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When Bill Howell hires a recovering addict, he knows their situation first hand.

Bill Howell, owner of Concrete Bill. "Education and treatment is the silver bullet when it comes to overcoming addiction." (Photo by Michael Cummo) — Photo by Michael Cummo

This is the seventh installment in a continuing look at drug abuse and its effect on the Island community by Times reporter Barry Stringfellow. The series began on Jan. 2 “Opiate addiction hits home,” and was followed on Jan. 22 “Martha’s Vineyard police and physicians confront opiate abuse,” on Feb. 12 “Opiates, a love story,” and on May 7 “Battling Addiction on Martha’s Vineyard,” on June 5 “Section 35—when addiction calls for drastic action” and on June 25, Intervention—tackling addiction head on.

Bill Howell arrived at the Vineyard House construction site off Holmes Hole Road in Vineyard Haven early on a recent sunny Monday morning with his dog, Keeper, kicking up a cloud of dust behind him. Mr. Howell didn’t look like a typical cement contractor in baggy shorts, low-cut Chuck Taylor All-Stars and faded “Keep off grass” tee-shirt. He also bucked the stereotype with his easy-going, soft-spoken manner.

Jamie Kergaravat hauls boards that will make the form for a concrete foundation. (Photo by Michael Cummo)
Jamie Kergaravat hauls boards that will make the form for a concrete foundation. (Photo by Michael Cummo)

He gave instructions to his young and eager five-man crew as they put the finishing touches on an expansive foundation for the men’s dormitory at the new Vineyard House, the Island’s only sober living facility. The job has special significance for Mr. Howell. “I was one of the first residents of Vineyard House; I started living there in 1999,” he said. “I bid low on this job. I really wanted this one.”

Mr. Howell started Concrete Bill, his cement contracting company, in 2001 when he was still a resident at Vineyard House. He’ll have 15 years clean time on November 29 — “5,377 days clean, but who’s counting?” he said.

Mr. Howell has hired many Vineyard House residents and alumni over the years. “A lot of people in recovery won’t hire people in recovery. I don’t get that,” he said. “I did from day one. This is not a not-profit company. But I can’t not hire these guys.”

Four out of five of his crew today are in recovery. “We were five out of six, but we lost one last week,” he said. “He needed to borrow $500 for a new car, that’s the last I’ve seen of him.” Mr. Howell shrugged. “I don’t fire people who are struggling. In the past 10 years, I only had to fire one person.”

Solid reputation

Mr. Howell’s company, Concrete Bill, is well respected in the Island building community. “Bill has been doing foundations for me since he first started out,” Bill Potter, CEO of Squash Meadow Construction, told The Times. Squash Meadow is the general contractor for the new Vineyard House. “Integrity and honesty are core principles that we believe in as a company and we expect from the people we work with. Bill Howell lives up to that in every respect.”

“Bill’s easy to work with and his crews are quality,” project manager Woody Mitchell told The Times. “When you’re doing modular homes like Vineyard House, foundations have to be perfection. It’s not like you’re framing in the field when you can make adjustments on the fly. Bill does a quality job every time.”

Rock bottom

Originally from the Cape, Mr. Howell, 51, came to the Island because he was “basically homeless,” and he hoped the move would lead to the path of recovery.

Initially, it didn’t.

“Pills, cocaine, heroin, I took whatever was there,” he said. “It doesn’t matter to an addict. It has nothing to do with logic. lt’s a form of insanity.”  Mr. Howell began using drugs and alcohol at the tender age of 9. Addiction runs deep on both sides of his family. “My father died of complications from alcoholism, my grandfather was an alcoholic,” he said. “Being around addicts was normal for me, and I just kept doing it.”

In the end, the move to the Island was key to his recovery. In addition to gaining a foothold at Vineyard House, “It felt good to have an ocean between me and the people I was spending time with,” he said.

Pillar of the community

Mr. Howell is active in the Island recovery community. In addition to providing employment, he’s a sponsor, mentor and he helps organize an annual celebration of recovery that the Vineyard community has hosted for the past 26 years.

Per 12-step program protocol, no individual can speak to a particular  recovery program. While the ultimate goals are the same, there are differences in dictum. “The goal for us is not abstinence, it’s recovery,” Mr. Howell said, adding that he relapsed for the last time in the 90’s. “There’s zero hope or expectation when you start in recovery. All you think about, all day, every day, is using again. But if the times a person uses are shorter, and the clean times last longer, that’s a win.”

Mr. Howell said the dark days create a special bond among recovering addicts. “We’re all survivors of the same near-fatal catastrophe,” he said. “We pull for each other. If you need support, go to a meeting. There’s one on this Island every day.”

Mr. Howell also had a suggestion for people who aren’t sure if they need help. “If you’re wondering if you have a problem, ask your family and friends what they think,” he said. “They’ll tell you.”

De-stigmatizing addiction

Mr. Howell was unfailingly forthcoming about his addiction and his recovery and he didn’t hesitate to give his last name. “I think people are more comfortable doing that because the perception of addiction is changing,” he said. “It has to change. Education and treatment is the silver bullet when it comes to overcoming addiction.”

Two of Mr. Howell’s crew also elected to give their full names.

Jamie Kergaravat, 29, has been working for Concrete Bill for three months. He has the build and the close-cropped hair of a Marine who just finished boot camp. “I was homeless three times,” he said, lighting a cigarette. “I lived in halfway houses, homeless shelters, outdoors. I was not into my recovery.”

Like Mr. Howell, he was down to his last stop when he came to the Island. His aunt took him in after yet another rehab stint at the Brockton Addiction Treatment Center. He’d stolen so much from his mother that she had a court order to keep him 50 feet from her house. “Now, I can’t get her off the phone,” he said laughing.

“The best thing I ever did was going to my first meeting here. I raised my hand and asked for help. It was hard to do. It was like putting my tail between my legs. I was scared. I sat at a table afterwards, and there was a line of people who wanted to help.”

Mr. Kergaravat has six months clean time. He’s lived at Vineyard House for the past five months. “It’s a great group of guys — we all click,” he said. “It’s impossible to do this alone. It’s all about surrounding myself with people who are doing the right thing.”

Which is not to say it’s been a smooth ride. “There’s definitely white-knuckle times, especially in the beginning,” he said. “But I’m not going back. I love living here. This Island has so much to offer.” Mr. Kergaravat reached into the back of his pick-up and picked up a brand-new surf rod and reel. “I haven’t caught anything yet, but I figured it’s time to start learning.”

Emmett Cook, 21, went to 12-step meetings with his father when he was a child. “He did work at it,” Mr. Cook said. By the time his father moved the two of them to the Island for a fresh start, Mr. Cook had been a frequent guest of Rhode Island and Connecticut state youth facilities, starting at age 13.

He enrolled at Martha’s Vineyard Regional High School but dropped out after a year. His appetite for drugs grew unabated. “My drug of choice was ‘More,’” he said. “It didn’t matter what it was, just ‘more.’”

Mr. Cook’s father has since moved back to the mainland and is no longer in recovery. Mr. Cook stayed and, after one relapse, has been clean for over a year. “April 17, 2013,” he said.

Mr. Cook had turned 21 the day before he spoke to The Times. He celebrated with a cake and a dip in the ocean, and a meeting. “I usually go to a meeting every day,” he said. “It’s an hour a night: there’s no excuse not to go.”

As the crew packed up, Mr. Kergaravat surveyed the finished job. “It’s very cool that we got to build the foundation for this place,” he said. “If someone wants help, I’d say come to Vineyard House. There’s always a bed. The new place will have tons of beds.”

For more information about Vineyard House, call 508-693-8580 or go to VineyardHouse.org.

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The difficult process of placing an addict into involuntary rehab comes with additional hurdles for Islanders.

In order for family members to file a Section 35, they must go to Edgartown Court, or file a petition via fax. — Photo by Susan Safford

This is the fifth installment in a continuing look at opiate abuse and its effect on the Island community. The series began on Jan. 2 “Opiate addiction hits home,” and was followed on Jan. 22 “Martha’s Vineyard police and physicians confront opiate abuse,” on Feb. 12 “Opiates, a love story,” and on May 7 “Battling Addiction on Martha’s Vineyard.”

The Section 35 commitment is the final stand in the battle against addiction. When voluntary rehab, reasoning, begging and pleading have failed, and an addict’s family, doctor, or local law enforcement officer believe that there’s an imminent threat of serious harm to the addict or to others, Section 35 enables them to request that the court put the addict into involuntary inpatient rehabilitation for up to 90 days.

“Section 35 is the last resort,” said Dr. Charles Silberstein, resident psychiatrist and addiction specialist at Martha’s Vineyard Hospital. ”For a lot of people it feels cruel to say ‘you can’t live with me anymore’ for worry that it will backfire. But it’s reasonable to say, from a place of compassion, ‘I can’t tolerate this anymore. I worry I am enabling you and I can’t bear it.’ The problem is when people say it and don’t mean it and it becomes meaningless, or worse, it tacitly says ‘I’m powerless and I’m going to continue tolerating your addiction.’”

On the rise

Due to the increase of opiate and heroin addiction, Section 35 commitments have been rising steadily in Massachusetts. According to the Massachusetts Department of Public Health (DPH) there has been a 67 percent increase in the number of Section 35 commitments since 2006. A total of 4,982 Section 35 commitments were made in fiscal year 2013 (FY 13), which began on July 1, 2012. The numbers were particularly grim for the Cape and Islands in FY 13. According to the office of state senator Jennifer Flanagan, there were 975 Section 35 commitments in the Cape and Islands region, which is by far the most in the state. The MetroWest region was a distant second with 597 commitments; there were 218 in Boston, which has a population of roughly three times the Cape and Islands.

An Islander who wants to initiate a Section 35 petition must go to Edgartown District Court and file an application with clerk magistrate Liza Williamson, who will guide them through the process.

“It’s very difficult for loved ones to file a Section 35,” Ms. Williamson said in an interview with The Times. “Our judges, the police, every department here is very sensitive about it.”

Although the  judges are only in Edgartown district court on Monday, Thursday, and Friday, Ms. Williamson said the petition can also be handled via fax.

“We find a way to make it work, no matter what day of the week it is,” she said. Ms. Williamson said the local chapter of the National Alliance on Mental Illness (NAMI) is an excellent resource for family members who are considering petitioning for a Section 35.

It’s not uncommon for police to file a Section 35 petition.

“When I review police reports, if I see we have a lot of interaction with that person and it’s clear that substance abuse is a problem, we can fill out the [Section 35] paperwork,” Edgartown Det. Sgt. Chris Dolby said. He added that the definition of family member is blood relative or spouse.

Live-in companions, even if they have children together, cannot file a petition for commitment under current Massachusetts law.

An Edgartown District Court judge reviews the petition and decides it has merit, a warrant of apprehension will be issued, which enables the police to take the person into custody and transport them to the Duke’s county courthouse. Before a judge can issue a commitment the individual must be examined by a Department of Mental Health (DMH) approved physician. This is where the Island complications arise. There is no DMH approved physician on the Vineyard. Consequently, commitments are handled in Falmouth District Court.

“If the judge decides to issue a warrant, it’s only good for the close of that court day,” Mr. Dolby said. He said he must get the individual on the boat to Falmouth, hope the doctor is available in court, and hope he or she can see the person before 4 pm. “If not, the person walks,” he said. “I had a recent case where the person, who clearly needed help, walked off the boat because time ran out.”

Getting an early start is important. “They’re called sunset warrants,” Ms. Williamson said. “I advise people to file as early in the day as possible. Getting someone off Island is a time-sensitive puzzle with a lot of moving parts. The sheriff’s department makes every attempt to get people transported in timely fashion. The Steamship Authority is as helpful as they can be. Dr. [Jeffrey] Zack and the emergency department at the hospital do a great job coordinating their efforts. But if you get the person to Falmouth and there’s no doctor there, it doesn’t matter,” she said, highlighting a major Island complication.

Island exigencies

“Unfortunately, in order to commit, you need an evaluation from a department of mental health (DMH) designated forensic psychologist, and we don’t have one on Martha’s Vineyard,” Ms. Williamson said. “There’s one DMH doctor, Donna Maynard, who does evaluations for the entire region. That covers from New Bedford to the Cape and Islands. Donna does a great job but there’s only so much one person can do. When I get a Section 35 I’ll call her and ask, “Can you help today, yes or no?”

Ms. Williamson works on the Committee for Public Counseling Services with the goal of finding on-Island DMH doctors and psychiatrists. “I’ve reached out to several psychologists and psychiatrists to ask them about getting DMH designated certified,” she said. “But it’s difficult when you already have a very busy private practice. The mental health system on the Island is extremely overburdened.”

If the Islander is seen by the appropriate doctor in Falmouth and committed before the sun sets on the warrant, the judge will order him or her to a licensed inpatient substance abuse treatment facility, such as the Women’s Addiction Treatment Center (WATC) in New Bedford, or the Men’s Addiction Treatment Center (MATC) in Brockton. If no beds are available, which is often the case, men are sent to the Bridgewater Correctional Complex and women are sent to the Framingham Correctional Institution, state-run prisons, where they are kept separate from the criminal population.

“It’s frustrating because there are so few beds available,” Ms. Williamson said. “Sometimes the only beds are at Bridgewater or Framingham. It can be traumatic for someone to go to one of these places but when you get to a Section 35, you’re out of options. You’re trying to save that person’s life.”

Mr. Dolby, a member of the Vineyard drug task force, was sharply critical about the support system that currently exists on the Island. “We’re up against it. We’re in a tough situation,” he said. “There’s no rehabilitation on this Island. It’s ridiculous that someone has to go to Falmouth to be evaluated. Addiction is a huge problem here. I see how frustrating it is for the addicts and the families of addicts. New Paths and Vineyard House do good work, but they’re just putting a finger in the dike.”

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Construction on a new campus for Martha’s Vineyard’s only sober living program has officially begun.

From left: Representative Tim Madden, Brian Mackey, John Colucci, Bill Potter, Mark Jenkins, John Early, and Mary Nada broke ground on the new Vineyard House construction last spring. — File photo by Ralph Stewart

A festive crowd gathered on Monday morning at Short Hill Road in Vineyard Haven to celebrate the groundbreaking for the new Vineyard House campus. Many heartfelt hugs were exchanged among the guests, which numbered over 100 people, and included Vineyard House alumni, current Vineyard house residents, law enforcement, and the counselors, medical professionals, and volunteers who battle in the trenches against one of the Island’s most critical health problems. Underscoring the importance of the event, state representative Tim Madden and Cape and Islands District Attorney Michael O’Keefe were also in attendance.

“To actually embrace a facility like this, it doesn’t happen in other towns,” Mr. Madden said. “The people of this Island said ‘we have to take care of our ourselves’ and you did that, with very little help from the state. I can’t wait to come back for the ribbon cutting.”

Cape and Islands district attorney Michael O' Keefe.
Cape and Islands district attorney Michael O’ Keefe.

“Addiction is not a new problem,” Cape and Islands district attorney Michael O’ Keefe said. “But if all we do is revive addicts we’re not dealing with the problem. It’s refreshing to see people who have done something about this growing scourge. I’ll be writing a check as soon as I get home.”

It started with a phone call

“I was in Florida on vacation in December of 1996,” recalled Hazel Teagan, substance abuse counselor and co-founder of Vineyard House along with Dr. Charles Silberstein and Clarence “Trip” Barnes. “Charlie called and said, ‘Do we need a halfway house?’ and I shouted ‘Yes!’ so loudly I think they probably heard me on the Vineyard.”

Since 1997, Vineyard House has been the only long-term sober living facility for Islanders who are coming back to the Island after detox or rehab.  To date, more than 400 Islanders in recovery have made Vineyard House their temporary home.

Ms. Teagan recalled the earliest days of Vineyard House, when she and a cadre of volunteers worked to restore and repair the original Vineyard house, which is over 150 years old. “We did everything, we scrubbed floors, painted walls, we even pulled poison ivy.” she said with a laugh.  Over time, Vineyard House expanded to three converted houses, two for men, one for women, that house 23 people in total. But the buildings were showing their age. “It got to the point where we outgrew the houses, and they were becoming very expensive to maintain,” said Mark Jenkins, president of the board of directors. After years of fundraising that began with an anonymous $500,000 donation in 1997 and was temporarily derailed by a nationwide financial crisis, the Vineyard House reached the $3 million goal this past January.

Support from far and wide

“This is a miracle,” Ms. Teagan said, looking at the recently cleared 4.4-acre acre lot, where heavy construction equipment sat at the ready. “So many people helped make this happen with their donations of their money and their time. This is a great day for the Island.”

Ms. Teagan was particularly effusive about the efforts of Mary Nada, chairman of the Vineyard House capital campaign committee. “Mary is the main reason we’re standing here today,” she said.

“I’ve been raising funds since I was a Brownie,” Ms. Nada said modestly. “I’m not shy about asking for money.”

A seasonal resident from Boston and retired therapist from the Boston public school system, Ms. Nada said she has a personal stake in Vineyard House. “My family has its share of alcoholics. Many of them are sober today, I’m happy to say. But I’ve seen firsthand how addiction affects the entire family.”

Ms. Nada said she has raised funds for many different organizations, but Vineyard House was her biggest challenge. “Vineyard House was by far the hardest,” she said. “There are a still a lot of people that don’t understand the disease of addiction.”

Ms. Nada gave kudos to her husband, Sherif Nada, for putting up with her relentless efforts. “Every time we were at a social event and someone said they went to the Vineyard, I got their name and number right away. He said, ‘When are you going to stop?’ I said, ‘Never.’”

Ms. Nada said that three of the biggest donors, one of whom donated $500,000, are summer residents who asked to remain anonymous. She added that the 6-figure challenge grant by Joel Greenberg and Marcy Gringlas was also a big boost to the coffers. In the end, well over half of the capital campaign funds were contributed by seasonal residents. Many Islanders have stepped up to the plate in a variety of ways.

Part and parcel

In 2006, a big piece of the puzzle came into place when Jerry Goodale of Vineyard Haven offered the large tract of land off Holmes Hole Road to Vineyard House for $270,000, far below market price.

By January of this year, the money raised by capital campaign combined with the projected sale of the three houses owned by Vineyard House, along with a $75,000 Community Recovery Innovations (CCRI) grant — the only government funding in the project — got the new Vineyard House over the $3 million finish line.

The new Vineyard House will house 24 people — two houses will accommodate 17 men, and one house will accommodate seven women. Additionally, there will be an office building and a common building with a meeting room for 12-step support groups. As with the old Vineyard House, residents will be required to pay rent, to attend support group meetings, to participate in house meetings and to submit to random drug tests that come with a “one strike and you’re out” policy.

Squash Meadow Construction will build the facility. “Bill Potter [owner and president of Squash Meadow construction] is incredibly passionate about this project,” said Dawn Bellante Holand, managing director of Vineyard House. “He’s been getting 5 to 10 percent discounts on materials from many of the suppliers. He’s already taken it far beyond what we could do.”

Mashek MacLean Architects, designers of the YMCA of Martha’s Vineyard and the Oak Bluffs Library, are the design architects for the new campus.

Ms. Holand said the new campus should be finished by year’s end. “We want to be home for the holidays,” she said.

It was fitting that the ceremony took place on a sun-dappled day when spring had finally arrived to the Vineyard.  A majestic beech tree, intentionally spared in the excavation process, was beginning to bud. It is a tree under which which many hopeful and heartbroken conversations will surely take place. And it will likely stand, resolute, on idyllic summer days and through tempestuous winter storms, for many years to come.

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As the rising tide of addiction strains treatment resources on the Island, a dedicated few make sure that help is still available.

Substance abuse counselors Dianne Mackellar (left) and Hazel Teagan, seen here at the Vineyard House groundbreaking, are available 24 hours a day to Islanders in need, by calling 508-693-0410. — Photo by Ralph Stewart

This is the fourth installment in a continuing look at opiate abuse and its effect on the Island community and Islanders. The series began on Jan. 2 “Opiate addiction hits home,” and was followed on Jan. 22 “Martha’s Vineyard police and physicians confront opiate abuse,” and on Feb. 12 “Opiates, a love story.”

On March 27, Governor Deval Patrick declared opioid addiction a public health emergency in Massachusetts. He entrusted $20 million to the Department of Public Health (DPH) with a mandate to combat overdoses, to slow the spread of the epidemic with prevention and education, and to map a long-term solution for the Commonwealth.

Martha’s Vineyard is not immune. Six Islanders have died of opiate overdose since August, according to Dr. Charles Silberstein, psychiatrist and addiction specialist at Martha’s Vineyard Hospital. Island-wide, there was one heroin arrest in 2012 and 10 heroin arrests in 2013; in 2012 there were 13 arrests for oxycodone and percocet pills, in 2013 there were 15 arrests. Anecdotally, Island law enforcement, counselors, and physicians say that opiate addiction, and the crime that invariably comes with it, have become a scourge on the Island.

“We definitely feel it in the emergency room,” Dr. Jeffrey Zack, director of emergency medicine at Martha’s Vineyard Hospital, told The Times. “We’ve seen a big rise in cases related to opiates and heroin.”

Dr. Zack said that people often come to the emergency room (ER) for services the hospital doesn’t provide, which can take up valuable beds, sometimes for days.

“We want people to feel this is a safe place to get help. We’re the backstop on the Island, and we won’t turn anyone away. That said, we’re not a detox facility or a psychiatric facility. If it’s not a life-threatening situation, the first call I’d make would be to Hazel or Dianne,” he said, referring to Hazel Teagan and Dianne Mackellar, the substance abuse counselors at the hospital, who between them have close to 70 years of experience.

Tenacious team

“All they have to do is call the main number at the hospital, 508-693-0410, and ask for the substance abuse team,” Ms. Teagan said. “Either Dianne or myself will get beeped and we’ll answer the call.”

Even though the substance abuse team is inexplicably absent from the hospital website, Ms. Mackellar and Ms. Teagan are available via the hospital main phone number, 24/7.

“We do a lot of work on the phone, educating people, giving phone numbers to call, and finding beds for people who need them,” Ms. Mackellar said. “Hazel and I work very closely together. We know the ins and outs of a system that can be very complicated.”

Ms. Mackellar also encouraged people to call rehabilitation facilities directly. “I’d definitely recommend calling a place like Gosnold and getting on the list,” she said, referring to Gosnold addiction treatment center on the Cape, where a high percentage of Islanders have gone for treatment. “They don’t need a referral. Sometimes it can take a while, but if you call every day, you’ll get a bed.”
Ms. Mackellar said it has to be the addict, not a loved one, who makes the call. “That call is significant,” she said. “It’s the addict saying ‘I want to do something.’”

Detox deficiency

Ms. Teagan said the absence of a detox facility on the Island is a significant shortcoming. “We had a facility here and it was wonderful. It was small but it worked. It also saved a lot of people from relapsing. But after the hospital filed for Chapter 11, the detox unit was one of the first things to go,” she said, referring to the hospital bankruptcy filing in December 1996. “It hasn’t come back, and I don’t know if it ever will.”

“The numbers just aren’t there,” Tim Walsh, Martha’s Vineyard Hospital chief executive officer, said in a phone call with The Times. “I get a lot of grief about this, but it’s a very expensive proposition. You’d need at least three full-time doctors, and nurses and support staff. The population here doesn’t support it.”

Ray Tamasi, President and CEO of Gosnold, agreed with Mr. Walsh. “A detox facility on the Island has been swirling around for a number of years,” he said. “Over the long haul, it’s probably not sustainable.”

Mr. Tamasi also said that opiate addiction requires a different modality of treatment. “With the opiate crisis there’s been a clamor for more [detox] beds. I have a different take on that. If we were building a new health care system, would we focus all the attention on building emergency rooms? Eighty-seven percent of patients admitted to detox in Massachusetts are returning patients; 55 percent have five or more stays in detox. If you had 20 more beds they’d be filled in two weeks. We’re focusing on extended engagement after they leave.”

A pilot intensive outpatient program (IOP) at Gosnold for addicts between 18 and 28 years old is yielding promising results. “There is a 75 percent decline in admissions to detox units, almost complete elimination to hospitals or ER, and no issues with the law,” Mr. Tamasi said. “Detox is only one compartment of care. The biggest challenge is to manage the condition for life.”

Outpatient options

Recovery on a small island means many of the recovery groups, and the people in them, overlap. “The recovery community on the Island is very tight,” Jeremy Norton, director of Dukes County community corrections center said. “People who are committed to their recovery tend to look out for each other.”

Mr. Norton works with recovering addicts who are released on probation. “If someone gets a GED while they’re with us, they’re much less likely to reoffend,” he said. “They’re also less likely to reoffend if they know they’re getting drug tested.”

Two pillars of the Vineyard recovery community are New Paths Recovery Program, the only long-term outpatient facility on the Island, and Vineyard House, the Island’s only sober living facility.

“We’re very fortunate to have programs like New Paths and Vineyard House on the Island,” said Ms. Teagan, who is also a co-founder of Vineyard House, which was established in 1997. “People can live in a completely sober environment at Vineyard House or, depending where they are in their recovery, they can live at home and go to intensive outpatient treatment at New Paths as well as Narcotics Anonymous (NA) or Alcoholics Anonymous (AA).”

Drug testing is a way of life at Vineyard House. As house manager Rick Manning spoke to The Times, he cheerily handed a cup to a resident. “It’s got chemicals at the bottom so drugs and alcohol show up right away,” he explained. “You don’t get three strikes here. If you test positive, you’re out.”
All Vineyard House, residents are required to pay rent, to attend support group meetings, and to participate in house meetings.Mr. Manning became a resident at Vineyard House in April,  2010, after coming back from his fourth detox. As he was being discharged, the counselor told him that his mother had called to say he was not welcome in her home.

“When you lose the respect of your mother, that’s bad,” he said. “When I came back, I knew I wasn’t ready to hit the street, so I got into Vineyard House.”

Now Mr. Manning is a house manager at Vineyard House. He’ll be four and a half years sober on September 15. He’s working steadily and has reestablished ties with his daughter. “I’m proud of my recovery, and I don’t hide my disease from anyone,” he said. “I’ll stand on a rooftop and scream ‘I’m an alcoholic.’ Now people turn to me and I’ve been able to help. That’s a great feeling. Now I can go to functions where alcohol is being served and it doesn’t bother me. That’s a great feeling too.”
Vineyard House is about to expand. Following a successful fundraising campaign, on Monday, May 5, Vineyard House officials and supporters broke ground on the new Vineyard House campus on Short Hill road in Vineyard Haven.
While the future looks bright for Vineyard House, there are clouds on the horizon for New Paths Recovery Program, which operates under the umbrella of Martha’s Vineyard Community Services. New Paths began operation in 2010, funded by a one-time five-year grant from Martha’s Vineyard Hospital. The New Paths IOP program is the first stop for recovering addicts returning to the Island from detox. New Paths also offers other programs for people in various stages of recovery. Since its inception, New Paths has served over 350 recovering addicts on the Vineyard. But now it’s running at a deficit and when the hospital grant ends in December, another $51,000 will be lost from the ledgers.
“The grant from the hospital was finite from the beginning,” Jill De La Hunt, program coordinator at New Paths, said. “Insurance companies were projected to pay for a sizeable part of the cost, but they approve fewer and fewer sessions, and they also required licensed therapists to call them about billing, which takes up a lot of their time.”
Ms. De La Hunt said no one is turned away from New Paths for financial reasons. If someone comes to New Paths without health insurance, a staff member will help them through the application process.
She thinks there is a need for on-Island detox. “A detox facility is a real community need,” she said. “We have people coming to us needing more than we can provide medically. If the numbers don’t support an inpatient detox facility, we could have ambulatory detox and outpatient detox, which was offered here in the past. Some people just don’t have the means to get treatment off Island.”
Although the financial future is uncertain, Ms. De La Hunt remains optimistic that New Paths will continue to serve the Island. “We get all kinds of community support,” she said. “I think that’s the silver lining. We get in-kind donations from businesses and from individuals and that sends the message that the community cares, which is very powerful. The support from the community means people want them to be healthy and want them back.”

Correction: The original story stated that Richard Manning has been a resident at Vineyard House since May, 2012 and has been sober for two years. Mr. Manning has been a resident at Vineyard House since April, 2010 and will be sober four and a half years on September 15, 2014.

For help

For an overview of recovery options to Islanders, call Martha’s Vineyard Hospital, 508-693-0410, and ask for substance abuse counseling.

Off Island medical detox/extended inpatient care

Gosnold, Cape Cod: 1-800-444-1554gosnold.org

High Point treatment center, Plymouth: 800-922-7703 hptc.org

AdCare hospital, Worcester: 1-800-345-3552  adcare.com

Private inpatient programs

Farnum Center, Manchester, N.H.,  603-622-3020estreatment.org/farnum-center

$12,000 for 30-day inpatient care. $3,400 for medical detox.

Plymouth House, Plymouth, N.H., 800-428-8459theplymouthhouse.com

$6,860 for four weeks. No medical detox available.

High Watch Recovery Center, Kent, Conn., 860-927-3772,highwatchrecovery.com

$8,337 for minimum 22 day stay. $11,193 for one month.  Will arrange off-site medical detox.

On-Island resources

New Paths Recovery, 508-693-7900  mvcommunityservices.com
Vineyard House, 508-693-8580   vineyardhouse.org

Alcoholics Anonymous, 508-627-7084  alcoholics-anonymous.org

Al-Anon/AlaTeen, 508-394-4555  ma-al-anon-alateen.org

Narcotics Anonymous, 866-624-3578na.org

A full schedule of meetings appears in the Calendar section of The Times.

 

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A cache of pain killers seized by Oak Bluffs police in a recent arrest. — Photo courtesy of Oak Bluffs Pol

Opiate addiction on Martha’s Vineyard cuts across all ages and social classes. There is not one profile of an opiate abuser. What is certain is that the abuse of prescription painkillers is a growing problem, one with a ripple effect throughout the community, police and doctors on the front lines say.

Last week, members of the Martha’s Vineyard Drug Task Force (MVDTF) stopped a tow truck driver who said he sold percocet pills to support his heroin habit. In a second case, police arrested a known opiate dealer who had just filled a legitimate prescription for 180 oxycontin pills.

While the details varied, in each instance opiates played the central role. Increasingly, the weekly Martha’s Vineyard court report documents a growing problem on the Island, matched statewide, a problem that is attracting the attention of lawmakers.

Last week, the Massachusetts Senate formed a special committee to address what Senate President Therese Murray called the “epidemic” of opiate addiction in Massachusetts.

“Since 1999 the state has seen a 47 percent increase in overdose deaths from prescription painkillers,” said Ms. Murray in a press release. “I’ve sat in the drug courts in my own district and it just tears your heart out to see families coming and pleading with judges to put their children away—adult children, not just small children.”

The pills that were created to rid people of pain are creating more and more of it.

As part on an ongoing series about opiate addiction here, The Times spoke with Island physicians and law enforcement to gauge the extent of the epidemic here, and to see what can be done to fight it.

Pills become a societal ill

The United States makes up 4.6 percent of the world’s population, but consumes 80 percent of all manufactured opioids, according to IMS Health, the largest vendor of U.S. physician prescribing data. Between 1991 and 2010, prescriptions for opiates increased from about 75.5 million to 209.5 million, according to the National Institute of Drug Abuse (NIDA).

According to the Centers for Disease Control and Prevention (CDC), opiate overdose deaths in the United States have more than tripled since 1990, and now cause more overdose deaths than cocaine and heroin combined. The fastest growing group of addicts is 12-17 year olds—nearly one in 12 high school seniors reported non-medical use of Vicodin; 1 in 20 reported similar abuse of oxycontin.

“It’s a much bigger problem than most people realize,” said Dr. Pieter Pil, chief of the medical staff at Martha’s Vineyard Hospital, in a telephone conversation with The Times. “Fifteen, twenty years ago, the patient is in pain, we gave him or her narcotics. Now we know that’s not a good idea. The body quickly becomes tolerant of narcotics and requires escalating doses. Then you’re putting into circulation doses of medication that may be appropriate for one person, but way too much for another.”

Dr. Pil said physicians at Martha’s Vineyard hospital require a signed pain contract with their patients before prescribing any painkillers. “It says, ‘I understand you have pain, here’s how we’re going to control it. If you get 20 pills for ten days, that’s all you’re going to get, whether you lose the pills or your dog ate them, that’s it, period.'”

The CDC estimates that emergency department visits for prescription painkiller abuse or misuse have doubled in the past five years to nearly half a million. Dr. Pil said in an emergency room situation, it’s particularly difficult to determine if someone is pill shopping.

“The emergency room is very different because the emergency room physician doesn’t have a relationship with the patient and doesn’t know if the patient truly has pain or whether the patient is getting the medication to divert. That can be very hard to sort out. If you go in and say you have back pain, there’s no medical test to see how bad the pain is or if it even exists.”

Dr. Pil said ER physicians are aware of the abuse issues, so they tend to prescribe lower quantities to get through the immediate crisis.

While to many, a prescription for 180 pills might seem excessive, medical conditions differ from patient to patient.

“Would I look at a prescription of 180 pills more than 40 pills? Yes,” said Dr. Pil. “But a patient with chronic severe pain is a patient who’s probably markedly tolerant. What may seem like an outrageous amount for one patient, enough to knock down an elephant, can be a minimal amount of medication for patients with a built up tolerance.”

Rise in crime

Edgartown detective sergeant Chris Dolby said there has been rise in crime on the Island linked to the rise in opiate addiction. “In 2011, we had 60 homes broken into in Edgartown, all directly connected to individuals trying to feed their addiction to pills,” he said. “We had a series of about 20 break-ins in 2012, also tied to an addict. Last year around 30 break-ins were tied to addicted individuals.”

Sergeant Dolby said that there was also a known addict whose court appearances coincided with car break-ins in downtown Edgartown. “He was taking cash and credit cards to feed his addiction,” he said.

According to Sergeant Dolby, prescription drug abuse cases are some of the most challenging investigations for law enforcement. “They’re not a normal drug investigation because at any given time the person can legally possess those pills. If I go into someone’s house and find pills with their name on it, that’s not illegal. We literally have to catch them red handed, which is very difficult to do.”

Sergeant Dolby said that the increase in opiate addiction has also led to a spike in heroin addiction on the Island. “As is often the case, when people can’t get pills, they resort to heroin. A lot of these people would never in their lives dream that they’d be a heroin addict, but it’s only substance that fills the craving. Heroin died out for a while until the pills became popular, all of a sudden heroin was right back on the scene.”

Last week, Mr. Dolby and members of the Drug Task Force arrested Bryan A. Cimeno, 45, of Morgan Way in Edgartown on a charge of possession with intent to distribute oxycodone. He was also charged with conspiracy to violate drug laws.

According to the police report, Mr. Cimeno had 64 oxycodone pills in his vehicle at the time of his arrest, and during booking at the Dukes County Jail, police discovered 10 more oxycodone pills concealed in the brim of his hat.

“He has a legitimate prescription for 180 oxycodone pills every 15 days,” Det. Sgt. Chris Dolby said in court, acting as prosecutor for the Commonwealth. “These pills are being diverted and sold.”

Police also summoned Mr. Cimeno’s wife, Carrie A. Cimeno, 39, of Morgan Way, Edgartown as a co-defendant in the case.

Also arrested was Brianna E. Combra, 23, of Edgartown-West Tisbury Road in West Tisbury for possession with intent to distribute oxycodone, and conspiracy. Police seized 37 oxycodone pills and $779 in cash from her when she was arrested.

Sergeant Dolby said Mr. Cimeno was selling pills to Ms. Combra for $15 apiece and she resold the pills for $25 apiece.

Broken contract

Dr. Gerald Yukevich is on the staff of Vineyard Medical Services, a private clinic on State Road in Vineyard Haven that provides primary and walk-in care. A former hospital emergency room doctor, he is widely known and respected in the community.

In a telephone conversation with The Times on Monday, Dr. Yukevich said

he also enters into pain contracts with his patients. Asked to comment on the arrest of his patient, Mr. Cimeno, Dr. Yukevich said, “I’m very sorry this event happened,” adding that he could not comment on particulars of the case because of patient confidentiality laws in the Health Insurance Portability and Accountability Act (HIPAA). “Pill diversion is a problem because there’s no real way to know if someone is going to lie to you, and you can’t prevent them from doing something that’s dishonest.”

Dr. Yukevich said that in a general sense, the amount of pills prescribed for Mr. Cimeno—180— is not necessarily unusual.

Fighting back

In 1992, the Massachusetts Department of Public Health (DPH) established the Prescription Monitoring Program (PMP) to track controlled substance prescriptions written by doctors in the state. Both doctors and law enforcement say the PMP has been extremely helpful in battling opiate abuse.

“Before the PMP, you had no idea what this patient was taking,” said Dr. Pil. “If you suspect the patient is pill shopping and you check the PMP, it becomes apparent very quickly. That said, there is a wide range of acceptability in pain management.”

“The PMP has helped law enforcement considerably,” said sergeant Dolby, who noted that access to the PMP by law enforcement is restricted. “I need to have a legitimate open investigation to put anyone’s name in there. I don’t have an investigation open on any doctors on the Island right now, so I don’t have the right to search it.”

Paradigm shift

Dr. Pil said the addiction epidemic has spurred major changes in pain management protocol at Martha’s Vineyard hospital, and elsewhere.

“The paradigm is shifting from pain medication to managing the pain with other means. It’s not about eliminating all pain, but managing pain to the point where people can have a productive life,” he said. “Steroid injections into the spine, and radiofrequency ablation—a probe generates heat from high frequency current and destroys the nerve that carries the pain signal to the brain—are highly effective pain reduction techniques.”

Martha’s Vineyard hospital, in conjunction with Massachusetts General Hospital, has established a pain clinic and intervention service. Cheryl Kram R.N., a high risk intervention and pain nurse, hosts video conferences with patients and Mass General doctor Chris Gilligan, to evaluate how pain can be controlled without narcotics. “The demand has really taken off,” said Dr. Pil. “It’s been unbelievable.”