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The opioid epidemic in the United States represents a confluence of systemic failures by the pharmaceutical, insurance, and healthcare industries, the government, and the criminal justice system. Since 1999, 841,000 Americans have died from an opioid overdose. Much has been written in the past few years about “deaths of despair,” or the shortened life expectancy in low-income Americans. Economists have interpreted this to mean that financial stressors play a role in exacerbating addiction and creating barriers to the recovery path

Like all American communities, the City of Boston is experiencing the tragic and long-reaching consequences of this scourge. Like many American cities, Boston is carrying more than its fair share of the burden of treating people who struggle with the disease of addiction, and trying to lead them to help and health. 

Though this epidemic is not confined to any one neighborhood or group of people, the area around the intersection of Massachusetts Avenue and Melnea Cass Boulevard, including the adjacent areas of Newmarket Square, the South End, and Nubian Square, is struggling under the weight of an overly dense concentration of services that attract people to the area on a daily basis. This concentration of services for people grappling with addiction attracts other people who prey on them.

All of this adds up to a proliferation of problems including crime, traffic hazards, discarded needles, and litter, making it unsafe and unsanitary for both residents and people seeking services. In Boston, it’s the epicenter of pain, sorrow, and tension. It’s not fair to anyone.

Mass & Cass, as it’s called, is home to a multitude of services utilized by people struggling with addiction and mental health conditions.

Services provided by the Boston Public Health Commission (BPHC):

  • Two homeless shelters, one for men and one for women;

  •  PAATHS, a one-stop shop for people looking for information about substance use treatment services;

  • The Engagement Center, a daytime, low-threshold, climate-controlled space where people who have no place to go can access respite space and services;

  • Mom’s Project and Women’s Wellness Center, an outpatient treatment center for women with substance use disorders;

  • Men’s Health and Recovery, an outpatient treatment center for men with substance use disorders;

  • Safe and Sound Recovery Center, a peer-led outpatient treatment center for people with substance use disorders;

  • Behavioral Health Services, an outpatient treatment center for people with co-occurring mental health and substance use disorders; and

  • AHOPE, a harm reduction and needle exchange site providing services to active injection drug users.

Additional services:

  • Boston Medical Center, the largest safety-net hospital in New England;

  • Boston Health Care for the Homeless, a private non-profit health care provider for people experiencing homelessness;      

  • Two privately-operated methadone clinics;

  • Rosie’s Place, an emergency shelter for women; and

  • Suffolk County House of Correction, an 1800-bed facility that serves men and women convicted of crimes and serving sentences of less than 2.5 years.

The programs listed above are open to and utilized by people from the Greater Boston area. BPHC and others have estimated that as many as 60% of the people who come to Mass & Cass for services either live or last lived at an address outside of Boston. While no one in need will be refused services, we must exert pressure on surrounding communities to help us. And if they won’t, we need the State to step in and help.

The problems of Mass & Cass are complex, and require funding, innovation, patience, temerity, and most importantly, shared sacrifice. At the heart of all of this, many people, and their families, are suffering, and it’s a moral imperative for us to use the resources we have to help. As Mayor, with the help of all stakeholders, John will execute the three part plan below.

1. Immediate Work: provide relief for people coming to Mass & Cass and the neighbors who live nearby.


People who live in the neighborhoods surrounding Mass & Cass deserve peace of mind and quality of life. People seeking services should have access to the best we can provide. John will get to work on day one with the strategies below:

  • Immediately appoint a Special Advisor for Mental Health and Substance Use Disorders. The Special Advisor will be a doctor with administrative experience in the field, and be tasked with reforming the way the City coordinates and provides services to people struggling with mental health and substance use disorders. They will immediately assemble a team with the intention of quickly providing services to those who need help. They will be charged with proposing solutions for a number of issues impacting Mass & Cass. They will speak with the authority of the mayor on all issues related to Mass & Cass, and citywide with regard to mental health and substance use disorders, and they will be given the staff and financial resources to accomplish their goal. Below are some of the initiatives they will be expected to undertake, and they will be encouraged to add more as solutions begin to emerge.

  • At the same time, work with BPHC and ask them to declare a public health emergency, in order to bring the additional personnel and resources required for a comprehensive approach. In the past 15 months, additional capacity has been added to BPHC, the Office of Emergency Management, and other City departments. As we continue to move toward the end of emergency pandemic response, this additional capacity will be refocused to address the crisis at Mass & Cass.

Address Conditions on the Ground

  • Create a large, multi-disciplinary street outreach team available 24 hours a day that includes social workers and health care workers appropriately trained to deal with a range of people and issues. This means creating new and supporting existing outreach jobs - which pay family-sustaining wages and provide support and good working conditions - to alleviate the high rates of burnout we have seen at Mass & Cass over the years. 

  • Create and hire three new liaisons in the Mayor’s Office of Neighborhood Services to oversee constituent services to neighborhoods impacted by the concentration of services at Mass & Cass. 

  • Establish a City of Boston Operations Center near Mass & Cass to operate 24/7 throughout this crisis. This will include a dedicated team from Public Works, Transportation, EMS, Parks and Recreation, and other City agencies, as well as teams from the appropriate state agencies, hospitals, and CBOs.

  • Work with Boston Medical Center, libraries, and other public buildings to re-open bathrooms that were closed as a result of the pandemic.

  • Expand the operating hours of the Engagement Center, in consultation with the neighboring community.

  • Work with adjacent neighborhoods to define the perimeter of the Mass & Cass area that will receive extra services from Boston’s Public Works Department.

  • Establish a team with representation from all property owners in the area, including private, non-profit, and government, to meet twice a week for an assessment of activity in the area.

  • Create a multi-department coordinated response team to address 311 calls related to Mass & Cass.

  • Expand the Mobile Sharps Team so that it provides all-day coverage in the impacted area.

  • Install new disposal kiosks in places where they are needed.

  • Increase the availability of Narcan across the city. 

  • Continue to support the work of the Department of Neighborhood Development, as well as Pine Street Inn and other service providers, to build as much supportive housing as we need. 

  • Lead beautification efforts, such as street light banner installation and public artwork, to create a sense of place.

2. Short Term Work: deconstruct and reimagine the way we deliver services.

We need to de-densify the services, and share the accountability, both throughout Boston and surrounding communities. No mayor wants to embark on a quest to move these kinds of services into neighborhoods around the city, especially when they are running for office. However, John knows that solving these big problems requires courage and fortitude. He is ready to talk to Bostonians, many of whom are dealing with addiction in their families, about the need for shared sacrifice. As we de-densify, we will work with proven providers to invest in service and facilities. We must work across jurisdictions and methodically to identify, by name, each person experiencing chronic homelessness and their needs, and then they set out to meet those needs.

  • Create a strategy team that will oversee daily communications with all providers in the area, including the State, Newmarket Business Association, neighborhood associations, nonprofit organizations, and other stakeholders.

  • Work with community health centers and other health care facilities in Boston to create needle exchange programs in other parts of the city. We must protect public health and safety, and incentivize proper disposal of needles. 

  • Explore methadone home delivery systems, which will eliminate the need for people to come to Mass & Cass for methadone treatment. Hundreds of people come to Boston every day for methadone treatment. Eliminating their need to travel will cut traffic, and keep patients safer by not exposing them to the open-air drug market that has emerged at Mass & Cass.

  • Expand access to medication-assisted treatment in other parts of the city and Commonwealth by investing in mobile service delivery and partnerships with community health centers.

  • Convene a regional summit to discuss the crisis and resulting challenges with surrounding cities and towns, and ask them to do their part. In Boston, we have heard tales of people being released from treatment and given a bus ticket to Mass & Cass. There are shelters in other cities and towns that require the user to be from that town and/or have ID. There are also shelters that refuse people who are inebriated. We all have to work together to help the people who present themselves for help.

  • Advocate to the State for more treatment beds, as well as short- and long-term residential treatment centers, all of which are spread out around the state. This will require the State’s support to ask cities and towns to do their part.

  • Convene a Citywide Relocation Task Force, charged with exploring how some services currently centered at Mass & Cass could be broken into small groups and moved elsewhere, either within or outside the city. The Task Force will work towards reducing the number of shelter beds near Mass & Cass.

  • Continue the conversations about other harm reduction measures, like overdose prevention centers located across the city, which have been proven to save lives.

  • Develop a plan to address the resurgence of HIV in IV drug users.

  • Direct the Boston Police Department (BPD) to create a unit devoted to disrupting drug dealing near Mass & Cass. The area straddles three separate BPD jurisdictions, which has hampered the work to make Mass & Cass safe, and must be changed.

  • Design a process to transparently communicate the work of the office.

3. Long Term Work: establish a recovery campus on Long Island and expand the continuum of care for those struggling with recovery in Boston and the region.

The single most important, long-term solution we can pursue to alleviate the opioid crisis is to reopen Long Island. By working with community stakeholders, and Gensler and Ascension Recovery Services, the Walsh Administration developed a plan that would create a continuum of care-centered residential treatment facilities that would serve the region. It’s an ambitious vision that addresses one of our society’s most pernicious problems. Once built, it will be a model for the rest of the country.

In order to realize this vision, the bridge that was condemned has to be rebuilt. Ferry service to the island, which is often suggested, could only be utilized if the island had its own emergency medical and fire service. John is open to exploring both of these paths, but is committed to the recovery campus if elected mayor.

However, once people graduate from programs on Long Island and return to their homes and families in Boston and the region, the work is far from over. John will work with the State and other willing partners to build and strengthen existing support programs to ensure that people are able to manage their disease in the long term.

This challenge calls for bold solutions and shared sacrifice. The opioid epidemic and the fallout from this crisis at Mass & Cass may seem like intractable problems. It is important to keep in mind the human face of the struggle we must tackle together. John does not believe there is a family in Boston that does not have experience with addiction. It’s our moral obligation to do everything we can to help our mothers, fathers, brothers, sisters, sons, daughters, aunts, uncles, and neighbors who suffer from this disease. As mayor, John will pledge to work with anyone who wants to help solve this problem.


Just as this campaign is a community effort, this policy plan has been informed by a diverse group of residents, policy makers, and community organizations who reflect Boston's ingenuity, passion, and future. In this policy you will see your voice reflected and your neighborhood priorities front and center. I am incredibly grateful for the hours, data, and guidance leant to support this effort. I welcome continued feedback and suggestions from all corners of the city, because I know that policies are most successful when led by the community.
Now, more than ever, I have the opportunity to bring all voices to the table to create a Boston that brings prosperity and justice for everyone.Together we can create a Boston where nobody is left behind.
Thank you for reading and helping to shape Boston's future, I look forward to working with you.