Addiction should be approached as we would any other health condition
Shirley Leung’s recent commentary importantly highlights the urgency in responding to the humanitarian crisis occurring in the Melnea Cass and Massachusetts Avenue area of Boston (“Recognize intersecting interests: Mass. and Cass solutions must come from working together,” Page A1, Oct. 5).
As physicians who have dedicated our careers to addressing community health and addiction, we applaud all who are proposing solution-oriented approaches to immediately address the suffering of our community members who are affected by houselessness, substance use disorder, mental illness, trauma, and infectious diseases, particularly in a city as well-resourced as Boston.
This crisis needs bold, effective interventions to immediately offer needed medical and social services. Thankfully, some stakeholders, including the state’s Opioid Recovery and Remediation Fund Advisory Council, have homed in on evidence-backed priority areas: expanded harm reduction services, access to lifesaving medication, supportive housing, and community outreach.
What is not supported by evidence, however, is transferring care into correctional settings or expanding involuntary treatment. We and colleagues have significant concerns with any proposal to do so. Treatment for substance use disorder must be approached as we would any other health condition: by expanding treatments grounded in science, delivered with compassion, and rooted in equity and mutual trust. Health care agencies, with appropriate funding, support, and collaboration, can and should lead efforts to address this crisis.
Dr. Sarah E. Wakeman
Medical director for substance use disorder, Mass General Brigham
Associate professor of medicine, Harvard Medical School
Dr. Elsie M. Taveras
Chief community health equity officer, Mass General Brigham
Professor of pediatrics, Harvard Medical School
Addiction is an illness, not a crime
Shirley Leung quotes Massachusetts Attorney General Maura Healey as saying that “all options need to be on the table” when it comes to treating substance use disorder. However, one option that should be off the table is incarceration. Recognizing that addiction is an illness, not a crime, is not a matter of “ideology.” Rather, it is a matter of science. As a psychologist and a state legislator, I know that behavioral health, just like all other medical conditions, requires treatment in a health care facility.
Suffolk County Sheriff Steve Tompkins is trying to avoid using Section 35, the state law that allows commitment to involuntary addiction treatment, because the state has prohibited using correctional facilities for women who are committed, and the state is being sued for using such facilities for men, and legislation I filed that would prohibit this practice is being considered.
Instead, he is suggesting arresting those with outstanding warrants. Apparently, he thinks he can get around the bail statutes.
That there are empty beds because Suffolk County has stopped detaining immigrants for the Bureau of Immigration and Customs Enforcement does not mean that a detention site is the right place for a treatment center. If we ran out of cardiac beds, would we send patients with heart disease to prison?
Let’s follow the science, and treat addiction in a health care setting, not a jail.
Ruth B. Balser
State representative, 12th Middlesex District
Take a drive through the area and you’ll see why a solution is urgent
Driving through Boston on a recent afternoon for a doctor’s appointment near Kenmore Square, my biggest concern was running into crowds of Red Sox fans outside Fenway Park. Instead, we faced immeasurable human pain and suffering as we drove through the section of the city characterized as “Mass. and Cass” — such a convenient verbal shortcut to anesthetize one from the unimaginable scene that plays out along these streets. No amount of reading articles in the paper or watching the reports on the evening news can prepare one for the misery unfolding for the men and women who reside (the word “live” seems inapt) in this hellhole.
I would encourage every Massachusetts resident and public official who seeks to block the desperately needed solutions to this humanitarian crisis to visit the area, and that includes the mayor of my own city, Quincy, who opposes the reconstruction of the Long Island Bridge.
There is simply no excuse for these conditions to continue in a city with as many resources and supposed good will as Boston, in a state that calls itself a Commonwealth, and in a country said to be as exceptional as the United States. No excuse.
Ask the people there what they want and need
Picking up people on open warrants and locking them up in South Bay is nothing like “college dorm” life, contrary to what Sheriff Tompkins envisions. What people living at Mass. and Cass need is freely available, low-threshold supportive housing, not imprisonment and coerced treatment, which has been found to be ineffective and to increase mortality.
Sadly, no recent Globe reports on Mass. and Cass have asked the people gathered there what they want and need.
Dr. Mark Eisenberg
Our elected leaders have failed to rise to this challenge
I have just finished listening to a podcast on the Attica Prison riot in 1971, during which then-governor of New York Nelson Rockefeller’s strategy was to stay uninvolved, in an effort to protect his political ambitions. It reminded me of our situation at Mass. and Cass.
Leadership means making a tough decision with the information you have at the time. Former mayor Martin Walsh spent years forming task forces and visiting other cities, but what we need is to see a strategy put into action. Homelessness and drug addiction are statewide problems. It is disappointing to realize that our leadership, from Governor Charlie Baker to former Walsh, to our current mayoral candidates, either don’t have the ability to pull the communities together and execute or, it would seem, are protecting their political ambitions.
Pour resources into treatment and housing, not detention
As a physician who cares for people experiencing homelessness near the Mass. and Cass intersection, I am discouraged by Sheriff Steve Tompkins’s proposal to detain people for substance use disorder treatment in an unused space near the Suffolk County House of Correction (“Sheriff’s proposal to ease crisis at Mass. and Cass gets pushback,” Metro, Sept. 28). This is not an innovative solution; rather, it continues an enduring pattern of treating substance use disorder within carceral systems.
In Massachusetts, people involuntarily committed for substance use disorder treatment in correctional facilities have experienced substandard treatment and abuse. Although Tompkins suggests the alternative is “people dying on the street,” involuntary treatment increases a person’s risk of dying from overdose as compared with voluntary treatment.
What if, instead, we invested in addiction treatment and housing? I frequently see patients who want help with their drug use but encounter a dysfunctional addiction treatment system, plagued with insufficient inpatient beds, lost opportunities to start medications for opioid use disorder, a lack of methadone clinic capacity, and a failure to arrange supportive housing after discharge.
All this means that people leave such so-called treatment and return to living on the same street corner, primed for relapse. Instead of spending money and time detaining people, let’s make evidence-based addiction treatment and safe housing accessible to all who want it.
Dr. Jordana Laks