How COVID-19 has exacerbated the opioid epidemic and its impacts on Boston neighborhoods

“It’s a terrible situation.”

Boston,MA - 9/9/2020: A man sorts through injection supplies near a comfort station on Massachusetts Ave, an area known as “Methadone Mile,” in Boston, MA on September 09, 2020. (Craig F. Walker/Globe Staff) coronavirus Covid-19 heroin addiction homeless
A man sorts through injection supplies near a comfort station on Massachusetts Ave. on Sept. 9. –Craig F. Walker / Boston Globe

For two weeks in a row, South End and Roxbury residents have taken to the streets to demand elected officials take action to address impacts to their neighborhoods from the opioid epidemic

Dozens of demonstrators took over the intersection of Mass. Ave. and Washington Street on Sept. 3 to draw attention to issues the neighborhoods face related to the epidemic, including open drug use on the sidewalks, improperly discarded needles, and human feces on public and private property. Neighbors argue the conditions are unsafe and inhumane for people who are struggling with addiction and homelessness, adding suffering and hardship as they seek help in a location where services are still available during the pandemic. 

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Residents gathered again on Sep. 10 to demand city and state officials take action. The group of neighbors, calling itself the South End – Roxbury Community Partnership, has started a petition listing short- and long-term actions and commitments they want to see in order to create a “comfortable community for all.”

The impacts related to substance use and homelessness in the area known as “Methadone Mile,” the stretch of city blocks surrounding Mass. Ave. and Melnea Cass Boulevard where shelters and services offer support to those struggling with substance use disorders, are not new. 

But both neighborhood residents and city officials say there is no question that the coronavirus pandemic has exacerbated the already raging epidemic. 

“The perfect storm has created some challenges,” Marty Martinez, chief of Health and Human Services for the city, told Boston.com of how COVID-19 has impacted work in the area officials refer to as “Mass./Cass.” “It doesn’t mean the city hasn’t stopped working on it with intentionality to walk that balance between public health, public safety, and quality of life. But we hear what the neighbors are saying, and we understand their concerns.”

Here’s what city officials and neighbors are saying about the situation. 

‘There’s just too many people’

The scene on “Methadone Mile” in May. —Barry Chin / Boston Globe
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There’s consensus among nearby residents that those who haven’t walked the area don’t believe or fully comprehend the situation on the ground. 

“It’s shocking,” George Stergios, president of Worcester Square Neighborhood Association, said of the conditions on the streets in the area. 

While the opioid epidemic has been raging for years, the last two summers have been the worst in terms of impacts from “Mass and Cass” and Newmarket Square creeping farther into the nearby residential areas. Both 2019 and 2020 saw a clear increase in the number of people living on the streets, neighbors agreed.

“There’s a range of emotions,” Stergios said of seeing the impacts on a day-to-day basis. “There’s how can we help them? There’s also why does it all have to be here?

According to Boston 25 News, the impacts from the crisis are pushing some residents to move out of the area. Even within the area, the issue is hyper local, Stergios said. 

“If I walked out on my steps, I’ll say, ‘Oh it’s been better the last few weeks’ and then I talk to a friend who’s living on Mass Ave., and he’ll say, ‘No it’s gotten worse,’” he said.  

In response to the conditions seen in 2019, the City of Boston launched the “Melnea Cass/Mass. Ave. 2.0″ plan in October, a strategic plan that included the addition of more city staff assigned to working in the area of Melnea Cass Boulevard and Mass. Ave., funding for new programs and initiatives, and improved coordination between the existing services in place across multiple departments to address the public health and safety impacts of the opioid epidemic in Newmarket Square and surrounding neighborhoods. 

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David Stone, president of the Blackstone Franklin Square Neighborhood Association and a member of the Mass./Cass Taskforce, said there’s no doubt the COVID-19 pandemic has interfered with the city’s efforts to address issues of homelessness, substance use disorder, and mental health that are concentrated in the area. 

And while he agreed that the severity of impacts this summer are similar to those experienced last year, the pandemic has clearly contributed to altering the feel of the area. Especially at the height of the surge and lockdown, it felt to residents as if the majority of the people who were out on the streets were struggling with homelessness, mental health, substance use, or a combination of those issues, he said.

“There’s less foot traffic and less people coming and going,” Stone said. “It becomes easier for people to hunker down.”

With many businesses closed due to the pandemic, Stone said more encampments have popped up in the doorways or on the stoops of buildings — a notable change from last summer.

“The scale of the problem and the amount of need that these people have and the number of people there just exceeds any amount of realistic resources that could be brought to bear,” he said. “There’s just too many people.”

Another “major problem” this summer, which neighbors and officials have connected to the pandemic, has been a vast increase in the amount of human waste left on public and private properties. 

The city’s 311 service is littered with reports of feces in public alleys and sidewalks, submitted by frustrated residents.

“All the public bathrooms were closed because of COVID,” Stergios said. “So that means people, they have to do it, right? And they end up doing it on our steps and our stairs and in our alleys.”

The city has opened what they called “comfort stations,” which are tents with portable toilets, hand washing services, and outreach services. The task force is also continuing to develop more public restrooms, according to officials. 

Stergios said the measures taken so far have somewhat helped with the human waste issue, but he expressed concern about the crowds of people near the comfort stations, wondering how safe they are in preventing the spread of COVID-19.

“You have this huge mass of people who come in every day, and it’s a total mess — it’s a total mess,” Stergios said. “It’s not necessarily dangerous … it’s just the misery. Nobody likes to go around the corner and see people who are some of the sorriest people you’ll ever see in your life.”

The two neighborhood association leaders were in agreement that the combined crises of COVID-19 and the opioid epidemic show the need to address the plight faced by those drawn to the city’s streets for services and how neighbors in the area of Mass./Cass are impacted. 

It also hammers home concerns Stergios and Stone said neighborhood residents have been raising for years: that shelters and services for addiction and recovery shouldn’t be concentrated in just one part of the city and that more investment in addressing the opioid crisis statewide is needed.

“There are three things that can be done more or less immediately or in the very near term that would make a significant difference on the quality of life,” Stone said. “One is a moratorium on any additional homelessness beds or new services that would tend to bring additional people into the neighborhood. Number two is retaining the commitment that had been made under the Mass. and Cass plan [for] dedicated policing services for the neighborhood and for Mass. and Cass … and then the third is a much greater role for the state, a much greater involvement for the state. Both in terms of providing services and support for the population in the South End, Lower Roxbury, and Newmarket, but then also creating similar services around the state.”

Stergios stressed that no existing services in the area should be closed or moved elsewhere.  

“We do need other neighborhoods in the city, other towns and cities in the state, to open facilities,” he said. “That’s what we keep on saying to everyone, is ‘take responsibility.’ It’s not all ours. You take care of your own — then we’ll be in much better shape if every area took care of the people who need help in those areas.”

‘There are less services in other parts of the state’

Guibert Tercino hands out boxes of food to people outside a “comfort station” run by the Boston Public Health Commission on Mass. Ave. on September 10. —Craig F. Walker / Boston Globe

Officials are emphasizing that work has continued to address the opioid crisis in the area and implement the Mass./Cass plan, despite the hurdles presented by the pandemic. 

In a progress report released Sept. 4, the city noted the launch of a website with a dashboard tracking metrics such as needle distribution and collection, the institution of fixed posts for Boston police as a way to increase police presence and improve public safety, and the creation of a public works team assigned to the area.

In that update, Mayor Marty Walsh acknowledged that the pandemic has “exacerbated existing inequities” and presented new challenges.

“As we continue to battle the pandemic, we are providing supportive services for individuals struggling with substance use disorder, while also implementing public health and safety measures to improve quality of life for the entire Boston community,” he wrote in a statement.
During an appearance on GBH’s “Boston Public Radio” on Friday, the mayor called the situation in the city “a big problem” and reiterated his commitment to “finding a solution.”

“We have to get it better under control,” he said, according to The Boston Globe

The mayor’s health and human services chief told Boston.com there’s “no question” that the city has experienced an increase in the number of people on the street since the start of the pandemic.  

“People are experiencing that and feeling that,” Martinez said. “Neighbors are — no question. We see that in our 311 calls. That there’s more issues of people in the street, there’s more issues of some of the challenges that people are experiencing in their alleys or in the parks, etcetera. 

“And obviously we’re in the midst of … a pandemic, which has created circumstances that have closed day programs, have reduced the capacity of treatment programs,” he continued. “It has also forced us to reduce the capacity of our shelters and done a lot of things that unfortunately has made the situation more challenging. And the opioid epidemic didn’t go anywhere. Coronavirus came and said, ‘Hey you can’t be in close proximity and you can’t have people congregating and you can’t spend all that one-on-one time with people that you normally would and yet, the epidemic is still here. People are still in the midst of a disease, and people are still coming to get treatment, services, and help and trying to find their way.”

The health and human services chief said progress has been made across the three fronts laid out in the Mass./Cass plan — public safety, public health, and quality of life — since last fall. 

“Ideally we’d like to have many more people in our low-threshold shelter, the engagement center,” Martinez said. “We normally would have a lot of people in there and keep connecting with people and bringing them off the street, but because of COVID, you can’t do that. So it definitely did throw in obstacles, challenges. And the system itself created a scenario where more people are in Boston, in the streets, in this neighborhood.”

The city estimates there are about 300 individuals unhoused on the streets in the area, not including those accessing shelter services, which is an increase from the numbers seen last summer. 

“It is directly tied to the fact that there are less services in other parts of the state,” Martinez said of the increase. “There are people — rightfully so — being released from programs because of density, but then having no transition plans for folks to be able to get the care they need. So definitely seeing more folks on the street.”

Individuals come to the city for recovery services from across the region and even the country, Boston City Councilor Annissa Essaibi-George pointed out. The member of the Mass./Cass task force told Boston.com more than 60 percent of individuals in the city’s shelter system are from outside Boston. 

Even before the coronavirus, she noted, Boston’s systems of care for substance use disorders, homelessness, and behavioral health were “bending” under the demand.

With the increased number of people, the city has seen a “tremendous increase” in the number of improperly discarded needles in the area and an “uptick” in violence, Essaibi-George said. 

According to the Mass./Cass dashboard, the city collected more than 100,000 needles in August alone.

And while Boston’s programs have made adjustments due to coronavirus, the city’s services did not completely shut down through the pandemic, continuing outreach and getting people on pathways to treatment and responding to the rise in individuals in the area with increased resources. 

“We’re still keeping people alive,” Martinez said.

The health and human services chief estimated city workers are probably reversing about three or four overdoses a day in the area. He attributed the fact that Boston hasn’t seen an increase in fatal overdoses during the pandemic, unlike other major cities, to services staying online during the shutdown.

“We are a regional hub … and that hasn’t changed,” Martinez said. “People know they can get care and help and support. And then unfortunately, some people try to take advantage of those people and try to prey on them — and that’s also continued. So that’s why that balance is key: public safety, public health, quality of life, all three of those strategies are there.”

‘It’s a difficult set of circumstances that COVID has only exacerbated’

Officer Josh DeLisle, left, of the Boston Police Department Street Outreach Unit, offers a fresh mask to a man sitting outside a comfort station run by the Boston Public Health Commission on Sept. 10. —Craig F. Walker / Boston Globe

Both Martinez and Essaibi-George urged that compassion not be forgotten for those who are unhoused or struggling with addiction as the work to tackle the opioid epidemic and its impacts in the area continues.

Just like the city’s residents, they too deserve the provision of safe and clean environments and are impacted by the current conditions being experienced in the area, Essaibi-George noted. 

“The city is not going to turn our backs on people who have needs who are struggling with disease,” Martinez stressed. “We are not going to do that, so we have to walk a balance so that people are getting the care that they need but that we’re also focused on the quality of life issues that we know are a big concern. And it’s a difficult balance, it’s a difficult set of circumstances that COVID has only exacerbated, and anyone who says there’s a simple solution just doesn’t understand the problem very well.”

Both city officials also agreed that getting the Long Island bridge rebuilt and recovery services up and running on the island remains an important part of taking the strain off of the neighborhoods around Mass./Cass.

“We know the benefit that the work that happened on that island could have for this particular population,” Essaibi-George said. “And for communities in the Greater Boston area — not just the residents of the City of Boston.”

The City of Quincy has spent hundreds of thousands of dollars in an ongoing legal and engineering challenge of the project, according to the Patriot Ledger. Quincy officials have declared they will do everything they can to fight the project, arguing the Squantum neighborhood where the bridge would begin can’t handle traffic the project would bring. 

As for the actions neighbors want to see taken, Martinez said the city is, through goals laid out in the Mass./Cass plan, committed to not adding additional shelter beds in the neighborhood this winter and is working to find space in other parts of the city.

Essaibi-George said she agreed with the concerns expressed by neighborhood residents, saying “too many communities” outside Boston have “just walked away from their responsibility to care for their residents.” 

The decentralization of services is “critically important” to addressing the issues facing both the neighborhoods and the city, she said, adding that it’s time for other communities to step up. 

“The system fails because of its own success,” Essaibi-George said. “Where we have an opportunity to shelter individuals and provide services — other communities walk away from their responsibilities to support their residents, to offer services within their communities. The burden of this work is left to the city, and the city wants to do this work and will continue to do this work. But again, the pressures of other communities not doing their part adds a tremendous burden and weight to the system of care here in the City of Boston.”

The health and human services chief said the city sees and hears the concerns being raised by neighborhood residents and remains committed and focused on an intentional approach to the epidemic. The city “[feels] the pain that people are experiencing” and is working to be as responsive as possible, he said.

“COVID did change our reality. It changed everyone’s reality across the board in every neighborhood and every community, and it changed the reality of this work also,” Martinez said. “But it doesn’t mean that we’ve stopped working or that we’re going to let go and just not focus on those issues that we need to.”


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