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Looking Closer At How Best To Treat People On 'Methadone Mile'

The intersection of Massachusetts Avenue and Melnea Cass Boulevard is considered a gathering spot for people with substance use disorders. Recent police crack downs in the area have brought attention to a number of issues, including the state's opioid epidemic. WGBH Radio's Craig LeMoult spoke with ER doctor and state Rep. Jon Santiago about his experiencing treating people in the area that some people refer to as "Methadone Mile." The transcript below has been edited for clarity.



Craig LeMoult: You have a unique perspective on this issue, seeing it from several different vantage points. First, you live and work in that neighborhood. What do you see there? What's it like most days?


Rep. Jon Santiago: I think you bring up a great point. I see it from a whole host of different perspectives. I work right there as an ER doctor, so many people I see walking around are actually patients of mine — people I've seen over the years in search of help. I also live right there. I live a block away from Mass. Ave. and I jog the area quite frequently. And, in fact, I jog past Atkinson Street most mornings and I've seen what's going on there, and it's terribly sad. It's an issue that's gotten worse over the past several years, and you have to be honest with yourself and say things got really bad when the Long Island Bridge closed. When that closed several years ago, things got worse.


LeMoult: And that's because there were drug treatment centers on Long Island that got closed down when that bridge became unsafe.


Santiago: That's correct. There were many services on the island and the mayor felt that he had to close the bridge down for safety concerns, and people were moved in the South End. Overnight, hundreds of people came to the South End.


LeMoult: You do really point to that as being the thing that changed — the thing that really made this a place where people are gathering.


Santiago: Absolutely. I think if you were to speak to most neighbors there, they would agree with you. And that's been in combination with the growing opioid epidemic, now a fentanyl epidemic. So what's happening now is just the two in combination with one another making the situation a whole lot worse. Now when I jog the streets there, you'll see about 200 people on Atkinson Street. You'll see drug dealing and prostitution. You'll see a very bad situation, and a lot of these people are in need of dire help. These are some of the most complex patients you're ever going to see. It's not just an opioid use disorder that they are suffering. It's psychiatric issues and housing issues. And that's what we're battling right now.


LeMoult: And are they there in that neighborhood because that's where services are?


Santiago: No, for sure. There's no doubt that there's an over-concentration of services in that neck of the woods, and that has led to what's going on right now in Atkinson Street. It's not just an opiate use disorder that they're suffering from. It's psychiatric issues and issues of housing. I mean, these are very complex patients who are just at the very end.


LeMoult: And when you see them is it generally because of an overdose?


Santiago: Most often. Many times people will drop them off. Someone will call 911, and they'll be picked up and brought to the emergency department. And so what I do is we'll watch them, we'll assess them and if they need Narcan, we'll give it to them. After the overdose, we'll ask them if we can provide services for them, if we can get them to detox. And hopefully they'll say yes, but oftentimes they don't.


LeMoult: If they say yes, are the services available? Do we have the services to meet their needs?


Santiago: Well again, we have to be very intentional about what we mean by "services." If you're asking, do we have detox beds? Boston Medical Center does a great job of having support staff in the emergency room to get people to detox. Now the question is, What happens after detox? What happens after the four to seven days that people detox from certain drugs or alcohol? Can they transition to short-term beds or long-term beds? I think that's where you'll find a gap in the continuum of care. And so some of us at the state level and the city level are fighting for how we can increase access to short-term recovery beds. Because what happens is that people will come to the emergency department — overdose or not — seeking detox services. It's not too difficult to get someone a detox. You have to make a couple of phone calls. But what happens after they leave detox is they can't go anywhere else. So they'll go back to their respective communities, they might experience some of the same triggers and issues that they've been going through that got them hooked on drugs and medication, and will overdose again. And so what happens is you have this vicious, revolving circle.


LeMoult: So you're seeing the same people coming back over and over?


Santiago: Oftentimes. I've taken care of some patients two or three times in the same day — literally, patients experience an overdose that almost cost them their life, leave, come back, and do it again.


LeMoult: Well in your role as a state representative, what can Massachusetts do to address this?


Santiago: Well, I think the legislature and the governor have done tremendous things in the past three or four years. They've passed two important and landmark bills. They really are leaders across the country, but there's so much more to do. And what's happening right now in Mass. Avenue and Melnea Cass really suggests to me that we have much more to do. I mean, that is clearly the epicenter of the opioid epidemic across the commonwealth. And so we need to fight for things like, How do we get Long Island back on board? How do we provide more regional capacity? How do we make sure places like the Shattuck Hospital in Jamaica Plain keep a public health purpose? And how do we provide access, care and services to people across the commonwealth so they can get care in their own respective cities and towns?


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