Maine’s government will open up a pool of money in the coming months to help people with addiction find a safe place to live. It will be the first time the state has devoted funding to so-called recovery homes, after years of rising death tolls from the opioid crisis.
But the state won’t be able to support any existing recovery homes in the Bangor area as they stand now because not one currently meets the criteria required to qualify for the money, which could help subsidize the rent for their residents. Some homes are working on it, however, according to interviews with the owners and managers of each known residence.
To qualify for the public money, recovery homes, which are also known as sober homes, will have to be certified as meeting national standards, and they will have to allow residents to be on addiction treatment medication such as methadone or Suboxone, according to legislation Gov. Janet Mills signed July 2.
None of the approximately 15 homes in the Bangor area has been certified, and just five homes permit residents to take medication. (Three of those open to medication are licensed residential treatment programs.)
While home operators in the area expressed appreciation for the state devoting up to $2 million toward subsidies to help people afford to live at recovery homes, and to the startup of new homes, the policy also unearthed debate, within the recovery community itself, about the kind of recovery the state should prioritize.
Some recovery home operators are open to adapting their approaches, they said, but are hesitant to make changes that their own residents oppose. Others said they won’t change, for various reasons including religion and tradition. A different owner that already allows medication said that she will pursue certification, but she would try to avoid accepting subsidies on behalf of her residents because part of the hard work of recovery involves figuring out how to be independent.
The intent of the legislation was to encourage homes to improve, and to prevent the tragedies and exploitation that have occurred in other states that did not have standards for their recovery residences. While it’s clear Maine’s policy will likely prompt homes to change, rather than simply reward those that are already operating, a substantial number of homes that are fundamentally at odds with the direction the state has set will also keep running.
Of the approximately 15 homes in the Bangor area, six are religious and do not permit medication-assisted treatment. Two more belong to the national Oxford House model and generally do not allow their residents to take medication for their addiction. Altogether, they account for 84 beds for adults.
The remaining homes — which already allow medication or are open to allowing it — collectively offer 68 beds. Forty of those beds are at Wellspring, which is a licensed treatment facility.
Most recovery homes that would likely qualify for the state’s new funding are far to Bangor’s south. No complete list of Maine homes exists, but, of the 102 known to Dr. Ron Springel, a volunteer inspector and board member of the nonprofit Maine Association of Recovery Residences, just 22 permit residents on medication. Of those, only nine are certified and would therefore be eligible for potential state funding.
Two of the nine are in Augusta. Then there is one in Rockland, one in Lewiston, two in Sanford, two in South Portland and one in Portland.
‘Respect the people who live there’
When Joanna Russell first visited the two-story house with white siding in Brewer, the inside walls were painted a dark blue, the bathroom upstairs needed remodeling, and the garage required all new siding and automatic doors. But, with no leaves on the trees at the time, there was a panoramic view of Bangor beyond the Penobscot River and something more intangible — a feeling that this was it.
“I said, ‘Oh, we’re there,’” Russell said. “It needed so much to it, but I could see it. I could see what I wanted to do.”
Using her own money from the sale of her townhouse, Russell bought the property, redid the bathroom, fixed the garage, added a new patio and painted the inside a bright yellow. One bedroom in the house, called 7 Holyoke, would be her private space, and, on April 8, 2018, she opened up the rest to women in recovery who needed a place to live that was free from drugs and alcohol.
So far, it’s fallen to private individuals and groups in the Bangor area to figure out how to create home environments where people have a chance to maintain their sobriety. Recovery homes are typically just that — homes.
Though some residential treatment programs, such as those run by Wellspring in Bangor, are considered a type of highly structured recovery home, most recovery homes in Maine are not regulated and do not offer therapy on site. Usually they have just a few bedrooms for a small number of men or women.
Russell, who is known across Maine for her role directing the Northeastern Workforce Development Board, was already taking on a challenge that few others had pursued in the Bangor region at the time by opening up the recovery home, which can fit five women including herself. But she decided to take another unusual step and welcomed in women taking prescribed medication for their addiction — because they “need a chance,” too, she said.
Medication is locked away, and she performs random drug tests and drug counts. Like many homes, she also keeps overdose-reversing Narcan on hand, she said, and residents have to abide by certain rules, such as not using drugs or alcohol.
Some homes kick people out immediately if they are found to be using again. Russell usually allows more time for residents to return to sobriety. Each home charges a different fee. To stay at 7 Holyoke, residents pay $130 per week for not just shelter but also food such as milk, eggs, bread, butter, cheese, fruit, sandwich meat, and peanut butter and jelly.
Running and owning a recovery home — while living in it and working full time — might seem like a lot. Russell, who will soon celebrate 30 years of sobriety from drugs and alcohol, does it to pass on the goodwill of the women who helped her many years ago.
“What really fuels that is remembering the number of women who helped me, and they did not have to,” she said.
One woman living at 7 Holyoke, who asked to remain anonymous because she’s taking Suboxone, said she understands there is a stigma against people on medication, even though decades of research have shown it’s more likely to prevent opioid overdoses and reduce illicit drug use than treatment programs that don’t use it.
“I try to not care what people think as long as I’m OK,” she said.
Russell’s home is one of the few in the region that appears to come close to eventually qualifying for state funding because it admits residents taking medication. But it is not yet certified as meeting national standards. Russell intends to pursue that process through the Maine Association of Recovery Residences, she said. It will require an inspection and can take between one and six months.
But she is “not totally in favor” of accepting rental subsidies from the state, she said, because she has seen how important it is to people in recovery to be able to support themselves. She also doesn’t need the money, she said. To live at 7 Holyoke, Russell requires that people work or volunteer at least 20 hours a week. She knows many employers and where there are job openings.
“If they don’t make a commitment, they’ll walk away. Why would they stay?” Russell said. “When people do not feel the success of caring for themselves, we have taken something away from them.”
Her efforts match much of what the U.S. Substance Abuse and Mental Health Services Administration says is critical for a successful recovery: health, which includes managing one’s diseases and abstaining from nonprescribed substances; having a stable place to live; finding a purpose, such as through a job; and maintaining supportive relationships.
Before opening 7 Holyoke, Russell was the house coordinator for the recovery home across the street, Holyoke Haven, which is owned by the community center Bangor Area Recovery Network. A spacious building with three bathrooms and five bedrooms, for up to eight women, Holyoke Haven does not admit residents on medication. But the subject comes up often, said Penny Joy, the current house coordinator.
“We’re open to change. We’re not saying no forever,” Joy said.
She continues to receive applications from people on medication, but current residents say no at nearly every weekly house meeting. It’s like an alcoholic not wanting to have alcohol in the cupboard, Joy said. Someone who used to abuse Suboxone does not want to be around it when they’re trying to maintain their recovery.
“I just feel like it’s safer to not have that option,” said a Holyoke Haven resident who declined to give her name, saying she used to misuse Suboxone on the street. She knows that, at the correct dose, it aids someone’s recovery, she said, but she personally just does not want to be near it.
Three medications are commonly used to treat opioid addiction: methadone, which is a liquid dispensed daily only in highly regulated clinics; naltrexone, which a primary health care provider can prescribe in the form of a daily pill or monthly injection; and buprenorphine, often known by its brand name Suboxone, which can come in the form of a daily dissolving tablet, cheek film or six-month implant under the skin.
Especially when combined with behavioral therapy, the medications are considered the standard of care for people with opioid use disorder. They do not produce a high when taken as prescribed, but there is the potential for abuse or diversion. People can shoot or snort crushed Suboxone pills, or even heat and then inhale the fumes of the sublingual film.
That’s why recovery homes may conduct random drug tests and pill counts, to determine if someone is taking a substance they shouldn’t be, including nonprescribed Suboxone. Holyoke Haven aims to provide stability in people’s lives, and if someone uses “it triggers the whole house,” Joy said.
One resident, who goes by her stage name Anastasia Black, strives for balance, she said. She spent time on South Portland streets, in prison, in a hospital while she detoxed, in a residential treatment program in southern Maine and has lived at Holyoke Haven for more than a month. She has a routine: She wakes up at 6 a.m., does her morning devotions, goes to addiction support meetings and volunteers at the nearby cancer center.
The home “is saving my life,” Black said. “I feel safe. They believe in me. She,” — gesturing toward Joy — “encourages me every day. My past doesn’t define me.”
At the same time, she does not have a problem with people using medication-assisted treatment.
“I don’t tell people what to do,” she said.
Not admitting people taking medication into Holyoke Haven has created an unusual challenge for the owner, the Bangor Area Recovery Network, which supports all roads to recovery, said Pat Kimball, the organization’s contract manager and former board treasurer.
Most applicants to Holyoke Haven are on medication, she said. Area health care providers have expanded access to it, and correctional facilities in Maine have begun to allow it.
“These are the people who are going to need housing, and BARN has to look at that as to where we stand. But we don’t want to rush into it. We want to respect the people who live there,” Kimball said.
The National Association of Recovery Residences, which established the voluntary standards by which recovery homes become certified, states that owners and operators “cannot legally deny admission solely on the basis of an applicant’s current use of physician-prescribed medications,” and must have ways for residents to store drugs securely and take their medications as prescribed.
However, there is a caveat. Homes may decline to accept applicants taking medication if they do not have the right staff or services. For instance, a home may not have a security system or may not have someone available to supervise residents as they take their medicine.
‘Very, very inclusive’
Each home in the Bangor area has its own story and perspectives on medication-assisted treatment.
Matt Roy, a machinist at General Electric, decided to open a recovery home for women in June on Pine Street in Bangor. He named it Viv’s Place in honor of his aunt who struggled with alcohol for many years. Every time she got sober, Roy said, she would return to her old environment and drink again.
Its rules are similar to Holyoke Haven, and it doesn’t allow residents on medication. Roy does not intend to make money from the endeavor; he just wants it to break even, he said. But the home, with two units that can fit a total of eight women, still has empty beds.
He wants to do what it takes to have “the best place possible,” he said. “I’m very open.”
Meanwhile, Fresh Start Sober Living House, a men’s recovery home on Ohio Street in Bangor that opened last year, has been so full that the operation is expanding. Scott Pardy, who runs the home under the company Fresh Start Incorporated, has another house under contract on Warren Street in Bangor, house manager James Rickrode said.
Fresh Start accepts men from jail and drug court, some of whom are taking methadone. So far no resident has been prescribed Suboxone, Rickrode said, but he would handle it the same way he deals with all medications, such as those for psychiatric disorders. He creates medication accountability contracts and requires residents to keep their pills secure in locked boxes, which stay in a safe. He watches them take their medicine when they need it, and conducts random drug tests and pill counts. So far, he said, he hasn’t had a problem.
When it comes down to it, people can abuse anything, he said, including cough medicine and other over-the-counter medications. That’s why it is important to have a strong screening process up front, he said, where he talks to people’s caseworker or sponsor; why residents have to have peer support; and why he has accountability measures in place.
All residents know, coming into the house, that others might be taking medication. “We require that our members have some open-mindedness on that particular subject,” Rickrode said. “We’re not scared of medication-assisted treatment here. We are trying to be very, very inclusive.”
Rickrode also appears to be the first in the Bangor area to submit an application for certification, a process that could make the home eligible for state rental subsidies. He wants to learn more about the subsidies, Rickrode said, but is open to them. The home already accepts residents who pay with general assistance.
Across the Penobscot River in Orrington, the Calvary Residential Discipleship program run by Calvary Chapel of Bangor appears to offer the greatest number of recovery home beds in the area: 24 for men and 20 for women, plus a home for four mothers with kids.
The program is Christian-based and supported by private donations. Assistant Pastor David Norsworthy, who runs it, described the first six months as a “spiritual bootcamp.” During the final six months of the yearlong program, residents have to work.
If prospective residents are on medication-assisted treatment, the program asks their health care provider to taper them off, Norsworthy said. If the provider does not want to do that, the program is not for them.
“Our goal is to get you totally medicine free on everything,” Norsworthy said. “We’re in the process of clearing people completely out and taking it from there.”
‘All in the same direction’
How, exactly, to boost the number and quality of recovery homes in Maine was the subject of debate at the Maine Legislature this spring.
Everyone who testified before the Health and Human Services Committee about LD 1523 — the legislation sponsored by Sen. Shenna Bellows, D-Manchester, that will become Maine’s new recovery home law Sept. 19 — either favored or spoke neither for nor against the bill. But several prominent figures in recovery in Maine expressed deep concern about requiring homes to take residents on medication if they wanted to get state funding.
Despite the input, the Legislature kept the provision. The Maine State Housing Authority, a quasi-state agency, is currently developing the recovery home subsidy pilot project with the Maine Department of Health and Human Services, which has to pursue more detailed rulemaking.
The Legislature did not appropriate funding for the pilot project, but the Office of Substance Abuse and Mental Health Services within the department is putting between $1.7 million and $2.1 million from available funds toward the effort, which will likely support both new and existing homes, said Gordon Smith, the director of opioid response for Mills’ administration.
The housing authority anticipates that one or more homes will become part of the program in a few months, spokesperson Cara Courchesne said.
As the number of recovery homes in Maine grows, it will remain the private operators’ decision whether to become certified and admit residents taking medication, Smith said, but the state has decided to promote what it knows works.
“The data, the science, is all in the same direction,” Smith said. “People seem to do better with some help medically. It doesn’t mean they need to be on it forever, but most people do better with it in terms of their relapse.”
Maine Focus is a journalism and community engagement initiative at the Bangor Daily News. Questions? Write to firstname.lastname@example.org.