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AIDS Support Group of Cape Cod

    RESULTS

    Cold Water and Warm Smiles at Swim for Life

    310 participants raise $300K for local health-care nonprofits

    By

    PROVINCETOWN — Hundreds of swimmers braved cold water on Saturday, Sept. 7 for the 37th annual Swim for Life fundraiser. The event, which consisted of 1.2-mile and half-mile swims in Provincetown Harbor and an additional one-mile swim in Wellfleet’s Great Pond, raised some $300,000 for the AIDS Support Group of Cape Cod, Helping Our Women, Outer Cape Health Services, and 10 other community beneficiaries.

    A flotilla of paddlers accompanies swimmers at the 37th Swim for Life on Sept. 7. (Photos by Nancy Bloom)

    “It was a huge success,” said event creator Jay Critchley, adding that the amount raised this year was a record. A total of 310 people participated in the event; of those, 222 did the 1.2-mile swim, 32 did the half-mile swim, 41 did the Great Pond swim, and 15 more “swam in place” in other places around the world.

    At the Johnson Street Beach, where entrants registered before the main Provincetown Harbor swim, the air was thick with excitement and nerves. People wandered the sand in wetsuits, goggles, and neon-red Swim for Life swim caps. The Wellesley High School swim team performed an elaborate chant in a circle, which elicited a round of cheers and applause from the other swimmers.

    “I’m excited,” said swimmer Julia Rugo of Barnstable, who said she had been getting into open-water swimming ahead of the event. “I’m just going to swim and have fun.”

    For Julian Schifano, this was his first Swim for Life, but it was his mom’s 20th, he said, and he was swimming it with her. “I’m going to take it slow, go at my own pace,” he added.

    Friends Liz Salomon and Jessica Flaherty, who were here from Cambridge, were also participating for the first time. They reported being both excited and nervous. “We’re very scared of sharks, but we thought we’d face our fears,” Salomon said.

    The swimmers boarded Funk Buses to head to the starting line at the beach in front of the Harbor and Breakwater hotels in the East End. They waved out the window to a cheering crowd like members of a Roman victory parade.

    The Wellesley High School swim team sends up a chant that elicits cheers and applause from the crowd.

    With all the competitors for the 1.2-mile swim lined up and ready, the town crier rang the starting bell, and the swimmers trotted into the water. They took off toward the finish line with a flotilla of kayaks and safety boats keeping them on course.

    According to Critchley, the water this year was particularly cold because of a north wind. “It was very challenging for a lot of swimmers,” he said.

    At the Johnson Street Beach finish line, swimmers were greeted by a cheering crowd of volunteers, plus emergency blankets for warmth, and a buffet of food.

    After the race, Flaherty said she was feeling good. “That was really, really fun,” she said. “I expected it to be harder.” She admitted, though, that the water was colder than she was used to.

    Boris Stefanov, from Bulgaria and Provincetown, was proud of his swim; this was his second year racing, and he finished seven minutes faster than last time, despite the chill.

    “Today was the coldest water I’ve seen,” said Stefanov. “My fingers stopped working. I couldn’t close them.”

    Critchley said that between 8 and 10 people had to be pulled from the water due to the cold, and many more stepped inside the rescue squad’s vehicles at the finish line to warm up. Fortunately, Critchley said, no one required hospitalization or further medical care.

    FUNDING

    Outer Cape Towns Institute Opioid Remediation Plan

    Most funds go to harm reduction and cash assistance; some expenditures have critics

    By

    The four Outer Cape towns began a joint effort on Jan. 1 to spend an unusual pool of money: $621,100 in “opioid remediation funds” that will come to the towns over the next 15 years.

    The AIDS Support Group of Cape Cod’s mobile outreach van parked in front of Provincetown Town Hall. (Photo courtesy ASGCC)

    The money is a result of lawsuits filed by officials of various states and cities, including then Attorney General Maura Healey, against four companies that manufactured and distributed opioid pills.

    The lawsuits were consolidated into one settlement agreement worth $26 billion; most of that money goes to state governments, however.

    The towns have received roughly a quarter of their overall settlement money already, with the rest to come in small increments over time. The town health departments worked with each other and with the nonprofit Outer Cape Community Solutions to develop a spending plan for the irregular funding.

    Over the next six months, the towns will together spend $41,865, which is about 27 percent of the money they have taken in so far — and about 7 percent of the money the towns will receive over the 15-year life of the program.

    Of that amount, $25,000, or about 60 percent, will go to the AIDS Support Group of Cape Cod (ASGCC) for harm reduction efforts, including money for fentanyl test strips, naloxone rescue kits, and a mobile outreach van to help distribute those and other supplies across the Outer Cape.

    The ASGCC currently has a mobile outreach van in Hyannis. The new funding is “not enough for us to dedicate a van full time to the Outer Cape, which is our ultimate goal,” said ASGCC CEO Dan Gates.

    Spending Decisions

    Advocates of harm reduction — a strategy that focuses on saving lives by providing resources such as clean needles, naloxone, test strips, and supervised use sites — have argued that the strategy is underfunded and understaffed relative to treatment and prevention programs. A recent Barnstable County Substance Use Assessment report found that about 30 times more money was spent on opioid treatment programs on Cape Cod than on harm reduction programs.

    “We have to step it up on the Cape, period, as far as what we’re doing for harm reduction,” said Kim Powers, executive director of Access HOPE and longtime harm reduction practitioner.

    The funding of the ASGCC van is a welcome change, Powers said, but it’s “not enough.”

    The next largest expenditure in the Outer Cape’s joint program is $5,000 for the Cape Cod Children’s Place, for its “discretionary fund” to help parents working on recovery with urgent expenses, such as car repairs or winter clothes. That allocation amounts to about 12 percent of the $41,865 spending plan.

    After that, however, the plan paid for two yoga classes, a stress reduction class for teens, an art program for teens, and alternative health treatments for participants in the Structured Outpatient Addiction Program at Outer Cape Health Services.

    Although those expenditures were small — $2,700 for the adult recovery yoga class, $1,100 for the young-adults recovery yoga class, $1,925 for the stress reduction program, $1,940 for the art program, and $1,200 for the alternative health treatments — they added up to $8,865.

    At a Dec. 18 presentation on the spending plan to the Eastham Select Board, board member Jamie Demetri criticized these small allocations.

    “How many people are going to be served — like three?” she said of the $1,200 allocation for alternative treatments at Outer Cape Health Services.

    According to the presentation by Outer Cape Community Solutions coordinator Alex Nelson, the alternative treatments would be those not already covered by insurance, such as art, mindfulness, movement, sound therapies, and acupuncture.

    Nelson told Demetri that one reason the allocations for those programs were so small is so that the four towns can wait to see how the programs are used and adjust spending accordingly.

    Nelson also said that the towns are trying to stockpile funds, given that the amount received from the opioid settlement will decline in future years.

    Rita Letsos is teaching the yoga for recovery class at Eastham’s Chapel in the Pines on Thursdays at 4 p.m. She is also a recovery coach at Outer Cape Health Services.

    “Yoga helps to emotionally stabilize the mind,” Letsos said, and offers “a safe environment.” It can also help with “recovery and treatment of addiction, reduced stress, anxiety, depression, and chronic pain,” Letsos said.

    “Giving it to yoga — I don’t know what that does to help people not overdose and die,” Powers argued. “The person that’s using drugs is the one that’s going to die, so you have to work with the person who’s using drugs. People still have a huge barrier when it comes to that.”

    Senior Reporter Paul Benson contributed reporting.

    OPIOIDS

    Fentanyl in Drug Supply Spurs Community Response

    Contaminated drugs may present dangers for unaware partygoers

    By

    PROVINCETOWN — Gwen Kavlouskas-Noyes, who owns Big Daddy’s Burritos in Provincetown, says that though she has long been aware of the problem of opioids, they always felt distant from her life. But when a representative of the AIDS Support Group of Cape Cod came to her business promoting training for Narcan, the life-saving opioid overdose reversal drug, she realized something had changed.

    ASGCC’s drop-in center at 301 Commercial St. (Photos by Elias Schisgall)

    There was reason to worry because fentanyl, the potent synthetic opioid, is being found more often in non-opioid recreational drugs. “It scared the crap out of me,” said Kavlouskas-Noyes, who lives with her husband in North Truro. She asked ASGCC to conduct a training session for businesses in the Aquarium Mall, where her restaurant is located.

    Over the past several weeks, ASGCC has been sounding the alarm in Provincetown about what it says is fentanyl being found more often in drugs such as cocaine, Adderall, and Percocet. Staff have been conducting Narcan training at bars and businesses and held a first community forum on fentanyl at their new drop-in center at 311 Commercial St. on June 27. A second forum will take place at 4 p.m. on Thursday, July 13.

    Fentanyl, about 50 times more potent than heroin, first came on the scene in the late 2010s, when it began showing up in heroin and counterfeit opioid pills.

    Because just milligrams can be fatal, fentanyl’s growing prevalence has coincided with a steep increase in opioid-related overdose deaths. In 2012, there were 733 such deaths in Massachusetts; in 2022, according to data released last month by the Mass. Dept. of Public Health, there were an estimated 2,357. In that year, 93 percent of opioid-related overdose deaths where a toxicology report was available showed evidence of fentanyl.

    Fentanyl’s presence has “increased significantly,” said Matt Davis, the regional vice president of Acadia Healthcare, which operates a mobile methadone clinic in Wellfleet and conducts drug testing. And not just in heroin but also in cocaine and other types of injectable drugs, he said.

    On the Outer Cape, fentanyl has become essentially ubiquitous in opioids. According to Kim Powers, a former ASGCC staff member who now leads her own harm reduction services under the nonprofit Access HOPE, fentanyl in opioids is so common that testing for it simply won’t make a difference.

    Eliza Morrison, ASGCC’s assistant director of harm reduction services, sees the same trend. She told those present at the first forum that fentanyl has basically supplanted heroin altogether as the opioid of choice.

    In 2022, EMS services responded to 8 opioid-related incidents in Eastham, between one and 4 in Wellfleet, 6 in Truro, and 11 in Provincetown, according to state data. Wellfleet also saw one overdose-related death in 2022.

    Dan Gates, the executive director of ASGCC, said these numbers could be underestimates because of the way overdoses are reported. He said so far this year, Wellfleet, Truro, and Provincetown have each seen one fatal opioid overdose.

    Regular opioid users tend to be aware that fentanyl is present in their drugs and develop a tolerance. But, Gates said, “what’s been really a shift in the last year in particular is the presence of fentanyl in other substances.”

    ASGCC says it is identifying fentanyl in more and more non-opioid drugs, especially stimulants. Morrison said that “most every substance” the group tests that is not an opioid still registers trace amounts of fentanyl.

    According to Traci Green, who heads the Opioid Policy Research Collaborative at Brandeis University, about 15 to 20 percent of powdered stimulants — particularly cocaine — in Massachusetts are testing positive for fentanyl.

    Though Green didn’t have Cape-specific numbers, she said drug use on the Cape tends to be seasonal, with more recreational or experimental use in the summer. “When there is more powder coke, we definitely see more powder fentanyl coming in at the same time, and that’s when things are very vulnerable to contamination,” Green said.

    Gates said the presence of fentanyl in non-opioids creates new risk factors for stimulant users or people who may only occasionally use drugs at parties or clubs and who wouldn’t necessarily think they could be ingesting fentanyl.

    “So, suddenly someone, some Saturday night, is at a bar, and someone offers them a line, and they think, ‘Oh, why not,’ ” Gates said. “And they don’t realize they’re at risk of an overdose.”

    A New Drug Appears

    Powers, who also conducts drug testing, said she thinks the presence of fentanyl in cocaine is overblown and said she’s rarely found fentanyl in methamphetamine samples. But she — and those at ASGCC — raised concerns about a new drug beginning to pop up alongside fentanyl in the drug supply: xylazine.

    A flyer advertising ASGCC’s second community forum in Provincetown at the town tourism office.

    A powerful animal sedative, xylazine is paired with fentanyl in some pills, Powers said. She said that while the drug is far more common in Boston, “it’s trickling in” to the Cape’s drug supply. Xylazine complicates harm reduction efforts, Powers said, because it can create serious skin wounds or cause infection.

    Powers also said she has seen MDMA, GHB, and ketamine — all popular party drugs, particularly within the queer community — test positive for fentanyl “sporadically over the last four years.

    “The drug supply is contaminated and adulterated, and it’s not a clean supply, so you don’t know what you’re getting,” she said. “That’s why drug testing is so important to try to see what’s in the drugs that people are using.”

    ASGCC has partnered with Outer Cape Community Solutions to purchase NaloxBoxes containing free Narcan and place them at various locations in town over the coming weeks, including at town hall and the MacMillan Pier bathrooms. Gates, at the forum in June, likened them to “lending libraries” for Narcan.

    Katie Ledoux, a former ASGCC staff member who now co-manages The Underground in Provincetown, said she has given her staff Narcan and fentanyl test strips for anybody who they know might be using drugs. For her, this practice stems from principles of harm reduction, which recognize the reality of drug use and aim to minimize its negative effects.

    “I don’t want anybody doing drugs in my bar, but I’m also not ignorant of the fact that it’s happening,” Ledoux said.

    For Kavlouskas-Noyes, it’s a question of being able to handle an overdose the moment it happens.

    “If someone’s going to be at risk coming into my establishment,” Kavlouskas-Noyes said, “I definitely want to be prepared, because rescue can’t always zip down Commercial Street. I figure that short window between response and when they could get here could make a big difference.”

    In Provincetown, Gates said, the risk can lie in non-opioid users who take an occasional pill or bump of cocaine — the “weekend warriors” who might not know about Narcan or have access to it in their social networks. The window to reverse an overdose can be just minutes, and a friend, bartender, or even a total stranger with Narcan can make the difference.

    “The point,” Gates said, “is to get it out to as many people as possible.”

    RESOLVED

    Where to Volunteer and Connect in the New Year

    From petting cats to planning events, opportunities to help abound on the Outer Cape

    By

    Walter Buckingham and Sheryl Jaffe at the Wellfleet Historical Society’s Banana Bash. (Photo by Lauren Hill)

    If volunteering is on your list of New Year’s resolutions, you’ll be glad to know that many local organizations are seeking people to help. The connection to others and the sense of purpose that comes with volunteering has been shown to be healthy, too. You can do something for others and for yourself by offering your skills to one of the organizations listed here. —Abraham Storer, K.C. Myers, and Edouard Fontenot

    Outer Cape

    Meals on Wheels, run by Elder Services of Cape Cod and the Islands, is in need of volunteer drivers to deliver meals to seniors in Wellfleet, Truro, Eastham, and Orleans. Training and mileage reimbursement is provided. Contact Dawn Ericson-Taylor, volunteer resource manager, at 508-394-4630 or [email protected].

    Helping Our Women, a resource center for Outer Cape women living with chronic or life-threatening conditions, is looking for volunteers to take on tasks ranging from driving clients to medical appointments to making home visits, doing data entry, and helping clients with basic technology. Find out more by clicking on “Get Involved” at helpingourwomen.org or by calling 508-487-4357.

    Mimi Friedman volunteers at the Methodist Church’s swap shop in Provincetown. (Photo by Nancy Bloom)

    Homeless Prevention Council is based in Orleans and helps people from Harwich to Provincetown take steps to keep their housing and attain financial independence. The volunteer positions listed on its website include general office support, marketing and development, events, and even landscaping at the office. To learn more and apply, go to “Get Involved” at hpccapecod.org or call  508-255-9667.

    Provincetown

    AIDS Support Group of Cape Cod has community members helping with administrative duties, food delivery, and events. There is a strong group of volunteers now, but new people are always welcome. Volunteers are free to commit as little or as much time as they want. To learn more, contact the office at 508-487-9445.

    Dixie Carter is one of the cats at CASAS who needs a home. (Photo by Nancy Bloom)

    CASAS, the Carrie A. Seaman Animal Shelter, is a no-kill shelter currently housing nine cats. The shelter has an all-volunteer staff. “We have some lovely cats that need some attention,” says Anita Butler, a full-time volunteer. The shelter is cage-free and volunteers are needed to sit with cats, brush them, and scoop boxes. Prospective volunteers should stop by during visiting hours (daily from 2 to 3:30 p.m.) to fill out an application. Information can be found at casasanimalshelter.org or by calling 508-487-4243.

    The Council on Aging in Provincetown is always looking for volunteers, according to Chris Hottle, the director. “I like to match volunteers with what they want to do,” she says. “Some volunteers are here every day and some are on call as needed.” Some 40 volunteers work in the meals program, teach classes, and help with over 175 other programs and services over the course of the year. Hottle meets in person with potential volunteers. She can be reached at 508-487-7080 or at [email protected].

    Provincetown Art Association and Museum likes to match volunteers with projects that use their skills. Currently opportunities are available for people to distribute flyers for the museum school, reorganize archives, install member exhibitions, and help with drop-off and pick-up days. Interested candidates should contact Lesley Marchessault, PAAM’s development officer, at 508-487-1750, ext. 112 or follow the “Support” link at paam.org.

    Truro

    Truro Historical Museum and the Cobb Archive have many year-round opportunities for volunteers interested in the history of the town and region. Although the museum is closed in the off season, archival work continues and volunteers catalog wills, deeds, newspaper articles, and photographs that document the history of the town. The archive welcomes and trains volunteers to help organize holdings. Some winter volunteers become greeters or docents come summer.  Currently the archive has a need for photographers to help with visual cataloging of museum collections and a technical person who can set up a new Wi-Fi network. To volunteer, contact museum staff at [email protected].

    The Cobb Library in Truro is open Tuesdays and Thursdays from 9:30 a.m. to noon and by appointment at 508-349-0200. Volunteers catalog historical documents there all year round. (Photo by Nancy Bloom)

    Truro Community Kitchen fights food insecurity in Truro by delivering free, nourishing home-cooked meals to those who need them. Winter volunteers are urgently needed to help with the preparation and packaging of food in the community kitchen at the Christian Union Church from 11 a.m. to 3 p.m. each Tuesday. Food delivery drivers are also needed on Tuesday afternoons. To volunteer, write to Wendy Lurie, [email protected], or call 973-868-7526.

    Sustainable CAPE supports local agriculture and farmers and combats hunger and food insecurity by donating fresh-picked fruits and vegetables on the Outer Cape. Volunteer possibilities include gardening with the team and making deliveries for the CSA program. To become a volunteer, go to “Get Involved” at sustainablecape.org.

    Carolina Marseglia volunteers at the Truro Swap Shop. (Photo by Nancy Bloom)

    Truro Swap Shop, located at the transfer station, is the town’s best place for repurposing unwanted items and keeping them out of the waste stream. It is in dire need of volunteers. Application materials are online at the Truro town website, truro-ma.gov, where you can click on the button for “Transfer Station” then choose “Swap Shop Volunteer.” Nancy Fenichel can help interested volunteers apply. Call her at 508-349-2591.

    Friends of the Truro Library are always looking for volunteers to assist library staff in keeping the library running smoothly. Volunteers’ skills go to event planning, staffing book sales, library work, publicity, presentations, and lectures. For the library’s current needs, contact Director Tricia Ford at 508-487-1125 or [email protected].

    The Food Pantry is looking for new volunteers to join its community of pantry helpers. For information or to volunteer, contact Barbara Bond at [email protected] or 617-515-4342.

    Editor’s note: An earlier version of this article, published in print on Dec. 29, 2022, incorrectly reported that the Cobb Library in Truro was closed for the winter. It is open Tuesdays and Thursdays.

    Wellfleet

    AIM Thrift Shop is volunteer-run and open year-round, six days a week, except for the month of February. Proceeds benefit local nonprofits that provide health, food, and other social services. The thrift store lost a lot of volunteers during Covid, and they’re hoping to rebuild their ranks, says Jim McAuliffe, a board member. Volunteers are asked to work at least one three-hour shift a week. Interested candidates can get an application at the shop at 305 Main St.

    Mass Appeal has a mission of providing free clothing to residents of the Outer Cape. Its Share Shop is staffed by volunteers who unpack donations, sort clothing, and assist customers. To become a volunteer, call 508-349-1173 or go to ccmassappeal.org and click on “Support Us” to send a message.

    246 Community Kitchen’s volunteer teams prepare meals all winter on Mondays and Tuesdays. The meals are currently packaged for pickup, but they plan to return to community meals later in the winter. This winter’s teams are pretty well staffed, but those interested in helping should call Amy Carow at 908-377-0677; she says 246 always has room for enthusiastic volunteers.

    The Wellfleet Food Pantry at Grace Chapel provides food to more than 150 families. Volunteers are needed to staff the pantry and serve shoppers. The time commitment can be as little as two hours per month. If interested, contact 508-349-3036 or send a message via the website, wellfleetfoodpantry.org.

    The Audubon sanctuary in Wellfleet is open year-round. (Photo by Agata Storer)

    Mass Audubon Wellfleet Bay Wildlife Sanctuary offers a wide variety of volunteer opportunities depending on the season. At this time of year they are seeking front desk volunteers. “It’s one of the most interesting and challenging positions,” says Director Melissa Lowe Cestaro. You’ll field questions about everything from trail conditions, wildlife, and where to go to eat, she says. Ideally a volunteer would take a three-hour shift once a week.

    Volunteers for the sea turtle rescue program underway now are recruited and trained in the fall. In the spring, there will be training for volunteer naturalists to lead guided walks, protect diamondback terrapins, or help with a horseshoe crab census. See massaudubon.org and click on “Get Involved” or call the sanctuary at 508-349-2615.

    Wellfleet Historical Society is looking for history buffs to join in a wide range of opportunities in grant research and writing, photography, gardening and landscaping, education, conducting oral histories, and fundraising. Schedules are flexible and “there’s something for everyone,” according to the website. Choose “Get Involved” at wellfleethistoricalsociety.org or email coordinator Sheryl Jaffe, [email protected].

    Eastham

    The Eastham Council on Aging seeks volunteers to be greeters at the senior center as well as activities organizers for the meals, events, and other programs offered there. Phone 774-801-3151 for information. People who have a mind for retail may also help at the thrift shop. For information on that, call 508-255-6164.

    Amy Sanders is the volunteer coordinator at Wild Care in Eastham. (Photo by Agata Storer)

    Wild Care attends to sick and wounded small wild animals. The staff is always looking for help cleaning the clinic, which includes disinfecting animal cages, washing dishes, doing laundry, and washing floors. A three-hour shift one day per week for a minimum of six months and attendance at a monthly meeting in Brewster is required. Volunteers are also needed to help with fundraising and events. For more information, email [email protected].

    Nauset Warriors Booster Club at Nauset Regional High School depends on volunteers to raise funds for sports equipment, transportation, and other expenses that allow students to participate in sports without paying any fees. Volunteers work at the concession stand at games and tournaments. The minimum time commitment is two to three hours a season. Community members and students are invited to sign up. Contact volunteer coordinator K.C. Myers at [email protected] or learn more at nausetboosters.com.

    The Windmill Weekend Committee’s president, Joanna Stevens, said her group has already started planning for Windmill Weekend in September 2023. The committee needs a chairperson to organize the road race, co-chairs for the raffle and car show, and a volunteer merchandising coordinator. These positions require attendance at monthly planning meetings throughout the year. Alternatively, you can volunteer just for the weekend itself. There’s a Windmill Weekend volunteer recruitment event at the Eastham Public Library on Feb. 2, 2023, from 5 to 6:30 p.m. or email [email protected].

    DROP IN

    Sexual Health and Harm Reduction Move Downtown

    With fentanyl in the drug supply, broader Narcan access is needed to save lives

    By

    PROVINCETOWN — On World AIDS Day this Dec. 1, the AIDS Support Group of Cape Cod (ASGCC) will open a drop-in center at 301 Commercial St. — that is, in the very middle of the hustle and bustle. At over 1,200 square feet, the center is about six times bigger than the group’s prior drop-in location, a former flower shop in Provincetown’s West End.

    The group’s CEO, Dan Gates, says the new center is the result of two different trends. The encouraging one: the attitudes of gay men toward sexual health have undergone a sea change in the last 10 years, Gates said, with sexually transmitted infection screenings going from being seen as a shameful activity to something that “groups of guys will come in here for on their way to tea dance.”

    AIDS Support Group of Cape Cod CEO Dan Gates in front of the organization’s new drop-in center at 301 Commercial St. in Provincetown. (Photo by Paul Benson)

    Because HIV can also be transmitted by needles, however, the ASGCC has worked for decades on harm reduction and safety for intravenous drug users, where the trends are grim.

    Fentanyl is in the drug supply on Cape Cod, Gates said, and overdoses can happen incredibly fast, knocking users unconscious and stopping their breathing before they have time to call for help.

    Narcan, a drug that can reverse an overdose, is already free, but it needs to be administered quickly. For that reason, Gates said, it needs to be everywhere.

    Fentanyl is not only in other opiates like heroin. It is now found in drugs associated with partying, including cocaine and crystal meth, Gates said. The AIDS Support Group plans to train restaurant owners, bartenders, hotel staff, and family members on the use of Narcan in the new drop-in center and give out free fentanyl test strips as well.

    Ten years ago, the giant window at 301 Commercial St. would have been a problem, Gates said. The ASGCC offered HIV and sexually transmitted infection tests at a much more private setting then, tucked off Commercial Street in the East End.

    Even now, not everyone will want to enter from Commercial Street, Gates said. The drop-in center will have another entrance at the rear of the building, facing the municipal parking lot.

    Still, Gates sees the building as a sign of the times.

    “I think, for the gay community, the way our sexual norms have changed in the last 10 years is staggering,” he said.

    HIV had already become manageable with medications when PrEP, or pre-exposure prevention medication, was approved in 2012. The CDC now estimates PrEP to be 99-percent effective at preventing HIV transmission, with only four documented cases of transmission to people who were taking the drug regularly.

    As the fear associated with a potentially lethal HIV infection has receded, gay men have become less ashamed about sexual activity and more businesslike about the other STIs, Gates said.

    “We used to do 300 screenings in a year,” he said, each of which involved tests for chlamydia, gonorrhea, syphilis, and HIV. “In 2019, the year before Covid, we did that many screenings just in July.”

    As the specter of HIV diminishes, “the moralism is removed,” Gates said. Sexual health screenings have become “maintenance” of well-being.

    Narcan Everywhere

    When it comes to fentanyl, however, Gates thinks both the gay and straight communities are underestimating the danger.

    Drugs that are mixed with fentanyl can kill their users incredibly quickly, according to Eliza Morrison, a program manager in ASGCC’s Falmouth office. That is why Gates believes the fast-acting antidote Narcan needs to be widely distributed in the community to help rescue people who are dying of overdoses.

    A single dose of Narcan, or naloxone, which is administered as a nasal spray, can revive a person who has stopped breathing because of an overdose of opioids, including fentanyl. (Photo by Ryan Stranz/ASGCC)

    The drugs in which fentanyl is now appearing are not themselves new on Cape Cod. Heroin is a powerful sedative that already had the potential to knock people unconscious and suppress their breathing, and it has been a killer, especially of younger adults, for decades.

    Stimulants like cocaine and methamphetamine are less likely to kill their users in a single overdose, although their effects on the body are still deadly over time.

    Fentanyl, however, has altered the odds on all these drugs, Gates said. Overdose deaths have increased 50 percent in America just since the end of 2019, according to Centers for Disease Control data, and 70 percent of overdose deaths now involve fentanyl.

    In 2021, overdose deaths nationwide passed the 100,000 mark. According to the New York Times, that means overdoses are now more lethal than car crashes, gun violence, or AIDS have ever been. The toll from overdoses last year was about one-quarter of that year’s deaths from Covid-19.

    Because it blocks the receptors in the brain that opioids bind to, a dose of Narcan, delivered as a nasal spray, can counteract an overdose and restore the brain to alertness almost immediately, Morrison said. If someone is given a dose of Narcan but isn’t actually on opiates, it has essentially no effect.

    Police officers and EMTs in all four Outer Cape towns already carry Narcan, Gates said, and last year the AIDS Support Group provided about 2,000 people with free doses through its Provincetown and Falmouth offices and its two mobile vans. Many of those clients also received fentanyl test kits, STI screenings, sterile supplies, and help arranging medical care.

    Because there is so little time to rescue a person who has stopped breathing, however, Gates wants to use the new drop-in center to train a much broader slice of the community to recognize an overdose and administer Narcan, including hoteliers, bartenders, restaurant owners, and family members of people who use drugs.

    “I think every business in town should have Narcan now, because fentanyl has just been sweeping the Cape,” Gates said. Knowing the difference between a customer who’s passed out from alcohol and one who is overdosing could save that person’s life.

    Crisis Counselors

    Gates is also hoping to use the new drop-in center as a space for crisis counselors. Offering such support at a sexual health center is not a new approach — after all, the nature of HIV testing is that sometimes a person will get bad news. Crisis or bridge counselors typically see a new client immediately after a crisis. They work with people for two to four months until a relationship with a long-term therapist can be arranged.

    On the Outer Cape, where mental health specialists are in short supply, and waiting lists for care can be long, Gates thinks the AIDS Support Group should host such a program.

    “We are hoping to introduce behavioral health services here to help address the shortage of support,” Gates said. “We don’t have the capacity to have five therapists with a full caseload. But we could do short-term bridge counseling here.”

    As part of its five-year mental health plan, the town of Provincetown had discussed spending $264,000 per year on a crisis counseling program — but that was put on hold last spring.

    Provincetown, Truro, and Wellfleet had been scheduled to discuss a regional approach to mental health needs at a joint meeting of the three boards of health on Dec. 7, but that meeting has been postponed, and a new date for it has not been announced.

    THE ADDICTION EPIDEMIC

    Kim Powers Fights the Cape’s Overdose Crisis on Her Own

    Her personal mobile service reaches drug users with life-saving help

    By

    Kim Powers is a one-woman drug-addiction harm reduction brigade. She is waging a solitary campaign to stem the rising tide of drug overdoses and deaths on Cape Cod and the Islands by providing services, including clean syringes, to drug users right where they are, in their homes and camps — a practice that has been endorsed by health authorities but remains too controversial for public health agencies and nonprofits to take on.

    Main Drag

    By

    The Club, at 193A Commercial St. in Provincetown, is hosting “2020 Has Been a Drag,” a dine-in drag event to benefit Helping Our Women, AIDS Support Group of Cape Cod, and the Carrie A. Seaman Animal Shelter. Come dressed up (or down) with your pod on Sunday, November 22nd, between noon and 5 p.m. Tickets, which don’t include food or drinks, come with a $50 to $250 donation at theclubdineindrag.square.site.

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