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June 14, 2019 Central Mass. HEALTH - Summer Edition

Opioid deaths hit record in Worcester County as officials keep trying countermeasures

Cafe Reyes photo Photo | Edd Cote Stephen Smith waits on tables at Cafe Reyes on Shrewsbury Street in Worcester, a business set up with the Hector Reyes House to provide employment for Latino men in recovery.
Cafe Reyes kitchen photo Photo | Edd Cote Fernando Ayala (left) and Eleuterio Vargas work the kitchen at Cafe Reyes, which serves Cuban food.

A report in May brought troubling news for Worcester: In 2018, 97 city residents died from opioid overdoses, the highest number ever recorded, up from a previous high of 82 in 2015. Worcester County also hit a new high of 283 deaths from overdoses of the drugs.

In contrast, the report – produced by the Massachusetts Executive Office of Health and Human Services – found the statewide numbers declined slightly for the second year in a row, from a high of 2,100 in 2016 to 2,033.   

In a city of close to 200,000 people, an additional 15 deaths could be chalked up to a couple of unusually strong batches of drugs hitting the area, or just random chance. But to Dr. Matilde Castiel, the city’s commissioner of Health and Human Services, the numbers suggest improvements in local institutions’ approach to the problem haven’t yet accomplished enough.  

“We overall have done some impressive things over the past number of years, but it takes some time to change,” Castiel said.

Dr. Pamela Tsinteris
Dr. Pamela Tsinteris

Initial efforts 
When the city hired Castiel, a doctor with a background addressing substance use disorders, in 2015, it was part of a broader effort to focus resources on the opioid problem.

Already, she said, the city had a task force working with homeless people in encampments, many of whom deal with addiction.

UMass Memorial’s Community HealthLink now offers 24-hour urgent care support for people with drug use problems. New recovery homes are opening up in Worcester. And the city in May rolled out the new app Stigma Free Worcester, created in partnership with Worcester Polytechnic Institute, to help residents find resources like housing, clothing, mental health support and addiction treatment.  
Dr. Pamela Tsinteris, director of Office-Based Addiction Treatment and the Chronic Pain Program at Family Health Center of Worcester, said she’s seen a big improvement in recent years in medical providers’ attitudes toward substance use treatment.   

“A few years ago, just a few people were willing to treat addiction,” she said. “We’ve really had an increase in the number of people providing this care.” 

Tsinteris said, in the past, practitioners’ only experience with addiction was encounters with people who tried to hide their drug problems in order to seek opioid pain prescriptions.  

Those encounters are often confrontational and uncomfortable, Tsinteris said, but when practitioners demonstrate they see addiction as a disease rather than a moral failing, they often find people in recovery are eager to work with them.

Fighting addiction with drugs
In both community settings like Family Health Center and larger institutions like the UMass Memorial Health Care system, increasing numbers of doctors, nurse practitioners, and physician’s assistants are getting trained and receiving federal waivers allowing them to prescribe buprenorphine. The drug, often combined with another medication called naloxone and sold under the brand name Suboxone, helps people avoid withdrawal symptoms and physical cravings when they stop using drugs like heroin or fentanyl. 

“It’s kind of a miraculous drug in some ways,” said Dr. Christopher Kennedy, chief of psychiatry at UMass HealthAlliance Hospital in Leominster. “It can allow people to think about getting a job, taking care of their family, as opposed to getting their next fix.”

HealthAlliance has formed partnerships in the surrounding communities. Like health institutions and campaigns in Worcester, the partnerships are helping make the overdose reversal drug naloxone, or Narcan, widely available. HealthAlliance is working with recovery coaches, people who have been through addiction themselves and can help others like them.
Helping people in recovery succeed
One longstanding institution demonstrating how people in recovery can help each other is Café Reyes, a restaurant and catering company on Shrewsbury Street that Castiel helped create before going to work for the city. The café employs men who have gone through treatment at the Hector Reyes House, which serves Latino men in recovery. 

“A lot of them have been incarcerated, and for a lot of them they have not had jobs,” said Dr. Aaron Mendel, who is the executive director of the organization, as well as a UMass physician and Castiel’s husband.  

Mendel said the business allows the men to learn both specific jobs skills and soft skills like workplace communication. It presents a positive public face of recovery.  

“When you walk in, you don’t know who in the restaurant serving you or sitting in the restaurant is in recovery,” he said. “Just because they have a substance abuse issue doesn’t mean they’re any less charming or less capable.”  

Beyond helping people succeed in recovery, Castiel said local officials and health providers are working to address the social issues creating fertile ground for substance abuse. That means things like helping people leaving jail or prison to get jobs and housing, and supporting public school students who have experienced trauma and high levels of stress.  

But those efforts won’t have immediate results in stopping overdoses. Meanwhile, healthcare officials are seeing a continuing rise in the prevalence of the powerful synthetic opioid fentanyl. Castiel said dealers are now mixing the substance not just into other opioids like heroin but in drugs like cocaine and marijuana too.  

To really get a grip on the overdose problem, Castiel said, it’s crucial for providers to become allies to people with addiction. She said only 20% of people with substance-use disorders seek help. Others are often worried about being punished as criminals for their drug use or stigmatized by healthcare systems.  

“For a long time, people with addiction and mental health problems have been marginalized,” Castiel said. “You can go into places and be treated horribly, and people will not go back.”  

Tsinteris said medical approaches are gradually shifting, becoming less judgmental and more focused on maintaining provider-patient relationships and helping drug users to keep themselves as safe as possible.   

“It’s helped simplify things, helped people be honest,” she said. “They don’t have to lie and hide it if they relapse.” 

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July 24, 2019

This is happing in Sao Paulo/Brasil the Reynaldo is the begin maybe of Crack(grow) related case in the 90,s at this time myself work in social facilite as Educator.
julho 22, 2019

The afternoon was sunny. A beautiful day we are sitting on the grass talking in an initial attempt of approach had him at that time 16 old. And much suffering on your coast. Had lived with parents up to 5 or 6 years old when he went to the street to escape the pain and suffering with other boys, easy to understand the mother maid struggled to keep the house on the outskirts he was the sixth child. The father electrician or something, but, was a man besides crude also alcoholic according to what Reynaldo remembers besides being violent with the children and with his mother was always absent from home in the club, nightclub, women and football.
So one day after being beaten violently by him he decided to run away and go to the city center to try his luck.
And so began to live on the street the first day tells him the cold the hunger and suffering and the homesickness and loneliness of the family. But soon everything was changed to meet a group of boys who walked along and asked for money, made small robberies, and when they did not work, they smelled of shoe-glue. And so wandering for a while grew up involved in heavier wallet hitting, small objects to be sold and stealing food markets, bakeries and fairs.
Lots of fun in the Plaza da Si bathing or on the slope of memory and always getting involved with everything that kept him alive. The first casualty was around the age of 14 was referred to FEBEM to be re-educated. He no longer remembered family or relatives getting used to being on the street and forgetting their own pain and suffering.
I stay there for a few months until an escape then came to the south zone got into the kids of his age and lead the same life the normal steal, smell and ask to survive.
Reported that on a certain date and made saw for the first time the death was taken by the camburão after many complaints from the local population under the thieves who were terrorizing the neighborhood.
He was invited to enter the car was arrested he found around the eight o'clock in the evening and had been in a circle for hours taken to the quarry dam where he was laid out and driven to run running towards the dam at this moment thought I will die came to an end was simple run would be shot from behind and thrown into the dam was easy like that.
For him what changed was a fusca with a couple looking for a little love solitude so to speak of headlamps linked the policemen sent the couple to return and leave and there was his chance one commented with the other loose if he appears around shot or disappear, they can say that it was the police and thus have him run and not look back. Arrived in Santo Amaro thinks by midnight and sleeping sniffing glue that night.
That's how I heard his first report sitting there on the grass, and still more to come not too long after another young man sat or maybe I do not know.
Reynaldo was sitting with Hawaiian slippers outside and so I on the other side and now the other next to him raised his voice and said the money I do not have now look this situation can not continue be subject man and pay what you got or else not you can guarantee nothing. As well as I can get to you is not the stop my brother thinks this well and just to refresh his memory and with a media knife sent in the middle of his foot engraving him with the flip flops on the floor. He said nothing to not create a conflict over the aggressor went away pulled the knife the blood washed the earth.
Please take him to the equipment but did not allow said he would rather go outside and if caring would be safer for him and us.
Then he disappeared into the world for a couple of weeks and reappeared with a bandage on his foot saying that it was okay to pay the debt (maybe the stone). And he did not touch the subject.
He came back even 2 times his smile was always contagious loud with soft features on the face despite all the suffering he hid.
Then shortly after we learned what happened had taken three shots inside the bus was recognized by a person who stole and between life and death referred to the hospital.
I learned long after by someone else who survived, but, was left with serious safe do not know what happened to him and just one more case than poverty and abandoned social power to do in the lives of millions of young people.
The story is real collected by me that I met him and I witnessed the happened and part of our way in search of a transformation of the social.

@Mauriciopartyguy / social worker / Cna ​​and Plebotomist


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