New Haven on the Mend

New Haven on the Mend

Connecticut’s Methadone Clinic Conflict and Battle Against the Opioid Crisis

Published on May 31, 2022

“On Dixwell Avenue in New Haven’s Newhallville neighborhood, a large billboard reads: “STOP THE APT FOUNDATION FROM RELOCATING TO NEWHALLVILLE.” When the APT Foundation, a Connecticut not-for-profit organization that provides addiction treatment services, purchased 794 Dixwell, a building at the corner of Dixwell Avenue and Elizabeth Street, in January of this year, they planned to use the space as their new foundation headquarters as well as a substance use disorder treatment facility and methadone clinic. The foundation’s intention to purchase the building was not disclosed to community leaders beforehand, and massive pushback from the Newhallville community has complicated the foundation’s plans to move into the neighborhood.

Newhallville, a neighborhood on the New Haven-Hamden border, is home to longtime residents who care deeply about their community. The neighborhood is battling a variety of systemic issues: poverty, violence and lack of access to healthy foods, amongst others. The area’s residents view the APT Foundation’s move into the neighborhood as yet another roadblock to progress. “We are looking to move forward … in a more positive community … with things that can help us and support us … and not stress our community where it’s going to go backwards,” said Jeanette Sykes, chairwoman of the Newhallville-Hamden Strong movement.

The APT Foundation, founded in 1970 by Herb Kleber, a former faculty member of the Yale School of Medicine’s Department of Psychiatry, is one of the oldest addiction treatment programs in the United States. The foundation uses a holistic treatment approach and provides mental health counseling, primary care, housing assistance and vocational training to its patients, in addition to the implementation of pharmacological treatment methods such as methadone maintenance. “At the APT Foundation, we have a very integrated care model,” shared Jeanette Tetrault, a Yale professor of medicine and public health and a staff physician at the foundation. “We provide on-site primary care … as well as having a distinct role in the management of substance use disorder with our patients. We also provide integrated care for things we commonly see in patients with substance use disorder, like HIV and hepatitis C treatment.” Opioid use disorder is not an illness with a wholesale treatment, and the foundation combines a variety of methods to best suit their patients’ needs.

Medication treatment for substance use disorder has proven to be one of the most effective rehabilitation methods for opioid use disorder. Methadone is an inexpensive, long-acting opioid that, when administered properly and consistently, can allow those recovering from opioid use disorder to stabilize and resume daily life with a decreased risk of overdose should they relapse. Robert Heimer, a professor of epidemiology and pharmacology at the Yale School of Public Health, described it as the “gold standard treatment for opioid use disorder.” Methadone works by fulfilling a biological need which has been produced by long-term opiate use. Methadone maintenance, the prescription use of methadone, doesn’t get users high, it simply allows people to feel normal again and to lead their lives without debilitating cravings or discomfort that might encourage some to return to illicit drug use. Other treatments such as buprenorphine and naltrexone are available as well.

While the medical community has understood the effectiveness of methadone for treating opioid use disorder since the 1960s, stigma, ethical concerns and an abstinence-only mindset within the community itself has left methadone as a highly regulated substance. Methadone can only be administered at special clinics, such as those run by the APT Foundation, which are sequestered from general medical services. “A state like Connecticut has 7,000 to 10,000 people a year who are getting abstinence-based treatment and having their tolerance reduced,” Heimer pointed out. If those people relapse and come into contact with fentanyl, their bodies are much less prepared to take on such a potent substance, leading to fatal overdose. Those in methadone treatment programs are less likely to relapse in the first place because their chemical cravings are being met, and if they do relapse, their tolerance is higher, so they are at a lower risk of overdose. The treatment is often used in conjunction with therapy or counseling.

The APT Foundation uses an open access model, meaning the clinics accept walk-in patients for voluntary treatment and counseling regardless of their ability to pay. “We really, really work hard not to turn patients away from treatment and also to keep them engaged in care,” Tetrault explained. The organization treats 8,000 people every year, and people from outside of New Haven commute into the city to receive treatment at their clinics. 

For several decades, New Haven has been in the throes of an opioid crisis that has only grown from year to year, parallel to national trends. Twenty-eight percent of Connecticut’s drug overdose deaths since 2015 have taken place in New Haven County, despite the city making up just under a quarter of the Connecticut population. The Connecticut Department of Public Health has tracked the number of unintentional overdose deaths in the state since 2015, which are accessible through a data dashboard. The number of drug-related deaths rises every year, with a 12 percent increase between 2020 and 2021. The COVID-19 pandemic increased the already-growing number of people using drugs and dying from drug use.

“ Addiction is a community issue, and it requires community compassion and response. ”

The New Haven Harm Reduction Task Force, founded in 2020, oversees many of the city’s harm reduction programs. “Harm reduction aims to decrease economic and social burdens and help save lives by equipping drug users with the tools necessary to keep themselves and the community safe,” Andressa Granado, an opioid community health worker on the New Haven Harm Reduction Task Force, said. “This could mean providing folks with drug checking supplies such as fentanyl testing strips, or making clean syringes available to prevent the spread of HIV or HEP C.” Their work includes facilitating syringe collection sites, medication take back days and awareness campaigns which aim to foster a sense of community and destigmatize substance use disorder. “Addiction is a community issue, and it requires community compassion and response.”

Increased prescription of opioids in the 1980s and 1990s to address the United States’ undertreated chronic pain problem sowed the seeds of today’s drug epidemic. “The medical establishment and the insurance companies created a situation that the pharmaceutical industry leapt on— it greatly expanded access to pharmaceutical opioids,” Heimer explained. Around 2011, new regulations significantly reduced the amount of pharmaceutical opioids available, but the problem really only started there. “We didn’t increase treatment. … We just cut people loose,” Heimer said. “Some people stopped using [opioids] … Some people couldn’t, so they had to find alternatives.” Many people develop a chemical dependence on their prescribed opiates or get them from a friend or family member with a prescription. When these prescriptions run out, some people turn to illegal drugs to avoid withdrawals.

In the last decade, the proliferation of fentanyl and other synthetic opioids on the illicit drug market has further caused overdoses to soar. Since 2015, fentanyl has been a leading cause of drug-related deaths in Connecticut; it was involved in 71 percent of fatal overdoses. Fentanyl is much stronger than other drugs such as cocaine or heroin and is often mixed in with other substances to make a cheaper product that is also more potent and addictive. Many users are unaware that the drugs they have been sold contain fentanyl.

The city of New Haven, along with other major urban areas in Connecticut such as Hartford, Bridgeport, and Waterbury, has become a hotspot for fatal overdoses. These cities have a far greater instance of drug-related deaths than the cities, towns and suburbs they neighbor. This is in part due to the concentrated populations of these cities, but the design of the state’s public and social service infrastructure contributes to these numbers as well. “New Haven is the magnet for the poor, displaced, and evicted people whose drug use in the suburbs makes their continued living in the suburbs unsustainable,” Heimer said. “Public health, education, housing, transportation — all those things are sort of seen as city or state responsibility.” 

Methadone treatment is daily for many patients, so they are required to return to a clinic every day to receive treatment. Due to this model, methadone treatment becomes inaccessible to many who are not easily able to visit a clinic every day. Connecticut’s Department of Mental Health and Addiction Services categorizes treatment programs by region. Five out of nine of Region Two’s methadone treatment programs are located in New Haven. These nine clinics, four of which are run by the APT Foundation, are intended to service 36 cities and towns in southern central Connecticut. New Haven is grappling with the drug use of not only its own residents, but also the residents of surrounding communities, and its opioid treatment programs take on regional responsibilities, as other communities without reduction and drug use prevention programs rely on New Haven for medical services and treatment programs. 

The APT Foundation’s proposed headquarters location “is [in] one of the areas in Newhallville that is making a really strong comeback,” said Barbara Vereen, a local representative of Newhallville and an organizer of the Newhallville-Hamden Strong coalition. “We built a park in that area. The businesses are coming back and thriving. We worked very hard to push in that area to make sure that we cleaned up.” The park in question was once the “Mud Hole,” a vacant lot central to Newhallville’s drug trade. It is now a community greenspace site, in essence a public park, called the Learning Corridor. A Connecticut transit bus stop near the clinic is across the street from this park. The Lincoln-Bassett Community School, a public elementary school, is just down the block.

“Bringing in a methadone clinic can set our neighborhood backwards,” Vereen added. She enumerated her concerns: patients will have to wait outside the clinic for their treatment, needles will be discarded around the clinic, the infrastructure of the area is not prepared for the influx of traffic from outsiders coming to the clinic and the building is not in an accessible spot for those coming from outside the city. “We’re a neighborhood that’s dealing with trauma and to put something that’s going to cause more trauma and cause more issues is not good.”

Katurah Bryant, a licensed alcohol and drug counselor and the former assistant clinical director at the Connecticut Mental Health Center in the substance abuse treatment unit, shares these concerns. She believes that neighborhoods like Newhallville, those that are “already economically and financially depressed, largely because we do not receive funds that other neighborhoods receive,” are often taken advantage of as spaces for opioid treatment programs. 

The relationship between Newhallville and the APT Foundation was contentious from the start. Newhallville residents expressed frustration that the APT Foundation was not in touch with their community representatives before purchasing the building. Lynn Madden, president and CEO of the APT Foundation, states that the foundation was looking at the building and its zoning alone without considering the surrounding community in their search for a new location. All their other clinics are currently in leased buildings, so the foundation was looking for a space they could purchase. Community members maintain that APT’s lack of consideration of the profile of the area is irresponsible.

The APT Foundation has long been a source of controversy in New Haven more broadly. “Their foundation has a track record for how they do business in black and brown communities,” Bryant said. City residents see the foundation’s clinics as hotspots for violence as well as drug use and solicitation. They expressed frustration over patients’ behavior while waiting outside the clinics for treatment as well as their conduct on the New Haven Green and other places they may visit on their way to or from treatment  centers. The clinic the APT Foundation currently runs in the Hill Neighborhood has been the subject of complaints and outrage due to allegations of increased crime and violence, drug selling and use and public health hazards such as dirty needles around the site. 

“ We’ve created a system that makes it hard to expand [the clinic system] and that makes communities nervous when you say, ‘I want to put a methadone program in [your] neighborhood.’ ”

Some New Haveners believe the clinics attract more people with substance use disorder to the city and are frustrated by what they view as poor community-membership on the part of the foundation’s leadership. “We’ve created a system that makes it hard to expand [the clinic system] and that makes communities nervous when you say, ‘I want to put a methadone program in [your] neighborhood,’” Heimer said. As neighborhoods that house opioid treatment programs will see an influx of people with opioid use disorder coming into their communities for treatment, clinics become “associated with the notion of all these drug users hanging around, and there is some truth to that.” People remain afraid of or misunderstand what having people with substance abuse order in their neighborhoods means for their communities; some may also be ignorant of the fact that members of their own communities are struggling with addiction.

At a monthly meeting of the Downtown-Wooster Square Community Management Team in 2018, Madden refuted many of the allegations against the foundation, citing its important work in the community and the steps it has taken to address concerns and be in communication with the neighborhoods that house its clinics. Her comments were not well received by the New Haveners at the meeting, particularly those who live or operate businesses near the APT Foundation’s clinics. The foundation’s unresponsiveness to previous attempts by community members to reach out has left some skeptical about the organization’s commitment to mending its relationship with the city.

Since the public became aware of the sale of the Dixwell Avenue property at the beginning of January, Newhallville has united to oppose the foundation’s move with rallies, public hearings, letters of support from surrounding communities and a petition that has gathered over 1, 000 signatures from local residents. Per the Yale Daily News’ reporting from a protest at the proposed Dixwell Avenue site in early February, community leaders and concerned citizens gathered to speak out against the APT Foundation’s move into Newhallville with impassioned speeches about the crime, violence and other negative impacts that the clinic would bring to the community. Both New Haven Mayor Justin Elicker and Hamden Mayor Lauren Garrett were in attendance. “We are reaching out and gaining support from the Greater New Haven Area. We are reaching out to our legislators to ask for their support,” Vereen shared. 

In their petition, Newhallville-Hamden Strong proposes finding “alternate solutions to treating county patients suffering from addiction.” “I’m not going to put [the clinic] in another community because I don’t believe any community should have it,” said Sykes. “There are appropriate industrial areas that it should be in where everybody can get support.” 

Opinions are divided regarding the impact of a clinic more accessible to Newhallville residents. “It’s better to have a treatment program in your neighborhood than to have drug users who are unwilling to go elsewhere for treatment continue to be drug users in your neighborhood,” explained Heimer. On the other hand, Bryant said, “I mean we can always, always, always use more, but there’s adequate spaces … places that are more appropriate for this kind of service than down the street from an elementary school or near the corner where children have to catch the bus.” Bryant cites other programs that are available to the citizens of Newhallville seeking treatment in the broader New Haven area, such as the Connecticut Mental Health Center and MAAS CASA.

Opioid treatment programs, particularly those which offer medication treatment, are highly stigmatized spaces. The APT Foundation’s mission may in fact be better suited for a different location, but viewing these clinics as inherently dangerous or detrimental spaces can contribute to a larger narrative which disparages people with addictions in their journey to treat a chronic disease. ​​I wish no one felt that way. Look at what we are providing, what we are doing,” Tetrault said. “On the other hand, constantly pushing treatment programs into residential neighborhoods may not be the right answer. In a perfect world, methadone, which is an evidence-based treatment for a highly morbid condition, would not be segregated from the rest of health care.” 

An alternative use for the Dixwell Avenue space as a community wellness and education center is now on the table, and Rev. Boise Kimber and the New Haven-based mental health organization Clifford Beers were awarded a $2 million state grant to go towards the proposed Resilience Academy. “It can be used for a fresh food market. It can be used for … mental health services for the community. It can be used for … our children in this community. Just by being a black or brown person in America you are traumatized, so we need healing spaces,” Bryant said. “I mean there’s so many things that can go into that space — meeting spaces, education spaces, training spaces.” 

In response to plans for Resilience Academy, New Haven Mayor Justin Elicker announced that the APT Foundation would put their applications for zoning approvals for the Dixwell Avenue building on pause to see if they can find another suitable location to move to. Discussion between local government, Newhallville residents and the APT Foundation to resolve this issue is still ongoing. Another press conference and rally led by members of the Newhallville-Hamden Strong coalition, called the “Hour of Prayer,” took place outside the site on May 21. According to reporting from The New Haven Register, Kim Harris, president of the Newhallville Community Management Team, said at the event: “We are in solidarity … This (battle) is going to have a huge impact on who we are and where we live … There’s been a unification in Newhallville that is here to stay.”

As Newhallville gathers support to keep the APT Foundation out of their neighborhood, they are also building a coalition within the New Haven community that has the power to inhibit the mission of the APT Foundation more generally. The foundation’s clinics in commercial areas such as Long Wharf have been cause for complaint in the past, as has the mere presence of people from these programs at bus stops and on the New Haven Green. Wherever the foundation moves, the community’s concerns will follow. Conversely, the opioid epidemic is showing no signs of slowing down, and communities in New Haven are going to have to bear the responsibility of treating citizens with opioid use disorder. 

The situation in Connecticut is representative of a nationwide drought of opioid treatment programs, or OTPs. For example, “the Veteran Affairs health care system has a total of 33 OTPs nationally,” Gabriela Garcia, director of the Opioid Treatment Program for the Virginia Connecticut Healthcare System, said. The clinic system not only precipitates the insufficiency of treatment availability but also promotes the misconceptions associated with opioid use disorder by physically separating these services from general medical care. “Limiting treatment to these clinics can be a barrier because A) they could not be available, and B) people feel the stigma, and they don’t want to go there.” 

“ We have so demonized drug users that we don’t think of them as capable of self-control. ”

Heimer believes there is a much more effective model for methadone distribution, one that is already in practice for many other prescription drugs. He proposes allowing patients to pick up their monthly supply of methadone at their local pharmacy and to administer the drug themselves. “We have so demonized drug users that we don’t think of them as capable of self-control,” Heimer explained. However, research demonstrates this is a misconception.

When visiting clinics daily for treatment became untenable due to the COVID-19 pandemic, the Substance Abuse and Mental Health Services Administration, or SAMHSA, loosened methadone regulations to allow for take-home self-administration of the drug. “Clinics are probably implementing different approaches at this point, with the loosening of federal guidelines … during COVID,” said Garcia. “We have people coming to clinic once a week or every two weeks that in the past might have come much more often.A study led by Heimer at the Yale School of Public found that this model did not lead to an increase in methadone overdose-related deaths or reduce the number of people participating in treatment. “I have a patient who said: ‘My family now thinks this is just a treatment. I get a prescription every 30 days. I take my medication every day. They finally don’t look at methadone as a problem,” Tetrault shared. This methadone maintenance model is far less intrusive to the daily lives of patients. Experts are advocating for an indefinite continuation of these pandemic-induced practices, but the path to reform is slow.

The clinic-based system for methadone distribution creates a plethora of hurdles to successful treatment. Opioid treatment programs become stigmatized, unwelcoming spaces, and the clinics are often too far and few between to be easily accessible. Whether the travel time is too long to make the trip on such a regular basis or impedes patients’ ability to maintain jobs and mend relationships or people feel disrespected in the communities and spaces they have to be in to access treatment, the current model can deter people from starting or maintaining treatment, as Garcia explained. Creating more opioid treatment programs may alleviate the issue of accessibility, but this plan would not be easily achieved given how difficult it is to establish these clinics, as evidenced by the current situation in Newhallville.

By integrating pharmacological treatments for substance use disorder into the broader medical community, an interprofessional approach across medical disciplines becomes more feasible, allowing holistic care for the illness itself, as well as its associated comorbidities. “If there were changes in regulations around methadone, we could link it to things like federally qualified health centers. We could link it to hospital-based clinics. We could link it to pharmacies,” Tetrault shared. “Then none of this would be an issue.” Recontextualizing opioid use disorder as a chronic disease, one which requires consistent, accessible, evidence-based treatments such as methadone, will bring us closer to meeting this epidemic where it’s at and offering communities the help they need. 

“Drug user stigma has taught us all the wrong ways to think, feel and talk about people with substance use disorder, and it has affected our policies, funding and programming meant to assist individuals and families,” Granado said. “Until we fundamentally change how we decide the amount of respect, dignity and care that people are deserving of, regardless of their drug use status, we will continue to hurt the communities we are trying to help.”


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