Pubdate: Sun, 17 Jul 2016
Source: Boston Globe (MA)
Copyright: 2016 Globe Newspaper Company
Authors: Nestor Ramos and Evan Allen


Last night's needles line the sidewalks at dawn along the blighted 
blocks where Massachusetts Avenue and Southampton Street meet. People 
emerge from shelters and halfway houses and trudge toward the 
methadone clinics that lend this place its ugly nickname.

An open-air drug market is in full swing on the corner outside a 
convenience store, where offers of drugs trill like music. 
"Clonidines-Clonidines-Clonidines-Clonidines!" "Does anybody need 
Xani Bars?" Phenergans, Pins, Johnnies? A man grimaces one chilly 
morning, unsteady on his feet. He opens his mouth to reveal a knotted 
bag of heroin, double-wrapped and ready to be swallowed should police 
wade into the crowd. "This is all I have left," he says.

Some come to this sad section of the city to get high, slumped on 
street corners and shooting up between parked cars. Some come to get 
clean, ducking into low-slung clinics where they swallow the fuchsia 
medicine, sweet and bitter at once, that frees them from heroin's 
grasp. The people here call it Methadone Mile, and it is the 
congested heart of Massachusetts' raging opioid crisis.

Those working toward recovery at the many clinics and services here 
try to steel themselves against the streets outside. On the mornings 
when she must brave the chaos, Alyssa Bowman swallows her 80 
milligrams of methadone and walks to work quickly, eyes on the ground 
and earphones stuffed in her ears.

Like many of the others who populate this place, Bowman, 35, is 
passing through on her way to somewhere else: A life with her 
children, a return to her career as a dental assistant.

Clean at 23 thanks to daily methadone treatments, she relapsed about 
a year ago with a seven-month binge of alcohol and benzodiazepines, a 
type of tranquilizer, that destroyed her life and her liver. By 
March, she was living in a nearby halfway house where the other women 
called her "mom," and brought her their broken necklaces and 
eyeglasses to fix. She collects heads-up pennies for luck and gives 
them to women having rough days on the road to recovery. Now, she 
lives in her own apartment; she walks through Methadone Mile some 
days on her way to her job doing merchandising and marketing for a 
retail service company.

The sing-song offers of pills and dope make her stomach turn.

"That road," she said, "leads to nothing."

But these streets were paved with suffering long before today's drug 
epidemic earned much notice. And in the wake of the closing of the 
Long Island Shelter, the chronically homeless mingle with a new 
generation caught in addiction's grip, parading this most confounding 
of problems out before an audience at a busy Boston intersection.

Even as a rising death toll stokes compassion and newfound resolve, 
gaping holes remain in the systems set up to combat the crisis - 
nowhere more visible than here. As more and more people stumble along 
the sidewalks of Methadone Mile each morning, those holes seem harder 
than ever to patch.

Recovery and relapse jockey for space in the same few blocks. A 
constellation of services for those suffering from homelessness, 
mental illness, and drug and alcohol addiction line the streets near 
Boston Medical Center, compressed into one of the only corners of the 
city where such facilities can exist without uproar from nervous neighbors.

The Woods-Mullen and Southampton Street shelters, for women and men 
respectively, house hundreds every night, a few blocks apart. The 
headquarters of Boston Health Care for the Homeless, a 30-year-old 
program dedicated to the city's most vulnerable patients, occupies 
part of the building next to Woods-Mullen. The same building is home 
to several Boston Public Health programs - among them one that 
distributes clean needles and another, PAATHS, that helps coordinate 
services for people making their way through a thicket of acute, 
residential and outpatient care for drug addiction. In the middle of 
it all is Boston Medical Center.

In the battle against substance abuse, these are the front lines. For 
some, access to so many services in such close quarters is a boon. 
People who live in one of the shelters can make it to therapy groups, 
see their primary care doctors at BMC, and visit a recovery center 
without commuting all over the city. And service providers here, many 
say, show their patients a respect they rarely find elsewhere.

Jennifer Tracey, head of the city's Office of Recovery Services, says 
there is "probably nowhere else in New England if not the country 
where you find . . . . the level of services that you're finding here."

But the challenges of the area are obvious. Despite a heavy police 
presence, low-level dealers work the streets, harassing and baiting 
those clinging to sobriety, and selling to those who have lost their grip.

By dawn, people are already beating a path toward the methadone 
clinics. Dozens make their way down Southampton to the clinic on 
Topeka Street, a shabby one-block roadway flanked by industrial 
businesses and a fenced, inactive construction site that signs warn 
is an environmental hazard. People sleep there anyway, bedding down 
behind a concrete structure that's either half-built or half-demolished.

Couples walk by holding hands. Women push strollers. Yesterday's 
panhandling signs sit discarded along the chain-link fence. A 
billboard rises over the run-down gas station on the corner, where 
Michael McCarthy and Rachelle Bond, charged in the killing last 
summer of Bond's daughter Bella, used to sit in the dirt. The 
billboard faces the other way; the side overlooking Topeka Street is blank.

Some drive to the two methadone clinics here and duck inside for a 
few minutes to take their dose before driving away. Others walk in 
and out quickly, dressed in the uniforms they'll wear at the jobs 
they're bound for. But many - those with nowhere else to be - linger 
outside, crouching on the dusty roadside.

Methadone, an opioid that wards off withdrawal symptoms while 
blocking the chemical craving associated with heroin, is one of the 
most effective treatments against opioid addiction, along with 
Suboxone, a similar drug that can be taken at home. That's why this 
area's derisive nickname infuriates many who have spent years working 
in the treatment programs here: It stigmatizes the people whose pain 
and suffering is very public and mocks their efforts to get clean. 
They wish it were known instead as Recovery Road.

But methadone itself can be extremely addictive, and some take it 
indefinitely for years, trading one addiction for another that allows 
them to go to work and lead less fractured lives. Others, still 
active drug users, take it to ward off withdrawal symptoms for the 
days or hours until they cobble together enough money to buy heroin 
from one of the dealers on Massachusetts Avenue.

Even the combination of pills the dealers sell in their looping 
cadence - a specially tailored mix of seemingly random medications 
called "the cocktail" - is designed to intensify heroin's potency or 
amplify the pain-relieving effects of methadone into a powerful high.

Users swallow a benzodiazepine like Klonopin or Xanax, the blood 
pressure medication Clonidine, and the seizure medication Neurontin 
or Gabapentin. An antinausea drug, Phenergan, completes the blend.

Then they drift away. The people piling the pills on top of their 
methadone doses are easy to spot: Some, overcome, stoop so low that 
their hair and hands scrape the sidewalk.

One woman, a regular on the sidewalks and under the bridges here who 
studied toward a master's degree in health education before her life 
fell apart, likened the layering of pills atop an opioid to Maslow's 
hierarchy of needs, the theory in psychology that basic physical 
needs must first be met before a person can seek safety, love, or esteem.

In the cocktail - and for many on the Mile - opioids come first. 
Shaun and his wife, Donna, have been homeless opioid abusers for 
several years. They kiss in the parking lot of a mall near Methadone Mille.

Shaun stands shivering in front of the Cumberland Farms store on 
Mass. Ave. and does the math: A week, maybe more, before he can get 
on Suboxone after being kicked out of his methadone clinic. Two hours 
before he'll be dopesick. Less than $20 needed to buy a quarter-gram of heroin.

His stomach is cramping. He is nauseated, and he is anxious: Soon, 
the diarrhea and vomiting will start, and pain so complete he'll be 
able to feel it in his hair.

The tall and skinny 45-year-old from Lynn has been clean for several 
months, he says, and so has his wife, Donna. Among his prison 
tattoos, he has her name inked across his chest and her initials on 
his wrist. They always promised each other: We'll quit this together. 
For years, they said, they have lived in shelters, rooming houses, 
and on the streets; using, detoxing, relapsing, getting arrested - 
always together.

Now, in early May, Donna is living in a halfway house, looking for a 
job. He is staying in a homeless shelter, and wakes up at night 
reaching for her. He walks her down Southampton Street every morning 
so she can get her methadone without succumbing to the temptation of 
the dealers she passes on the way.

He's too old to go through withdrawal, he says. He doesn't have it in 
him anymore. He decides: He'll use heroin, just for a week. Then, Suboxone.

Shaun, who goes by the nickname "BonZ" (pronounced Bone-zee), 
panhandles $17, and vanishes into the stir of people in front of 
Cumberland Farms, looking for his dealer. He emerges moments later, smiling.

"It's as easy as that," he says.

Like many others here, Shaun's addiction predates the current opioid 
crisis. For him, heroin serves as a refuge from a lifetime of traumas 
- - some self-inflicted. Even with the wealth of treatment options he 
is surrounded by every day, a remedy has been elusive, the damage 
that deep. Court papers document a tumultuous childhood, 
hospitalizations for mental health issues, and repeated arrests. He 
started drinking at 8, the documents show, and by 13 he was smoking 
angel dust, snorting cocaine, and using LSD; he started using 
Oxycontin in the late '90s, he said, before switching to heroin. He 
served time for a failed robbery at a McDonald's. His brother died of 
an overdose in 2012.

"I love heroin. I live it. The first time I ever did it I fell in 
love with it," he says. "But you hate it. You want to kill it. But 
you can't. It always wins. It's the biggest lie." Shaun holds a 
needle in his teeth before shooting up heroin.

He lopes over to a low orange box of a building at the edge of Mass. 
Ave., The Universal Church, and squats down on blacktop wet with 
rain. He opens a water bottle, takes out a clean syringe, and 
squeezes a few drops of water into the upturned bottle cap on his 
knee. Then he unwraps the folded Keno ticket that holds his heroin.

It is too windy to cook, so he stirs it up in the bottle cap and 
draws the amber liquid up into the syringe through a makeshift 
filter, a cotton pad he found discarded on the ground. He rolls up 
his sleeve, revealing dark blue veins he calls "ropes," and plunges 
the needle in, waiting for the eddy of blood called the "red flag" 
that means it is safe to inject.

The red swirl beckons, and he presses the plunger.

His shoulders relax, no longer sharp points under his jacket. He is 
not thinking about the hours and days that will follow this one 
perfect moment of relief: That his plan to use just once every day 
will fail by the afternoon; that he will begin missing his morning 
walks with Donna to panhandle for more dope; that he will spend two 
days trying to raise enough money to take her to see "Captain 
America: Civil War," only to spend it on heroin instead; that he will 
fail to get into a Suboxone clinic, try detox, then return to the 
streets and to heroin, then detox again. In this moment, there is 
only the pain leaving his body.

In many ways, the center of this teeming neighborhood - the hub of 
the Mile - is not a shelter or a clinic. It's a convenience store.

The Cumberland Farms on the corner of Massachusetts Avenue and Albany 
Street was the company's first foray into an "urban location" in 
Boston since 1981, and a month-long fund-raiser for Boston Medical 
Center accompanied the store's opening in November 2013 - a nod to 
their new neighbors.

"With our brand new look and store concept, we felt the timing was 
right for us to provide this vibrant neighborhood with a convenient, 
affordable option for freshly prepared food and our everyday 
convenience items," Cumberland Farms president Ari Haseotes said in a 
news release at the time.

The firm couldn't have known what was coming. Less than a year after 
the store opened, in October 2014, the condemnation of the bridge to 
Long Island shuttered the shelter there and tossed the city's already 
overburdened support systems into chaos. It also resettled hundreds 
of Boston's homeless here.

Almost overnight, the number of homeless, drug- and alcohol-dependent 
people crowding around Cumby's appeared to double. Shoving matches 
block the doorway. People mill around inside indefinitely, buying 
nothing. The bathrooms stay locked, to keep people from shooting up 
heroin inside. One night, a pair of men's dress shoes sat abandoned 
in front of the register; a woman with a black eye and a metal bar 
slid through the belt loops of her jeans added packet after packet of 
sugar to a yogurt she brought from outside.

Many of the people out front are simply having a cup of coffee with 
their friends outside the local shop - they're living in the shelters 
and spend their days outside, said Tracey, whom Mayor Martin J. Walsh 
appointed in 2015 to head the city office charged with addressing 
substance abuse. But others are nodding off on their feet, conked out 
by the cocktail.

"It's scary for people to see people that sick and unaware," Tracey said.

Service providers in the area meet with one another and with police 
and neighborhood and business groups regularly, addressing problems 
as they arise - harassment outside methadone clinics, or parked cars 
being used as cover for injection drug use. But the daily 
responsibility for reining in the chaos often falls to the Boston 
Police Department.

"Gotta go, gotta go," say the police officers who show up every hour 
or so to sweep away the restive crowd, pointing down the sidewalk. 
But no one here has anywhere to go. Everything they own, they carry 
in backpacks and plastic bags. They grumble and swear, walk 
grudgingly 20 or 30 feet, stop. A skinny man spreads his arms wide, 
gesturing to the public sidewalk. "They always say that this is 
theirs, but what's ours out here?"

Cumberland Farms, in a prepared statement, said it appreciates the 
efforts by police, but the company worries that the concentration of 
troubles is overmatching city efforts, forcing reconsideration of the 
store location. "We at Cumberland Farms have tremendous compassion 
for the homeless and people affected by drug and alcohol addiction . 
. . It's a difficult situation for everyone. Cumberland Farms is 
unwaveringly committed to keeping our customers and employees safe."

Police are trying. Officers can often be seen searching backpacks or 
questioning loiterers, and they arrested more than 200 people within 
a quarter-mile of the Melnea Cass Boulevard and Mass. Ave. 
intersection in a nine-month period ending in June alone, according 
to department statistics. But the most common charges are low-level 
possession or distribution of drugs, and people are often back on the 
corner within days or hours. Many need help, police and health 
officials say, more than they need jail time.

Officers patrol on bikes, in cruisers, and on walking beats, and some 
hand out postcards filled with information about how to get clean. 
Just last week, Boston Police launched a pilot program designed to 
refer people who are summonsed to court on drug charges in South 
Boston and the South End into treatment at PAATHS while they wait for 
their court hearings, which can often take weeks.

"The problem is, you've got so many public health resources to help 
the people that need help, but then you've got the people who want to 
take advantage of people down on their luck," said Lieutenant 
Detective Brian J. Larkin, commander of the Boston Police Drug 
Control Unit. "The shelters open up in the morning, and they flood 
the streets."

When the cops leave, the Cumberland crowd inches back. Jae Cleva 
reclaims his spot in front of the store selling synthetic marijuana 
joints and dreaming of becoming a rap star: "I own this galaxy," he 
spits out in one of his favorite verses, "I burn you like a calorie." 
He darts away to deal with his customers.

Robert, who at 39 has been using heroin since he was 17, wobbles on 
the corner. "I have no one except for my sister," he says. "She begs 
me to come home. For some reason, I don't."

He's high on heroin and Xanax. Cars whip past. He feels like he's flying.

These streets were paved with suffering and struggle decades before 
the bridge to Long Island came down.

Boston City Hospital, which merged with Boston University's hospital 
in 1996 to become Boston Medical Center, has served the city's 
"worthy poor" at this site since 1864, according to a city-published 
history of the hospital.

About a century later, the boulevard that now bisects the 
neighborhood was slated to become an interstate - an inner beltway 
through the city. But the project was canceled in 1971, and instead 
of Interstate 695 racing past these blighted blocks, a new surface 
road was named for Roxbury civil rights leader Melnea Cass.

In the refashioned cityscape, cars and trucks cluster as they enter 
or exit Interstate 93, cut across Roxbury toward Fenway Park on game 
night, or head home to the South Shore after a downtown workday. The 
traffic islands on Mass. Ave. and Melnea Cass quickly became an ideal 
spot for panhandling, with beggars accosting drivers waiting two or 
three light cycles to turn through the busy intersection. Some hold 
signs, but many simply walk down the dotted lines separating lanes, 
peering into window after window, cup in hand.

By the time Mayor Thomas M. Menino said in 2007 that some homeless 
people "had become problems on the street," the intersection of 
Massachusetts Avenue and Melnea Cass Boulevard was the most obvious 
example. Panhandlers crowded the streets right outside the 
Woods-Mullen Shelter even then - an intersection a Globe columnist 
called "the crossroads of all cadgers" in 2008.

"This is a neighborhood that has for a very long time been a place 
where poor people in Boston receive services," said Dr. Jessie Gaeta, 
medical director of Health Care for the Homeless, which has been on 
the corner of Massachusetts and Albany for 30 years.

Some of the homeless people they try to help have been here nearly as 
long. Craig, a 61-year-old husk of a man missing most of his teeth, 
said he has been out panhandling on Methadone Mile for nearly 20 
years. He spends his nights shuffling through traffic, leaning on his 
cane with his cup outstretched, alongside the men in reflective vests 
selling $10 roses on the median.

Gradually, more services set up shop in one of the few parts of the 
city where it was possible to open new recovery centers and methadone 
clinics. As Boston's real estate market exploded, the notion of 
opening more facilities elsewhere started to feel like a fantasy.

"There are pros and cons to having things clustered this way," said 
Gaeta. "If we were doing urban planning today, would we do it this 
way? I have no idea."

The area, which spans corners of four neighborhoods - Roxbury, 
Dorchester, the South End and South Boston - has always accepted the 
burden graciously, Gaeta said. But the influx of people displaced by 
the Long Island closure, which came as the opioid crisis was reaching 
new heights, pushed the concentration to a new and concerning level, 
and brought addiction - and all the eyesores that accompany it - into 
plain view.

At the same time, the crisis outside of the city has grown, a wave 
that many leading the fight against substance abuse saw coming a 
decade ago but were powerless to stop.

People from the suburbs show up in larger numbers now, said Devin 
Larkin, director of the Recovery Services Bureau at the Boston Public 
Health Commission, who is not related to Lieutenant Detective Brian 
Larkin. Once they're downtown, they "pick up a case" - slang for an 
arrest - or become regulars at one of the methadone clinics here. 
They sleep in shelters, or under the highway overpass. Their families 
won't let them come home, or they stay away out of shame.

This new generation of those from outside the city, for whom 
homelessness is relatively new, add to the already overburdened 
shelter and recovery systems. They stumble side-by-side with those 
who have spent decades on the street.

Huddled on a fire escape above Massachusetts Avenue on a soggy 
Saturday morning, Andrew, 31, reaches the same conclusion he's come 
to again and again during a 15-year battle with addiction: "I'm ready 
for this to be over."

He'd spent Friday night high, bouncing on the balls of his feet as if 
an electric current was coursing through him. A small crowd writhed 
nearby: A wild-eyed man with a scraggly beard grabbed a woman by both 
shoulders and shook her; another, barely conscious, stood hunched on 
the sidewalk, staring vacantly into the middle distance.

"It looks like a scene out of 'The Walking Dead,' " Andrew says. Late 
at night it can seem just as dangerous.

When a handful of men threatened him with a knife late that rainy 
Friday night, he fled and hid on a fire escape, still and silent and 
too scared to sleep.

He's been done with heroin a hundred times before, promising himself 
and his family that he was finally committed to getting clean. And 
again and again he's relapsed - bolting from his mother's house in 
Abington, drawn inexorably to drugs and sometimes to the Mile, where 
they are cheap and plentiful.

Each time he promises he's done, he says his mother asks a question 
he can't answer: "What's different this time?"

Like many of the other men and women who parachute in from the 
suburbs, Andrew can leave the Mile whenever he pleases. He looks 
young for his age. He's long-armed and thick-shouldered like a 
welterweight fighter. A warm bed awaits back in Abington; a 
well-connected uncle will help him get into recovery beds that are 
always scarce.

But the cycle keeps repeating: He's been through detox 15 or 16 
times, he thinks; six or seven 'Section 35' commitments, named for 
the statute that allows his mother to force him into rehab without 
his consent; a long record of arrests for minor crimes, nearly all of 
which he beat. Andrew cools his head off in the sink after feeling 
hot as he tries to reduce his heroin usage in his home in Abington.

He's been to Florida for treatment. He's stayed in one of the sober 
homes his family operates - that lasted only a few days. He's even 
detoxed right here on the Mile, at CAB Boston, where he remembers 
looking out over the chaotic scene.

"You can literally see your drug dealer," he says. "He's waving to you."

Now, the men he calls the walking dead look frighteningly like his future.

"My next step is washing my hands," says Barbara, his mother.

Andrew isn't a bad guy, says his uncle, who operates several sober 
homes and recently retired from a job with the Boston Public Health 
Commission - "he's not a criminal element." But this has gone on for 
more than a decade now, and the family is waiting for a call from 
police to tell them he's dead.

But the call Barbara gets that morning is from Andrew. From the fire 
escape, he begs her to rescue him.

At home in Abington, where Barbara makes chili and a shiba inu dog 
trots around the yard, the madness of the Mile feels very far away. 
Andrew heads to one doctor's appointment after another, hoping to try 
a relatively new medication called Vivitrol that's said to mute the 
effects of opioids so thoroughly that shooting up is pointless. In a 
few days, driving back from a job interview, he passes exit 18 on 
Interstate 93 - the highway entrance to the Mile - and doesn't turn 
off, grateful for once to be carrying an empty wallet.

Within days, the cycle starts again: Barbara finds Andrew passed out 
on the couch, overdosed on a bag of pills his friend said were Xanax. 
A dose of Narcan at the hospital revives him, but within hours he's 
lying shoeless under a highway overpass in Quincy.

He's ready for this to be over. Again. But what's different this time?

He finds a bed at a detox facility on the Cape, but they can't take 
him for a few days - long enough to go into withdrawal. So Barbara 
drives him to his dealer in the city to get heroin to hold him over. 
Taking her money, he shoots up while she waits in the car - a new low, he says.

As she drives him to the Cape, to a detox facility far from the Mile, 
Andrew says he's grateful that she hasn't given up on him, and 
hopeful for a happy ending. He'll get clean and look for a bed in a 
nice sober home on the South Shore, far from the fire escape and the 
grim glimpse of where his life is leading him.

"I don't want to be one of these 40-, 50-year-old guys still going to 
detox," he says. So he keeps fighting for sobriety, hoping each time 
that something will be different. Men wait to board a van that will 
take them to a homeless shelter.

There are dozens of programs for combating addiction, but a typical 
path to recovery is supposed to look like this: Determined to get 
clean, a drug user walks into an emergency room. Users are admitted 
to whichever Boston-area detox program has an available bed, and - 
prescribed methadone or Suboxone - they spend up to two weeks under 
medical supervision.

Once the heroin is out of their system, they move for a month into a 
transitional program somewhere, where the work of treating addiction 
begins in group or individual therapy sessions.

Finally, they move into a halfway house, from which they can go back 
to work or hunt for a new job. They can visit drop-in centers and 
attend group meetings, which are typically a requirement for 
methadone therapy. Slowly, sober days pile up; lost lives are reclaimed.

But the system is fractured and inadequate, said Gaeta.

Detox - the first step - is generally available on the Mile and 
elsewhere, though that varies some by time of year and even time of 
day. But after that, the obstacles to recovery mount.

"Getting into detox is a four lane highway. Coming out of detox is a 
one-lane country road," said Vic DiGravio, president of the 
Massachusetts-based Association for Behavioral Healthcare.

Critical post-detox programs such as transitional support and 
clinical stabilization services are in short supply around Boston, 
and the 40 beds at Boston Public Health's only facility - 
Transitions, in Mattapan - are typically full. Beds are so scarce 
that agencies here put patients onto trains or in taxis with 
instructions not to stop until they reach facilities in Tewksbury or Worcester.

While some agree to go, many are not comfortable leaving their lives 
behind. Discharged from detox and back on the street, people who have 
spent a week or more getting clean make their way back to the Mile to 
wait. Relapse is almost inevitable.

That problem was compounded when the Long Island closure eliminated 
more than half of the city's post-detox addiction recovery beds.

Even those who navigate the gantlet that far can find themselves back 
on the street, because beds in halfway houses are also hard to find, 
said Andrew's uncle Charlie, whose sober homes are typically full. 
After several drug overdoses, he got clean in 1989 and became an 
addiction counselor.

"The whole system is short on beds," Charlie said. "There's no place 
where you can just knock on the door and get in."

But many on the Mile aren't ready to knock on those doors anyway - 
they are still deep in the throes of addiction.

That, says Drug Control Unit commander Brian Larkin, is the most 
difficult part of policing the area.

"You can arrest people all day long, but you dump them in jail for 30 
days, and what happens then?" he said. "People who are addicted have 
to want the help. There are plenty of people offering it."

Solutions for those who aren't looking for help have always been 
harder to come by. Boston Public Health's AHOPE needle exchange 
program and Healthcare for the Homeless's SPOT (Supportive Place for 
Observation and Treatment) target those who aren't yet in recovery, 
seeking to reduce the health risks and steer people toward treatment. 
And the city plans to hire a street worker focused on substance abuse 
- - something once supported by the state but cut during recession-era 
budgets, Devin Larkin said.

State funding for substance abuse treatment has climbed in recent 
years after stagnating from 2007 through 2014, according to 
statistics provided by the Association for Behavioral Healthcare, 
which represents mental health and addiction treatment organizations. 
But even a dramatic ramp-up in spending in recent years could not 
keep pace with demand, said DiGravio.

More frustrating for many who have long worked in drug treatment was 
how long help was in coming, and how slow sympathy for addiction was to arrive.

"It's tough to argue that there's more attention on this epidemic 
because it's reaching into suburbs," DiGravio said. "I think there's 
resentment . . . It took this spreading to Wellesley and Needham and 
Milton for people to sit up and take notice."

Sleep will not come for Terrance tonight. The 21-year-old homeless 
man is restless, lonely, and afraid of his dreams, so he paces Mass. 
Ave., waiting for something to happen. Around him, headlights 
illuminate the nighttime panhandlers, and a sinewy man with his hair 
in his eyes tries to hawk a television set he pushes in a shopping 
cart. Terrance, who goes by "Delicious," is less than 24 hours 
removed from a stint in the hospital, where he was admitted after 
threatening to kill himself.

"All I could ask for was to be loved," he says. "And I could never get it."

He grew up in foster care, residential homes, and psychiatric 
hospitals, he says, and has been living on Methadone Mile for two or 
three years. In a year or two, he says, he imagines he will be dead.

He's not afraid. He's waiting.

Behind him, Mass. Ave. stretches into Back Bay, the grit and 
construction giving way to brownstones and gardens. But his world is 
small. He has no one, owns nothing but what is in his pockets: a 
photographer's business card, a lighter, and two pictures he drew 
while hospitalized. One depicts the apocalypse, and the other, the 
beaked beast that stalks his dreams, poisonous sulfur pouring from its mouth.

"This is not a life I would wish on anyone," he says, his voice slow 
and clear. "This is just a death sentence waiting to be carried out."

But people understand him here. And besides: Where else would he go?

The cacophonous dirge of the morning drug market is just hours away, 
but the streets are never fully quiet. People huddle in tight groups, 
passing K2 joints back and forth. A drunk man in a loose business 
suit slurs his way through a story about his dead parents. A woman 
pulls off her hat to show an open head wound.

Sleeping here is dangerous: Thieves snatch bags and rifle through 
pockets. Some people bed down together on patches of grass, parking 
their shopping carts like circled wagons.

Others hover just above slumber. White sheets draped across their 
shoulders, they shuffle under the streetlights like ghosts.

This story was reported and photographed from April to July 2016. 
Produced by Jennifer Peter, William Greene, Mark Morrow, Laura Amico 
and Michael Workman. Maps by David M. Butler.
- ---
MAP posted-by: Jay Bergstrom