Doctor providing addiction care to homeless shares what is needed to address impacts of opioid crisis on Boston’s neighborhoods

“If there’s not housing on the other end, people end up back where they were.”

Malik Calderon Jr., who is homeless, cleans the sidewalk outside a comfort station run by the Boston Public Health Commission on Mass. Ave. Craig F. Walker / The Boston Globe

Residents of the South End and Roxbury are continuing to demonstrate against the conditions they are witnessing on their neighborhood streets, effects of the COVID-19 pandemic’s exacerbation of the opioid epidemic in the city.

Related Links

Weekly protests have sought to draw attention to the situation that residents say has grown untenable outside their doors — an increase in the number of people living unhoused and struggling with addiction, leaving discarded syringes and human waste in parks, public alleys, and on sidewalks.

In calling for action, neighborhood residents are circulating a petition of demands online aimed at both city and state leaders, asking that services in the area be decentralized, among other steps. On Sunday, some neighborhood activists went as far as Swampscott to gather outside Gov. Charlie Baker’s house, depositing syringes on the sidewalk they said were from the area known as Mass. and Cass, 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 and homelessness.

A request for comment on the protest specifically was not returned by the governor’s office, but in a statement, a spokesperson for the Department of Public Health told Boston.com the “health, safety, and well-being of people facing substance use disorder” remains an “urgent priority” for the Baker administration.

“The state has partnered with the City of Boston in allocating resources and addressing challenges faced by patients and treatment providers along the Massachusetts Avenue corridor,” the statement read. “Most recently, the state provided over $3.85 million​ to support the City’s street outreach and opioid-related programs, including at the Pine Street Inn, Boston Medical Center, and the Suffolk County House of Correction. The state will continue to invest in and collaborate with the city and health and human service providers to meet the needs of individuals with substance use disorders.”

Advertisement:

City officials have said there’s no question that the pandemic has worsened the opioid crisis on Boston’s streets, saying the shut down of many shelters and recovery services across the state and region due to the virus has led to more people convening at Mass. and Cass, also referred to as Methadone Mile,” where services remain available, if altered, to accommodate social distancing and COVID-19 safety precautions.

Health care providers working to provide services to those struggling in the area also say they understand the concerns being raised by neighbors. But, they point out, the circumstances are the result of much more than an “addiction problem,” urging there to be more focus on solving the broader policy issues of housing and harm reduction rather than just the presence of the struggling individuals themselves.

The conversation about the situation in the area of Mass. and Cass often glosses whether it recognizes the people as the problem or “sees the problem of the people,” Dr. Joe Wright, director of addiction treatment at Boston Health Care for the Homeless, told Boston.com.

“The presence of the people is not the problem that people without homes are experiencing,” he said. “The problem the people without homes are experiencing is that they don’t have anywhere else to go. So framing it in terms of can we fix these people’s individual problems doesn’t get at why are they on the street in the first place and how difficult is it to get them off the street.”

Advertisement:

There’s a misconception among most people looking at the issues of substance use and homelessness in the area — or just thinking about homelessness in general — that if individuals just stopped their drug use, they wouldn’t be homeless anymore, Wright said.

That’s just not the case, the doctor said.

He argued the problem is they have nowhere else to go, and they’ve been pushed into a small area.

“One of the biggest struggles we have is that people can stop using and then be on many months-long — sometimes years-long — lists to get housing,” Wright said. “It is not easy. And it is not easy to maintain your focus in that setting. When we’re saying, ‘Let’s have you recover and have a vision of hope and future,’ and what you’re left with is staying awake in your shelter bed, acutely conscious of every past trauma you’ve ever experienced and just holding on with white knuckles to your desire to not use drugs today — that’s a pretty difficult setting in which to accomplish that.”

The problem isn’t that there are no programs to help people or that there is no hope, he said. It’s that there are not enough intermediate housing options. For most that are struggling, housing options largely come down to waiting — either on a list or through a lottery.

“That question of what does it mean to be one of the people who is in the area and who may be using drugs — just sort of saying, ‘Well, stop,’ or, ‘Go to a recovery program’ — there are so many experiences of people going through the first few months of recovery treatment, residential treatment,” he said. “Residential treatment is powerful for people without homes, but if there’s not housing on the other end, people end up back where they were.”

Advertisement:

There’s a structural problem in Boston, and other major cities, where more affordable, marginal housing options — such as single-room occupancy hotels — have become scarce.

“That had its own problems, but it meant that if you were struggling but you could put a little bit together, that you could have housing,” Wright said of the cheaper housing options. “In cities like Boston, New York, San Francisco where rents are so high, it’s sort of publicly supported housing or nothing if you have no money and no way to get money. It’s very, very difficult.”

At the same time, in Boston there are smaller and smaller areas where anyone is simply allowed to “just exist” in public spaces, he said.

It’s a reality on the ground that coronavirus has just made worse, shutting down public spaces that were previously open as welcoming areas, like libraries, to those in need of a spot to hang out for a little while.

“If you’re homeless and you’re creating any kind of discomfort for other people just by existing, the likelihood is that you will be pushed in one way or another down to the zone where the city has decided that they’re gonna push folks,” the doctor said. “And I don’t think that there’s a single master plan to push people. I think it’s more that it’s a series of decisions made by lots of different people — as the best I can tell — to say well, the neighbors don’t tolerate this person here, the neighbors don’t tolerate this person here, the neighbors don’t tolerate this person here, now they are moved into a different police district, now the police district moves them someplace else. They just get pushed around the city because their presence is not welcome.”

Advertisement:

Wright noted coronavirus has also both made some individuals wary of big shelters because of the congregate setting and made beds in shelters harder to come by at times.

“It’s just literally the amount of space that can be occupied by the people who have no space of their own is less and less and less,” he said of 2020.

But separate of the pandemic, to truly address the issues being observed and felt in the area of Mass. and Cass, officials have to either provide housing to the individuals or stop pushing them into a concentrated area, the doctor said.

“It’s a policy choice,” Wright said. “So on one level, I have a certain sympathy with the point of view of people being mad that there’s a set of policy choices that created this. But I don’t think that if your policy choice is, ‘Let’s push them someplace else,’ that’s also not a long-term policy choice.”

A second, closely related issue is what is available — or unavailable — for those who are being released from jail, Wright said.

There really is this cycle of coming out of jail and then having your choices be so constrained that you kind of end up back in the setting that you were already in and then ending up back in jail,” he said. “And for some of our patients, that’s entangled with addiction. For some of them, it’s more just poverty, to be honest. But I think the connection of addiction, incarceration, release to no housing, release to homelessness is very common.”

Advertisement:

Individuals who may have been on a housing list before being jailed, lose their place. If they were making progress to getting other services, that progress is often lost.

In 2019, when Boston also saw a surge of people living unhoused during the summer in the area of Mass. and Cass, Wright recalled patients who, from their cells in the Suffolk County House of Correction, could look down at the streets they were about to inhabit.

“They were literally looking down at the homeless shelter,” he said. “It’s pretty bleak.”

Wright said he supports the call from neighbors in the area of Mass. and Cass., pushing for recovery and addiction treatment services, as well as shelters, to be decentralized and spread through other parts of the city. But he expressed skepticism about how feasible such a move would be in the face of anticipated opposition from the residents in those new neighborhoods.

“The process of neighborhood associations vetoing these services is something that happens all over the city,” he said. “So there’s a reason that they’ve been centralized. If you try to locate them elsewhere, there’s usually neighborhood opposition to it. So I think if there was an overall city plan and all the neighborhood associations and business associations and civic associations sort of said everybody needs to contribute to solving this problem, and that means a number of small decentralized services, I think that would be fantastic.”

Health care providers noted during the Opioid Screening and Awareness Day last week that the coronavirus pandemic forced society to jump into action to work creatively and with immediacy to address the public health emergency, but the response to the opioid crisis, which killed more than 72,000 people in 2019, continues to face challenges rooted in stigma.

Advertisement:

Wright said with the COVID-19 pandemic, “remarkable” rapid changes were made to regulations to broaden access to substance use disorder treatment amid the virus shutdowns.

But the quickness with which the measures were implemented prompts the question of why the changes, which included allowing addiction care to take place through telemedicine and allowing a longer take-home supply of medication for addiction treatment, weren’t made sooner, he said.

“It goes to the question of do you see this as your crisis or someone else’s?” the doctor said. “And do you see the problem as contagious and therefore something that could affect you and something that everybody has to respond to, or something ‘other’? Something stigmatized to be pushed away and contained.”

Wright stressed that he applauds some of the measures being called for to address the dehumanizing situation in the area, including opening a recovery services campus on Long Island, which, prior to its abrupt shuttering in 2014, provided social services and hundreds of beds for homeless individuals.

But those policy solutions that involve the “hope” that the people on the street will go somewhere else, either to another neighborhood for services or Long Island, need to take into consideration what that would realistically look like, facing all the challenges in the path.

Right now, Wright expressed skepticism that the sense of priority and civic responsibility is there among the broader community to step up and tackle the epidemic together.

“You have to have both a city-wide and a regional approach that makes this everyone’s responsibility,” he said.

Advertisement:

Get Boston.com's browser alerts:

Enable breaking news notifications straight to your internet browser.

Jump To Comments

Conversation

This discussion has ended. Please join elsewhere on Boston.com