Amy Molinski, a peer support counselor at the treatment center Community Medical Services (CMS), began her journey to recovery from cocaine and heroin addiction 13 years ago. “I went to school to be an addiction counselor,” Molinski says, “and then had an opportunity to do peer support, which is just way more up my alley.” She has been providing peer support through her job with CMS since 2019, when the Milwaukee Overdose Response Initiative (MORI) began to take shape.
Joining MORI took Molinski out of the office, where she most often worked with patients, and into their lives. “My experience with patients in the past had been in an office,” Molinski tells Wisconsin Examiner. “And while they may describe to you what their life is like outside, you only create a picture … I think our minds only create a picture that is easy to tolerate.”
Drug overdose and awareness information in Milwaukee. (Photo | Isiah Holmes)
The Milwaukee Overdose Response Initiative operates as a grant-funded partnership between the Milwaukee Health Department, Milwaukee Fire Department, community organizations, and treatment centers including CMS, with the goal of connecting surviving overdose victims with treatment. Milwaukee fire Capt. Dave Polachowski explains that MORI began with two fire department members, joined by a peer support specialist, spending four hours a day driving around in a car together, visiting survivors and their loved ones. “Now we’ve went from that one car for four hours, to two cars at seven hours a day,” Polachowski says. The program also offers services to families who’ve lost a loved one to an overdose.
We meet them where they’re at.
– Capt. Dave Polachowski, Milwaukee Fire Department
In Milwaukee County, a fatal overdose occurs every 16 hours. Across the U.S., the crisis touches every community and outpaces homicides, suicides and motor vehicle accidents combined. In 2021, there were 644 lives lost to drug overdoses in Milwaukee County. Most deaths are related to the synthetic opioid fentanyl, which has vastly contaminated the black market drug supply. Non-opioid and opiate-related drugs including xylazine have also emerged recently. Treatment specialists believe that an estimated 20,000 people are using opioids in Milwaukee.
A different way forward
Searching for and checking on survivors is a round-the-clock job for MORI participants. Daily reports summarizing overdose incidents are generated and reviewed by fire fighters and treatment staff. Over the last few years, MORI has had time to practice and improve the delicate dance of approaching survivors. “We’ve always said that our badge gets us in the door and then, from there, the peer support kind of kicks in,” says Polachowski. “We meet them where they’re at. So we can’t force anybody to go in and get treatment, or to accept harm reduction, or anything that we have to offer. We just hope that they’re willing.”
Some survivors only want harm reduction materials like Narcan, which is used to reverse an opioid overdose, fentanyl testing strips, or other supplies. If they’re ready for treatment, MORI can provide immediate transportation. Sometimes people simply need some space before they can accept help. “Some people want to go right away,” says Polachowski, “other people we’ll go back to. There’s no limit on the amount of times we’ll go back if they want us to come back. Because we want to make sure that they know we’re there for them if they need us, and that we’re supportive of them.” Polachowski adds, “We have no expectations other than having an open mind. And [we ask people to have] the same thing for us.”
Nasal Narcan, used to reverse an overdose, stock the inside of Milwaukee County’s first harm reduction vending machine. (Photo | Isiah Holmes)
Molinski has seen how being involved in MORI changes people’s perspective on the crisis. “The MORI team has been eye-opening for both parties, the peer supports as well as the members of the fire department,” she says. Often, first responders in the middle of an overdose, meeting people in their worst moments of crisis. Resentment and burnout can build.
They feel judged by everyone they encounter.
– Amy Molinski, CMS peer support specialist
“The fire department members have been able to see a completely different side of the individuals that they encounter,” says Molinski. She’s seen her own perspective change as she moved from encountering patients in an office to visiting them at home. “The fact that we’re there, and we’re just offering them a non-judgemental approach to helping them is probably the greatest gift you can give someone that is struggling with addiction,” says Molinski. “They’re judging themselves, they feel judged by everyone they encounter.”
Local residents struggling with addiction must face the grim, twin realities of the waves of death ripping through communities and lack of access to treatment. “Because so many more people are using opiates, because of the high rate of overdose and overdose death, more and more people are trying to get into treatment, are trying to get help, and there’s just not enough places to take them,” says Molinski. “There’s just not. And that goes from residential beds all the way up to medication-assisted treatment.”
Polachowski agrees that housing availability is one of the biggest barriers that MORI encounters. For patients receiving methadone treatment, “there’s a lot of places with housing [that present] a real issue because they have to go in for their methadone every single day,” he explains. If a patient has a criminal record, that could also present challenges.
Community Medical Services in West Allis, Wisconsin. (Photo | Isiah Holmes)
While some treatment facilities are at capacity, patients are faced with having to travel long distances. CMS, for example, has three locations, in Fond du Lac, South Milwaukee, and West Allis. The clinic’s website states that two locations in Pewaukee and Madison are planned to open soon. “When you have an individual that lives on the North Side of Milwaukee and you’re asking them to travel to West Allis every single day, that’s a lot,” says Molinski. “Especially for someone that’s trying to get their life back on track.”
Fighting stigma to open Milwaukee treatment centers
Since arriving in the Milwaukee area, opening new facilities has been difficult for CMS. The issue often comes down to perceptions and stigma within the community. In 2021, the clinic’s attempts to open a new facility on the South Side of Milwaukee were quashed by community outrage. Had it opened, the clinic would have operated at the center of a cluster of fentanyl-related deaths that occurred the previous year. Now, the clinic is attempting to open a new location on the North Side.
On May 24, Ald. Lamont Westmoreland, firefighters and CMS staff joined Milwaukee residents at a community forum, held at Covenant Lutheran Church. The forum was held ahead of a Milwaukee zoning hearing for the clinic on June 1. Throughout the meeting, residents expressed a sentiment treatment staff are accustomed to hearing: “take it somewhere else.”
Covenant Lutheran Church. (Photo | Isiah Holmes)
A variety of concerns were raised by a group of about 20 neighborhood residents. “This is a family neighborhood,” one man said. Another man, comparing medication-assisted treatment like methadone to street drugs asked, “why aren’t you using heroin to get people off of heroin?” Others brought up “quality of life issues” they feel will only worsen by opening a treatment center. Residents said they didn’t want to see their children playing in parks filled with needles from drug users hanging around the facility. Yet, the same residents also complained that needles and drug use were already present in their area.
Neighbors also noted that two treatment centers, one of which is associated with the Milwaukee Bucks, are already open and are looking to expand. Representatives of that treatment center, the Vin Baker Treatment Center, came to the forum to say they don’t want another facility opened within three miles of their own. When it opens in July, the facility will be able to offer treatment to up to 800 people.
Vin Baker, a former Bucks player and current assistant coach for the team, told Wisconsin Examiner that he’d also struggled with addiction, and has been in recovery for 13 years. Baker said his own project received some of the same questions from neighbors when he launched it. “I would say some of the questions were the same … I wouldn’t say as much as here tonight,” Baker said. “But all of the questions ironically concerned both facilities.” He added that, “for us and even for them [CMS], we just want to make sure that we’re giving people an opportunity in the community to get people sober, because it is an epidemic throughout our country.”
Rules hung near the methadone dosing windows at Community Medical Services in West Allis.
(Photo | Isiah Holmes)
Amanda DeLeon, community impact manager for CMS, was unsurprised by the conversation on Wednesday night. “We knew we were going to get a lot of opposition because that’s what happened the last time we were here,” DeLeon told Wisconsin Examiner. “I just wish they would view these individuals suffering from substance use disorder as individuals and as humans. But I can’t force them to do that.” DeLeon wonders why people wouldn’t want more treatment centers, and why some facilities are staking a claim to territory. “One treatment center is not a one-stop, fix-all kind of thing,” says DeLeon. “If we come into the community, we’re just giving them an added benefit.”
During the meeting, a couple of particularly vocal men repeatedly noted that CMS is a private entity, and that profits are their bottom line. CMS was also criticized for being from out of state, despite many of its local staff being from the area. “They got plenty of bus routes,” one woman yelled, challenging the idea that recovering addicts are stranded in far-away treatment center locations. In reality, the county is expecting to cut 11 routes and special services this year, while another four routes will be slowed, due to budget shortfalls. These cuts will put further strain on people who are in recovery and who must travel for treatment. Many of these residents are dependent on public transportation.
An example of a secure drip device for methadone at a Community Medical Services clinic. Methadone is dripped into a cup and consumed orally. (Photo | Isiah Holmes)
Some community members brought up religious faith and will power as the route to recovery, denouncing people struggling with addiction as weak-minded. “There is no solution, people are going to constantly do this,” said one of the most vocal neighbors. One man said he’d rather see more police patrols than more treatment centers. “You can’t tell me it’s not a choice,” he said. “Treatment is a bad direction when that treatment has enabling qualities.”
Several individuals who were opposed to the clinic said either they or their loved ones had battled addiction. Some had lost loved ones to an overdose. Others pushed back against their neighbors, arguing that they don’t grasp the reality facing their community. At few heated debates erupted among the neighbors themselves.
We are in a church talking about people being lesser-minded…Come on people, we’re better than that!
– Chief Aaron Lipski, Milwaukee Fire Department
The tone of conversation eventually led fire department members to interject. “I don’t want to say it, you don’t want to hear it,” said Milwaukee Fire Chief Aaron Lipski. “This isn’t a movie, it’s not television … It’s here, people!” Addressing the comments by some of the most vocal neighbors Lipski said, “We’re in a church talking about people being lesser-minded … Come on people, we’re better than that!” Armando Suarez Del Real, deputy chief at the West Allis Fire Department, echoed that sentiment. “I understand and respect all of your concerns,” he told the crowd. Del Real stressed, however, that Milwaukee County is overwhelmed by the overdose crisis. “I’m not talking about needles in dog parks, I’m talking about people’s lives.”
Del Real told Wisconsin Examiner that in 2018, West Allis had the highest death rate per capita from overdoses in the county. Over the last few years the city has increased its partnerships with the Milwaukee Fire Department and treatment centers including CMS and has instituted its own MORI-like program. “We’ve seen, overall since the inception of our program, a decrease of 21% in non-fatal overdoses,” Del Real says. “Over that same time period, Milwaukee County saw an overall 58% increase in non-fatals.”
Needles are seen littering the pavement in Glasgow, Scotland. (Photo by Jeff J Mitchell/Getty Images)
Chief Lipski is all too familiar with neighborhood reactions like the one he saw on Wednesday evening. “It doesn’t matter what neighborhood you go into, there is so much stigma associated with the mental disease of addiction,” Lipski says. “And let’s face it, none of those folks in there are bad people, they’re not ignorant people. They’re incredibly intelligent, experienced, wise people. But yet, we’re in a tsunami of addiction and overdose fatalities in this city. And if nobody wants it in their neighborhood — meaning the real treatment facilities — if nobody wants it in their neighborhoods, what am I supposed to do about that? I’m just the 911 call, and we’re running out of people.”
Despite being disheartened by the conversation, Lipski says he still finds it rewarding to participate in the democratic process of debating the issue. Nevertheless, the reality remains the same for the fire chief. “The numbers don’t lie, we absolutely need every available resource, all hands on deck amidst a whole bunch of other all hands on deck crises gripping our city.”
DeLeon wants Milwaukeeans to understand that “we’re trying to bring hope to a community, we’re trying to make a community healthier.” She adds that, “we keep hearing there’s a problem, but yet no one wants the treatment that’s needed to solve the problem. They just want to keep stating the problem. So we want to be here to make the community better. We know it’s not going to solve everything, because nothing does. But if you don’t do anything about it, then the problem is just going to get worse.”
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originally published at https%3A%2F%2Fwisconsinexaminer.com%2F2023%2F05%2F30%2Fperspectives-on-addiction-and-recovery-in-a-city-plagued-with-overdose-deaths%2F by Isiah Holmes