EAGLE INVESTIGATIONS: As the pandemic recedes, another public health crisis lingers in its wake, one that has caused immense grief and suffering for years and will continue to plague the Berkshires. That crisis is addiction.
On his drive to the cannabis dispensary, Tim Kasuba saw his old drug dealer. He thought about pulling over, but instead he kept driving, picked up his weed, and went home.
He was proud of that. Later that week, he described it during a recovery meeting in a small, warmly lit room in Great Barrington.
This was not a Narcotics Anonymous or Alcoholics Anonymous meeting. It was just a group of people like him, who had struggled or were struggling with substance use disorder, who were defining their own recovery and fighting for it.
“We want a new way to come, to tell our stories, to talk,” he told The Eagle, describing the meeting. “For me, to say, ‘I didn’t use fentanyl today. I didn’t use crack cocaine today. I took all my medications, and I smoked some pot. I’m good.’”
The idea behind Friday’s meeting, organized by South County-based Rural Recovery Resources, is that recovery has no single shape or form. That it requires work, but not necessarily abstinence from all drugs. That the goal of recovery is to stay alive and lead a meaningful life, whatever shape that takes.
“We’re a group that supports each other regardless of one’s recovery pathway,” said Adam Post, a recovery coach with Rural Recovery Resources who works closely with people who use and people in recovery. “It’s all-inclusive, non-denominational. The idea is to have a place where people can share and learn freely from other people who’ve found recovery.”
Substance use disorder is a crisis that has plagued the Berkshires for years, taking more than 300 lives over the last decade, with an escalating urgency as fentanyl, a powerful opiate, has flooded the country and the region.
But even as the crisis turns as deadly as it has ever been, people touched by substance use disorder have thrown themselves into the fight, working on keeping themselves and others alive, helping people move toward “recovery,” however they define it. Rural Recovery Resources, a group led by Gary Pratt, is one of the organizations that has leapt into action.
At one Rural Recovery Resources meeting, on a snowy Friday in Great Barrington, a dozen people and one dog sit spread out over worn couches and metal chairs.
The participants speak, one by one. They tell each other how they got here – through medication, recovery houses, the care of loved ones, checking themselves into the hospital, monthly shots or daily methadone doses, cannabis, emotional support animals.
One participant describes surviving an overdose and starting a new medication. His goal? To be alive this time next year. Another woman, sober for nearly a decade, describes her struggle to help her own children dealing with substance use disorder.
Many people in the meeting say they started using drugs or alcohol at a young age. That was Kasuba’s story too.
After the meeting, he told The Eagle he started taking the narcotic Percocet as a teenager, without a prescription. He spent years in active addiction. His periods of recovery were often enforced by the courts. But not this last one. After his younger brother’s recent death, he was on the phone with his parents, when his father started to cry.
Tim Kasuba: “I’m so grateful today, that I don’t have to live that exhausting life. … It’s so much work, to use drugs and try to hide it."
“He said he didn’t want me to die too,” Kasuba said.
He checked himself into the Clinical Stabilization Services Unit at Berkshire Medical Center for treatment. That was more than four months ago. It’s not his longest period of recovery, but it’s working for him, one day at a time.
Here are some of the things Kasuba leans on: methadone, which he gets in weekly takeout packages because of the pandemic; cannabis, which he uses at night in low doses to calm his anxiety; regular exercise, to help manage his depression; Prozac, which he has been taking for about a year; therapy; regular phone calls with his recovery coach, Adam Post; weekly recovery meetings; and the old Narcotics Anonymous saying: “One is too many, a thousand is not enough.”
Nothing about it is easy, he adds.
“Every day is a struggle,” he said. The other night, he felt himself getting angry over losing a card game and thought about using. Drugs “work,” he points out, in the sense that they can temporarily relieve anxiety and manage strong emotions, particularly in the absence of mental health treatment or medication.
But they never work for long, at least in his experience.
“Man, it was exhausting living like that,” he said. “I’m so grateful today, that I don’t have to live that exhausting life. … It’s so much work, to use drugs and try to hide it. I think that’s what a lot of people do in this county. They try to hide it.”
He’s now studying to be a recovery coach, like Post, and he spends his spare time with his baby niece and nephew. A few weeks ago, he became his nephew’s godfather.
By the numbers
A recent landmark study by STAT News found that, as of 2015, more people were living in recovery than had an active substance use disorder – about 22.3 million compared to 20.8 million.
That same study found 75 percent of people who seek recovery accomplish their goal, though it often takes time and several tries.
Most importantly, STAT reports this: People who went into recovery saw “significant improvements in quality of life and a decrease in psychological distress over time in recovery.”
But those improvements can only be gained if the person makes it through active addiction into recovery. And when fentanyl is in the equation, anyone using drugs – including cocaine – faces a much higher risk of dying than they might have a decade ago.
That is why advocates for people with substance use disorder have fought for structural fixes in the Berkshires that can keep people alive as they use drugs.
Some of those changes:
— Over the last year, the number of first responders carrying naloxone has increased dramatically, thanks to the work of the Berkshire Overdose Addiction Prevention Collaborative.
— The Never Use Alone hotline has helped save lives amid COVID-19-isolation.
— The district attorney’s office has declined to prosecute possession cases, often keeping people who use drugs from obtaining a criminal record, and de facto decriminalized the opioid medication buprenorphine, commonly known as Suboxone.
— Berkshire Health Systems emergency rooms offer immediate access to substance use disorder medication and connect patients to further treatment.
— Access to syringe programs has increased, advocates say, and the Brien Center even opened a new house for people struggling with mental health and addiction – though the addition of beds there was offset by the loss of Keenan House for Women in Pittsfield.
There are, of course, also long-standing resources, such as Alcoholics Anonymous, Narcotics Anonymous and religious communities, which have helped many people stay in recovery from alcohol and drug use.
Then there are new programs, born out of the idea that keeping people alive, giving them empathy and letting them make their own choices about drug use are more important goals than total abstinence from substances – which is often the focus at AA and NA meetings.
Those new meetings include a group on Fridays in Great Barrington and another on Tuesdays in Pittsfield, at the former Second Street Jail.
Showing ‘compassion and understanding’
At the Great Barrington meeting, participants at one point break into a gentle debate about how much you can help other people struggling with addiction. One woman wants to know: Is there a point where you have to give up on someone you love?
That’s a question Post, the recovery coach who facilitates Friday’s meetings, struggles with. But he’s starting to come around to an answer – that wholehearted compassion has a critical place in addiction recovery.
Adam Post, who is in long-term recovery from addiction, works with Rural Recovery Resources. “As a recovery coach, I show up for people, unconditionally, without any judgment.”
“As a recovery coach, I show up for people, unconditionally, without any judgment,” he said. “Do they really want to stop doing drugs? Are they doing this because someone told them to? Is it to fulfill something for court? I don’t worry about any of that.”
That’s because of his own recovery, he says. After using on-and-off for years, he found himself in active addiction in his mid-30s. That time, he tried something new: Suboxone. That’s an opioid use disorder treatment, often administered under the tongue, that helps reduce cravings and has been shown to decrease the rate of overdose deaths. The medication became part of his long-term recovery, paired with support groups and as many other tools as he could fit into his life.
“For me, what worked is a combination of untold numbers of conversations, situations, feelings and experiences that all add up to who I am right now, which is a person in recovery,” he said. “It’s true that there’s not a single thing anyone can say to convince someone else to stop using drugs. But you can show them compassion and understanding.”
The magnitude of the opioid crisis leaves him feeling hopeless, sometimes. But his day-to-day work as a recovery coach brings him into contact with other people, often at points of crisis, where he can do good. Often he connects people to resources they need. Sometimes he just talks to them.
“I don’t know if any of this works,” he said. “But to me it feels hopeful. I feel hopeful when I can sense that somebody else feels understood. When they can look around and say, ‘This guy did it.’ And the barrier to entry isn’t high. It’s very low. Just start showing up.”
Coming home
For some people, recovery means pulling from a variety of resources. Several people who spoke with The Eagle for this story, but asked not to have their names used, credited NA and AA with saving their lives – between the steps, the community, and the spiritual practice, they have been able to stay in recovery for months or years.
Bob D., one of the participants at the Great Barrington meeting, also goes to weekly Narcotics Anonymous gatherings in South County. Those changed his life, he says. The Eagle is using his first name and last initial to protect his privacy and the anonymity of his NA meetings.
An opioid prescription after knee surgery sparked Bob’s addiction. He used even while holding down a steady, well-paying corporate job. After an overdose last year – from what he suspects could have been carfentanyl, an opioid analgesic used to anesthetize elephants – he awoke on his floor, surrounded by paramedics and his terrified wife.
Bob called a 30-day program and got himself into detox.
Back home, he found himself in unfamiliar territory – in recovery for the first time after decades of substance use.
“You search for some kind of support,” he said. “You search for something you can grab ahold of.”
He went to a Narcotics Anonymous meeting, one where he knew he would recognize a few faces. The men in the group stepped up and hugged him, every single one. “It felt like I was welcomed,” he said. “Like I was home.”
Bob just hit six months of recovery. He goes to those meetings every week. A few months ago he started bringing his brother, who has also struggled for years with substance use disorder. Bob took his brother each week even when his brother was actively using, trying to show him the compassion and understanding he had received from his wife. Somewhere along the line, something shifted – and Bob got to see his brother begin his own process of recovery.
“Now, every single day, he gives me a hug and a kiss on the cheek,” Bob said.
And now he thinks, if he can make a difference for someone as difficult and persistent as his brother, then it’s worth sticking by the other people in his life who are struggling with addiction. Maybe there’s a little hope.
Staying alive
The rising toll of the opioid crisis in recent years can be traced at least in part to the rise of synthetic opioids, such as fentanyl and fentanyl analogs, which likely caused Bob’s overdose.
A decade ago, synthetic opioids were responsible for just 12 percent of opioid-related overdose deaths, according to federal data. As of 2019, they were involved in nearly 75 percent.
Stephen Murray looks at those numbers and sees a mass poisoning. That means the fight, his fight, has to be to keep people alive.
Stephen Murray responded to overdose calls throughout the pandemic as a paramedic with Northern Berkshire EMS. He now works at Boston Medical Center in the CARE Unit as a Community Implementation Specialist. He was involved in the effort to equip Berkshire County first responders with naloxone.
Murray has seen addiction from two vantage points. First, as someone struggling with active substance use disorder. Now, as someone in recovery, who spends his life working in harm reduction.
During the pandemic, Murray worked as a paramedic for Northern Berkshire EMS and on harm reduction projects in the area. He watched as opioid-related overdose deaths spiked in the northern Berkshires, where he was responding to calls. He saw fentanyl deaths linked to opioids but also, more and more, to cocaine use.
A surge in accidental poisonings was killing people, and he could see it. Sometimes, they were people he knew.
“We consume unhealthy products all the time, it’s part of our society,” he said. “Like alcohol, foods high in sugar, in fat. All those things are unhealthy. But from a consumer protection standpoint, they’re safe. You’re not going to die from using or taking it once. We need that sort of standard of protection across the board.”
To keep people alive, Murray says, people need access to regulated substances. And to help them recover, they need to be able to choose their own path. Abstinence worked for him. It doesn’t work for everyone.
“I don’t want people to look at me and say, ‘This is the one way to do it,’” he said. “It worked for me, but it might not work for you. Don’t beat yourself up. Find a way that works for you, that makes you feel good, that makes you stay safe.”