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Boston Globe
4 days ago
- Health
- Boston Globe
Can free money help people stay off drugs? These programs are trying it.
Nothing stuck until Pagan, a 36-year-old personal caregiver from Revere, learned late last year of engaged in physical exercise, Pagan was rewarded with $5 loaded onto a debit card. Advertisement While modest, the payments were enough to motivate Pagan to keep coming back, week after week, to a program that taught her new strategies for controlling her cravings. 'When you're living on the edge, sometimes you need something — even if it's small — to feel better about yourself and your future," she said. Pagan is among hundreds of people addicted to stimulants in New England who are part of a bold but debated experiment: giving financial rewards to people who abstain from illicit drugs. In cities across the region, treatment providers are embracing the concept of monetary awards as they seek new ways to combat a troubling surge in the use of psychostimulants such as methamphetamine and cocaine. Advertisement The approach is known as Policy makers are banking on the intervention to help address a gaping hole in the substance use treatment system. There are no targeted medications for the estimated 'People have been brainwashed into thinking that depriving people and letting them `hit bottom' is the only way for somebody to get better, and contingency management flies in the face of that,' said Deirdre Calvert, director of the state Department of Public Health's Bureau of Substance Addiction Services. 'Most importantly, it works.' While offering people small rewards for abstinence dates to the 1980s, the approach has been slow to catch on. One of the biggest obstacles has been the moral objection to the idea of paying people to stay off drugs — which, critics argue, they should be doing anyway. Legal concerns have been another barrier. Treatment providers have long worried they could run afoul of Advertisement Yet attitudes began to change a few years ago amid a troubling new reality. Many people were taking cocaine and meth without realizing it was At the same time, states received the So in 2021, Boston Medical Center received a $1.43 million grant from the Massachusetts Department of Public Health to launch Interest in the program has far exceeded expectations. Justin Alves, co-medical director for the START program and a nurse educator with the Advertisement All told, 660 patients with stimulant use disorders have participated in the program since 2021; and more than 50 percent have been people of color, according to Boston Medical Center. Organizers of the program are now looking to tap opioid settlement funds to expand the incentives to $300 to $500 per person per year, consistent with scientific studies showing that larger amounts are more effective in promoting abstinence. 'The $75 was enough to get people to come to group [meetings],' Alves said. 'By the time the $75 ran out, we had nurse-patient relationships with people and that's what has made the program blossom.' Behavioral scientists said the programs are effective in part because the prizes act much like stimulants do — by increasing dopamine levels in the brain. The US Department of Veterans Affairs was Advertisement The concept is also taking hold in Maine, which has been And in Vermont, Some treatment providers are wary of giving prizes that they say patients could then sell or trade for drugs. Yet that hasn't emerged as a problem, say clinicians and researchers. The Howard Center tracks how participants spend the rewards and found they largely use the money to buy food, gas, and other basic items. Rosario Malcolm-Testaverde credits a contingency management program with potentially saving his life. He spent 15 years addicted to crystal methamphetamine, bouncing in and out of hospital emergency departments, before he discovered the Boston Medical Center program. He didn't need the money, yet the weekly prizes gave him an incentive to show up at group meetings. There, he encountered a community of people who understood the powerful pull of crystal meth and its dangerous side effects — including paranoia and auditory hallucinations. Advertisement 'I felt fully recognized as a human being,' said Malcolm-Testaverde, 36. 'And the rewards system helped replace the dopamine hit I would get [from crystal meth].' At noon on a recent Monday, the mood was upbeat as Pagan and a dozen other people in recovery filed into a brightly lit conference room at the Boston Health Care for the Homeless office at 780 Albany St. One by one, members introduced themselves and talked about what they were looking forward to in their lives. An older man named John described the daily challenge of staying sober when, each day, he encountered people using cocaine outside his apartment building in Cambridge's Central Square. Among the last to speak, Pagan proudly announced to the group that she had just received word of a new job opportunity and was brushing up her resume — something she never would have imagined just a couple of years ago, when she was still living on the streets and using drugs. 'Hopefully a door opens because I feel like I'm ready,' Pagan said. In an instant, everyone around the table burst into applause. Chris Serres can be reached at
Boston Globe
30-01-2025
- Health
- Boston Globe
‘A forgotten generation': Older Black men in Boston are dying of drug overdoses at alarming rates
'It felt like I was already dead,' James, 61, said. Advertisement James is among the fortunate ones. The deadly opioid scourge that has long been perceived as an epidemic that started largely in white communities has evolved into something else: a crisis among Black men, who are now suffering in far greater numbers from the increasingly potent mix of cocaine and fentanyl hitting the streets. Even as deaths are falling sharply among white people, they are skyrocketing among Black men — particularly the middle-aged and elderly, according to a Globe analysis of death records. Statewide, the rate of deadly overdoses among Black men over 55 soared 242 percent between 2017 and 2023, while overall, the rate for men of all races declined over the same period, state Department of Public Health data show. In Boston, middle-aged and elderly Black men are overdosing at rates dramatically higher than any other demographic group — and far outpacing their share of the overall population. 'It should be our number one public health priority,' said Deirdre Calvert, director of the state Department of Public Health's Bureau of Substance Addiction Services. 'I don't think that there's a more important subject matter or discussion that we should be having than the overdose death rates among Black populations, and specifically older Black men.' Advertisement Yet the systems designed to treat addiction have not kept pace with this rapid shift in the racial dynamics of the opioid crisis. Many Black men in addiction recovery programs in Boston said they feel unwelcome in programs that are largely designed by white people and run by them. Too often, they find themselves surrounded by people who cannot relate to their experiences and past trauma, say treatment specialists, therapists, and Black people in addiction recovery. What has become increasingly clear is that a deadly opioid epidemic that was born in rural and suburban America is now devastating communities of color in large cities — and Black men are now bearing the brunt of the epidemic. An investigation into millions of death records — In cities including Baltimore, Chicago, Philadelphia, and San Francisco, deaths among this cohort of older black men (now between 54 and 73) are higher than for any other group — just as they have been for much of the past three decades, the analysis found. This disparity was not as pronounced in Boston until more recently. Previously, Black men of this generation died of overdoses at similar rates to all men until the fentanyl crisis. Founder Gregory Davis, founder of Metro Boston Alive, stood in the recovery meeting room at the Marcus Garvey Center in Boston. Craig F. Walker/Globe Staff But in 2022, the most recent year with national data, this generation of Black men died at rates more than four times the average in Suffolk County, and more than eight times the national average. The Globe's review of Massachusetts data showed that trend has continued. In 2023, Black men in this generation, age 54 to 73, died from overdoses at more than four times their share of the population, according to a Globe analysis of death certificate data. Advertisement The immediate driver is fentanyl, which is cheap to produce and is increasingly being laced into cocaine — the drug of choice for many Black men struggling with addiction. In Suffolk County, 77 percent of the Black men who died of overdoses in 2023 had cocaine in their systems, often in combination with fentanyl, compared with 52 percent of white men, according to a Globe analysis of death records. State health officials acknowledged they need to do more to reverse the trend, and they are tapping more of Yet the deadly toll reflects decades of financial insecurity, the legacy of the 1980s war on drugs, and longstanding barriers to treatment. Black men born between 1951 and 1970 came of age at a time when harm reduction strategies were in their infancy, when Advertisement 'For too long, a blind eye has been turned toward our community,' said Lovelee Harvey, 55, a former cocaine user and senior recovery coach with In interviews, Black men in addiction recovery describe feeling alienated in programs that are not designed for them and their particular drugs of choice. The overwhelming focus is on opioids, such as prescription painkillers and heroin, and not on cocaine — a stimulant — with a range of different side effects. In Suffolk County, the vast majority of people enrolled in substance use addiction services over the past five years were white. Even today, Black people who use cocaine face a legacy of discrimination that dates back to the war on drugs. Many sober homes and treatment programs in Greater Boston require drug users to first complete a detoxification program to prove they are sober. Yet detox programs often won't admit people whose primary drug is cocaine because the withdrawal symptoms are perceived as less severe. In interviews, Black men in recovery said they sometimes have to hide their cocaine use, or even take heroin, simply to be admitted to a detox center, often a first step on the road to recovery. 'The disparities reflect the fact that we've medicalized opioid use disorder and have not medicalized stimulant use disorder,' said Miriam Komaromy, medical director of Boston Medical Center's Advertisement In interviews, many Black men in addiction recovery described feeling unwelcome at treatment programs and support group meetings in Boston, which tend to be run by white people for people struggling with opioid use. James recounted several experiences of racism in treatment programs, including an incident in which a white patient threw a chair at him and called him a racial slur. Others said they felt uncomfortable opening up about their past trauma and experiences using drugs with white treatment specialists. Eric Henderson, 39, a musical artist from Dorchester who goes by the name 'Say you're coming from Dorchester, Roxbury, or Mattapan, and all of a sudden you've got some kid who just graduated college telling you what to do who's never walked where you've walked,' said Henderson, who now works as a recovery coach with Members of the Outreach Squad, Cornelius Hood, Lovelee Harvey, and Shanna Johnson, shared a laugh while preparing to visit Nubian Square in Boston. Craig F. Walker/Globe Staff There are also cultural differences in the approaches to addiction. Many in the Black community object to what they see as an overly tolerant attitude toward drug use among white therapists and recovery coaches. Moreover, many in the Black recovery community object to programs that hand out drug needles to users or tolerate frequent relapses. 'It's very difficult to stay sober when the person next to you is using,' said Stephanie Jackson-Wilson, who owns and operates a sober home in Mattapan. 'A lot of us in the Black community come from a place of abstinence.' On a bright January afternoon, Harvey and two other outreach workers with Metro Boston Alive gathered beneath a woven portrait of Within moments after arriving at Roxbury's Nubian Square, a small crowd of Black men — some homeless and familiar to the group as longtime drug users — surrounded the outreach squad. The blue bags were quickly gone. 'You gotta go back! Go back to treatment!' Harvey exhorted an old friend, Eric French, 59, who looked unsteady and admitted to a recent relapse. 'If you fall off that horse 99 times, you gotta get up 100 times!' Senior recovery coach Lovelee Harvey (center) of Metro Boston Alive talked about recovery with Eric French (left) while doing outreach work in Nubian Square. Craig F. Walker/Globe Staff As they circled Nubian Square on foot, talk among the group turned to a familiar topic: what was ailing older men in the predominantly Black neighborhood. Some had been taking cocaine for decades while holding jobs and remaining active in the community, they said. But that changed dramatically a few years ago when fentanyl and other toxic substances started showing up in the illicit drug supply; and even casual cocaine use became deadly. 'When the fentanyl came in here, it destroyed everything,' said Shanna Johnson, a volunteer member of the outreach team and the community engagement coordinator with Codman Square Health Center in Roxbury. 'I tell people now, `You may not be looking for fentanyl, but fentanyl is definitely looking for you.' ' Yet the odds that a Black resident of Boston will be offered treatment — even after surviving a life-threatening overdose — are slim compared to their white counterparts, research studies have shown. In another survey of 59 Boston overdose survivors, published last spring, several Black and Latino participants reported that A tear streamed down Anthony James's cheek as he worshiped during Sunday service at Morning Star Baptist Church. James said that his faith has been instrumental in keeping him focused on his recovery from a crack cocaine addiction that he has struggled with since he was a teenager. Jessica Rinaldi/Globe Staff James said his recent experience with fentanyl-laced cocaine was 'a giant wake-up call,' and he's resolved to stay clean. Since the incident in December 2024, he returned to a sober home in Mattapan and landed a full-time job as a cook at the Pine Street homeless shelter, where two months ago he took his last dose of cocaine. He's also found solace in his faith, dropping to his knees on his hardwood floors each morning to pray. On a recent Sunday morning, James was upbeat — blaring gospel music from his smartphone — as he strolled down the snowy sidewalk to 'God can turn your life around in 24 hours!' thundered Borders from the pulpit, amid cheers and shouts of 'Amen!' Then, as the congregation dispersed, James waited patiently with a Bible tucked under his arm for a moment alone with the pastor. Heads bowed and hands clenched, the two men prayed for the strength to stay sober. James prayed with Bishop John Borders (right) at the conclusion of Sunday service at Morning Star Baptist Church where he has been a member for twenty years. Jessica Rinaldi/Globe Staff Chris Serres can be reached at
