Medical and public health experts Wednesday called on Boston city officials to abandon their effort to break up the community of people living in tents near the intersection of Massachusetts Avenue and Melnea Cass Boulevard, the heart of Boston’s opioid and homelessness crisis. Speakers especially resisted proposals to jail residents or coerce them into addiction treatment.
Gathering in a driving rain a block away from the notorious “Mass. and Cass” encampment, the group said it would be cruel and counterproductive to evict the tent dwellers without providing transitional housing.
“Our state has been a leader in health care, public health, and substance use disorder treatment,” said Dr. Sarah E. Wakeman, medical director for substance use disorders at Mass General Brigham. “Now more than ever we must channel available funding, political will, and energy into proven solutions.”
Those solutions, the doctors and advocates said, include providing easy access to housing, with vouchers or by converting hotels, as well as expanding voluntary treatment and “harm reduction” programs such as needle exchanges. Several people spoke at the press conference, and they were surrounded — and cheered — by about 30 others, many wearing white coats.
“We have spent more on policing this issue than it would have cost to provide housing to every individual on this side of town,” said Boston City Councilor Ricardo Arroyo.
On Monday, city officials began notifying residents of the encampment that they would have to move, after Acting Mayor Kim Janey issued an executive order saying the city would enforce existing laws and regulations that prohibit such encampments in public spaces. City officials emphasized that no one would be asked to move without being offered alternative shelter.
Asked to comment on the doctors’ press conference, a city spokesperson e-mailed a statement that said: “Mayor Janey is committed to maintaining a public health approach in confronting this complex challenge. That is why these orders are focused on connecting individuals to shelter, providing substance use disorder and mental health services, expanding low-threshold housing, providing safe road and sidewalk access, and enforcing laws against those who prey on the vulnerable, or present a danger to themselves or others.”
Janey’s office did not reply to questions about whether anyone has yet been moved and, if so, where they went.
The area, near where Dorchester, Roxbury, and the South End meet, has been described as a humanitarian crisis requiring action before the winter. Businesses in the area have also complained of crime and disruption.
But speakers yesterday said the city’s approach would do more harm than good. “It is my medical opinion that displacing people, offering them ultimatums that include only congregate shelters, medically supervised withdrawal or being funneled into a correctional setting, will worsen the public health crisis that we are seeing,” Wakeman said.
The result will be more overdoses, greater spread of HIV, and “fracturing the linkages to needed health and human service providers,” she said.
Speakers were especially alarmed by a proposal by Suffolk County Sheriff Steven W. Tompkins to offer treatment in jail, noting that coerced treatment has not been shown to work and doubles the risk of overdose upon release.
“We have learned across decades of research on other disease outcomes from HIV to COVID that punitive measures do not work in public health,” said Dr. Natalia Linos, executive director of the FXB Center for Health and Human Rights at the Harvard T.H. Chan School of Public Health. “At best they do not work. At worst they can backfire.”
Although Boston-area homeless shelters have empty beds, people often have good reasons for not using them, including a lack of stability because beds are offered night to night; the inability to bring partners or belongings; and the “warehouse and jail-like environment,” said Cassie Hurd, executive director of the Material Aid and Advocacy Program, an advocacy group for homeless people.
Individuals need to have their own space in a setting that also provides services to help them with addiction and mental health issues, advocates said.
During the height of the pandemic, the city and state invested in hotel rooms for people who had to quarantine, said Hurd. “They can do the same again,” she said. “We can find space.”
Dr. Todd Kerensky, president of the Massachusetts Society of Addiction Medicine, said that people struggling with addiction “experience fleeting moments of readiness to change.” Those who are not ready on any given day may be ready the next day. “In my experience, people can be helped along this continuum of readiness by respecting their autonomy and helping them stay safe until they are ready for treatment,” he said.
Dr. Miriam Komaromy, medical director of Boston Medical Center’s Grayken Center for Addiction, said that she is working with city officials on a housing plan that would include a “sobering center” for brief stays, followed by transitional housing with supports, ideally in a hotel.
“It’s unacceptable for people to be living on the street through a Boston winter,” said Komaromy, who was not at the press conference. “We’re not offering them viable options. … The shelters are not in themselves a solution. People need intensive stabilization services.”
The program would be entirely voluntary, but Komaromy thinks people would line up out the door if they knew they could get housing. “My experience in providing services to many of the people who are living at Mass. and Cass is that they actually do want to come off the street,” she said. “People are asking for this.”
Komaromy noted that the city’s previous efforts to move people into hotels were abandoned after meeting resistance from neighbors. “We need really bold action to say, ‘This has to happen,’” she said.