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ASGCC

    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.”

    RESILIENCE

    Nonprofit Groups Adapt and Persevere in a Crisis

    Virtual services and fundraising aren’t easy, but there are a few surprising benefits

    By

    Updated Aug. 18, 2020.

    When the lockdowns of mid-March first hit, the Cape’s nonprofits were faced with a series of questions. Organizations like the AIDS Support Group of Cape Cod (ASGCC), Wellfleet’s Preservation Hall, and the Cape Cod Children’s Place have had to rethink their services and how they would raise money without traditional summer fundraisers.

    “Very early on we made a call to go mostly virtual with our services,” said Dan Gates, CEO of ASGCC. “For people living with HIV, we provide medical case management, and so we shifted to put everything [online], with occasionally some sort of paperwork dropoff.”

    HIV testing and Narcan syringe services couldn’t be as easily switched online and required more creative solutions. “If someone wanted Narcan,” Gates said, “they would call our office, we would do a Zoom and give them a tutorial on how to use Narcan, how to identify an overdose, and then how to administer it, and then we would deliver the Narcan with contactless delivery.”

    Moving services online had a surprising benefit. “The innovative things we did in syringe services and Narcan were really helpful,” he said, “because it allowed some people to access services who might have felt uncomfortable walking up to the door — but they were comfortable calling.”

    Janet Lesniak at Wellfleet Preservation Hall
    Executive Director Janet Lesniak stands next to the Jonathan Kendall doors at Wellfleet Preservation Hall. (Photo Nancy Bloom)

    In Wellfleet, Preservation Hall has also found ways to work online. “The upside is, virtually, our reach is endless,” said Executive Director Janet Lesniak. “We did a cooking event with Michael Ceraldi, who has a restaurant in town, and we thought we might get 30 or 40 people. We had 140 people participate. I had to up my Zoom account to accommodate them!”

    Lesniak described the role of the arts in a time like this, when people are focused on health and human services. “I would say the arts are human services,” she said. “Truthfully, the evidence is in what we’re watching. People are watching films, they’re writing, they’re making art. Arts and culture feed us. We find ways to heal ourselves, and, obviously, we use Western medicine and health centers. But I deeply believe that arts and culture can be preventative of what ails us socially.”

    The Cape Cod Children’s Place in Eastham underwent a massive shift in adapting to the pandemic. According to its website, in-person services — the majority of its activities — were suspended. Instead, the CCCP website became a connector for families and other organizations. On its Facebook page, it hosts virtual programs to help parents adjust and promotes programs like the Eldredge Library’s Virtual Storytime.

    The ASGCC switched from in-person lunches at its office to delivering the meals in early March.

    “Before long, we were delivering over 50 lunches every day,” said Gates. “Some clients were already homebound, but a bunch were people who decided to quarantine because of compromised immune systems.”

    There were disappointments, naturally. Preservation Hall’s Youth Film Festival went online, “which really broke my heart,” said Lesniak. “But, again, people from everywhere got an opportunity to see somebody from Nauset High School who made a movie.”

    The Hall has a tradition of free outdoor movies in its back yard, an activity made for summer nights. “Right now, we’re thinking we’ll limit it to 30 people,” said Lesniak. “Everybody will be given a pool noodle. You can pick your spot on the lawn, but you have to distance yourself with that.”

    More films and some concerts will find their way to the back yard as summer winds down, with recordings uploaded online in the days following.

    AIDS Support Group of Cape Cod
    The AIDS Support Group of Cape Cod’s Provincetown drop-in center. (Photo Garrison Guzzeau)

    Outer Cape nonprofits depend on donors along with day-to-day work behind the scenes. Last month the New York Times reported that nonprofits had laid off 70 to 95 percent of their employees, with the offices of organizations like the Y.M.C.A. shutting down. The article painted a dire picture, with a sharply increased demand for services and decreased funding.

    Here, nonprofit leaders say the picture is more mixed.

    “Many people have been unbelievably generous,” said Lesniak. “I can’t say enough about it. A big concern for us, and most of my nonprofit colleagues, is that as the pandemic continues and people feel less certain of an end in sight, will they have the means to continue to be generous.”

    Preservation Hall received funds through the CARES Act to help with payroll.

    The ASGCC converted one summer fundraiser into an online race. “We have a 5K event that would’ve been July 19, but we shifted that to virtual,” said Gates. “Its momentum started building as July progressed and people asked to extend it, so we’ve extended it through August 16. They register on our website, pay the $25, and then they run or walk and email us the time.” ASGCC hopes to reach its goal of raising $10,000 from the event.

    Nineteen nonprofits participated in the One Provincetown event in late June, in which they showcased their work alongside musical performances and interviews with activists and artists. “A lot of the work is about building community,” said Gates. “It was empowering to see how the community stepped forward with the One Provincetown event. The way the nonprofits came together and supported each other was unexpected. The Provincetown Health Dept. put together a weekly meeting that was vital. Faith organizations, medical organizations, social services agencies were hearing, ‘This food pantry is stocked. This food pantry needs support. This group of volunteers with the Provincetown Task Force is available.’ ”

    Provincetown Health Director Morgan Clark set up these meetings because she saw the many ways the pandemic was affecting daily life. “Covid-19 has such a deep and rippling effect on our total well-being, one that we’ll not fully know about for years to come,” said Clark. “So I wanted to gather everyone who serves our community in one place (virtually), so that we could share what we’re seeing with our populations, to troubleshoot gaps as they arose, and to report to policymakers in real time issues that come up.”

    Clark said that, while these groups previously communicated and collaborated, the Covid-19 crisis required that that all voices be represented and included.

    In Wellfleet, Lesniak has been able to work with groups like Common Table, which provides meals for families and those unable to leave their houses from the Fox & Crow Cafe, partnering with them to be their fiscal agent and alerting Preservation Hall’s friends of Common Table’s need for volunteers.

    The most visited page on Preservation Hall’s website is its community resources page, and the Hall’s email list has grown by over a thousand people in four months. “People are looking to us as a connector,” said Lesniak.

    Editor’s note: The original version of this article, as printed in the Aug. 13 edition, erroneously reported that Wellfleet Preservation Hall had shared its email list with Common Table. The Hall does not, in fact, share its list with anyone, according to Executive Director Janet Lesniak, but did notify its own contacts of Common Table’s needs.

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