Over the past decade, Western Massachusetts has been devastated by a nationwide opioid crisis that has proved especially calamitous for the rural northeast. According to a study published by Brandeis University on Sep. 6, Berkshire County experienced a 48 percent increase in opioid-related deaths between 2017 and 2018, and Western Massachusetts as a whole faced a 73 percent increase.
Opioids are a class of drugs that trigger the opioid receptors of the brain, often relieving pain or producing morphine-like effects. Opioids include illegal narcotics such as heroin, synthetic substances such as fentanyl, which is over 50 times more potent than morphine, and prescription medications such as OxyContin.
In 2015, Berkshire County faced the highest opioid use disorder prevalence anywhere in Massachusetts, with over 6 percent of residents having opioid use disorders. At the time, opioid use was largely fueled by overprescribed pain medications developed by companies like Purdue Pharma, which faces lawsuits for concealing the addictive qualities of its products. Recently, however, opioid use has shifted away from this prescription medication, according to Megan Wroldson, division director of adult and family services at the Brien Center, which offers services to combat mental health problems and addiction in Berkshire County.
“The opioid epidemic can be characterized in waves,” Wroldson said. “The first wave was prescription opioids, the second wave was heroin and the third wave was fentanyl. So we’re currently in that third wave. We’re seeing fentanyl not only in heroin, but also in illicit pills and in cocaine and other stimulants.”
Susan Cross ’88, prevention and recovery program associate at the Northern Berkshire Community Coalition (nbCC), emphasized the role that stigma pays in making this epidemic invisible for many. “There are no boundaries to who the people who use opiates are,” she said. “There are doctors, lawyers, professors, teachers, nurses, the people that, for the reason of stigma, are not open at all about it.”
Cross said that misconceptions around people’s ability to stop taking opioids can contribute to this stigma, addng that opioids are physically addictive, and those who go through opioid withdrawal often experience deep pain. “People don’t typically die from withdrawal, but I think they probably would tell you they feel like they’re dying,” she said.
Opioids in the rural Berkshires
Several community organizers mentioned transportation and distance as factors that make it more difficult to combat the opioid crisis in rural areas like Berkshire County.
“I think rural areas are particularly hard hit for many reasons,” said Wendy Penner, director of prevention and recovery nbCC. “Transportation, isolation, just not having the population base means not having the same amount of services per capita.”
“It just costs more to do programming in rural areas,” said Jennifer Kimball, principal planner of public health at the Berkshire Regional Planning Commission. “We have to drive more. We have fewer people. The costs are just going to be higher.”
For Kimball, many of the problems with access in rural areas are intersectional. “When you do a deeper dive into the areas of social determinants of health, you really look at the poverty rates of these areas, the educational attainment levels of these areas, you start to look at systems that hinder even the best-case scenario of people who want to not overdose or want to be well or want to get services,” she said.
Western Massachusetts has a significantly lower GDP per capita than the rest of the state, and its population is five years older than the state average, making it especially susceptible to opioid use.
“I think about this as layers upon layers upon layers,” Kimball added. “So you start seeing perhaps why it hit Western Massachusetts particularly hard.”
Increased resources and an enduring need for change
The Brandeis study praised Berkshire County for its numerous collaborations among different organizations working to combat the opioid crisis. According to Penner, these collaborations began in 2012. Today, informal and formal partners in fighting opioid abuse include nbCC, the Railroad Street Youth Project, BOAPC, Healthy Steps, Berkshire Health Systems, the Brien Center and the district attorney’s office.
According to Kimball, efforts to fight opioids in Berkshire County have made deep strides in recent years. She credits, in part, a Substance Abuse Prevention Collaborative grant that the Berkshire Opioid Abuse Prevention Collaborative (BOAPC) received from the Massachusetts state government.
“When I started this program in 2013, when we first got this grant, … there were no treatment beds in Berkshire County,” she said. “We had no syringe access programs.”
Since then, BOAPC has facilitated the opening of a recovery center for addicts, a methadone clinic that sees approximately 300 people weekly and numerous syringe access programs, which provide syringes to allow for safer drug use. Methadone is a drug commonly used to treat narcotic addiction.
Penner emphasized the importance of syringe access programs, and added that access to suboxone, another addiction treatment medication, has increased. “Since 2015 we’ve gone from one suboxone provider, the Brien Center, in North Berkshire, to I believe three or four,” she said. Nevertheless, Wroldson brought up a lack of access to syringe exchange sites and methadone in southern Berkshire County.
The federal and state government’s historical approach to treating drug addiction has also worsened the problem, according to Kimball. “You have certain areas of the state when dealing with different things around overdose or low-level possession or trafficking where you have a system of just arresting the heck out of everybody, to be honest with you,” she said. “And that creates its own trouble and a recurring cycle within certain communities, specifically communities of color.”
Penner added that Berkshire County does not yet have any dedicated recovery housing, though the Brien Center plans to open a recovery home within the next sixth months for people with addiction and mental health disorders. This current gap, however, creates difficulties regarding follow-ups with patients.
“If someone overdoses, maybe they’re taken to the hospital, they’re revived and they just want to leave,” Penner said. “How can we do better to follow up with those folks, because we know folks who have overdosed are at very high risk?”
For community workers, interactions with state entities can be mixed. “We have a lot of really positive relationships with the district attorney’s office and local law enforcement and EMS,” Kimball said.
However, she has found that state-level anti-opioid legislation can be unresponsive to the Berkshires. “Over and over again, and I think they’re finally hearing us in Boston, the models that they’ve come up with, be it funding or whatever, don’t always work for the way things are out here,” she said.
“We barely qualified to even get this grant, which is a prevention grant, mind you, because we didn’t have enough people who died from overdose in a certain number of years,” she added. “Why, to do prevention work, would you want to have X amount of bodies on the ground?”
Kimball also advocated for increasing the availability of medication-assisted treatment in the Berkshire County House of Corrections. “That is something that’s up to the Sheriff’s office and it’s definitely a best practice that’s going on all over Massachusetts and it’s not happening here,” she said.
For Penner, prevention can be one of the most effective ways to combat opioid use. “What science tells us is that if you can delay the age of onset for when young people first use addictive substances, that reduces their risk of developing substance use disorder,” she said. This philosophy animates the work of both BOAPC and nbCC.
At BOAPC, daily activities include distributing flyers and newsletters and speaking at local community meetings.
“We created materials that did a lot of education around what are opioids, what are they indicated for, what are they not indicated for,” Kimball said. This includes informing people that they have the ability to only fill a portion of an opioid prescription, which is an option many are unaware exists.
nbCC, which has programs on family support, healthy eating and youth development, as well as substance abuse, has a similar focus on preventative care. “We’re a community coalition and our role is to enhance the quality of life within the community by connecting, commuting and supporting the community, so we don’t provide direct care services,” Cross said.
In March, nbCC opened the Beacon Recovery Community Center (BRCC), which offers a community space for those recovering from all kinds of addiction, though Cross estimated that approximately a third of attendees have opioid-related addictions.
The meetings at BRCC are often fairly free-flowing. “It’s just a way to talk about a topic and allow people, without being judged, without being advised, without being counseled, to just talk about whatever it is that you’re feeling and supporting their recovery,” Cross said. Sometimes, meetings include events like poetry workshops.
Cross decided to devote herself to this work following the emergence of an opioid addiction in a close family member. “I took an opportunity to use my lived experience as a family member and someone that bore witness to the pain, the agony, the manipulation, the lying, the stealing, the hurting, all of the things that go on when you love someone who’s addicted,” she said. “And I took an opportunity to give back.”
Children of opioid abuse
The phenomenon of parents becoming addicted to opioids has created significant childcare issues for Berkshire County. “One of the byproducts of the substance misuse epidemic right now is the number of grandparents that are raising grandchildren,” Cross said, adding that nbCC has a group focused on directing grandparents who are raising grandchildren to resources. “A lot of times the grandparents had been retired and with the introduction of their grandchildren back into their house because the household expenses increased, they often tend to go back to work. So they’re juggling things like childcare,” Cross said. “Now they’re 24/7 parents.”
According to Wroldson, Massachusetts has had an approximately 20-percent increase in foster care placements over the past several years, and she believes that the majority of these cases are attributable to drug addiction. The Brien Center currently offers living space for families that are reunifying and has nursery homes for new mothers who may have used opioids during pregnancy.
Other initiatives, like the Massachusetts-wide group FIRST (Families In Recovery SupporT) Steps Together, provide home visits to mothers who have experienced opioid use disorders. “I’m glad to have that in Berkshire County, but many times, we’d be too small to have a program like that,” Wroldson said.
Unlike nbCC and BOAPC, the Brien Center is focused primarily on treatment rather than prevention. The center has three adult outpatient clinics in Berkshire County, which offer therapy and medication, and currently has 69 slots for residential addiction treatment, though it plans to add another treatment house in North Adams. “We see over a thousand adults in our outpatient clinic each year to specifically treat addiction,” Wroldson said.
The Brien Center operates differently than many treatment centers across the country, specifically with regard to relapse. “The philosophy of treatment was that if you relapsed, you got kicked out of a program,” Wroldson said. “We can’t operate that way anymore. So we will continue to prescribe medication for someone who’s actively using and we will try to maintain them in our residences as long as it’s safe.”
The Brien Center follows the practice of integrated care, which merges treatment of mental health and addiction.
Cross expressed support for this integration. “Oftentimes the people that would go into a detox program might also be suicidal, or in the mode of self-harm,” she said. “The people that were helping them detox or monitoring their withdrawal from substances weren’t necessarily trained in mental health.
For staff at the Brien Center, and for all those who work to combat the opioid crisis, exposure to death can be deeply emotionally damaging. “The therapists that work here and the staff that work here develop very close relationships with clients and it’s not just experiencing the loss of the client and finding out the client’s passed away,” Wroldson said. “It’s experiencing that over and over and over again.”