The opioid and homelessness crisis at Mass. and Cass: whose problem is it?

Massachusetts Statehouse. (Photo by Ana Goni-Lessan/BU News Service)

By Katherine Sabido
Boston University Statehouse Program

BOSTON – Mass. and Cass – the Boston intersection that serves as the epicenter of the commonwealth’s substance abuse and homelessness problem – is simply the most visible example of a statewide problem that requires a statewide solution, community mobilizers, public health experts and legislators say.

The tent city located at the intersection of Massachusetts Avenue and Melnea Cass Boulevard has generated lots of headlines and little in the way of concrete solutions to date. Boston neighbors – and communities bordering Boston – have disagreed on who should deal with the issue, until now.

“The commonwealth looks at Boston as its own sort of entity [that can] handle its own issues, and so the governor doesn’t want to maybe trample on the mayor or the mayor doesn’t want to ask the governor for help, but I think we’re beyond that level of political jockeying. People are dying,” said Marla Murphy-Smith, a resident local to the Mass. and Cass neighborhood and an organizer for the South End – Roxbury Community Partnership

“The impact on the community has just been horrific, and the governor has been too hands-off for this critical humanitarian crisis that’s occurring. That needs to stop.”

Gov. Charlie Baker has deployed the Department of Public Health to engage with the city to find ways that the state can lend aid to the “humanitarian and public health crisis” at Mass. and Cass, but he has ultimately said that Boston “has the jurisdiction on this stuff.” 

Community members, such as Murphy-Smith, and state legislators argue that while the state’s opioid and homelessness crisis might be the most visible at the corner of Mass. and Cass, it demonstrates a plague of addiction and homelessness that threatens to take over each corner of the commonwealth.

“The state definitely has to play a role because not everybody who’s at [Mass. and Cass] is from Boston or the Greater Boston area,” said Sen. John Keenan, D-Quincy, Senate Chair of the Legislature’s Committee on Housing. “They come from all over the commonwealth for a variety of reasons, so every community in the commonwealth and the commonwealth itself has an obligation to address [its] homelessness and substance abuse issues.”

Opioid-related overdose deaths in the state increased by 1% over the last year, as 1,613 confirmed and estimated deaths occurred in the first nine months of 2021, according to a November DPH report.

The commonwealth’s uptick in opioid-related overdose deaths coincides with a nationwide epidemic that was most recently blamed for the deaths of more than 100,000 people during 2020-2021. Since around 2008, Massachusetts has consistently remained in the top percentile of opioid-related death rates in the country, recording more than twice the U.S. average in 2016. 

Public health experts, such as Bertha Madras of McLean Hospital, who has served on a number of presidential opioid commissions, applauds Baker for implementing programs that have helped the state turn its upward-climbing curve with the opioid crisis. 

“In the past year, when the U.S. was traumatized by over 100,000 deaths, the rate of increase in Massachusetts was only 5.8%, whereas it was almost 50% in California, 70% in Vermont and 18% in Rhode Island,” said Madras. “While the rates were increasing steadily in the country, the rates in Massachusetts were either remaining stable or going down, except for very recently.”

But constituents and lawmakers are demanding that the Baker administration do more, reasoning that the crisis happening in Boston needs more attention from the executive branch, as it has grown beyond the city’s control and is not exclusively made up of individuals from Boston or the Greater Boston area.

Newly elected Mayor Michelle Wu’s most recent plans include converting the Roundhouse Hotel at the Mass. and Cass intersection into a space for low-threshold housing to be overseen by the Boston Medical Center. This plan has drawn significant backlash from community members, who say it works against their calls for the decentralization of services. 

“We’ve been demanding that they decentralize services throughout the commonwealth,” said Yahaira López, another organizer from the South End-Roxbury Community Partnership. “[That] does not mean you move it from Mass. and Cass to another Black and Brown, urban or low-income, low voter turnout community … we mean decentralize [services] throughout the entire Commonwealth of Massachusetts. How can we help stabilize people if we’re not giving them the opportunities to [recover]? By not removing them from the same spaces that trigger them?” 

Madras expands on the calls for the decentralization of services, explaining that allowing people to remain in an environment that fuels their addiction, or in proximity to that environment, traps them in an endless cycle.

“The drug dealers are permanent residents of the area, meaning that they know exactly where the customers are, and that’s where they go,” said Madras. “There is almost no attention paid to reducing the supply or changing the environment in order to help these folks.”

Madras is in favor of rebuilding the Long Island Bridge and the island’s facilities, which used to be a campus of substance abuse disorder treatment facilities. However, it does not serve as an immediate solution because the reconstruction would take years and cost millions.

López says that while she sees benefits to rebuilding the Long Island Bridge and facilities, she does not want it to become a way for the state to veil its issues with addiction and homelessness, allowing people to foster an “out of sight, out of mind” mentality. 

But Madras argues, from a public health perspective, that Long Island should still be rebuilt because it offers a space for people to fully recover, free of temptations to return to the toxic environment they left.

“It wasn’t perfect, but it was idyllic because it was inaccessible to the people who perpetuate the problem, and that’s a critical part of the solution,” said Madras. “It was isolated from drug dealers [and] from every possible environmental issue that could feed into a person’s problems.”

Multiple lawmakers have agreed that the state must play a role in first, addressing the opioid and homelessness crisis at Mass. and Cass, and second, ensuring that widespread services are put in place to combat and prevent similar scenarios from breaking out in other counties.

“It is absolutely not just Boston’s responsibility, there needs to be a commitment that every region of the state has not only substance abuse clinics but support services for people that have a predilection to addiction,” said Sen. Jamie Eldridge, D-Acton. “It’s about strengthening the social safety net … everything from affordable housing to better re-entry services for [formerly] incarcerated people.”

“It’s a crisis with many different facets; it’s a public health crisis, it’s a mental health crisis, it’s a housing crisis, and it’s a major problem that has impacted countless lives,” Rep. Bruce Ayers, D-Quincy, wrote in a statement. “A multi-faceted problem deserves multi-faceted solutions. We need to continue to invest in addiction treatment and recovery services, but we also need to look beyond that at how we can support a sustained recovery through comprehensive housing, nutritional, and educational initiatives.” 

Madras echoes legislators’ sentiments that transitional housing options must be paired with proper treatment and rehabilitation programs to give those suffering from substance abuse disorders a chance to reintegrate into society. 

“The most important resources are mental and physical health evaluations; these people absolutely require to be assessed,” said Madras. “And there has to be a little a bit of an effort [toward] also imposing a level of responsibility on the individual to take their medications, if they need them, to try to show up for treatments, appointments, group therapy or what have you … and if there is a sense of recovery, there should be job training.” 

And while Madras believes that there are more pros than cons to the decentralization of services, she reiterates that the government needs to be very intentional about the way they disperse them.

“If we decentralize the Mass. and Cass [facilities], we have to figure out what the positives of being in that location were and make sure that we can replicate them, not eliminate them,” said Madras.

Keenan said the commonwealth’s opioid and homelessness crisis requires a collaborative effort from all levels of government and a more flexible approach to people’s housing needs. 

“A lot of shelters are dry shelters, meaning people who go there cannot use drugs, and if you are addicted to heroin or fentanyl, you need drugs constantly … so people can’t access homeless shelters because of their addiction,” said Keenan.

“[They need] a structure that acknowledges their addiction … and in those types of shelters, [there has to be] access to services so that when people are there, [they] have people that are ready to move them into treatment and recovery, and make sure that they’re aware of the various programs that are available.”

Rep. Lindsay Sabadosa, D-Northampton, who has been vocal about homelessness in western Massachusetts, also finds that dry shelters are a barrier to solving the housing crisis. She believes that transitional housing services would be more successful with a personalized approach.

“The issue is hard because every individual is extremely different and needs a really personalized pathway,” said Sabadosa. “I’m a huge proponent of moving away from a traditional shelter model to[ward] something that is more personalized for people because I think we have spent a lot of time just kind of putting Band-aids on things and not really addressing the underlying issues of them.”

Sabadosa sides with her colleagues in the argument that the state should be responsible for tackling its opioid and homelessness crisis, especially considering there are costs involved.

“The state absolutely needs to play a role because the citizens can’t pay for it on their own, there’s no way,” said Sabadosa. “Services need to be dispersed throughout the commonwealth because there are people who are unhoused throughout the commonwealth.”

Murphy-Smith has voiced that costs are a concern for the community as well. 

“In order to provide housing, we need money to acquire housing,” said Murphy-Smith. “You need money to run programs, and I think having the state involved would provide more access to things that are available out there if only we had somebody at that level to make the ask.”

Keenan says the Legislature will look to further address these funding needs in the second half of the ARPA distributions, following Baker’s approval of the first half of commitments in the Legislature’s proposed spending plan that Baker signed on Dec. 13, which allocates $964 million for health care and $624 million for housing.

As of December, the Baker administration has also committed funding for 38 syringe service programs and the creation of 33 overdose education and naloxone-distribution sites, and it plans to create a temporary housing “cottage community” on the Lemuel Shattuck Hospital campus that would provide the type of personalized housing mentioned by Sabadosa.

“It is quite clear that this is not only a Boston problem, it is, at least, a statewide problem, if not a regional problem … and the state, unfortunately, has been very slow to get involved with addressing the issues centered around Mass. and Cass,” said Murphy-Smith. “There is no excuse, in a resource-rich area like Massachusetts, where we have so many hospitals and schools and colleges and highly educated people, [for the state not] to be addressing this issue.”

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