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According to the Boston Public Health Commission, preliminary data shows 120 people died from opioid overdoses last year.
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Now that's down 29% from 2024.
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A new vending machine is up and running in Boston, and what's inside could be life-saving.
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Vending machines that dispense overdose reversing medication.
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A first of its kind fund to help families grieve and put to rest people they've lost.
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Boston created both of these.
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But what's worth understanding is how the city decided to.
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In 2022, when billions in opioid settlement dollars began flowing into cities and jurisdictions across the country, every one of them faced the same question: What do we actually do with our money?
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Boston's answer was instead to ask a question of its own: What do the people of our city actually need?
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Before spending the funds, the city sat down with more than 600 residents, reviewed surveys, read letters, held listening sessions, and then built what they asked for.
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What was the outcome of this community engagement?
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Well, it resulted in a few meaningful and focused actions.
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One was setting up naloxone in saver use kits and vending machines, tucked inside trusted neighborhood health centers, available even after the doors close for the night.
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Another was the First in the Nation fund for grieving families.
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What we heard was that if we're going to use the opioid settlement dollars in any way that's most meaningful, then we need to allocate money first and foremost to families who had lost loved ones.
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And then the city handed grants to the community organizations that have done this work for decades.
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The result?
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Boston just recorded its fewest opioid overdose deaths in a decade, down 56% from its peak in 2023.
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This is Empathy Affect, Force Marsh Media's podcast that explores the human side of government.
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I'm Melissa Szyzinski, and our guest is one of the people turning that settlement money into effective programs on the ground.
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Christian Arthur is a senior policy and strategy specialist in Boston Public Health Commission's Recovery Services Bureau.
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And he's a clinician who knows this work from the inside as someone in long-term recovery himself.
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Today we get into how one city listened first, spent with intention, and what might other states, counties, and cities might take from it.
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Christian, welcome to Empathy Affect.
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Thank you for taking the time to join us today to share a bit about the very important work you do for the people of Boston.
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Yeah, thanks so much, uh Melissa, for having me here to talk about that work.
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Of course.
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So as senior policy and strategy specialist in Boston's Recovery Services Bureau, I'd love to know what that work actually involves and where does policy and strategy meet the work on the ground?
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Sure.
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So in my role, I do work tightly with the policymakers.
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And just like you said, rolling it out and bringing it to the street in the form of programming.
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So BPHC strategy, I mean, core to our mission is health equity, partnering with communities.
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More recently, we did the OPOA settlements assessment, and from there, there were priorities that were lifted up.
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And so for me and my job, uh I try and translate that to programming.
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So what is that?
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What does that actually look like?
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It has looked like launching community overdose prevention grants with community agencies.
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It has looked like uh deploying public health vending machines, other kiosks that are used to distribute naloxone, things like that.
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Tangibly, though, like what is what does my work like look like on a day-to-day basis?
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It could range from sitting in a round table with 20 plus agencies, then literally getting my elbows deep in care coordination emails myself, doing some direct care, but it can also look like more sort of macro work, communicating the opioid settlements to to communities and then also listening to them and helping aggregate the results.
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So yeah, thanks for that overview.
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So Boston just recorded its fewest opioid overdose deaths in a decade.
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It's down 56% from its peak in 2023.
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From what it sounds like uh from you, a lot of it's you know, being community informed, uh the settlement funds and the the way you've been able to invest certainly contributes to a lot of that.
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But from where you sit, what's actually behind this turnaround?
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Yeah, so our Department of Public Health released a report about Massachusetts, and they have lifted up drivers such as the expansion of overdose prevention programming, also things like the changing drug supply or how less youth are using substances.
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So this sort of, you know, they they're not in the pipeline to potentially fatally overdose.
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I've certainly been at the front line of the expansion of overdose prevention uh programming in the city of Boston.
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So I've I've seen that expansion for sure.
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Like I said before, uh, we launched five community grants through our settlements.
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They were doing things like naloxone distribution, linking people to care.
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And this was a great opportunity because you know, some of these orgs historically were skeptical of naloxone.
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And we sometimes forget it's only a couple of years, we're like five years maybe away from when there's really a much higher level of skepticism around naloxone.
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But this these grants were an opportunity for folks to get some funding and then to integrate it in.
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And so I think we saw some culture shift there.
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And we're about to launch six more, too, for for what it's worth, uh, community grants.
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Yeah, I don't want to miss the fact that um, you know, community engagement and listening is really key to you know Boston's approach and how you value this work.
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So in 2023, I understand that your bureau led community engagement process to decide how to spend the city settlement money.
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So walk me through what that looked like and what did residents tell you they needed the most?
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Yeah, so we engaged over 600 residents and it was through multiple methods.
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So we did a survey, we also did listening sessions, gave people the opportunity to write letters as well.
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And this was nice because it provided a robust sense of what people wanted.
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We have these different types of data, but then it also was accessible because some people, you know, don't have the time to write out a full letter or just prefer having a dialogue around things.
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So we're really proud of that.
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From this effort, there were some broad buckets like housing support, overdose prevention, family support that were lifted up.
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And then even farther, there were some specific recommendations.
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So, like funding boots on the ground, funding orgs that have been doing the work for a while that have those relationships and they just need more support.
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And then we also specific recommendations, for example, around creating a program that provides financial assistance to families when they've lost someone to overdose.
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So that's just an overview.
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But yeah, we had uh definitely priorities were lifted up.
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Yeah, I love that.
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And the family overdose support fund is really truly something special.
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We'll also chat about that in a second.
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But uh going back to the community grants you were mentioning, I understand that that assessment really informed how to deploy those grants to organizations in neighborhoods hit hardest by overdose.
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So after you know, doing the assessment, setting this groundwork, how did you decide where the money goes?
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And what are those local partners able to do with those grants that the city couldn't do on its own?
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Yeah, so we assembled a committee of people who had been impacted, many of folks who were have lived experience or family members, service providers, and they uh helped score proposals.
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So between that and then also thinking strategically around geography, trying to make sure that the neighborhoods with the highest burden were also getting programming.
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That's what went into deciding uh who ultimately got those contracts.
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And then, yeah, to your point, there's reach that the government would never be able to achieve on its own without partnering with agencies who have decades of experience in these neighborhoods, right?
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So agencies who have relationships with the fit, personal relationships, with the families, with the people who need support that are physically geographically located in the communities so they're accessible, can provide a culturally tailored programming as well.
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So, particularly when thinking about equity, and that was a big priority for this grant program because Black and Latinx folks have the highest rates of overdose.
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That's the only way to do public health, in my opinion, is to partner with the community agencies.
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Absolutely.
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Now getting into the family overdose support fund.
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Notably, I think this is the first of its kind in the country, which is really, really awesome.
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But you were mentioning it helps families who've lost someone from overdose through grief.
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So, where did this idea come from?
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And why did your group decide to lead with the bereaved?
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Yeah, and it was launched in tandem with some other things, but it certainly was right up front.
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And that's in part because it was such a priority in during that community assessment.
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Like through the listening sessions, especially the one that was specifically families, this need for a program that provides financial assistance was lifted up.
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And we've been seeing it in the family for years.
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We had families reach out, they'd say, you know, we don't, we're lower income and we we can't pay for funerals, we can't pay for funeral service, we can't pay to dignify our loved one.
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So we'd always seen that it was, you know, a gap.
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And then in doing a scan, as is common before you're sort of undertaking something new, we saw that there really wasn't a program specifically for this niche, right?
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There are similar programs for for victims of violence, for example, across all the states, but there wasn't one for families who have lost someone to overdose.
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So that was that went into why it was such a high priority.
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Yeah.
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Um, and it's something to not overlook too.
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I think that uh we often focus on the people who, you know, are affected by substance use disorder, who um struggle with addiction, but their families or friends, they they matter a lot too.
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So I appreciate that attention.
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So turning to the uh the public health vending machines now, I think it's really innovative, definitely a really great way to increase access.
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You've put these across the city.
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So can you walk me through, you know, how the idea sort of uh came to fruition?
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What was the thinking?
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Why a vending machine?
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And what does this choice ultimately say about meeting people where they are?
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Yeah.
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So first I'd just like to shout out the great public health work happening across the US, but also just the world, right?
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We were paying attention to this trend of this there's a new intervention.
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It's you know, it's a vending machine and it's a way of getting supplies to people.
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So that definitely went into the why why we did it in the first place.
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But the research was compelling.
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It allows for more discrete access for some people who don't want to get those supplies face to face.
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They might be feeling stigma, right?
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They don't want to get it from someone because they'll feel judged.
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But discreetly accessing a vending machine is a different story.
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It can expand access because you can put them outside.
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And so now when the program shuts down for the day because it's 5 p.m., people gotta, you know, workers gotta go home.
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Folks in the community could still come to that vending machine and get supplies.
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I think it's also a foot in the door, meaning that it's an initial form of engagement.
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And that might lead people to sort of look beyond the vending machine and say, oh, wait, what's in that building?
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And maybe, maybe I should walk in.
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I need help.
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So maybe today is the day that I'll step farther and go in and engage.
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So uh we saw that in the research.
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We've certainly seen that uh in the implementation.
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So I think it's it is doing its job and meeting people where they're at.
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Yeah.
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No pressure if you don't know off the top of your head, but how many vending machines have you put across the city?
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And um, you know, have you been trying to strategically place them in maybe places where you see that there are a disproportionate number of people sort of affected by overdose and substance use disorder?
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Yeah, so we uh have seven as of very recently, and there's always uh intentionality around placing machines, like I said, into the neighborhoods that have experienced disproportionate overdose burden, placing it in proximity to Black and Latinx communities who have experienced disproportionate overdose burden.
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But I'm really proud to say that we have actually placed five of these machines into community health centers.
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So I love working with community health centers.
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I love putting these machines in community health centers because they have long-standing trust with the community and it's a bridge to all sorts of other health care, right?
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Like people who use drugs also need primary care.
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They might need dental care, they they might need uh mental health care.
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And so in working with community health centers, you could get that integration.
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So that's what I'm I'm really excited about, that part of our implementation.
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So yeah, that's really important and um really exciting too.
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So I know that between like this and the family overdose support fund, these are really awesome ways to implement some of those opioid settlement dollars.
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And earlier this year, you drew a pointed contrast with the way the 1990s tobacco settlement dollars got squandered.
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And you've been determined to make sure that this money actually reaches its intended uh people.
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It sounds like, you know, you are being really intentional about it.
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But I'm wondering what are the guardrails that sort of make its reach real?
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And how do you build something that outlasts the settlement money once it runs dry um in 2038?
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Well, uh, you know, 2038 is is 12 years away, so I can't even begin to imagine what the funding looks like then.
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I'm I'm just focused on really getting through there to that point.
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I'll say there's a couple of different things.
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One is it's important to have a big team.
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And the the settlements were a new thing, right?
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So I I've seen it in Massachusetts, it happened here in Boston.
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There's a sort of point where you're like, what do we do with this, right?
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We got to get a team together.
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It's a it's a new thing.
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So we have like over a dozen people over here at BPHC from programmatic to evaluation to admin communication.
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So first things first, it's uh it's important to have a big team, it's a big project, it's a lot of funding.
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Constant feedback loops with the community is super critical, right?
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Like, is the funding getting deployed uh in the ways that people want it, in the ways that people need it?
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So, in addition to simply just always listening and being engaged in the community, we did a recent push with some surveys, with uh some community meetings as well.
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So it's not exactly the scale of our original community assessment, but a bigger effort.
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I also just feel a moral imperative.
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I I consider that a guardrail.
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Like I take this funding really seriously because I mean I've lost people myself.
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I know how much it means to the families who have lost somebody.
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And I try and instill that in people and talking up to our even our contracts saying, like, we have a responsibility, you know, to do this work.
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So I consider that a guardrail as well.
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Yeah.
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I also understand that uh you're someone in long-term recovery yourself.
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So I'd imagine that you also feel like you need to be a good steward of this, and that, you know, I'd imagine you also have a lot, like a lot of empathy for the people who are impacted.
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So uh I definitely sense that in in your response there too.
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I know that Boston is a city that puts a lot of weight on data.
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For instance, uh, you have a public overdose dashboard.
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So from a sort of quantitative perspective, how do you actually know that these investments are working?
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And how is that data helping steer where you go next?
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Well, we've uh, like I said, been strategic in where we're standing up programming under settlements.
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So being attentive to name drop neighborhoods.
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There's Dorchester, Roxbury, South End.
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These are all uh neighborhoods in Boston who've experienced disproportionate overdose burden.
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So strategically placing these programs there, that's an example of following the data.
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The priority on Black and Latinx communities as another example.
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And even more recently, there was some research showing that older black men in particular were dying at higher rates.
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So thinking about who you partner with, tailoring messaging, coordinating around those needs is uh something we've done.
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Yeah.
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I know that it's easy to get caught up with dashboards and data, uh, but you know, throughout this conversation, you've been mentioning that the community engagement, that very like soft skill bit is really important too.
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So how do you balance these data-driven decision-making moments with the human feedback and conversations that you have across the city?
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Well, I think I have to shout out my colleague, uh Katrina Cooley, who co-chairs a health coalition in Roxbury.
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So it's a historically black and brown neighborhood, has had some of the highest rates of overdose.
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And she is out there almost daily with a presence, organizing this health coalition week after week.
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And so that is just a perpetual feedback loop of them lifting up, you know, what the needs are in their community and in Boston.
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So I think it's just it's all about finding those feedback mechanisms.
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And I stand by and encourage health departments to be involved in health coalitions.
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I think it's it's where the community's at.
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Definitely.
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Boston is one of the bigger cities in the country.
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Other cities are probably watching what Boston is doing.
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So if a colleague in another city called you tomorrow to, you know, maybe implement some of what you built in their own location, what's one or two things that you would like to tell them that matters most?
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So I'd like to highlight our implementation of public health vending machines because it's not necessarily something I've seen elsewhere, although I'm sure it's I'm sure it's happening, but we took a very decentralized approach.
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So we were scrappy.
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We we ourselves didn't have a large vending machine sort of budget, but we had some machines and we had community partnerships.
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So the community partners they share the costs with us, right?
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It's it's all a team in terms of supplies, but we provide infrastructure, we provide the machines.
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And I think this is a model that other maybe smaller cities or towns that also find themselves in situations where they need to be scrappy, they could mirror.
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That decentralized approach has a real upside.
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Each partner surveys its own neighborhood and stocks the machines with what the community actually asks for, rather than one identical setup imposed everywhere.
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It's worked out for us.
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We have seven machines on the ground, and so for other particularly smaller cities, I think it could be what check out.
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Yeah, and it's it's really cool to hear that you took like the scrappy approach.
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It doesn't have to be like the biggest lift in the world, sort of go as you go and collaborate with the people who, you know, care about it as well.
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I know that we tend to measure substance use, um, especially with opioids and the drug crisis, in terms of overdose deaths.
00:20:40.720 --> 00:20:53.039
But if you got to define what winning actually looks like for Boston, what healing actually looks like beyond just numbers going down, how would you describe it?
00:20:53.440 --> 00:20:58.480
I mean, staying alive is obviously the most important step, but it's just step one.
00:20:58.640 --> 00:21:03.200
And from there, it's healing, but even farther than that, thriving.
00:21:03.440 --> 00:21:11.680
So, you know, what is thriving, feeling good about yourself, having positive relationships, having a sense of purpose.
00:21:11.920 --> 00:21:18.240
In recovery culture, the value of service to others is also awesome that's that's pretty pervasive.
00:21:18.480 --> 00:21:20.000
How do you measure these things?
00:21:20.160 --> 00:21:28.319
You know, putting my technical hat on, maybe you would do population surveys, but the reality is it's that's super difficult and super expensive.
00:21:28.480 --> 00:21:37.599
So in the meantime, you know, we do things like linkages to care, evaluating the impact of a particular program, community discussions, things like that.
00:21:37.920 --> 00:21:49.759
But when I reflect on my my own personal experience, so like I through through 18 to 26, except for a couple patches, I had you know active substance use disorder.
00:21:49.839 --> 00:21:58.160
And for me, it was particularly struggling with alcohol and um prescriptions of all kinds benzos, opioids, stimulants, things like that.
00:21:58.400 --> 00:22:04.880
And for me, Like I was in sober housing, but I was still, you know, like feeling sort of broken and raw.
00:22:05.519 --> 00:22:14.480
You know, just because you're in sober housing and not using drugs, it didn't mean that I was I was well and uh that necessarily fully healing.
00:22:14.640 --> 00:22:24.319
So for me, I had peer recovery supports, and I also got involved with something called the Phoenix, and they sort of handle physical health.
00:22:24.559 --> 00:22:29.039
And I highlight these things because you don't really necessarily think of them.
00:22:29.119 --> 00:22:39.039
If you're only thinking about treatment as the cure to addiction, you sort of lose sight of some of these other things that help someone in recovery uh initiate and sustain recovery.
00:22:39.359 --> 00:22:46.079
And my personal journey, and it all this is it also uh connects with my personal philosophy.
00:22:46.640 --> 00:22:53.839
I'm a clinician, and so I personally recommend working on these different domains in addition to treatment as well.
00:22:54.160 --> 00:23:07.359
But the city of Boston, I'm I'm happy, also has a similar philosophy in the sense that you know, we fund a back to work, which provides job training to people who are in early recovery.
00:23:07.599 --> 00:23:10.319
We fund, you know, low threshold housing programs.
00:23:10.480 --> 00:23:13.440
There are some great programs in the city, like I mentioned, the Phoenix.
00:23:13.519 --> 00:23:17.599
So BPHC has this uh strategy, live long and well.
00:23:17.839 --> 00:23:24.559
And to answer your question, you know, it's living, it's living long, but it's also living well.
00:23:24.799 --> 00:23:27.599
And so uh that's that's how I would describe winning.
00:23:28.079 --> 00:23:29.759
Yeah, really beautiful.
00:23:29.920 --> 00:23:33.839
I think that I hear this a lot in the recovery space.
00:23:34.000 --> 00:23:41.200
You know, it's it's it's I think as I've I feel like I've said in other conversations too, it's what differentiates recovery from treatment.
00:23:41.359 --> 00:23:45.680
It's uh really a holistic view of how to take care of a person in the long run.
00:23:45.839 --> 00:23:47.599
So I really appreciate it.
00:23:48.079 --> 00:23:50.160
This has been such a thoughtful conversation.
00:23:50.480 --> 00:23:57.839
Thank you for your time and for the care that you and your team are putting into Boston's recovery work.
00:23:58.000 --> 00:24:01.279
I'm grateful that you joined us, and I know that our listeners will be too.
00:24:01.599 --> 00:24:03.599
Thanks so much, Melissa, for the opportunity.
00:24:03.759 --> 00:24:04.559
Thank you.
00:24:06.640 --> 00:24:10.880
Boston might look like one of the biggest, best resource cities in the country.
00:24:11.039 --> 00:24:17.839
But the approach Boston undertook and the process Christian laid out today is something almost any jurisdiction can use.
00:24:18.079 --> 00:24:19.759
It started with listening.
00:24:20.000 --> 00:24:27.119
The city asked people what they needed before it acted, and then kept asking, long after money went out the door.
00:24:27.440 --> 00:24:32.720
That's how you get a fund for grieving families, an naloxone in a neighborhood health center.
00:24:33.039 --> 00:24:36.880
And as Christian was honest about, it didn't take the biggest budget.
00:24:37.119 --> 00:24:38.880
Boston was scrappy.
00:24:39.119 --> 00:24:43.279
A few machines, real partnerships, and people who cared.
00:24:43.440 --> 00:24:47.440
Which means the bar to start it is lower than most places may think.
00:24:47.680 --> 00:24:52.160
If this episode sparked inspiration or hope, help someone else find it.
00:24:52.400 --> 00:24:58.960
Follow Empathy Affect wherever you listen, leave us a review, and share it with someone who should hear it.
00:24:59.279 --> 00:25:05.519
And if you or someone you love is struggling, remember that help is available right now at 988.
00:25:05.920 --> 00:25:11.599
Or reach the SAMHSA National Helpline at 1-800-662-HELP.
00:25:12.160 --> 00:25:14.480
Stay well and take care of each other.
00:25:14.640 --> 00:25:16.240
I hope you'll join me next time.
00:25:16.400 --> 00:25:17.599
Thanks, y'all.
00:25:20.000 --> 00:25:22.640
Empathy Effect is a product of Forrest Marsh.
00:25:22.960 --> 00:25:29.680
You can reach us at Forzmarsh Media at forzmarsh.com with any feedback, questions, or inquiries.
00:25:29.920 --> 00:25:39.279
If you want to know more about today's guest, are interested in participating with Forrest Marsh, or becoming part of our community, check out our show notes for more information.
00:00:02.560 --> 00:00:10.800
According to the Boston Public Health Commission, preliminary data shows 120 people died from opioid overdoses last year.
00:00:10.960 --> 00:00:14.560
Now that's down 29% from 2024.
00:00:15.119 --> 00:00:20.960
A new vending machine is up and running in Boston, and what's inside could be life-saving.
00:00:22.559 --> 00:00:26.320
Vending machines that dispense overdose reversing medication.
00:00:26.719 --> 00:00:32.320
A first of its kind fund to help families grieve and put to rest people they've lost.
00:00:32.640 --> 00:00:34.880
Boston created both of these.
00:00:35.600 --> 00:00:39.920
But what's worth understanding is how the city decided to.
00:00:40.719 --> 00:00:54.159
In 2022, when billions in opioid settlement dollars began flowing into cities and jurisdictions across the country, every one of them faced the same question: What do we actually do with our money?
00:00:54.479 --> 00:01:02.000
Boston's answer was instead to ask a question of its own: What do the people of our city actually need?
00:01:05.200 --> 00:01:15.840
Before spending the funds, the city sat down with more than 600 residents, reviewed surveys, read letters, held listening sessions, and then built what they asked for.
00:01:16.079 --> 00:01:19.040
What was the outcome of this community engagement?
00:01:19.280 --> 00:01:23.439
Well, it resulted in a few meaningful and focused actions.
00:01:24.000 --> 00:01:34.319
One was setting up naloxone in saver use kits and vending machines, tucked inside trusted neighborhood health centers, available even after the doors close for the night.
00:01:42.480 --> 00:01:46.239
Another was the First in the Nation fund for grieving families.
00:01:46.799 --> 00:01:58.480
What we heard was that if we're going to use the opioid settlement dollars in any way that's most meaningful, then we need to allocate money first and foremost to families who had lost loved ones.
00:01:58.799 --> 00:02:04.560
And then the city handed grants to the community organizations that have done this work for decades.
00:02:05.040 --> 00:02:05.680
The result?
00:02:06.239 --> 00:02:14.240
Boston just recorded its fewest opioid overdose deaths in a decade, down 56% from its peak in 2023.
00:02:17.599 --> 00:02:23.120
This is Empathy Affect, Force Marsh Media's podcast that explores the human side of government.
00:02:23.280 --> 00:02:30.800
I'm Melissa Szyzinski, and our guest is one of the people turning that settlement money into effective programs on the ground.
00:02:31.039 --> 00:02:38.719
Christian Arthur is a senior policy and strategy specialist in Boston Public Health Commission's Recovery Services Bureau.
00:02:38.960 --> 00:02:45.280
And he's a clinician who knows this work from the inside as someone in long-term recovery himself.
00:02:45.680 --> 00:02:55.840
Today we get into how one city listened first, spent with intention, and what might other states, counties, and cities might take from it.
00:02:58.479 --> 00:03:00.719
Christian, welcome to Empathy Affect.
00:03:00.879 --> 00:03:07.039
Thank you for taking the time to join us today to share a bit about the very important work you do for the people of Boston.
00:03:07.360 --> 00:03:11.120
Yeah, thanks so much, uh Melissa, for having me here to talk about that work.
00:03:11.520 --> 00:03:12.319
Of course.
00:03:12.639 --> 00:03:25.840
So as senior policy and strategy specialist in Boston's Recovery Services Bureau, I'd love to know what that work actually involves and where does policy and strategy meet the work on the ground?
00:03:26.240 --> 00:03:26.800
Sure.
00:03:27.199 --> 00:03:31.360
So in my role, I do work tightly with the policymakers.
00:03:31.599 --> 00:03:37.199
And just like you said, rolling it out and bringing it to the street in the form of programming.
00:03:37.520 --> 00:03:43.840
So BPHC strategy, I mean, core to our mission is health equity, partnering with communities.
00:03:44.080 --> 00:03:50.240
More recently, we did the OPOA settlements assessment, and from there, there were priorities that were lifted up.
00:03:50.319 --> 00:03:54.400
And so for me and my job, uh I try and translate that to programming.
00:03:54.560 --> 00:03:55.360
So what is that?
00:03:55.520 --> 00:03:56.800
What does that actually look like?
00:03:56.960 --> 00:04:02.479
It has looked like launching community overdose prevention grants with community agencies.
00:04:02.639 --> 00:04:10.800
It has looked like uh deploying public health vending machines, other kiosks that are used to distribute naloxone, things like that.
00:04:11.039 --> 00:04:15.840
Tangibly, though, like what is what does my work like look like on a day-to-day basis?
00:04:16.000 --> 00:04:36.319
It could range from sitting in a round table with 20 plus agencies, then literally getting my elbows deep in care coordination emails myself, doing some direct care, but it can also look like more sort of macro work, communicating the opioid settlements to to communities and then also listening to them and helping aggregate the results.
00:04:36.480 --> 00:04:39.120
So yeah, thanks for that overview.
00:04:39.439 --> 00:04:44.240
So Boston just recorded its fewest opioid overdose deaths in a decade.
00:04:44.399 --> 00:04:48.319
It's down 56% from its peak in 2023.
00:04:48.639 --> 00:04:59.199
From what it sounds like uh from you, a lot of it's you know, being community informed, uh the settlement funds and the the way you've been able to invest certainly contributes to a lot of that.
00:04:59.439 --> 00:05:03.360
But from where you sit, what's actually behind this turnaround?
00:05:03.759 --> 00:05:19.439
Yeah, so our Department of Public Health released a report about Massachusetts, and they have lifted up drivers such as the expansion of overdose prevention programming, also things like the changing drug supply or how less youth are using substances.
00:05:19.600 --> 00:05:24.240
So this sort of, you know, they they're not in the pipeline to potentially fatally overdose.
00:05:24.480 --> 00:05:30.160
I've certainly been at the front line of the expansion of overdose prevention uh programming in the city of Boston.
00:05:30.240 --> 00:05:32.639
So I've I've seen that expansion for sure.
00:05:32.879 --> 00:05:38.240
Like I said before, uh, we launched five community grants through our settlements.
00:05:38.319 --> 00:05:42.560
They were doing things like naloxone distribution, linking people to care.
00:05:42.879 --> 00:05:51.360
And this was a great opportunity because you know, some of these orgs historically were skeptical of naloxone.
00:05:51.439 --> 00:05:59.519
And we sometimes forget it's only a couple of years, we're like five years maybe away from when there's really a much higher level of skepticism around naloxone.
00:05:59.600 --> 00:06:05.040
But this these grants were an opportunity for folks to get some funding and then to integrate it in.
00:06:05.199 --> 00:06:07.120
And so I think we saw some culture shift there.
00:06:07.199 --> 00:06:11.279
And we're about to launch six more, too, for for what it's worth, uh, community grants.
00:06:11.839 --> 00:06:21.519
Yeah, I don't want to miss the fact that um, you know, community engagement and listening is really key to you know Boston's approach and how you value this work.
00:06:21.839 --> 00:06:30.720
So in 2023, I understand that your bureau led community engagement process to decide how to spend the city settlement money.
00:06:30.959 --> 00:06:36.160
So walk me through what that looked like and what did residents tell you they needed the most?
00:06:36.800 --> 00:06:43.839
Yeah, so we engaged over 600 residents and it was through multiple methods.
00:06:44.079 --> 00:06:50.639
So we did a survey, we also did listening sessions, gave people the opportunity to write letters as well.
00:06:50.800 --> 00:06:55.839
And this was nice because it provided a robust sense of what people wanted.
00:06:56.000 --> 00:07:07.120
We have these different types of data, but then it also was accessible because some people, you know, don't have the time to write out a full letter or just prefer having a dialogue around things.
00:07:07.279 --> 00:07:09.199
So we're really proud of that.
00:07:09.519 --> 00:07:16.399
From this effort, there were some broad buckets like housing support, overdose prevention, family support that were lifted up.
00:07:16.480 --> 00:07:19.519
And then even farther, there were some specific recommendations.
00:07:19.600 --> 00:07:28.480
So, like funding boots on the ground, funding orgs that have been doing the work for a while that have those relationships and they just need more support.
00:07:28.639 --> 00:07:38.800
And then we also specific recommendations, for example, around creating a program that provides financial assistance to families when they've lost someone to overdose.
00:07:38.959 --> 00:07:40.240
So that's just an overview.
00:07:40.319 --> 00:07:43.680
But yeah, we had uh definitely priorities were lifted up.
00:07:44.000 --> 00:07:45.279
Yeah, I love that.
00:07:45.519 --> 00:07:49.839
And the family overdose support fund is really truly something special.
00:07:50.079 --> 00:07:52.319
We'll also chat about that in a second.
00:07:52.560 --> 00:08:05.759
But uh going back to the community grants you were mentioning, I understand that that assessment really informed how to deploy those grants to organizations in neighborhoods hit hardest by overdose.
00:08:06.000 --> 00:08:12.560
So after you know, doing the assessment, setting this groundwork, how did you decide where the money goes?
00:08:12.720 --> 00:08:19.199
And what are those local partners able to do with those grants that the city couldn't do on its own?
00:08:19.519 --> 00:08:32.879
Yeah, so we assembled a committee of people who had been impacted, many of folks who were have lived experience or family members, service providers, and they uh helped score proposals.
00:08:33.120 --> 00:08:41.840
So between that and then also thinking strategically around geography, trying to make sure that the neighborhoods with the highest burden were also getting programming.
00:08:42.080 --> 00:08:46.480
That's what went into deciding uh who ultimately got those contracts.
00:08:46.720 --> 00:08:59.600
And then, yeah, to your point, there's reach that the government would never be able to achieve on its own without partnering with agencies who have decades of experience in these neighborhoods, right?
00:08:59.679 --> 00:09:14.639
So agencies who have relationships with the fit, personal relationships, with the families, with the people who need support that are physically geographically located in the communities so they're accessible, can provide a culturally tailored programming as well.
00:09:14.720 --> 00:09:24.720
So, particularly when thinking about equity, and that was a big priority for this grant program because Black and Latinx folks have the highest rates of overdose.
00:09:24.879 --> 00:09:29.759
That's the only way to do public health, in my opinion, is to partner with the community agencies.
00:09:30.080 --> 00:09:31.200
Absolutely.
00:09:31.600 --> 00:09:34.639
Now getting into the family overdose support fund.
00:09:35.039 --> 00:09:40.080
Notably, I think this is the first of its kind in the country, which is really, really awesome.
00:09:40.320 --> 00:09:45.759
But you were mentioning it helps families who've lost someone from overdose through grief.
00:09:45.919 --> 00:09:48.320
So, where did this idea come from?
00:09:48.559 --> 00:09:52.799
And why did your group decide to lead with the bereaved?
00:09:53.200 --> 00:09:58.320
Yeah, and it was launched in tandem with some other things, but it certainly was right up front.
00:09:58.399 --> 00:10:02.559
And that's in part because it was such a priority in during that community assessment.
00:10:02.639 --> 00:10:12.240
Like through the listening sessions, especially the one that was specifically families, this need for a program that provides financial assistance was lifted up.
00:10:12.480 --> 00:10:14.399
And we've been seeing it in the family for years.
00:10:14.559 --> 00:10:24.639
We had families reach out, they'd say, you know, we don't, we're lower income and we we can't pay for funerals, we can't pay for funeral service, we can't pay to dignify our loved one.
00:10:24.879 --> 00:10:28.080
So we'd always seen that it was, you know, a gap.
00:10:28.240 --> 00:10:38.799
And then in doing a scan, as is common before you're sort of undertaking something new, we saw that there really wasn't a program specifically for this niche, right?
00:10:38.879 --> 00:10:47.919
There are similar programs for for victims of violence, for example, across all the states, but there wasn't one for families who have lost someone to overdose.
00:10:48.159 --> 00:10:51.840
So that was that went into why it was such a high priority.
00:10:52.240 --> 00:10:52.559
Yeah.
00:10:52.639 --> 00:10:55.200
Um, and it's something to not overlook too.
00:10:55.360 --> 00:11:07.200
I think that uh we often focus on the people who, you know, are affected by substance use disorder, who um struggle with addiction, but their families or friends, they they matter a lot too.
00:11:07.279 --> 00:11:09.200
So I appreciate that attention.
00:11:09.519 --> 00:11:18.960
So turning to the uh the public health vending machines now, I think it's really innovative, definitely a really great way to increase access.
00:11:19.360 --> 00:11:20.879
You've put these across the city.
00:11:21.039 --> 00:11:26.639
So can you walk me through, you know, how the idea sort of uh came to fruition?
00:11:27.200 --> 00:11:28.399
What was the thinking?
00:11:28.559 --> 00:11:30.240
Why a vending machine?
00:11:30.480 --> 00:11:35.519
And what does this choice ultimately say about meeting people where they are?
00:11:35.919 --> 00:11:36.159
Yeah.
00:11:36.320 --> 00:11:44.320
So first I'd just like to shout out the great public health work happening across the US, but also just the world, right?
00:11:44.480 --> 00:11:48.320
We were paying attention to this trend of this there's a new intervention.
00:11:48.399 --> 00:11:52.399
It's you know, it's a vending machine and it's a way of getting supplies to people.
00:11:52.639 --> 00:11:56.960
So that definitely went into the why why we did it in the first place.
00:11:57.120 --> 00:11:58.960
But the research was compelling.
00:11:59.200 --> 00:12:05.360
It allows for more discrete access for some people who don't want to get those supplies face to face.
00:12:05.440 --> 00:12:06.720
They might be feeling stigma, right?
00:12:06.799 --> 00:12:09.519
They don't want to get it from someone because they'll feel judged.
00:12:09.759 --> 00:12:13.120
But discreetly accessing a vending machine is a different story.
00:12:13.279 --> 00:12:16.000
It can expand access because you can put them outside.
00:12:16.080 --> 00:12:21.200
And so now when the program shuts down for the day because it's 5 p.m., people gotta, you know, workers gotta go home.
00:12:21.440 --> 00:12:25.440
Folks in the community could still come to that vending machine and get supplies.
00:12:25.679 --> 00:12:30.559
I think it's also a foot in the door, meaning that it's an initial form of engagement.
00:12:30.639 --> 00:12:35.840
And that might lead people to sort of look beyond the vending machine and say, oh, wait, what's in that building?
00:12:36.000 --> 00:12:37.440
And maybe, maybe I should walk in.
00:12:37.519 --> 00:12:38.000
I need help.
00:12:38.080 --> 00:12:41.919
So maybe today is the day that I'll step farther and go in and engage.
00:12:42.080 --> 00:12:43.759
So uh we saw that in the research.
00:12:43.840 --> 00:12:46.080
We've certainly seen that uh in the implementation.
00:12:46.240 --> 00:12:50.480
So I think it's it is doing its job and meeting people where they're at.
00:12:50.799 --> 00:12:51.440
Yeah.
00:12:51.919 --> 00:12:57.200
No pressure if you don't know off the top of your head, but how many vending machines have you put across the city?
00:12:57.279 --> 00:13:09.120
And um, you know, have you been trying to strategically place them in maybe places where you see that there are a disproportionate number of people sort of affected by overdose and substance use disorder?
00:13:09.600 --> 00:13:29.759
Yeah, so we uh have seven as of very recently, and there's always uh intentionality around placing machines, like I said, into the neighborhoods that have experienced disproportionate overdose burden, placing it in proximity to Black and Latinx communities who have experienced disproportionate overdose burden.
00:13:30.080 --> 00:13:35.519
But I'm really proud to say that we have actually placed five of these machines into community health centers.
00:13:35.679 --> 00:13:38.799
So I love working with community health centers.
00:13:38.960 --> 00:13:49.039
I love putting these machines in community health centers because they have long-standing trust with the community and it's a bridge to all sorts of other health care, right?
00:13:49.120 --> 00:13:52.159
Like people who use drugs also need primary care.
00:13:52.320 --> 00:13:56.559
They might need dental care, they they might need uh mental health care.
00:13:56.720 --> 00:14:00.480
And so in working with community health centers, you could get that integration.
00:14:00.559 --> 00:14:03.759
So that's what I'm I'm really excited about, that part of our implementation.
00:14:03.840 --> 00:14:07.759
So yeah, that's really important and um really exciting too.
00:14:08.080 --> 00:14:17.440
So I know that between like this and the family overdose support fund, these are really awesome ways to implement some of those opioid settlement dollars.
00:14:17.679 --> 00:14:25.519
And earlier this year, you drew a pointed contrast with the way the 1990s tobacco settlement dollars got squandered.
00:14:25.759 --> 00:14:32.240
And you've been determined to make sure that this money actually reaches its intended uh people.
00:14:32.399 --> 00:14:35.759
It sounds like, you know, you are being really intentional about it.
00:14:36.000 --> 00:14:42.000
But I'm wondering what are the guardrails that sort of make its reach real?
00:14:42.159 --> 00:14:49.120
And how do you build something that outlasts the settlement money once it runs dry um in 2038?
00:14:50.080 --> 00:14:56.480
Well, uh, you know, 2038 is is 12 years away, so I can't even begin to imagine what the funding looks like then.
00:14:56.639 --> 00:15:00.960
I'm I'm just focused on really getting through there to that point.
00:15:01.200 --> 00:15:02.720
I'll say there's a couple of different things.
00:15:02.879 --> 00:15:04.639
One is it's important to have a big team.
00:15:04.799 --> 00:15:07.919
And the the settlements were a new thing, right?
00:15:08.080 --> 00:15:11.679
So I I've seen it in Massachusetts, it happened here in Boston.
00:15:11.919 --> 00:15:14.960
There's a sort of point where you're like, what do we do with this, right?
00:15:15.039 --> 00:15:16.080
We got to get a team together.
00:15:16.159 --> 00:15:16.960
It's a it's a new thing.
00:15:17.120 --> 00:15:23.360
So we have like over a dozen people over here at BPHC from programmatic to evaluation to admin communication.
00:15:23.519 --> 00:15:27.840
So first things first, it's uh it's important to have a big team, it's a big project, it's a lot of funding.
00:15:28.159 --> 00:15:31.759
Constant feedback loops with the community is super critical, right?
00:15:31.919 --> 00:15:37.519
Like, is the funding getting deployed uh in the ways that people want it, in the ways that people need it?
00:15:37.759 --> 00:15:48.480
So, in addition to simply just always listening and being engaged in the community, we did a recent push with some surveys, with uh some community meetings as well.
00:15:48.639 --> 00:15:54.159
So it's not exactly the scale of our original community assessment, but a bigger effort.
00:15:54.320 --> 00:15:56.639
I also just feel a moral imperative.
00:15:56.960 --> 00:15:58.639
I I consider that a guardrail.
00:15:58.720 --> 00:16:03.279
Like I take this funding really seriously because I mean I've lost people myself.
00:16:03.440 --> 00:16:06.399
I know how much it means to the families who have lost somebody.
00:16:06.559 --> 00:16:12.879
And I try and instill that in people and talking up to our even our contracts saying, like, we have a responsibility, you know, to do this work.
00:16:12.960 --> 00:16:15.120
So I consider that a guardrail as well.
00:16:15.600 --> 00:16:16.000
Yeah.
00:16:16.240 --> 00:16:20.000
I also understand that uh you're someone in long-term recovery yourself.
00:16:20.159 --> 00:16:30.399
So I'd imagine that you also feel like you need to be a good steward of this, and that, you know, I'd imagine you also have a lot, like a lot of empathy for the people who are impacted.
00:16:30.720 --> 00:16:34.639
So uh I definitely sense that in in your response there too.
00:16:35.200 --> 00:16:40.080
I know that Boston is a city that puts a lot of weight on data.
00:16:40.320 --> 00:16:44.639
For instance, uh, you have a public overdose dashboard.
00:16:44.960 --> 00:16:52.799
So from a sort of quantitative perspective, how do you actually know that these investments are working?
00:16:52.960 --> 00:16:56.480
And how is that data helping steer where you go next?
00:16:56.879 --> 00:17:04.319
Well, we've uh, like I said, been strategic in where we're standing up programming under settlements.
00:17:04.640 --> 00:17:08.720
So being attentive to name drop neighborhoods.
00:17:08.880 --> 00:17:11.119
There's Dorchester, Roxbury, South End.
00:17:11.279 --> 00:17:15.839
These are all uh neighborhoods in Boston who've experienced disproportionate overdose burden.
00:17:16.079 --> 00:17:21.599
So strategically placing these programs there, that's an example of following the data.
00:17:21.839 --> 00:17:26.400
The priority on Black and Latinx communities as another example.
00:17:26.559 --> 00:17:33.039
And even more recently, there was some research showing that older black men in particular were dying at higher rates.
00:17:33.200 --> 00:17:40.880
So thinking about who you partner with, tailoring messaging, coordinating around those needs is uh something we've done.
00:17:41.359 --> 00:17:42.000
Yeah.
00:17:42.240 --> 00:17:54.079
I know that it's easy to get caught up with dashboards and data, uh, but you know, throughout this conversation, you've been mentioning that the community engagement, that very like soft skill bit is really important too.
00:17:54.160 --> 00:18:02.559
So how do you balance these data-driven decision-making moments with the human feedback and conversations that you have across the city?
00:18:03.119 --> 00:18:11.599
Well, I think I have to shout out my colleague, uh Katrina Cooley, who co-chairs a health coalition in Roxbury.
00:18:11.759 --> 00:18:17.200
So it's a historically black and brown neighborhood, has had some of the highest rates of overdose.
00:18:17.440 --> 00:18:24.559
And she is out there almost daily with a presence, organizing this health coalition week after week.
00:18:24.640 --> 00:18:32.000
And so that is just a perpetual feedback loop of them lifting up, you know, what the needs are in their community and in Boston.
00:18:32.160 --> 00:18:36.400
So I think it's just it's all about finding those feedback mechanisms.
00:18:36.559 --> 00:18:41.519
And I stand by and encourage health departments to be involved in health coalitions.
00:18:41.599 --> 00:18:43.519
I think it's it's where the community's at.
00:18:43.920 --> 00:18:45.039
Definitely.
00:18:45.440 --> 00:18:48.720
Boston is one of the bigger cities in the country.
00:18:48.880 --> 00:18:51.920
Other cities are probably watching what Boston is doing.
00:18:52.240 --> 00:19:05.519
So if a colleague in another city called you tomorrow to, you know, maybe implement some of what you built in their own location, what's one or two things that you would like to tell them that matters most?
00:19:05.920 --> 00:19:18.319
So I'd like to highlight our implementation of public health vending machines because it's not necessarily something I've seen elsewhere, although I'm sure it's I'm sure it's happening, but we took a very decentralized approach.
00:19:18.720 --> 00:19:20.480
So we were scrappy.
00:19:20.559 --> 00:19:30.720
We we ourselves didn't have a large vending machine sort of budget, but we had some machines and we had community partnerships.
00:19:31.039 --> 00:19:35.359
So the community partners they share the costs with us, right?
00:19:35.440 --> 00:19:41.839
It's it's all a team in terms of supplies, but we provide infrastructure, we provide the machines.
00:19:42.079 --> 00:19:52.960
And I think this is a model that other maybe smaller cities or towns that also find themselves in situations where they need to be scrappy, they could mirror.
00:19:54.480 --> 00:19:57.920
That decentralized approach has a real upside.
00:19:58.079 --> 00:20:08.720
Each partner surveys its own neighborhood and stocks the machines with what the community actually asks for, rather than one identical setup imposed everywhere.
00:20:10.240 --> 00:20:11.359
It's worked out for us.
00:20:11.440 --> 00:20:16.559
We have seven machines on the ground, and so for other particularly smaller cities, I think it could be what check out.
00:20:16.960 --> 00:20:21.359
Yeah, and it's it's really cool to hear that you took like the scrappy approach.
00:20:21.440 --> 00:20:29.920
It doesn't have to be like the biggest lift in the world, sort of go as you go and collaborate with the people who, you know, care about it as well.
00:20:30.400 --> 00:20:40.480
I know that we tend to measure substance use, um, especially with opioids and the drug crisis, in terms of overdose deaths.
00:20:40.720 --> 00:20:53.039
But if you got to define what winning actually looks like for Boston, what healing actually looks like beyond just numbers going down, how would you describe it?
00:20:53.440 --> 00:20:58.480
I mean, staying alive is obviously the most important step, but it's just step one.
00:20:58.640 --> 00:21:03.200
And from there, it's healing, but even farther than that, thriving.
00:21:03.440 --> 00:21:11.680
So, you know, what is thriving, feeling good about yourself, having positive relationships, having a sense of purpose.
00:21:11.920 --> 00:21:18.240
In recovery culture, the value of service to others is also awesome that's that's pretty pervasive.
00:21:18.480 --> 00:21:20.000
How do you measure these things?
00:21:20.160 --> 00:21:28.319
You know, putting my technical hat on, maybe you would do population surveys, but the reality is it's that's super difficult and super expensive.
00:21:28.480 --> 00:21:37.599
So in the meantime, you know, we do things like linkages to care, evaluating the impact of a particular program, community discussions, things like that.
00:21:37.920 --> 00:21:49.759
But when I reflect on my my own personal experience, so like I through through 18 to 26, except for a couple patches, I had you know active substance use disorder.
00:21:49.839 --> 00:21:58.160
And for me, it was particularly struggling with alcohol and um prescriptions of all kinds benzos, opioids, stimulants, things like that.
00:21:58.400 --> 00:22:04.880
And for me, Like I was in sober housing, but I was still, you know, like feeling sort of broken and raw.
00:22:05.519 --> 00:22:14.480
You know, just because you're in sober housing and not using drugs, it didn't mean that I was I was well and uh that necessarily fully healing.
00:22:14.640 --> 00:22:24.319
So for me, I had peer recovery supports, and I also got involved with something called the Phoenix, and they sort of handle physical health.
00:22:24.559 --> 00:22:29.039
And I highlight these things because you don't really necessarily think of them.
00:22:29.119 --> 00:22:39.039
If you're only thinking about treatment as the cure to addiction, you sort of lose sight of some of these other things that help someone in recovery uh initiate and sustain recovery.
00:22:39.359 --> 00:22:46.079
And my personal journey, and it all this is it also uh connects with my personal philosophy.
00:22:46.640 --> 00:22:53.839
I'm a clinician, and so I personally recommend working on these different domains in addition to treatment as well.
00:22:54.160 --> 00:23:07.359
But the city of Boston, I'm I'm happy, also has a similar philosophy in the sense that you know, we fund a back to work, which provides job training to people who are in early recovery.
00:23:07.599 --> 00:23:10.319
We fund, you know, low threshold housing programs.
00:23:10.480 --> 00:23:13.440
There are some great programs in the city, like I mentioned, the Phoenix.
00:23:13.519 --> 00:23:17.599
So BPHC has this uh strategy, live long and well.
00:23:17.839 --> 00:23:24.559
And to answer your question, you know, it's living, it's living long, but it's also living well.
00:23:24.799 --> 00:23:27.599
And so uh that's that's how I would describe winning.
00:23:28.079 --> 00:23:29.759
Yeah, really beautiful.
00:23:29.920 --> 00:23:33.839
I think that I hear this a lot in the recovery space.
00:23:34.000 --> 00:23:41.200
You know, it's it's it's I think as I've I feel like I've said in other conversations too, it's what differentiates recovery from treatment.
00:23:41.359 --> 00:23:45.680
It's uh really a holistic view of how to take care of a person in the long run.
00:23:45.839 --> 00:23:47.599
So I really appreciate it.
00:23:48.079 --> 00:23:50.160
This has been such a thoughtful conversation.
00:23:50.480 --> 00:23:57.839
Thank you for your time and for the care that you and your team are putting into Boston's recovery work.
00:23:58.000 --> 00:24:01.279
I'm grateful that you joined us, and I know that our listeners will be too.
00:24:01.599 --> 00:24:03.599
Thanks so much, Melissa, for the opportunity.
00:24:03.759 --> 00:24:04.559
Thank you.
00:24:06.640 --> 00:24:10.880
Boston might look like one of the biggest, best resource cities in the country.
00:24:11.039 --> 00:24:17.839
But the approach Boston undertook and the process Christian laid out today is something almost any jurisdiction can use.
00:24:18.079 --> 00:24:19.759
It started with listening.
00:24:20.000 --> 00:24:27.119
The city asked people what they needed before it acted, and then kept asking, long after money went out the door.
00:24:27.440 --> 00:24:32.720
That's how you get a fund for grieving families, an naloxone in a neighborhood health center.
00:24:33.039 --> 00:24:36.880
And as Christian was honest about, it didn't take the biggest budget.
00:24:37.119 --> 00:24:38.880
Boston was scrappy.
00:24:39.119 --> 00:24:43.279
A few machines, real partnerships, and people who cared.
00:24:43.440 --> 00:24:47.440
Which means the bar to start it is lower than most places may think.
00:24:47.680 --> 00:24:52.160
If this episode sparked inspiration or hope, help someone else find it.
00:24:52.400 --> 00:24:58.960
Follow Empathy Affect wherever you listen, leave us a review, and share it with someone who should hear it.
00:24:59.279 --> 00:25:05.519
And if you or someone you love is struggling, remember that help is available right now at 988.
00:25:05.920 --> 00:25:11.599
Or reach the SAMHSA National Helpline at 1-800-662-HELP.
00:25:12.160 --> 00:25:14.480
Stay well and take care of each other.
00:25:14.640 --> 00:25:16.240
I hope you'll join me next time.
00:25:16.400 --> 00:25:17.599
Thanks, y'all.
00:25:20.000 --> 00:25:22.640
Empathy Effect is a product of Forrest Marsh.
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You can reach us at Forzmarsh Media at forzmarsh.com with any feedback, questions, or inquiries.
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