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Can This Small Town Lead America in Fighting the Opioid Crisis

Can This Small Town Lead America in Fighting the Opioid Crisis?

Downtown Greenfield, Massachusetts

Chris Sheperd lost 14 friends to heroin overdoses, including a girlfriend who was pregnant with his child. But what made him stop using heroin was an organic gardening class he took while incarcerated in Greenfield, Massachusetts.

Ninety minutes west of Boston, Greenfield has a population of 17,000, and like so many rural places across the U.S., it has been hit hard by the opioid epidemic. Greenfield, though, has waged an ambitious response — one that may be a blueprint for other communities.

In 2013, Greenfield residents formed the Opioid Task Force, and its members have since won significant victories, including the launch of a 64-bed treatment center a mile from downtown, and an upending of the way the local jail administers corrections. They tackled the easiest interventions first, such as educating the public about the problem and improving access to naloxone, the medication that reverses overdoses, says John Merrigan, a Task Force co-founder and the county’s register of probate. These are steps that many communities have undertaken; Greenfield, though, began to confront some of the deeper issues underlying drug use, including the fact that overdose deaths are more common among the underemployed and unemployed.

THE WORK THAT’S HAPPENING IN GREENFIELD IS A MICROCOSM OF WHAT NEEDS TO HAPPEN ALL ACROSS THE COUNTRY.

MICHAEL BOTTICELLI, FORMER DIRECTOR, NATIONAL DRUG CONTROL POLICY

Greenfield’s Franklin County Jail is now at the vanguard of U.S. correctional facilities, offering something that’s common in European jails but rare in the U.S.: Qualifying inmates receive medication-assisted treatment, including buprenorphine, which curbs opioid cravings, or Vivitrol, which blocks the effects of opioids. Clinicians encourage inmates, whom they call clients, to name what truly matters to them, as part of an approach known as dialectical behavior therapy, or DBT. In a facility where around 90 percent of the roughly 200 inmates at any point report a substance use disorder, these services are critical.

Greenfield is also striving to rebuild an economy that depended on a thriving manufacturing industry in the 20th century. It is emerging as a hub for the food industry, sparking hopes that it will once again be able to offer living-wage jobs to the city’s residents.

At the treatment center, medical director Dr. Ruth Potee — who also holds the same post at the jail — is trying to facilitate the recovery of patients by giving them more than just medication: a reason to get better.

“Everybody needs a sense of purpose,” Potee says. “It could be taking care of your kids, or having a job, or going back to school, or walking your neighbor’s dog.”

What works in a small city in Massachusetts may not in other parts of the country. But the multipronged, holistic approach the city has taken to deal with the crisis represents a model worth emulating, suggests Michael Botticelli, executive director of the Grayken Center for Addiction at Boston Medical Center and former director of the Office of National Drug Control Policy.

“The work that’s happening in Greenfield is a microcosm of what needs to happen all across the country,” says Botticelli.

At the heart of the city’s strategy is the Franklin County Jail, located on the west side, at the base of Greenfield mountain. Sheriff Chris Donelan and his staff treat the jail as a “locked treatment facility.” There’s appropriate medication on offer, and also DBT. Clinicians encourage inmates to articulate the triggers associated with their inclination to use drugs, such as sadness, stress and memories of traumatic experiences. According to Levin Schwartz, the jail’s director of clinical and re-entry services, such awareness creates a split second, a tiny window, in which former drug users can consider whether using will move them toward or away from what they really want. “You see things one way, then DBT gives you another way of reacting,” says Sheperd, who was held at the jail twice, most recently for a 10-month sentence that ended in 2016.

The city’s treatment center is offering similar therapy. Adam S. checked in to the Franklin Recovery Center last April and participated in intensive group sessions that covered coping skills and developing a sense of purpose, as well as practical tactics like picking up the phone rather than isolating himself when he was at risk of relapsing. Those sessions helped, Adam says — but his insurance only covered a week and a half of inpatient care, so he was discharged. He relapsed, though he has been clean for the past two months. It’s easier to offer intensive therapy at the jail than at the civilian treatment center, where patients stay for 30 days max, says Potee. Greenfield wants to do both.

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But any long-term success will also hinge on Greenfield’s success in rebuilding its economy. Once a manufacturing hub, the city boasted a local silver company, Lunt Silversmiths, that employed 800 people as recently as 2001. By 2009, though, Lunt’s had filed for bankruptcy and shut its doors. The city’s low official unemployment rate of 2.9 percent may be misleading. According to the Census Bureau, more than 2,000 residents in Greenfield between the ages of 18 and 64 are neither employed nor looking for work, and therefore are not counted among the jobless.

The food industry is emerging as a savior. Housed in a squat building with solar panels on its gently sloping rooftop and a Black Lives Matter sign in one window, Real Pickles makes fermented foods from regionally sourced produce. It sells its products in around 400 stores from Pennsylvania to Maine, including 50 Whole Foods Markets. Real Pickles, which employs 20 people, and a couple of other local companies — like the Artisan Beverage Cooperative, which distributes ginger beer and kombucha to a thousand stores nationally — have found a niche in the production of locally sourced packaged foods that command a high price. Across the street from Real Pickles is the Western Massachusetts Food Processing Center, which helps entrepreneurs incubate businesses that turn agriculture into packaged products.

The jail, meanwhile, has created explicit pathways from addiction and incarceration to the food industry through vocational training. Abrah Dresdale, who sports rectangular glasses and an asymmetrical haircut, coordinates the jail’s Farm and Food Systems program and teaches some of its college-accredited classes. One of Dresdale’s former students, Russ Lilly, was hired by Real Pickles when he still had nine months left to his sentence, so officers transported him to work and back. “The gardening and food programs are fast becoming the most popular here,” says Donelan.

Other former addicts have found their way into Greenfield’s new economy without assistance from the jail. Miguel Morales, who became addicted to heroin in his teens, now works at a nearby farm that raises free-range meats and eggs.

Greenfield’s food industry is still modest in size. The food-processing facility has directly created 100 jobs. Still, those employed find the work meaningful. At Real Pickles, Lilly is part of the company’s mission to build a better food system.  “I feel like I’m making a difference,” he says.

Welcome

Levin Schwartz, LICSW is a licensed independent clinical social worker, whose primary training occurred at Smith College’s MSW program and at the Veterans Administration on the Specialized Inpatient PTSD Unit. Levin currently holds multiple positions in the greater community of Western Massachusetts.  Levin is the Assistant Deputy Superintendent of Clinical & Reentry Services at the Franklin County Sheriff’s Office; a member of the MPTC; a consultant to the Greenfield District Court’s Drug Court; an adjunct professor at Westfield State University; and sits on a number of boards including the Human Services Program Advisory Board at Greenfield Community College; Department of Mental Health Site Board; Transitions from Jail to Community Core Task Force and Mental Health & Law Enforcement Board of Franklin County.

Levin is a cognitive behavioral therapist who has worked with a variety of client populations including: combat veterans, uniformed first responders, forensic populations, drug courts, couples, families, adolescents, and children. Levin specializes in providing Acceptance and Commitment Therapy (ACT) and Dialectical Behavioral Therapy (DBT); in addition he has extensive experience in large scale program implementation and evaluation.