September 19, 2018
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The unregulated Maine industry that’s grown with the opioid death toll

Troy R. Bennett | BDN
Troy R. Bennett | BDN
Dr. Ron Springel stands outside room seven at the Plymouth House Sober Care home on Glenwood Avenue in Portland. It's where he stayed while in recovery in 2014.
By Jake Bleiberg, BDN Staff
Updated:

At first glance, the yellow house Dr. Ron Springel had come to inspect looked like any other old home where people share space to make the rent.

A spring rain had begun to fall in Portland as he carried his tape measure and flashlight up the wooden steps. On the porch, a weathered couch slumped next to a half-full ashtray.

Inside, Springel prodded smoke detectors and opened windows. In one man’s room, a woman and young girl smiled up at him from unframed photos taped above a single bed.

But the inspection also turned up less familiar objects: There was a breathalyzer in the living room closet, and the cardboard boxes lining the front hallway were filled with urine test cups.

Springel isn’t from the city or any government agency. Nor is he concerned with permitting. When the retired physician inspects a house, one of his first questions is: “Where’s the Narcan?”

The Valley Street home he was inspecting is one of scores of sober-living houses that have quietly opened throughout Maine in recent years. In them, hundreds of people battling addiction pay monthly rent, mostly out of pocket, to live and recover alongside their peers.

To gauge the growth of Maine’s sober-living industry, the Bangor Daily News reached out to more than 90 homes believed to be recovery residences in the state. The survey confirmed 76 operating in Maine, with more than 77 percent of those in the Portland area. Of the 39 homes that provided a year of opening, 82 percent were founded in the past five years.

The industry has grown along with the death toll of the opioid crisis, offering the promise of help and a new home to people fighting a deadly disease. With the limited support for drug rehabilitation in Maine, men and women in recovery have opened these homes as a way to help each other. People who’ve passed through their doors often say the support they received saved their lives.

But these private homes get no oversight from the state. Because they operate without government regulation, there’s no official list of sober-living homes in Maine, no state assurance that they are safe and no recourse for most residents if they’re not.

“Unfortunately, because of the lack of regulation I don’t believe the state knows very much at all [about sober homes operating here],” said Sen. Shenna Bellows, D-Manchester, who sponsored a bill to create a recovery residences state certification, which was left unfunded and effectively dead this legislative session. “What I think we’ve seen in other states is the lack of regulation has led to tragedy.”

In May, a Massachusetts lawyer and sober home operator was charged for allegedly offering drugs and legal representation to residents in exchange for sex; a self-styled “rehab mogul” who once ran homes in Colorado and California now faces decades in prison for sexually assaulting and offering drugs to tenants; and networks of Florida homes have been implicated in widespread fraud, keeping clients in an often deadly cycle of addiction to keep the money flowing in.

So far, Maine seems to have been spared from the kind of abuses seen elsewhere. And all indications are that those opening sober-living homes here are doing so with the best of intentions, if not always the best of results.

It is only in recent years that federal and state governments have begun to look at regulating sober homes. There’s no settled model of how to approach the issue. And the states that have led in passing legislation have tended to be reactive — enacting oversight following the revelation of major abuses in their sober-living industries.

In Maine, advocates say, problems could be preempted with a system of oversight and inspection to ensure that sober homes meet basic safety standards and provide environments genuinely conducive to recovery.

Some Maine sober home owners worry that heavy-handed regulation might shut down houses providing a badly needed service that’s hard to find outside the Portland area. But state recognition could also offer guidance to cities and towns, which can be leery of sober homes and have rules that make it hard for them to open despite federal law protecting their residents.

So far, state government appears to have little interest in taking a more active role in the swiftly growing industry that serves some of Maine’s most vulnerable residents. The state Department of Health and Human Services has acknowledged not knowing how many sober homes operate statewide even as it’s lobbied against Bellows’ bill to regulate them.

Troy R. Bennett | BDN
Troy R. Bennett | BDN
Jesse Harvey stands in front of the newly opened Journey House sober home he founded in Lewiston. For Harvey, who is also in recovery, his "rock bottom" was the concrete floor of a Massachusetts prison cell.

‘Now there are 10 times that number’

In the world of sober living, Maine’s largest city has become a sort of mecca. People come from across the Northeast to sober houses tucked into Portland’s quiet neighborhoods and bustling downtown.

“Ten years ago, there were three or four recovery houses in the Portland area, and now there are 10 times that number,” said Springel, who volunteers for a group trying to self-regulate the industry and tracks sober homes in a personal effort to ensure each one stocks the overdose-reversing medication naloxone, branded Narcan.

“We’ve seen a period of rapid growth,” he said, “and along with that growth, we’ve seen the establishment of recovery residences of different kinds, including some that, frankly, are not operating at the highest standards.”

People come to sober homes around Portland from all over. But they usually make the trip after arriving at a personal rock bottom.

For Jesse Harvey, bottom was the concrete floor of a Massachusetts prison cell.

It was July 2015 and he recalled sitting alone in a cell at Bridgewater State Hospital swaddled in a suicide-prevention smock.

“Everything was concrete and everything was metal, and I was in this ridiculously itchy and scratchy turtle suit, and the guards would come by on regular intervals and look in the little window of the door to make sure I hadn’t killed myself yet,” Harvey said. “I just thought there must be more to life than this.”

Then 23, Harvey had been involuntarily committed to the Massachusetts Alcohol and Substance Abuse Center when a judge decided his drug use made him a risk to himself and others. It was his fifth commitment, he said.

Even sitting in a cell, Harvey recalled being skeptical of his counselor’s suggestion of sober housing. But after arrests, suicide attempts, a college expulsion and years of using and selling everything from pot to oxycodone, he was left with few options.

“Finally, after everyone else in my life told me that they wouldn’t take me back and that I’d be forced to live on the streets, I decided I’d go to this sober house in Portland, Maine,” he said.

In August 2015, he went to Skip Murphy’s.

For years after it opened in 2009, many saw the home as a model of sober living. But by the time Harvey arrived there, things had changed.

Named for its owner’s late grandfather, Skip Murphy’s began in a clapboard duplex on Deering Avenue. There, men dedicated to recovery paid $750 a month to live under a regimen of curfews, drug tests, recovery meetings and a 12-step program.

But as the home expanded to other locations, adding programming and raising prices — up to $2,500 per month in some cases — it ran into trouble. The owner relapsed and began selling things from the homes, including the van used to take residents to buy groceries and attend Alcoholics and Narcotics Anonymous meetings, according to public records and two former employees and residents with direct knowledge of the situation.

In 2016, he was arrested on drug charges in New Hampshire. The owner, who could not be reached for comment, eventually pleaded guilty to another misdemeanor drug possession in Maine, and Skip Murphy’s ultimately closed.

Men who lived at the house in its earlier days and worked there toward the end credit the owner with helping them to sobriety. But they also acknowledged his behavior became a problem.

Harvey said he had negative experiences during his five months there but wasn’t comfortable discussing the details publicly. “I’ll never know if I succeeded because of that or if I succeeded despite that,” he said.

After leaving Skip Murphy’s, Harvey thrived, getting a full-time job and an apartment, and later enrolling in a master’s degree program at the University of Southern Maine. By late 2016, he was looking to open his own sober home, and he wanted to learn from his experiences at Skip Murphy’s.

“I went through a process that I realized could be improved on,” he said. “I realized that just because my process was a mess doesn’t mean that this couldn’t be a public health intervention.”

Harvey decided to get involved with a then newly formed group, the Maine Association for Recovery Residences.

“You see this in every industry: There’s an association of social workers, an association of construction workers,” he said. “Why shouldn’t there be an association of sober house operators who are committed to doing more than the law requires of them? Because the law doesn’t really require anything of them.”

‘It’s buyer beware’

When Dr. Ron Springel went to inspect the yellow house in Portland this spring, he was doing it for MARR.

The nonprofit was formed in 2016 by a small group of Portland sober home owners who’d watched abuses crop up at homes in other states and wanted to ensure the same things didn’t happen here.

“I was reading about the atrocities in Florida,” Sarah Coupe, MARR’s president and the founder of the Grace House for Women, said of the moment she realized Maine homes needed oversight.

It’s a world that Springel knows well. Decades before the physician inspected sober homes, he lived in one.

In 1984, the young doctor landed in a house in rural Washington after he began to recognize his own behavior in the alcoholic patients he was treating. Thirty years later, after raising a family and having a successful career, Springel had back surgery and ended up back in sober living, this time in Portland.

“The prescriptions just sort of got away from me,” he said.

In the time between leaving the Washington recovery home and arriving at the one in Maine, Springel has seen the sober-living industry develop, change and then swiftly expand with the onset of the opioid crisis.

Maine is now one of 26 states with an affiliate of the National Alliance of Recovery Residences. The national group maintains standards that organizations like MARR use to inspect and accredit sober homes in an effort to ensure safe and ethical practices.

“Forever and ever and ever, the recovery housing field has really been treated as an orphan — not really part of medicine, not really part of housing,” said NARR president Dave Sheridan, who has long worked in sober living in California. “That’s how the whole industry grew for years.”

In this largely untamed frontier, there are few signs people can use to tell good homes from bad ones. And what people find when they arrive at a sober home in Maine varies widely.

A few houses are associated with detoxification or treatment centers, and a few have professional staff. But most are opened and run by people who found their way to recovery and want to help others down that path.

Monthly rent ranges from $400 to well into the thousands. A few homes run by religious groups are free. And houses at all price levels offer scholarships and discounts for those in need. Some provide single rooms, but many like the accountability of roommates.

Some sober homes are rundown, and others are lavish. One advertises a climbing wall, trips abroad, a batting cage and a spa with “float pods.”

Some provide little more than a bed. Others have carefully structured programs and offer help finding work and health care, managing finances, and getting to recovery meetings and support groups.

No sober home identified by the BDN allowed men and women to live together, and there are far fewer homes for women than for men.

At least one home is outfitted with sprinklers, but most seem to have the fire safety equipment required of a family residence.

“The quality of the programs has varied substantially from house to house,” said Bob Fowler, executive director of Milestone Recovery, which runs one of Maine’s two dedicated detox centers and plans to open a recovery residence. “They’ve become a tremendously important component in the system of care for people seeking recovery, and the next evolution is to find some opportunity for consistency and quality management of those programs.”

The only quality standard for Maine sober homes, MARR accreditation, is entirely voluntary, and some house operators shrug at its legitimacy.

“You have two or three people on the board who own sober houses, and they’re certifying their own homes,” said Ben Skillings, who runs several low-cost recovery homes around Portland and has helped others open residences. “It doesn’t pass my smell test.”

So far, the group has accredited 18 of the state’s 70-plus recovery homes.

“For now, it’s buyer beware,” Springel said.

Troy R. Bennett | BDN
Troy R. Bennett | BDN
Dr. Ron Springel sits at the Plymouth House Sober Care home on Glenwood Avenue in Portland where he received treatment in 2014. Springel now serves on the board of the Maine Association of Recovery Residences.

‘They don’t want addicts congregating together’

In June, one of the homes awaiting a MARR inspection was a squat, white house tucked back on a side street near downtown Lewiston. It’s one of Jesse Harvey’s Journey Houses.

In late December 2016, Harvey opened a men’s sober home in Biddeford, and then another for men and one for women in Sanford. The Lewiston men’s home opened in May. It’s believed to be the only recovery residence in Maine’s second-largest city.

Part of the reason for this seems to be that Lewiston, like many Maine communities, has zoning rules that limit the number of non-relatives who can live together in a family-style home.

Run out of a rented house, the Lewiston home has space for six and needs to be full to be financially sustainable, Harvey said. But officials initially told him it would have to abide by the city’s four-person cap.

Common across the state, such rules often define a home that’s shared by more than a certain number of unrelated people as boarding houses. They are required to have sprinklers and other costly fire safety equipment not required in family residences and rarely affordable for sober home operators.

These rules also can clash with federal law that treats people in sober living as a protected class. In 2016, the U.S. departments of Justice and Housing and Urban Development issued a notice saying that cities and towns that impose requirements on sober homes beyond what is demanded of a family residence can be found in violation of the Fair Housing Act.

Harvey opened the home despite the four-person cap and said in June that he was trying to “educate” local code officials on federal law.

The city in July decided to accommodate the sober home and waive the four-person cap, said David Hediger, Lewiston’s planning and code enforcement director.

“We have learned that there is no state agency that currently licenses group homes for persons recovering from substance use disorder … therefore, the city will provide the further accommodation,” Hediger said. ”The city will be reviewing in the future what measures it should be taking in the absence of state licensing to ensure that safety standards are satisfied.”

Harvey has had less luck in other communities.

In April, he filed a federal discriminatory housing complaint against Biddeford claiming that city officials forced the closure of the Journey House there because it didn’t have sprinklers.

The city denied this claim and Harvey eventually withdrew the complaint, saying he didn’t believe he could document what he maintains were discriminatory actions by city officials.

Although the opioid crisis blankets the state, large swaths of Maine appear to have little or no sober living. And among those who work in the field there’s a broad sense that many communities are closed to recovery homes.

“Portland has an abundance of resources, and we don’t have that here,” said Erik Lamoreau, who opened Aroostook County’s first recovery residence, Allen’s Way, in Caribou last November. “The smaller towns are less open to having facilities like mine because they don’t want addicts congregating together, and they kind of forget that they’re recovering addicts.”

Harvey is trying to change this. And on a damp Saturday in late June, he was still uncertain of how the city was going to treat his Lewiston home but determined it should make a good impression.

[How one Maine man’s battle with opioids led him to the ‘structure’ of a sober home]

Along with three members of Journey House’s board of directors and two residents, he was doing yard work to prepare the white house for its July grand opening.

At 26, Harvey has become an energetic advocate of harm-reduction and evidenced-based recovery.

He tends to speak faster when discussing the shortage of sober living in much of Maine. He carries Narcan nasal spray in his pocket and keeps a bag of sterile syringes in the glove compartment of his car.

After carrying branches into the backyard, Harvey briefly paused at the sight of the heavy scarring on both of his wrists. “Sometimes I can’t believe that person is me,” he said.

‘It’s a carrot rather than a stick’

As the number of overdoses and recovery residences has grown in parallel, lawmakers have begun to take interest, with different regulatory approaches cropping up across the country.

In Florida, legislators have focused on stemming the abuses and fraud that have run rampant in the industry there. A 2017 state law targets shady marketing practices, kickback schemes and something called “patient brokering,” which entails trading patients between homes and treatment programs in exchange for money or perks.

The Florida law does not require that sober homes be certified by the state — a move that’s complicated by federal housing law — but rather creates an incentive for them to get voluntarily accredited under the NARR standards. The law requires state-licensed treatment centers to refer patients only to sober homes certified by the Florida Association of Recovery Residences.

This approach, creating a voluntary oversight system and then giving homes a reason to join, is the one preferred by NARR. “It’s a carrot method rather than a stick,” Sheridan, the group’s president, said.

NARR’s state affiliates across the country inspect sober homes based on the group’s four-tiered standards. Sheridan said that even homes operating at the lowest end of the price range can meet the standards, which include having written policies regarding cost, drug tests and grievances; selecting staff and leadership based on their “model[ing] recovery principles”; documenting that residents are pursuing a recovery plan; and meeting an array of housing safety requirements.

In 2014 and 2015, Massachusetts also set up incentives for voluntary certification. Since then the Massachusetts Alliance for Sober Housing, a NARR affiliate, has certified more than 170 homes. But debate over making accreditation obligatory has cropped up in the state, following the May arrest of an attorney who allegedly offered residents of his uncertified Boston sober home drugs and legal counsel in exchange for sex.

In Maine, there’s currently little incentive for sober homes to get certified, and most aren’t.

During this year’s legislative session, Bellows proposed a bill to change that. It would have established a voluntary accreditation under NARR’s standards and a pilot program to test giving rental-assistance money to people in certified sober homes. It received approval in the House and Senate but was effectively killed along with a bevy of measures that the Legislature’s budget committee left unfunded.

During committee hearings, the Department of Health and Human Services testified against the bill. The department did not respond to questions for this story, but in a half-page of written testimony, it warned that offering residents of an unknown number of sober homes public housing dollars could throw existing housing programs into a funding “crisis.”

A different crisis was on Springel’s mind as he inspected the yellow house in Portland’s West End this spring. More than a person a day died of drug overdoses in Maine last year, including more than one a week in Portland.

As another volunteer inspector went over paperwork and house policy with the owner, Springel went looking for Narcan. He nodded upon finding a package of it sitting on a shelf outside the upstairs bathroom. But he wasn’t satisfied there.

Springel always asks sober home residents if they know where the Narcan is kept and what to do with it if someone overdoses.

At Valley Street, and nearly all the houses that have invited him in to inspect, they did. But sometimes they don’t.

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