The Front Lines of Addiction

Confronting the Opioid Epidemic

It would be easy to blame the growing tragedy of opioid abuse on the power of prescription painkillers. After all, for many addicts, that’s where it starts.

Lowell resident Keriann Caccavaro says “something clicked” the first time she took an OxyContin. “I had no idea what was in store for me,” she says. Caccavaro describes the next four years of addiction, homelessness and crime as “a vortex of hell.” She lived to tell about it. Thousands of others have not.

Why does this keep happening? How do we stop it?

There were over 4,000 opioid-related deaths in Massachusetts between 2012-2015, according the Massachusetts Department of Public Health. According to the Federal Centers for Disease Control, in 2014, New Hampshire ranked third in the country in the rate of drug deaths. To better understand what is driving this public health epidemic, leaders in government, law enforcement, health care and education are turning to those who have passed through the vortex and come out the other side in hopes of understanding what drives these addictions.

The answer, we are learning, goes far deeper than the power of a pill.

The government is addressing mental health and addiction services. Health care is adjusting how opioids are prescribed. Medical education is changing its curricula. And law enforcement is treating substance abuse more like a public health issue and less like a crime.

These are five voices from the front lines:

 

Keriann Caccavaro Recovery counselor, recovering addict ( shown top of page – photo by Kevin Harkins. )

“When you see someone who seems so hopeless in life, take a second to just say, ‘It’s OK. You’re going to make it.’ ”

Caccavaro was in her second year at Middlesex Community College, studying criminal justice, when she required a medical procedure and was prescribed a few days’ worth of Percocet for the pain.

A friend told her she was going to love them, and she did. So much so that she finished the supply in a day. With the Percocet gone, she tried an OxyContin and “something clicked.”

“I had no clue what was in store for me,” she says.

Caccavaro grew up in middle-class Winchester but struggled to stay out of trouble and started drinking as early as middle school. Looking back, she sees that attention deficit hyperactivity disorder, a lack of self-esteem, and the need for attention from her father drove holes in her life that her addiction would fill.

Her life and relationships quickly took on a singular focus — finding another pill. She became homeless, sleeping in a Lowell park or an abandoned house.

After stealing tens of thousands of dollars in jewelry from her mother in 2012, she was sent to a facility for women who were looking to assimilate back into society. The program showed her there was another way out. But her struggle wasn’t over.

When she left the facility, she relapsed almost immediately. Over the next two years, she was in and out of detox more than a dozen times. She went into rehab programs with no real intention of getting sober. In 2014, she was arrested for being present where heroin was kept and, due to prior convictions, she was given a choice — 5 years in jail, or a new court program for addicts called Drug Court. At first, she chose jail, but two weeks later, she changed her mind. “To me, [the court] saved my life,” she says. Her sober date is June 3, 2014.

In the Drug Court program and later in Project Hope in Lynn, people took the time, she says, to understand what she had experienced. These programs gave her structure and taught her accountability as she rebuilt her self-esteem.

Caccavaro graduated from Drug Court in February, and today she works at Megan’s House, a home in Lowell that helps women transition out of substance abuse and into independence.

If you want to help someone dealing with addiction, Caccavaro says you need to look at the person, not the addict. “ ‘Keep it up.’ You’re doing so good.’ Those little words meant so much,” she says. “Just one person can change your whole drive.”

 

Dr. Michael Collins, Chancellor, UMass Medical School

“From the school’s standpoint, I had a firm opinion that [opioids] had become a high priority of the governor. We’re a state institution, so we should take it as a high priority. Things don’t move fast in the curriculum world, but we went and did it right away.”

While addiction is often rooted in mental health and other personal issues, pain treatment and prescription painkillers often prove to be the gateway.

“The drugs are powerful, and [medical] practices want to alleviate pain,” Collins says. “Maybe society has even gotten to the point where we can make pain go away, so we do.”

With patient satisfaction surveys now a key component of a hospital’s reputation, there can be consequences to the conservative treatment of pain. Add to that a lack of investment in mental health and addiction treatment services, and the cracks begin to appear.

“We shouldn’t be surprised there is a large magnitude problem in front of us,” Collins says. He credits Gov. Charlie Baker for calling together leaders from the state’s four medical schools to help create 10 core competencies for the prevention and management of prescription drug misuse.

Inspired by Baker’s urgency, Collins didn’t want to wait. Last November, midway through an academic year, he went about changing the curriculum.

UMass Medical School students go through a series of real-world scenarios with actors playing the roles of patients. These days, there is a new one — the overdosed addict. Now, the training includes observational skills, communication, prescription planning, patient education and counseling, the administration of Narcan and effective screening for opioids.

By the time May arrived, when Baker spoke at the UMMS graduation ceremony, each of the graduates had been exposed to this new curriculum.

“If you look at the medical school’s reach in the Commonwealth, our graduates are in just under 200 towns, so if we do this right and we continue to educate them, we’ll be at a point where everyone who practices medicine will be exposed to this education and have an education in these core competencies.”

 

James Sagris, Probation Officer, Haverhill District Court

“We’re treating [opioid addiction] as a public health problem as much as a criminal problem as much as we can. Recognizing that, it gives me the most hope for success.”

Sagris has been employed in the criminal justice system for more than 30 years. Working with individuals facing substance abuse issues has always been part of the job.

When opioids became the drugs of choice a few years ago, he started seeing the same faces over and over again. Others overdosed and he never saw them again.

Sagris says the criminal justice system is realizing that punishments such as probation and jail don’t stop addicts from relapsing.

“There are people who try our patience, but there’s a lot less shaming and blaming that goes on,” he says. “We’re recognizing that these people come from different backgrounds.”

Instead of jail time, probation officers like Sagris have new tools at their disposal. They can mandate treatment for a probationer. And there are now 28-day treatment programs that enable probation officers to do more than just find an addict a detox bed for a
few days.

“I think best practices are showing in general across a lot of criminal avenues that the old approach to drugs doesn’t work,” Sagris says. “We’re becoming a little more enlightened as time goes on. When you’ve been here for the length of time I’ve been here, you really see it.”

 

Marian Ryan, Middlesex County District Attorney

“Issues like drunk driving and smoking, these were public health issues where we were able to change the trend. This is so much more of a challenge. It speaks to how deep it runs. We need to get to people before they get addicted.”

Ryan says she first noticed a rise in opioid abuse in Middlesex County in 2012. “We thought it was a spike, but looking back, it was a blip,” she says.

In 2012, there were 112 unintended opioid-related deaths in the county. In 2015, that number increased to 321, more than any county in the state. With her county at the epicenter of the crisis, Ryan decided she needed to listen. She convened her own opioid task force and organized a public policy forum that turned the tables. This time, law enforcement and health care professionals were the students, asking recovering addicts how to be more effective and to save more lives. Ryan knows there is a role for criminal justice to take these drugs off the street and punish criminal activity, but she believes in a more compassionate approach toward the users.

Her biggest lesson — the one thing that could truly help people who struggle with addiction — is to get to get ahead of the addiction.

To do that, she believes the conversation needs to start with kids, especially those who have suffered trauma in their lives, such as a divorce or the loss of a parent. These episodes often lead to behaviors such as substance abuse.

“Not all [addicts] have suffered trauma, but a lot of them have,” she says. “We need to identify trauma. … We need to get to people before they get addicted.”

Though some might think it’s too soon, Ryan believes the conversation can start as early as elementary school. “We can meet them where they are,” she says. “People would be surprised at how much these kids know.”

 

Kara Gagne, 27, recovering addict

“Everyone is different, but I know tough love worked for me. My parents had to completely let go, stop enabling me and basically shut me out of their lives until I realized I needed help and I needed to do it myself.”

More than four years sober, Gagne, a resident of Pelham, looks back and sees many reasons she was able to survive her opioid addiction.

She needed tough love, self-love, impending motherhood and a renewed relationship with her father, the lack of which, she believes, contributed to her addictive personality. Like many young people who become addicts, Gagne says there was trauma early in her life, stemming from the divorce of her parents, several moves and adapting to her father’s new relationship.

By the time her family settled in Pelham, she’d already displayed anorexic behavior, which led to drinking. In her senior year of high school, she tried OxyContin, crushing and sniffing it. “It made me throw up, but I didn’t care,” she says. “I loved the feeling it gave me.” Soon Gagne was stealing from her family and friends, failing in school and getting fired from jobs. “Then they made it so you couldn’t crush the pills anymore,” she says. “That’s when I started using heroin.”

With the help of her family, Gagne entered more than a half dozen rehabilitation programs. Rock bottom came one day when she relapsed while in treatment in Florida and was kicked out and onto the street. She was exhausted. “I didn’t care if I died,” she says.

On Feb. 7, 2012, Gagne called her father for her birthday. She told him she wanted to have a meaningful relationship with him. More importantly, she felt she was ready for it. She committed to a 30-day rehab and a 12-step program and finally found success.

Gagne now has children to care for and plans to get married on New Year’s Eve. Her relationship with her parents has never been stronger. Her wish for others caught in addiction is to give themselves a chance. “Help is out there, and it’s worth it,” she says. “Your life is worth it. And life on the other side is so much better sober than any day using. Even the bad days.”