What would actually cut homelessness and overdose risk?

Interviews with unhoused people who have recently experienced opioid overdose indicate more effective ways to deal with places like the “Mass and Cass” intersection in Boston, say researchers.

Massachusetts Avenue at Melnea Cass Boulevard in Boston is a noisy stretch of urban concrete—wide, traffic-clogged roads competing for space with businesses, parking lots, emergency shelters, health clinics, and a smattering of trees—that’s become a magnet for people who are unhoused and grappling with an opioid addiction.

Until the city moves them along, many of the hundreds of people who are drawn to the area sleep in tents and ramshackle shelters. In a recent story, the Boston Globe called the intersection a “notorious open-air illicit drug market.”

Boston has made multiple efforts over the years to address the complex problems that have gripped Mass and Cass. It’s started helplines to report discarded needles, removed tents, arrested people on the streets, diverted folks to shelter and treatment facilities, built a day center, and boosted investment in affordable housing. But the people and tents always seem to return.

It’s a familiar story across the country. Los Angeles, New York, and Philadelphia have all seen opioid overdose deaths rise in recent years, particularly among people experiencing homelessness. In Massachusetts, the crisis has taken a grim toll. There were more than 2,300 opioid overdose deaths in the state in 2022 and 500 between January and March of this year alone, according to the state’s Department of Public Health.

In an effort to find new ways of reducing the number of deaths, Boston University researchers spoke with opioid overdose survivors experiencing unsheltered homelessness in the streets around Mass and Cass. Those they interviewed talked about a series of common issues, including inadequate housing and shelter options and a chaotic and dangerous environment that stymied their recovery goals. The 29 interviewees—who had all overdosed within the past three months—also had ideas for improving available services.

The researchers conclude that Boston should consider “additional low-barrier housing services (i.e., including harm reduction resources and without ‘sobriety’ requirements)” to help tackle addiction and homelessness. The results appear in the International Journal of Drug Policy.

“This study was an opportunity to hear directly from people about their experiences,” says Simeon Kimmel, an assistant professor of medicine at Boston University’s Chobanian & Avedisian School of Medicine and an infectious diseases and addiction medicine physician at Boston Medical Center. “It has been really meaningful to take a more systematic approach to understanding the patients that I care for, what their lives are like, and what they’re looking for.” Kimmel is also medical director at BMC’s Project TRUST, a harm-reduction-focused drop-in center that offers medical resources, education programs, and connections to broader health care services.

The latest paper is part of a larger project, the Boston Overdose Linkage to Treatment Study, examining inequities in access to treatment after an opioid overdose. The study is a collaboration among the university, the Boston Public Health Commission, and the Institute for Community Health (ICH). Funding for the work came from RIZE Massachusetts Foundation, the National Institute on Drug Abuse, and the university’s Department of Medicine Career Investment Award.

Here, Kimmel and his fellow researcher Ranjani Paradise, ICH’s director of evaluation, talk about their research—and what they heard from the people who call Mass and Cass home:

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