Chad Barboza grasped the bar, looked upward, and lifted the weights onto his shoulders.
On May 16, Barboza worked out in the CrossFit training session at Phoenix Multisport in Roxbury, a nonprofit open to people who have been sober for at least 48 hours, to work out.
Phoenix Multisport, which is based in Denver but has locations around the country, is one of a number of innovative programs started by individuals, doctors, and cities that have popped up in recent years to combat the ongoing opioid addiction crisis, which last year claimed more than 2,000 lives in Massachusetts.
Barboza, a DJ, still carries the weight of addiction every day. Heroin was his last slide before clawing back from the edge.
“It feels so much better on this side of it, then it ever did on the other side,” he said.
Eddie is still on that other side. Full of shame, he asked NBC Boston to not use his full name. He is a college graduate turned heroin addict who has seen friends die all around him.
“Body bags, left and right. I never seen anything like it,” he said.
Eddie landed in the Emergency Department at BayState Health in Springfield, having overdosed twice in less than 24 hours.
Dr. Dr. Niels Rathlev, chief of the emergency department at BayState Health, said the hospital sees at least one heroin overdose every single day.
He checked Eddie out when he showed up after his second overdose, gently chiding him.
But hospitals have evolved around treating and stabilizing, not on counseling. So doctors like Rathlev saw the same people come in and out, a revolving door that left many feeling helpless and frustrated.
Rathlev took a leap. He helped create a database of frequent users, the kinds of patients who doctor-shop or hospital-shop for opiate prescriptions.
Instead of writing a prescription and shuffling them out, a specialty team creates a care plan to get them help.
“Control something. Whatever you can control do something about it,” Rathlev said.
In Lynn, North Shore Medical Center’s Union Hospital campus partnered with Peabody-based Bridgewell to incorporate recovery coaches into the ER’s protocol for dealing with overdoses.
“It’s just been crazy with the numbers,” said Jean Jones, the emergency department nurse manager. “So we thought, how are we helping these people? They come in, they present with an overdose, they come in by EMS, they treat them with Narcan, and they are out on the street again. This obviously isn’t working because they keep coming back.”
Since March, the ER nurses started calling an on-call recovery coach employed by Bridgewell every time a patient with an overdose arrived at the hospital. The coach on call comes in and talks with the user to find out where they are in their lives in order to see if there’s an opportunity to guide them into recovery.
Jimmy Billings, 60, is a recovering alcoholic. He’s been sober since 2005 and sees being a recovery coach as a way of paying it forward. His sister helped him pay for a recovery bed, and told him the only repayment she wanted was for him to help an alcoholic or an addict.
“You’re just trying to make a connection,” Billings said. “And what I do is, I’ve practiced on being a very, very good listener. And when I hear something that I could address, I try to encourage that.”
Jones and Mark Kennard, executive director of Project COPE, which is associated with Bridgewell, said 70 percent of the patients who spoke with recovery coaches in the ER followed up with at least a phone call later on. A few entered detox.
Data from the federal government shows that, in the most recent year data is available, Massachusetts had the highest rate of opioid-related ER visits in the country.
In 2014, the Bay State had more than 450 emergency room visits for every 100,000 residents, more than one and a half times the national average rate of 177.8 per 100,000, according to the U.S. Department of Health and Human Services.
Annual opioid-related deaths have quadrupled in Massachusetts since 2010, according to the state Department of Public Health.
Back then, 560 people died from opiate-related causes; last year, opiates claimed 2,069 people.
Since 2013, opiates have claimed nearly as many people—6,926—as live in Rockport—7,103.
The state has just received a $12 million federal grant, and Gov. Charlie Baker has pledged the bulk of that money will go into expanding recovery services.
The city of Boston is pushing boundaries too.
Berto Sanchez is the program manager for overdose prevention at AHOPE, a clean needle exchange program with the Boston Public Health Commission located on Albany Street. In addition to hypodermic needles, his workspace includes water droppers, alcohol wipes, rubber tourniquets, and what look like tin tea candle cups used for cooking a heroin solution.
The idea is for addicts who aren’t ready to quit to have clean materials and tips for safer using to prevent more deaths. And preventing deaths keeps open the opportunity for recovery.
“We really can’t help someone get into recovery if they’re not alive,” he said.
A wall of obituaries at BPHC looms as a stark reminder of the urgency of their mission as they help clients untangle red tape.
“People have to kind of hold on,” said Devin Larkin, a doctor who is director of BPHC’s bureau of recovery services. “And some people can do that and some people can’t.”
Boston Healthcare for the Homeless, also on Albany Street, drew attention last year with the opening of SPOT, which stands for Supportive Place for Observation and Treatment.
According to Boston Healthcare for the Homeless, SPOT gives addicts a place to ride out a high or have medical monitoring. It can observe eight to 10 people at a time.
In the first four months of SPOT’s opening, the program cared for nearly 200 individuals in more than 800 different encounters.
Dr. Jessie Gaeta, who runs SPOT, said those people have used on the street. But at SPOT they can be monitored to make sure they don’t die of an overdose.
“At the moment the second the instant that they're interested in treatment, we really need to be able to provide that on demand,” she said.
She estimates they’ve kept 1,000 cases out of the ER and gotten 50 people into treatment.
But she says she still sees two major issues. The first is not enough caregivers willing to prescribe treatments like methadone, Suboxone, and Vivitrol.
The second, she says is a critical shortage of long-term care beds.
Barboza was one of the lucky ones. He got detox, a residential rehab bed, and housing. Once stabilized, he also found Phoenix Multisport for recovering addicts. The 34-year-old survived long enough to get a chance to live.
“I never wanted to feel like that,” he said of his time high. “I just didn’t know how not to.”