites that save lives every single day, to prescription of Methadose, Methadone and Suboxone which is an absolutely crucial component to so many in staying away from what was their drug of choice.  To  providing prescription morphine or heroin to those who have tried absolutely everything else but have not been able to stay the course.

We need to keep people alive if we are going to save lives.  If harm reduction methods save lives and the evidence is there, then we are not enabling.  We are saving lives.  Each day a person battling the disease of addiction lives,  is another day with the opportunity that they may reach out and ask for the help that will ultimately save their lives.

Every day that a person makes contact with someone in harm reduction, is an opportunity to build a relationship.  Build trust. Build a opportunity for that person struggling to reach out for help.

When we provide options, we provide possibilities.

To deny people life saving options, to deny people possible treatments is just plain wrong.  Everyone deserves the opportunity to be their best self.  Whatever that best self is.  And one person’s best self may well be a far cry from another person’s best self.  But we are all different.  Our needs are different.  Our circumstances are different.  Our up-bringing may have been different.  Trauma experienced. We have different needs.  No one size fits all in anything in life but especially in the treatment of a horrific disease.

What works for one person may not work for another.  But the most important thing is to never give up on that person struggling.  Remember they are sick.  You just never know when they may decide to reach out for help.  And it is in talking about addiction openly.  About ending the stigma around addiction as somehow being a moral failing.

Addiction is not a moral failing.  It is a horrific disease that sadly has far to many people in it’s grip.  Harm reduction is not enabling people.  Harm reduction is keeping people alive.  If we can keep people alive we are giving them the opportunity to access help.  To access services that may lead them in the direction of gaining control over their addiction.  Over their life.  For some this may mean embracing several components of harm reduction.  For others it may be embracing one.

When I hear someone has been kicked out of or removed from a treatment program because they used, I cannot understand that.  They are only confirming that they desperately need help.  So lets put more action in place for them.  Don’t kick them out.

If someone struggling with diabetes eats a piece of chocolate cake every day.  If someone with high blood pressure does not watch their diet and exercise.  If someone is in a car accident because they were speeding, do we deny any of those people the help they desperately need?  Of course not.  We have them work with a dietitian or a trainer.  We get that car accident victim transferred to the nearest ER for full on treatment.  We don’t say, “sorry, you brought this all on yourself.  You didn’t listen. Get out, you are on your own”.

We have to give people struggling with the disease of addiction to drugs and alcohol that same consideration.  We can’t just pick and choose what disease deserves treatment.  These are precious lives.  And we are loosing them every single day because too many people view those suffering with the disease of addiction somehow less worthy.  They are not. This is a disease.  History will judge how we treat our most vulnerable.  We must embrace harm reduction in all its forms until someone working in science lab in a hospital or university discovers what is needed to eliminate  or treat the disease of addiction in a way we don’t yet know of.  Until that time, harm reduction is not enabling.  Harm reduction is compassionate care for those are struggling and have not been able to climb out of that dark hole of addiction.

Until next time, take care.

 

My Friend “Paulie From Whalley” Would Have Celebrated His Birthday Today

Many years ago while out on some rounds in Whalley, the area of Surrey, B.C. with  a tremendous poverty rate, where there are huge numbers of people living in homelessness, batting hardcore drug addiction, chronic alcoholism, many with mental illness, all people struggling to just get through the day, I met Paul and Bill.  They were sitting in some tall grass, beside two old bicycles drinking some beer.

That meeting would lead to a lifelong friendship.  Bill always smiles and laughs.  He is the nicest, most gentle of men.  He suffered a brain injury many years ago.  “Paulie” as he was known to everyone close to him, had the bluest eyes and the kindest heart.   Both men struggled with severe and chronic alcoholism.  Both were the utmost gentlemen at all times.

They offered me a beer and were especially relieved when I told them I didn’t drink!!  And there began our friendship.

Paulie and Bill truly were “brothers of other Mothers”, as the saying goes,  and they always referred to me as their “Westcoast Mom”.  What an honour to be given that title.

Neither men had family in the west.  Their families were back east, two thousand miles away.  But they were each other’s brother.  And they had a close circle of friends who looked out for each other.  Most of their circle of friends, like themselves, struggled with chronic alcoholism and homelessness.  They all knew who would seizure first after sleeping.  The body’s reaction to not having alcohol.  And they made sure to look after each other.

I remember one time while at the Mission, Paulie ran in the door yelling for me, “Danny’s having a seizure, it’s a bad one”.  I called 911 while running to the tree they were all sitting under.  I knelt next to Danny, trying to keep him safe while he seizured and waited for the ambulance to arrive.

When I stood up one of my knees were wet.  I said, “I sure hope I just knelt in some spilled beer and not pee”.  At which Paulie said, “sorry Mom, but nobody spilled beer”!!! Oh great.  Just great, of course I just knealt in pee!!  So I went inside the Mission and scrubbed my pant leg and my leg and got back to work.  Welcome to our world.  And at that time, there was no place I would rather have been.

Paulie and Bill rode their old bicycles probably 30 to 40 km a day.  They followed the recycling trucks pickup days and stuck to that schedule.  They made their money collecting cans and bottles.  They didn’t ask for any handouts.  They made their own money. And that money paid for their alcohol for the day.  After years of doing this, they had homeowners and businesses that would regularly set aside the bottles in a bag just ready for  Paulie and Bill to pick up. Every day you could see them riding their bikes balancing several full bags of empty cans and bottles on their way to the bottle depot. They were wonderful recyclers.

Like many of their friends, they preferred to be outside in the spring and summer months.  But when the cold wet weather of fall and winter arrived they would often stay with us inside the shelter.

Paulie started coughing a lot in the winter of 2014/2015.  One day I found him slumped against a tree.  I asked him to come inside.  He said no he was just getting some rest.  I took him out a pillow and blanket and told him I was worried he had pneumonia.  He’d get it check he said.  Of course he didn’t and over the next couple of weeks he was clearly getting sicker.  One of the nurses at the sobering centre noticed it as well and told him to get it check or she wouldn’t let him stay (sometimes you have to use a loving threat to take care of someone when they won’t take care of themselves)!!  It worked.

Paulie did go to the doctor, was diagnosed with pneumonia and given antibiotics.  Only he didn’t improve.  He just got sicker.  Paulie was given x-rays and an ultrasound.  He had lung cancer and it appeared terminal.  He agreed to chemo-therapy but after the first round he decided it wasn’t for him.  He was so sick and his hair was starting to fall and he just decided no.  Paulie always wore his hair in a long ponytail. Since he was a kid. His ponytail and his bright blue eyes were what attracted the girls he would say!!

I made it my mission, that my friend Paulie was not going to die on the street.  And I wanted him to reconnect with his family.  It had been over twenty years he said since he had seen or talked to them.  I encouraged him to make that call.  I told him, as a Mom, I knew his Mom would be overjoyed to hear his voice. It did not matter how much time had passed.

He called his sister first.  We explained the situation to her and she agreed to go to their Mom’s the next day with their other sister and be there when he called back.   Paulie’s family, aside from being devastated to hear of his terminal cancer were overjoyed to hear from the brother and son who vanished from their lives two decades earlier.  They always worried they would one day get a call that he had died.  After all that time they never expected to hear his voice.   And a few months later his sisters came out to visit with him for a week and took him on some wonderful local adventures.  And they provided him with a cellphone so they could all stay in touch every day.  Paulie’s Mom was not well and was unable to travel but she was able to speak to her son every day with that phone.  Paulie and his family were now reunited and everyone of them took advantage of the time they had with each other.  This was a very loving family whose lives had often been hijacked because of his addiction to alcohol.  Paulie left, not because he didn’t love his family.  He left because he did.  Addiction for most carries a tremendous amount of shame.  And because of that sense of shame people struggling  with addictions often make the decision to stay away from those they truly love.

But Paulie and his family were now reunited and they spoke every day on that cellphone.

Every week I drove Paulie to his doctor’s appointments for checkups and got his prescriptions filled for morphine and for fentanyl patches.  I gave him just one day supply at a time so he would not be a target for anyone wanting his painkillers.  I also did not want to take the chance of him trading his morphine and fentanyl for alcohol.

When we finished our appointment each week with the doctor we made it a habit of going to the Dairy Queen.  Peanut Butter Parfait was a treat he remembered eating with his father as a child and it was like a walk down memory lane.

But now I had to get Paulie off the street – he was getting sicker and weaker and becoming more vulnerable to violence in his weakened condition.  For a couple of months he slept on the couch in the shelter.  But he needed to be in hospice.  I met with a wonderful lady named Michelle  Wright, a very kind and dedicated Social Worker who pulled out all the stops and did everything she could to help and together we made progress in getting Paulie into hospice.  The only problem was his drinking.  Paulie drank two litres of cheap sherry every day.  Hospice would agree to take him but he would have to get down to one litre  a day.  Over the next two months Paulie steadily decreased his intake.  Finally he was down to one litre a day and Michelle was able to arrange that bed in hospice for my dear friend Paulie.

Hospice agreed that Paulie could have one bottle of sherry a day. That they would dispense it to him throughout the day if I provided them with the bottle daily.  Paulie’s family agreed to pay for the sherry and cigarettes.  We had a solid arrangement and Paulie was accepted into hospice.  It was a warm, caring compassionate environment.

His first night there he was lying in his bed with this big fluffy comforter and pillows propping up his head, with his bottle of sherry beside him, a pack of cigarettes that he could be wheeled outside to smoke, a TV on the wall, and the control in his hand.  He was dying and yet he felt like a king.  He said, “June, if everyone on the strip knew how good this was, they would all want to get cancer”!!  That was Paulie – he could make the best out of any situation.

October 31st – Halloween was Paulie’s birthday.  Two years ago today he had his last birthday. He lived Just a few weeks longer.  Paulie’s addiction was so severe, that even in his last days, alcohol remained his focus.  That is what addiction is.  As so extremely sick as my dear friend was, his body, his mind, demanded alcohol.  It was a disease so severe he was never able to escape it. The last two days he used a sipper cup.  He really could no longer drink but it could slowly seep into his body.

That is addiction.  That is not a choice.  That is not a moral failing.  It is not a human flaw. Or a weakness of character. That is a disease. Addiction is one of the most unforgiving of diseases.   And until you watch addiction up close, it is hard to sometimes understand just how profound it is.

Paulie always called me his “West Coast Mom”.  He said I was the best friend he ever had. He asked me if I would promise to be there  holding his hand when he died so he would not be afraid.  I was privileged to be there with Paulie when he took his last breath.  He was not afraid.  He went peacefully.

 

 

 

Addiction Affects Everyone And Everyone Handles It Differently – Even Strangers In Traffic

For those of us who have or have had a loved one who struggles with addiction, we all know one thing, addiction affects everyone  touched by it and everyone handles it differently.

Within the family unit, dynamics drastically change and how could they not.  Life as we knew it changed and to survive a loved ones addiction we have to recognize our lives have been tragically altered.

But what about strangers?

The other day I was driving through Langley, B.C.   I was stopped at an intersection when a young woman, clearly in distress, was trying to maneuver her shopping cart,  piled high with bags,  off the curb.  The cart tipped to the side and  bags of bottles and cans fell out of the cart spilling onto the road.  Her anxiety level escalated and how could it not?

She scrambled into traffic in attempt to pick up the cans that rolled away.

I put on my flashers and threw my car in park.  One other driver did the same.  We quickly retrieved  the cans and bottles she had clearly spent all night collecting and returned them to her cart.

Two  men in a raised Ram truck honked their horn and yelled obscenities.  A few drivers used hand gestures while continuing on their way.  But the majority of the drivers sat patiently in their vehicles.  Most people find no satisfaction in judging a person battling the disease of addiction.  The tide is turning.

Even just a couple of years ago, those struggling with addiction were judged as morally weak.  Morally corrupt.  Someone people avoided at all costs.

It has taken a very long time, but thankfully society for the most part is beginning to recognize that addiction is not a moral failing.  Addiction is a horrific disease that affects the brain and every single thought and action of the person affected.  Those struggling with addiction are not having fun.  They are simply trying to survive.  The party for them ended a long time ago when addiction raised its ugly head.

What has caused the dramatic change in the way society looks at addiction?  Sadly it has been the dramatic rise in overdose deaths due to the entry of fentanyl in the drugs being sold.

When the rate of deaths of teen, young professionals, parents with young children began to rise, and it wasn’t only the “homeless junkie on the street corner” overdosing and dying,  society started to look at drug addiction differently.  To those of us who have a loved one addicted, our loved ones were never the “homeless junkie on the street corner”, they were our very loved sons and daughters, brothers and sisters, mothers and fathers.  They were more than their addiction.  They were our beating heart and they were struggling every single day.

Tragically the number of deaths continue to rise.  Addiction can no longer be swept under the carpet as a dirty little secret within a family.  For too long many families suffered in silence afraid of the repercussions and stigma around addiction.

I was never one of those people.  I recognized very early on in my son’s struggle with addiction that he was battling a disease.  I called it a disease long before addiction and disease were used in the same sentence.  I recognized it was way bigger than any other disease I could imagine because it did not seem to present as a disease but rather a moral failing. But I knew my son was not morally weak.  I knew his heart.  I knew he was sick.

So today, thankfully much of society is looking at addiction differently.  But we still have a very long way to go.  Everyday our death rate is rising dramatically and families are left devastated, wondering what they should have done, what they could have done differently.  Thinking that somehow they had failed their loved one.

Addiction affects every single family member differently.

And clearly addiction affects society differently.   The “good old boys” in the Ram truck, honking their horn and yelling obscenities.  The people raising their fingers and driving over the pop cans and those who sat patiently in their cars aware that addiction had a once beautiful girl in its grip.  That the disheveled girl in front of them was someone’s daughter.  Was once a girl with hopes and dreams until addiction took hold and held her hostage. And so they waited while we picked up the bottles and cans and returned them to her cart.

Addiction affects everyone differently.  But be assured, the subject of addiction does affect everyone in one way or another.

We need all levels of government on board to address the drug crisis.  We need a dramatic change in how addiction is looked at and treated.  We need to embrace harm reduction full on.  We know harm reduction is the only way at this time.  Hopefully one day researchers and doctors who are working tirelessly, will find the cause and cure for those battling  addiction but that time has not yet come.   Lets all push for harm reduction.  Our loved ones deserve nothing less.  We deserve nothing less.  Society as a whole deserves nothing less.  Addiction is a disease.  Let us give those suffering with this unforgiving disease the kindness, compassion and respect they deserve.

Until next time my friend, take care of yourself.

Much love,

June

 

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.