In Mass. and Cass effort, the theme word is ‘decentralize’

The epicenter of homelessness and drug users known as Mass. and Cass is still populated after the removal of the tents.John Tlumacki/Globe Staff

As city officials explore ways to tackle the vagrancy that has haunted the area of Mass. and Cass, Mayor Michelle Wu’s administration has signaled she intends to follow through on a campaign promise to scatter recovery and harm reduction services, including needle exchange programs, across Boston’s neighborhoods — heeding the calls from neighborhood leaders who have long called for the decentralization of services from the area.

Spreading such services around the city and region, community leaders say, is necessary to disrupt the seemingly intractable dance of supply and demand — for the services in the area but also the street-level drug dealing that shadows the people who need it — that has made Mass. and Cass the epicenter of the region’s drug and homelessness epidemic.

The services “have to be everywhere — it can’t just be here,” said Sue Sullivan, head of the Newmarket Business Association, whose merchants have weathered the fallout of the region’s opioid epidemic for years, including the large tent encampments that took hold in the neighborhood last year.

Currently, the area hosts two homeless shelters and two methadone clinics, as well as the Boston Healthcare for the Homeless Program and Boston Medical Center recovery programs. A new housing site with health care clinics was recently set up at the Roundhouse hotel, on Massachusetts Avenue. An engagement center also sits nearby, where people can visit during the day, as do a city-run needle exchange and harm reduction center, services unmatched anywhere else in the region.

Earlier this month, during a community meeting, Dr. Monica Bharel, Wu’s top advisor on the Mass. and Cass planning, agreed that certain services such as needle exchange programs should be located throughout the city.

“That’s the place they should be: throughout communities,” said Bharel, adding, “We’re committed to decentralization.”

And Dr. Bisola O. Ojikutu, the head of the Boston Public Health Commission, added in a separate interview that “we would love to see standing centers of harm reduction elsewhere in the city.”

“In fact, if they could be available anywhere in the city, that would be a significant advance in our city’s [position] in addressing substance abuse disorder,” she said.

Their comments indicate that as her administration plans the next phase of its effort to address the crisis at Mass. and Cass, Wu remains committed to her campaign pledge to place recovery services throughout the city. During the mayoral race, Wu said she wanted to create a “hub and spoke” model that would locate such services along with supportive housing throughout Boston — not just concentrated near Boston Medical Center — and do so with an eye toward making sure people did not have to travel long distances from home to care.

Yet neighborhood business owners and other concerned parties fear that the warmer weather will cause people to return to the Mass. and Cass area, undoing the work accomplished by the Wu administration so far. Since the tents were broken down in January, more than 175 people have been moved to transitional housing, which experts say is the first step toward recovery.

But community leaders say people who have been housed in other neighborhoods regularly return to Mass. and Cass.

“They’re still coming back down here, and they’re coming because it’s the only place for them to come during the day that they know — a place they know,” Sullivan said. “We need to know who’s out on the streets now, and why.”

For community leaders, the overdose two weeks ago of a woman living in transitional housing at the Roundhouse after being relocated from the encampments underscored their concerns of the ongoing drug activity and vagrancy in the area, despite the removal of the tents. Though the city relocated people to temporary housing at other sites in Mission Hill and Jamaica Plain, community groups opposed the use of the Roundhouse site because of its proximity to the street-level dealing.

“How can someone who’s trying to get treatment deal with it if they’re trying to deal with all the temptations?” asked Andrew Brand, a community leader, during a recent meeting.

The Wu administration said it is still drafting plans on how to support people who have been living on the streets and are still in the transition to recovery; the tent breakdown in January was intended as an emergency response to the unsanitary and violent conditions that existed within the encampments.

But what is clear is that Wu’s top public health advisers, in listening sessions with community members and in private meetings with public health and other community advisors, have signaled they remain sincere in their willingness to relocate services across the city. It’s a politically fraught step that Wu’s predecessors were not able to make, and it remains to be seen whether Wu can pull it off.

The city appears to be considering a decentralized plan that could involve community centers, possibly neighborhood network centers, with needle exchange programs and their own engagement centers. Most of the tens of thousands of discarded needles the city collects each month are returned at Mass. and Cass, at the city-run center known as AHOPE (an acronym for Access, Harm Reduction, Overdose Prevention and Education) and at a community redemption center.

Some residents who have called for decentralization of services remain skeptical about whether the effort will take hold, and Ojikutu acknowledged that the ongoing stigma regarding drug addiction has thwarted decentralization efforts before. Neighborhood groups have opposed past proposals. Community organizations in other parts of the city, including those working in health care, have been reluctant to take on the burdens of adding the specialized care needed to treat substance abuse disorders.

As part of the effort to confront the crises at Mass. and Cass, city officials have held listening sessions citywide, among various neighborhood and industry groups.

“Having more of these conversations about, ‘What are the services that are needed, where do they need to be,’ that’s a forward-way thinking of approaching substance abuse disorder,” Ojikutu said in an interview. “We know there are people who are struggling and experiencing substance abuse disorder, so they should have services where they’re at.”

“We need to understand this more holistically,” she said.

Michael Curry, CEO of the Massachusetts League of Community Health Centers, which represents 52 neighborhood centers, including 21 in Boston, said he has been meeting regularly in recent weeks with Ojikutu and Bharel, as well as leaders from the nonprofit and philanthropic communities, to discuss strategies including relocating services in different neighborhoods. He acknowledged that similar proposals have stalled before, but he sensed a willingness among various community leaders to put forward a plan, thanks to many who have been “ringing the bell.”

There’s no blueprint in place, he stressed, but he said community health centers have worked in recent years to build substance abuse disorder treatment into their services, and there could be ways to expand that treatment.

“We think decentralization is a good idea; it’s smart, it fits the model of care that we provide … so it makes sense,” he said.

Outside the AHOPE building one afternoon recently, several people could be seen heading in and out, and loitering about the area.

Evan Howard, 29, who had been waiting for a bus to Kenmore, said he has been living on Tremont Street, but routinely comes to the area for what he called its amenities: the nearby Target store and a CVS, but also the services at AHOPE. He would welcome similar services near his home, he said. But at Mass. and Cass, he added, “I know a lot of people from the area; it’s convenient.”

Scott Giles, 38, said he is homeless, and bounces between Cambridge and Mass. and Cass. “It would be easier,” he said, if more service programs were scattered in different neighborhoods. “There would be less craziness.”

But, Giles said, the area of Mass. and Cass has its own lures, including the methadone clinics. “The addiction brings you here,” he said.

An earlier version of this story incorrectly spelled Dr. Bisola O. Ojikutu’s name.