Thesis Proposal Fall 2023

The

“For me, an area of moral clarity is: you’re in front of someone who’s suffering and you have the tools at your disposal to alleviate that suffering or even eradicate it, and you act.”

— Dr. Paul Farmer

“Architecture, more than any other art form, is a social art and must rest on the social and cultural base of its time and place.”

— Samuel “Sambo” Mockbee

1 European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), “Perspectives on Drugs Drug consumption rooms: an overview of provision and evidence”, (2018)

EXECUTIVE SUMMARY

Graziella Pilkington

Thesis Proposal Fall 2023

617.834.9288

graziella.pilkington@the-bac.edu

Thesis Statement

How can architecture contribute to community healing, and what are the areas in which our communities require healing? The recent experience of the pandemic has shown us the profound impact of anxiety and uncertainty on communities. When anxiety pervades a community, it can give rise to adverse circumstances. Currently, our nation is grappling with an epidemic, but its localized nature means that it often escapes our collective awareness. Yet, for those individuals whose lives are deeply entwined with this crisis, it can feel as though they have nowhere to turn, much like the sense of entrapment we all experienced during the COVID-19 pandemic. We were all searching for guidance in uncertain times. My vision is to create a sanctuary for those who feel trapped and in need of guidance—a safe haven where judgment is absent, and security and safety prevail.

One of the pressing challenges in our communities is the rampant opioid crisis. Many individuals become ensnared in a vicious cycle of addiction, compounded by the stigma surrounding this issue. These individuals require help, and I firmly believe that architecture can serve as a powerful tool for cities to assist people in overcoming their addictions. Real change can only occur when people are not surrounded by negative environments; they need accessible resources and support. Addiction is a disease, and individuals will continue to seek ways to satisfy their cravings. We should consider providing them with a safe space where they can access help when they are ready, on their terms, and use substances safely.

Drug Consumption Rooms (DCRs), as outlined in “Harm Reduction: Evidence, Impacts, and Challenges,” have three primary objectives:

• Creating an environment for safer drug use.

• Enhancing the health status of the target group.

• Reducing public disorder.1 My thesis aims to explore how architecture can offer solutions that address all three of these objectives.

Heart House: The role of architecture in creating a supportive environment for harm reduction, resource access, and reintegration into society.

Framing of the Thesis

The main goal of this project is to save people’s lives with a facility that fosters safe drug using practices and gives resources to people to choose to use when they are ready. But placing a safe drug use facility in a place where people use drugs is not the answer. The project must address much more- considering the context of the site, the people that live there, the culture, the communities, what happens to the people who choose not to use the facility and to the people that do? There are many different scenarios that may occur, and my project must address many of these variables in order to be successful. This investigation is important to the health of our society. If something is not done, or a place is not created for people to go to, then there will never be any change and people will continue to be addicted, hopeless, and likely to overdose and possibly die. This area of investigation not only affects people who use drugs, but also people who are homeless. This affects an entire geographical area and might require an urban plan at a larger scale rather than a simple building. This affects gentrification of an area versus creating resources for the people who need them. This affects the local drug trafficking and dynamic between groups in the community. This will affect crime rates, and mortality rates in both positive and negative ways.

Methods of Inquiry

• How will this project avoid gentrification and displacement by creating resources at a larger scale?

• How will this project facilitate long term care and resources for drug users who decide to take the next step to become clean? (like a post-occupancy study in architecture)

• How will this project address the likely changes in the community such as changes in drug trafficking resulting in higher crime rates?

• How will this project engage with the entire geographical/geopolitical community without becoming a large-scale urban development project?

Terms of Criticism

• What are the mortality rates of drug users now compared to before?

• We’re people displaced? Or did they stay?

• Are people using the resources provided?

Meaning of Heart House

One of Miriam Webster’s Definitions of “heart” is: “Courage or enthusiasm especially when maintained during a difficult situation. | Never lost heart” . To me, the name Heart House embodies courage, comfort, and support through the words, ”Heart, Hearth, and House”. Heart House will create a culture where those in need will find the heart to take the next step into recovery through the medical, emotional, and physical resources provided.

Location

The intersection of Massachusetts Avenue and Melnea Cass Boulevard in Boston, Massachusetts.

1 Centers for Disease Control and Prevention. Drug overdose deaths. December 12, 2022. https:// www.cdc.gov/drugoverdose/deaths/ index.html

2 Centers for Disease Control and Prevention; National Center for Health Statistics. Vital statistics rapid release: provisional drug overdose death counts. January 2022. https:// www.cdc.gov/ nchs/nvss/vsrr/ drug-overdose-data.htm

3 Kral AH, Davidson PJ. Addressing the nation’s opioid epidemic: lessons from an unsanctioned supervised injection site in the U.S. Am J Prev Med. 2017;53(6):919922.

4 National Center for Drug Abuse Statistics (NCDAS). Drug Overdose Death Rates. drugabusestatistics.org/

FACTS & FIGURES

United States

Drug overdose is a leading cause of injury mortality in the United States.

Drug Overdose Deaths:

2021 -- 106,699

2020 -- 93,655

2019 -- 70,630.1, 2

In a study of an unsanctioned supervised injection site in the United States, 90% of people using the site reported that they would otherwise be injecting in a public restroom, street, park, or parking lot. 3

People who regularly use Supervised Injection Sites are less likely to share needles and contract HIV and Hepatitis C .

Supervised Injection Sites may reduce the number of publicly discarded syringes, therefore improving public safety.

5 City of Boston. Mass/Cass Dashboard. dashboard. boston.gov

Boston (Mass & Cass)

Daily Operations:

• 254 people present -- highest average count of individuals July 2, 2023

• 31 people present -- lowest average count of individuals February 26, 2023

• 40 people transported throughout Boston to receive services -- average on November 12, 2023.

0.75 miles of Mass & Cass Intersection January 2022-November 2023:

• 713 Encampments

• 5,145 Needles picked up Syringe Data January 2022 - October 2023:

• 227,246 Syringes taken in

• 94,177 Syringes given out

• 2.41 Syringe return rate

EMS Incidents within 0.75 Mile Radius Since January 12, 2022*

• 33,708 EMS incidents

• 1,500 Squad 80 Responses**

• 15,793 BPD incident reports

Over 96,700 people die from drug overdoses in a year.

Opioids are a factor in 7 out of every 10 overdose deaths.

Drug overdoses have killed almost a million people since 1999.

*This chart includes attributable deaths for each drug; some deaths involve multiple drug types, and percentage totals will exceed 100%.

* January 12th, 2022 marks the date the Mass/ Cass encampments were cleared.

** EMS Squad 80 is a two-person team that travels in an SUV and answers calls where patients have a low frequency of being transported to the ER

FACTS & FIGURES

Europe, North America, & Australia: Supervised injection sites have been legally operating since 19861

83 Drug Consumption Centers in Europe as of June 20232

Vancouver

26% net reduction in overdose deaths in the area surrounding a supervised injection site in Vancouver, Canada, compared with the rest of the city.3

Barcelona

A supervised injection site in Barcelona, Spain, was associated with a 50% reduction in overdose mortality from 1991 to 20081

New York City Stats from OnPoint NYC

4,219 Overdose Prevention Centers (OPC) participants served since launch in November 2021

106,651 OPC Utilizations

1,235 Overdose Interventions

2,000,000 units of hazardous waste collected

1 Gostin LO, Hodge JG, Gulinson CL. Supervised injection facilities: legal and policy reforms. JAMA. 2019;321(8):745746.

2 European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), “Perspectives on Drugs Drug consumption rooms: an overview of provision and evidence”, (2018)

3 Levengood TW, Yoon GH, Davoust MJ, et al. Supervised injection facilities as harm reduction: a systematic review Am J Prev Med. 2021;61(5):738-749.

4 European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). Netherlands Country Drug Report 2017. p. 11

Point of view from a person who comes to the center to use.

It’s about 3 pm on a Tuesday. I am feeling anxious, irritable, and a little nauseous - I need my fix to feel better. I bought some this morning but I want to make sure it’s not laced with anything sketchy. I also don’t have a clean needle. I get up, and walk across the street to Heart House. I’m greeted by the front desk counselorhe asks me what I need. I tell him, “I need a test strip and a needle”. He reaches under the desk and gives me the heroin kit. I proceed down the hall to the injection rooms where there are private stalls- I quickly find the nearest open stall and go in, shut the door, and start by testing my heroin. There are a few doctors set up in the hall, ready with their narcan. The last thing I want is to get narcanned. It’s a horrible experience and obviously ruins my high. It’s nice that I can have my privacy in this place. They don’t bother you unless the alarm goes off. Each stall has a motion detector and if someone is still for longer than 15 seconds, then they come in and check on you. The stalls are comfortable- they are extremely clean, have natural light, the air quality feels good to breathe, and I feel like I can be alone and actually relax here. I only have about 20 minutes in the stall then I have to move on. There are other rooms in the building where I can sit down and relax either alone or with some others. I could also go outside to a private courtyard if it’s nice out. I choose to sit outside and feel the spring sun on my skin for about an hour. On my way out I have to talk to a counselor for about 5-10 minutes about how I’m feeling and what my plans are for the day. I also stop into the cafe and get a hot cup of coffee on my way out. I’m only there for about 1.5 hours a day but it really is the highlight of my day- I’ve made friends with the counselors and I love chatting with them and others who use the space. I’m starting to think about next steps to getting clean.

Client Data

47 1718

This drawing emphasizes the vicious cycle of opioid addiction and all of the factors and variables that go hand in hand with it. The drawing represents different forces that need to be applied both internally and externally of someone’s self in order to make a change. These interconnected elements all converge on the central issue of the opioid epidemic.

HEALTH & WELLNESS

In an age where social issues such as the opioid epidemic, homelessness, and the related challenges of overdose deaths, mental and physical health issues, crime, violence, and lack of resources are ever-present, it becomes the responsibility of both local and global communities to address these critical concerns. One significant cultural contribution is through the creation of safe spaces for people who use drugs and are homeless, tackling issues that permeate urban environments, workplaces, and neighborhoods.

Local and Global Responsibilities:

The opioid epidemic in America has brought to the forefront a national crisis. It has led to an alarming increase in overdose deaths, highlighting the urgent need for comprehensive solutions to address this public health emergency. Local governments and communities, as well as the global community at large, bear a shared responsibility in addressing this epidemic by creating environments that are safe and supportive.

Mental and Physical Health Issues:

Drug addiction and homelessness often go hand in hand, leading to numerous mental and physical health issues. The stigma surrounding drug users and the homeless exacerbates these issues, making it even more critical to provide safe spaces where individuals can seek help, find stability, and access the necessary healthcare and support services.

Wellness in the City/Neighborhood/ Workplace:

The impact of drug addiction and homelessness extends beyond individual experiences to affect the overall wellness of cities, neighborhoods, and workplaces. High crime rates and violence are often linked to areas with a high concentration of vulnerable populations. By creating safe spaces, communities can work toward reducing crime and violence while promoting well-being.

Lack of Resources and Job Opportunities:

Vulnerable populations often face the challenge of limited access to resources and job opportunities, which makes it difficult to escape their current situations. Safe spaces that provide not only shelter but also vocational training and job placement services offer a path to economic self-sufficiency and reintegration into society.

Culture:

The culture of a community plays a pivotal role in shaping the success of initiatives to create safe spaces. The stigma surrounding drug users and the homeless often stems from cultural biases and misconceptions. By shifting this culture towards greater understanding and empathy, the stigmatization can be reduced, fostering a more inclusive society.

Urban Planning and Architecture:

The urban planning of areas like Mass and Cass, notorious for high concentrations of homelessness and drug use, can significantly impact the cultural contributions of safe spaces. The lack of green spaces and shelters in such areas further compounds the problems. Architecture and urban design can make a substantial difference in shaping these environments to promote safety, health, and community integration.

Public Health Issues:

The lack of resources for people struggling with addiction or homelessness reflects broader public health issues. The stigma associated with these conditions contributes to the lack of resources and the cycle of vulnerability. Addressing these issues through the creation of safe spaces has the potential to shift the cultural conversation around public health, emphasizing support and recovery rather than judgment.

In conclusion, creating safe spaces for people who use drugs and are homeless is a profound cultural contribution with far-reaching effects. It carries local and global responsibilities, impacting not only the individuals directly affected but also the broader communities, urban environments, workplaces, and public health discussions. By recognizing the power of architecture, addressing the stigma, and providing comprehensive resources, we can begin to reshape the culture surrounding these critical issues, ultimately leading to healthier, more inclusive societies. This thesis underscores the importance of meaningful work in addressing some of the most pressing societal challenges and serves as a catalyst for cultural change that fosters greater empathy, support, and understanding for those in need.

1 MASS.

Mass & Cass Master Plan massdesigngroup. org

CASE STUDY 1

Mass & Cass Master Plan1

Location: Boston, MA

Architect: MASS.

Status: In Progress

Size: 900,000 sq. ft.

Program: Research into public health solutions for people without homes

Clients: The Mayor’s Working Group on Homelessness and Addiction at the Intersection of Mass Ave. and Melnea Cass Blvd.

The Boston Architectural College Rhode Island School of Design

Problem:

• Massachusetts is the sate with the 7th highest rate of homelessness in the nation

• Deaths from opioid overdose tripled between 2013 and 2017

• Development and inadequate urban planning in the area are leading to widespread gentrification, heightening tension between residents, patients, local businesses, service providers, law enforcement, and local governments.

Goals:

• Provide short and long term solutions to these public health issues.

• Develop holistic and inclusive design solutions.

• Address gaps in facilities and services for those seeking support for addiction or homelessness.

CASE STUDY 2

SAFE SHAPE2

Location: “Pop-up” traveling exhibit

Designers: Greg Scott, Andrew Santa Lucia, ANDORUS, Sawbuck Productions

Status: In Progress

Size: 10’x10’x10’ Pavilion

Program: Pop-up traveling exhibit that operates as a mock drug consumption room (DCR) Clients: To educate the public on the philosophy and practice of harm reduction.

Problem:

Repressive and stigmatizing institutions as a regular response to the opioid crisis.

Goals:

Integration of public health and activist architecture-design is not only achievable but can serve the best interests of the entire community.

Architectural Program: SAFE SHAPE’s floor plan builds upon the various arrangements of space found in the many DCRs operating across the world. Upon entering, the visitor encounters a greeting area and supplies station. From there the visitor is routed to the injection station, where DCR clients can engage in supervised and hygienic injections of pre-obtained drugs. The final stop is the “chill room,” where DCR clients can relax in a low-stress space and also access information on housing, employment, drug treatment, and so forth.

3 Office Andorus SAFE SHAPE and-or.us/SAFESHAPE

2 SAFESHAPE safeshapesif.com

1 PLH Architects Drug Consumption Center, Halmtorvet plh.dk/

CASE STUDY 3

H171

Location: Vesterbro, Copenhagen, DK

Architect: PLH Architects

Status: Opened 2016

Size: 10,760 sq. ft.

Program: Largest Drug Consumption Center in the North where users can take their drugs in safe surroundings and under the supervision of healthcare personnel.

Clients: Approx. 200 users a day

Problem:

• Condition of drug users in Copenhagen

• Problems and discomfort linked to drug abuse in the local community

Goals:

• Provide a safe and clean place where users can take their drugs in secure surroundings.

• Provide healthcare personnel ready to help and give first aid in dangerous situations.

• Provide services such as counseling and guidance in relation to other health related issues, participate in different activities and contact to social workers.

Program: General Requirements

Arrival

• Clear wayfinding on interior and exteriorvisible from the street.

• adequate lighting to prevent dark areas

• spacious indoor conditions to prevent conflict

• unidirectional flow

Drug Recovery Rooms

• must create a framework for safe ingestion of substances and the possibility of bridging other social and health resources for the target group.

• differences of behavior between smokers and injectors should be reflected in the interior design.

• flexible design for possible expansion of programmatic elements.

• maximum visibility for staff.

Access Requirements

• discretion for the users

• establish protocol for open vs closed hours

• access points for removal of hazardous waste and delivery and storage of goods.

• access for ambulances and rescue vehicles

Parking Conditions

• provide x number of spaces for staff

• provide bicycle parking

Programmatic Zoning

Zone A - Reception

• Main entrance for drug intake rooms where staff accepts and registers users

• Conflict Management including: wide, tall, large entrance welcoming, calm atmosphere through colors, light, air, acoustics, ample space to allow users to sit alone, colors separating the waiting area or for the two drug user groups

• visual connection for staff between reception and drug intake rooms.

• access to office-conversation rooms with two escape routes

• mobile phone charging stations

• bathrooms, sinks for hand washing and drinking water.

Zone B - Drug Intake Rooms

• 2 rooms for smoking, 2 rooms for injection

• These rooms must be flexible for future changes of use or possible periodic closure of individual drug intake rooms.

• It must be possible to enter and exit the room without going through other facilities

• All drug intake rooms must follow require-

ments for both smoke and injection. Functions require safe air quality for staff to enter without being exposed to harmful substances.

• Space for a person lying down is required in all rooms

• The possibility of being able to be in peace, to be able to receive first aid and emergency aid as well as health advice is highly valued.

• Nursing rooms are placed in a spatial context with both drug intake sections, furnished with a view and entrance to the injection room as well as the possibility of visual contact with a colleague. The observation facility is integrated in the injection room, and must be able to cover both rooms.

Zone C - Rest, Counseling Rooms

• Primarily for the users’ recovery after drug consumption and relationship-building between staff and users, with which, where appropriate contact with other offers and/ or agencies can be established.

• 3 areas for rest: (1) for those who are waiting for the substance to work, (2) for those who need a nap, shielded from traffic and unrest, (3) integrated into the cafe but slightly screened off from the room

• Exits between zones B and C

• Transition space between drug intake zone and the cafe area

Zone D - Cafe, Kitchen, Activity Rooms

• Purpose of this zone is to establish relationships

• Arranged for 50 seated people with standing tables, cafe tables, individual long tables

• Upholstered furniture is not recommended for hygiene/cleanliness/safety reasons

• Cafe must appear non-committal and welcoming

• Activity room for health-promoting activities, teaching situations for staff, users, volunteers. Can be separated with folding wall

• Hand washing and drinking water stations

• Waste rooms - sorting

Zone E - Staff Facilities

• Staff room for 6-10 people with dining and resting facilities and kitchenette

• Office must be located centrally - preferably around Zone C/D

• Visibility in relation to users but also with distance to staff room, confidential conversations between manager and employee

• Wardrobe and dressing room with access to toilet and shower rooms

• All employees must have lockable wardrobe

• Washer dryer

CASE STUDY 3 CONTINUED

Program:

• Reception

• Injection Facilities

• Smoking Facilities

• Health/GP Clinic, podiatrist

• Classrooms, Cafe, Kitchen, Offices, Staff Rooms

1 PLH Architects Entry + Exit Diagram. Translated by Author.

2 EMCDDA, Drug Related Deaths and mortality among drug users. DRD Annual Expert Meeting. September 2017

CASE STUDY 3

Section 2

Section 1

Section 3

ANNOTATED BIBLIOGRAPHY

Kidder, Tracy. “Rough Sleepers | Dr. Jim O’Connell’s urgent mission to bring healing to homeless people.” Thorndike Press, a Part of Gale, a Cengage Company, 2023.

Over the span of five years, the author of Rough Sleepers follows Doctor Jim O’Connell, “a gifted man who invented a community of care for [Boston’s] unhoused population, including those who sleep on the streets -- the ‘rough sleepers’”. Experiencing first hand the encounters he has with this community, Kidder tells Jim’s story from going to Harvard Medical school to running the night truck and the relationships he develops with the homeless along the way. Almost all of the medical and cultural information shared in this book are only obtainable through real life experience.

Murphy, Michael P., and Jeffrey Mansfield and MASS Design Group. “The Architecture of Health: Hospital Design and the Construction of Dignity”. Cooper-Hewitt Museum, 2021.

The Architecture of Health explores the history of hospital design through diagrams and typologies. The book identifies how to make today’s hospitals safe, dignified, and beautiful by explaining what succeeded and what failed throughout historical case studies across the globe.

Tran, Vincent, et al. “Assessing drug consumption rooms and longer term (5 year) impacts on community and clients”. Risk Management and Healthcare Policy, Volume 14, 15 Nov. 2021, pp. 4639–4647, https:// doi.org/10.2147/rmhp.s244720.

This document assesses the long-term impacts of Drug Consumption Rooms/Safe Injection Facilities through a systematic approach, literature review of published peer-reviewed literature.

Finke J, Chan J. “The Case for Supervised Injection Sites in the United States”. Am Fam Physician. 2022 May 1;105(5):454-455. PMID: 35559640.

A recent (2022) editorial supporting why Supervised Injection Sites are a viable option in the United States. The author backs up their argument with examples of successful injection sites in Europe and North America.

Marshall, Brandon DL et al. “Reduction in overdose mortality after the opening of North America’s first medically supervised safer injecting facility: a retrospective population-based study” The Lancet, Volume 377, Issue 9775, 1429 - 1437.

A study based in Vancouver, BC, Canada to determine whether the opening of an Supervised Injection Facility was associated with a reduction in overdose mortality.

Ng, Jennifer et al. “Does evidence support supervised injection sites?.” Canadian family physician Medecin de famille canadien vol. 63,11 (2017): 866. https://www. ncbi.nlm.nih.gov/pmc/articles/PMC5685449/ “Evidence from cohort and modeling studies suggests that SISs are associated with lower overdose mortality (88 fewer overdose deaths per 100 000 person-years [PYs]), 67% fewer ambulance calls for treating overdoses, and a decrease in HIV infections. Effects on hospitalizations are unknown.”

Spencer MR, Miniño AM, Warner M. “Drug Overdose Deaths in the United States, 2001–2021. NCHS Data Brief, no 457. Hyattsville, MD: National Center for Health Statistics 2022. DOI: https://dx.doi.org/10.15620/ cdc:122556

Data, charts, and graphics on drug overdose deaths in the United States from 2001-2021. Evidence of the epidemics growth in the last 20 years.

Esben Houborg, Marie Jauffret-Roustide, “Drug Consumption Rooms: Welfare State and Diversity in Social Acceptance in Denmark and in France”, American Journal of Public Health 112, no. S2 (April 1, 2022): pp. S159-S165. https://doi.org/10.2105/ AJPH.2022.306808. PMID: 35349316

Two case studies based in Copenhagen, Denmark and Paris, France. Study includes discussion on political challenges and stigmatization.

Kappel, N., Toth, E., Tegner, J. et al. “A qualitative study of how Danish drug consumption rooms influence health and well-being among people who use drugs.” Harm Reduct J 13, 20 (2016). https://doi.org/10.1186/ s12954-016-0109-y

A very comprehensive study including social acceptance, health and wellbeing, and bridge building between DCRs and other sectors.

Interview with Noble Powell, 19 Oct. 2023. Noble is a Clinical Supervisor at Boston Comprehensive Treatment Center, an Acadia Healthcare facility located on Topeka St. near the Mass & Cass intersection in Boston. Noble is also a counselor for those in the treatment process. We discussed topics including the different medications to help with treatment and overdose, what kinds of street drugs the patients are using and their effects, and the culture at the Mass & Cass Intersection. Major problems that Noble noted in the area are: Needles, feces everywhere; Women’s safety/ sex crime; lack of bathrooms, showers, & security; lost belongings in everyday shuffle, lack of shelter capacity; theft of property in sleep at shelters.

Sources: North America & Europe

On Point, NYC onpointnyc.org/

First organization in the United States to launch two Overdose Prevention Centers (Supervised Consumption Centers). Dedicated to improving the health, safety, and well-being of marginalized people who use drugs or engage in sex work.

Interlandi, Jeneen. “One Year Inside a Radical New Approach to America’s Overdose Crisis”. New York Times Opinion Article. 22 Feb. 2023. nytimes.com/2023/02/22/opinion/drug-crisis-addiction-harm-reduction.html

From the point of view of someone who works at OnPoint, NYC.

Snyder, Jason. “A whole new breed of architecture can help fight drug addiction and save thousands of lives every year”. The Architect’s Newspaper. 13 Jun. 2017.

archpaper.com/2017/06/architecture-drug-addiction-feature/

European Monitoring Centre for Drugs and Drug Addiction (EMCDDA).

“An overview of provision and evidence.” “Netherlands Country Drug Report 2017”. p. 11

“Infographic. Location and number of drug consumption facilities throughout Europe.” June 2023

Glaser, Susan. “Dutch cut overdose deaths by dispensing pure heroin”. Cleveland Metro. 15 Jul. 2018 cleveland.com/metro/2018/07/in_amsterdam_the_ government_pr.html

Edwards, Matty. “A Safe Fix for Bristol’s Drug users and the city”. The Bristol Cable. 25 Jan. 2019

Illustration: Rosie Carmichael https://thebristolcable.org/2019/01/a-safe-fix-forbristols-users-drug-consumption-rooms-needles/

National Institute on Drug Abuse (NIDA). “Overdose Prevention Centers.” National Institute on Drug Abuse, 28 Aug. 2023, https://nida.nih.gov/research-topics/ overdose-prevention-centers Accessed 29 Nov. 2023.

Sources: Boston & Massachusetts

Governor’s Opiod Addiction Working Group mass.gov/lists/governors-opioid-addiction-working-group

City of Boston

boston.gov/government/cabinets/boston-public-health-commission/mass-and-cass-showingwhats-possible

Includes the City’s Long Term Strategic Outlook, Data Dashboard, Transitional Housing Initiative, The City’s encampment Protocol, Advocacy priorities and efforts.

City of Boston’s Coordinated Response Team

“Working to better serve unsheltered neighbors experiencing substance use disorder centered in the intersection of Massachusetts Avenue and Melnea Cass Boulevard, also known as ‘Mass and Cass’.”

Includes:

1. The City’s Long Term Strategic Outlook Plan

2. Regularly updated Data Dashboard

3. Low Threshold Transitional Housing Initiative

4. The City’s Unlawful Camping Ordinance

5. The City’s Advocacy Priorities and Efforts

Long-Term Public Health Strategic Outlook

boston.gov/sites/default/files/file/2022/05/Strategic%20Outlook.pdf

“Serving the Mass & Cass area and unsheltered individuals in Boston”.

Includes resources on Outreach, Service Navigation, Low-Threshold Shelter + Housing, Permanent Housing, Harm Reduction + Treatment, Recovery Supports, Behavioral Health Workforce, and Contextual Data.

Mass/Cass Dashboard

dashboard.boston.gov/t/Guest_Access_Enabled/ views/MassCassDashboardv2/MonthlySyringeTab?%3Aembed=y&%3Aiid=4&%3AisGuestRedirectFromVizportal=y

Includes data on Daily Operations, 311, Syringe Return Rates, Public Safety, Treatment, and Housing.

City of Boston: Public Health Resource Map: Caring for Unsheltered Persons

https://boston.maps.arcgis.com/apps/webappviewer/index.html?id=67e786fa06c045f7a736f220166889c7

Includes Public Health Resources within Boston. Also includes visual “buffer zone” of 3/4 and 1/2 Mile Radius from the Mass Ave/Melnea Cass Intersection.

BUILDING SYSTEMS & TECHNOLOGY INTEGRATION

WHAT ARE THE DESIGN OBSTACLES THAT YOUR PROJECT WILL NEED TO OVERCOME?

Engineering

Mechanical

• Outdoor Heating & Cooling systems for “rough sleepers”

Ventilation

• Drug Consumption Rooms with negative pressure systems to mitigate risk of others ingesting harmful drugs.

Electrical

• Illumination of dark spaces at night for safety

• Emergency call systems

Landscape, Civil, & Site

• Entry and Exit sequences

• Safety, Accessibility, Universal Design

Plumbing

• Restrooms & Shower facilities

• Hand-washing stations

• Potable Water Locations

Design Strategies

• Large hallways, circulation, entryways to avoid conflict

• Direct lines of vision for staff

• Two points of exit

Social Acceptance

• Non-judgemental, non-bias design

• Design for integrity

• Space for positive interaction

Survival, Health, & Wellbeing

• Physical safety security

• Hygienic facilities

• Motion sensor overdose security in bathrooms and showers

• Privacy

1 City of Boston.

Created by DoIT

GIS Team. Public Health Resource

Map: Caring for Unsheltered Persons. boston. maps.arcgis.com

Goals for the Individual

Get well through resources such as medications and therapy to become a contributing member of society.

DRUG CONSUMPTION ROOMS (DCR)

DIGNITY PRIVATE ENTRIES

PRIVATE DCRs

PRIVATE EXITS

HOMELESS

STORAGE FOR BELONGINGS HEATING/ COOLING MEDICAL

Goals for the Community

Less exposure to crime, violence, and illicit drugs. Decreases emergency room and ambulance expenses (tax payer money) by preventing uncontrollable overdoses.

COUNSELING

GARDENS SUPPORT GROUPS AWARENESS DE-STIGMATIZING

COMMUNITY

HYGIENE GREEN SPACE EXERCISE LIKE SKILLS

MENTAL & PHYSICAL HEALTH

PSYCHIATRIC THERAPY JOB COUNSELING DRUG CLINIC What

• Syringe exchange programs (2)

• HIV/STI/STD Testing Sites (8)

• Opioid Treatment Programs (2)

• Daytime Drop-In Recovery Services (2)

• Emergency Shelters (2)

• Community Health Centers (3)

• Homeless Shelters (3)

• Bridge Clinic (1)

• Self-Help Groups (8)

• Recovery Homes (4)1

What is the area currently lacking?

Esri Community Maps Cont

• Legal Substance Use Sites

• Restrooms

• Showers

• Locked Storage

• Adequate Lighting

• Adequate Housing

• Syringe Disposal (Vs exchange)

• Lack of Intervention - Violence, Drug Trafficking, Human Trafficking, Overdoses

2 Boston Planning & Development Agency. GIS Maps: Dorchester, Mattapan and Roxbury. (11/2016)

Topoeka

SOUTH END

SOUTH Atkinson St. TopekaSt.

NEWMARKET INDUSTRIAL DISTRICT

DORCHESTER

SOUTH BOSTON

VISUALIZING THE PROGRAM

ZONE A

reception

waiting area

staff toilet

client toilet office/meeting room

ZONE B

smoking rooms

injection rooms

observation area

nurse suite office/meeting trash

ZONE C resting zone office conversation

ZONE D cafe kitchen trash office/meeting activity center home-ec classrooms

showers

laundry

ZONE E

locker room

toilets

laundry manager’s office

kitchenette

sleeping cots

OUTDOOR F

lockers

smoking area

outdoor interstitial spaces

community garden

PRIVATE ACCESS

UNIDIRECTIONAL

PUBLIC ACCESS

BUILDING SUPPORT

maintenance closets

cleaning closets

kitchen systems

HVAC systems - smoke intake rooms

electric/tel/data

loading dock

PRIVATE ACCESS: TREATMENT

PRIVATE ACCESS: ACTIVE USERS

H EART OUSE

Methods of Inquiry

The role of architecture in creating a supportive environment for harm reduction, resource access, and reintegration into society.

How will this project avoid gentrification and displacement by creating resources at a larger scale?

How will this project facilitate long term care and resources for drug users who decide to take the next step to become clean? (like a post-occupancy study in architecture)

• How will this project address the likely changes in the community such as changes in drug trafficking resulting in higher crime rates?

How will this project engage with the entire geographical/geopolitical community without becoming a large-scale urban development project?

Terms of Criticism

What are the mortality rates of drug users now compared to before?

We’re people displaced? Or did they stay?

• Are people using the resources provided?

Facts & Figures

96k+ 72% 1M

Over 96,700 people die from drug overdoses in a year.

Opioids are a factor in 7 out of every 10 overdose deaths.

Drug overdoses have killed almost a million people since 1999.

PROGRAM

Site

Goals

26% net reduction in overdose deaths in the area surrounding a supervised injection site in Vancouver, Canada, compared with the rest of the city.

Vancouver Barcelona

A supervised injection site in Barcelona, Spain, was asso-

*This chart includes attributable deaths for each drug; some deaths involve multiple drug types, and percentage totals will exceed 100%.

“For me, an area of moral clarity is: you’re in front of someone who’s suffering and you have the tools at your disposal to alleviate that suffering or even eradicate it, and you act.”

— Dr. Paul Farmer

Thesis Statement

How can architecture contribute to community healing, and what are the areas in which our communities require healing? The recent experience of the pandemic has shown us the profound impact of anxiety and uncertainty on communities. When anxiety pervades a community, it can give rise to adverse circumstances. Currently, our nation is grappling with an epidemic, but its localized nature means that it often escapes our collective awareness. Yet, for those individuals whose lives are deeply entwined with this crisis, it can feel as though they have nowhere to turn, much like the sense of entrapment we all experienced during the COVID-19 pandemic. We were all searching for guidance in uncertain times.

My vision is to create a sanctuary for those who feel trapped and in need of guidance—a safe haven where judgment is absent, and security and safety prevail.

One of the pressing challenges in our communities is the rampant opioid crisis. Many individuals become ensnared in a vicious cycle of addiction, compounded by the stigma surrounding this issue. These individuals require help, and I firmly believe that architecture can serve as a powerful tool for cities to assist people in overcoming their addictions. Real change can only occur when people are not surrounded by negative environments; they need accessible resources and support. Addiction is a disease, and individuals will continue to seek ways to satisfy their cravings. We should consider providing them with a safe space where they can access help when they are ready, on their terms, and use substances safely.

Drug Consumption Rooms (DCRs), as outlined in “Harm Reduction: Evidence, Impacts, and Challenges,” have three primary objectives:

• Creating an environment for safer drug use.

Enhancing the health status of the target group.

Reducing public disorder.

My thesis aims to explore how architecture can offer solutions that address all three of these objectives with the goal of helping addicts become contributing members of society.

Framing of the Thesis

The main goal of this project is to save people’s lives with a facility that fosters safe drug using practices and gives resources to people to choose to use when they are ready. But placing a safe drug use facility in a place where people use drugs is not the answer. The project must address much more- considering the context of the site, the people that live there, the culture, the communities, what happens to the people who choose not to use the facility and to the people that do? There are many different scenarios that may occur, and my project will address many of these variables in order to be successful.

This investigation is important to the health of our society. If something is not done, or a place is not created for people to go to, then there will never be any change and people will continue to be addicted, hopeless, likely to overdose and possibly die. This affects an entire geographical area and might require an urban plan at a larger scale rather than a simple building. This affects gentrification of an area versus creating resources for the people who need them. This affects the local drug trafficking and dynamic between groups in the community. This will affect crime rates, and mortality rates in both positive and negative ways.

Less

SCHEDULE OF REQUIREMENTS

January 2024

Weeks 1-3 Introductory Review

• Further Concept Development

• Finalize site & analysis

• Massing Diagrams and models on the site

• Finalize Program

February

Weeks 3-5 Preliminary Review

• Develop schematic level massing, plans, sections, elevations

• Materiality choices

• Programming plans

• Continue work on 3D model

March

Weeks 5-9 Schematic Review

• Continue development of plans, sections, elevations

• Continue development of 3D model

April

Weeks 9-13 Design Development

• Continue development of drawings and renderings

• Storyboard and concept communication development

• Practice presentation

Week 13 Final Review

Week 15 Final Book Due

May

Week 16 Graduation

EDUCATION

Boston Architectural College Boston, MA | Class of 2024

Masters of Architecture

GPA: 3.70

Miami University Oxford, Ohio | Class of 2020

Bachelors of Arts in Architecture, Self-Designed Thematic Sequence in Global Public Health President’s List 2020

PROFESSIONAL EXPERIENCE & RECOGNITION

My approach to the discipline of architecture begins with exploring solutions to the most urgent challenges society faces today including pandemics, homelessness, poverty, and above all: the existential threat of the global climate crisis. Meeting these challenges starts with developing healthy, resilient, and sustainable communities.

SMMA | Architectural Designer K-12 Studio August 2020 - Present Construction Administration November 2021 - Present Multi-disciplinary team member ranging from 2-20 individuals; Present design studies to team and client within Revit, Enscape, and Powerpoint; Draftsman for Construction Drawing Sets; Review Submittals and Shop Drawings.

COVID-19 Independent Study | Spring 2020

Self-Designed research project seeks to illustrate rapid design/build of increased healthcare facility capacity via reusable modular structures in response to airborne viral pandemic in a suburban University Campus Setting.

Plenary Speaker | Getting to Zero Forum, Oakland, CA October 2019

A/E/C Solutions | Boston Project Management Summer Associate July-August 2019

HANDEL Architects | New York City Architecture Summer Intern May-July 2019

Certified Passive House Consultant (CPHC®) | Spring 2019 Passive House Institute US

Solar Decathlon Design Challenge *First Place* | U.S. DOE, NREL Spring 2019

Elementary School Division. International Collegiate competition that challenges student teams to design highly efficient and innovative buildings powered by renewable energy.

Luxembourg Design Studio | Luxembourg City Fall 2018

Architecture studio + full semester abroad

Ghana Design/Build | Cape Coast, Ghana Summer 2018

Delivered hand-constructed 2,500 sf maternity ward in six weeks, including hand-dug foundations, hand-cast masonry units, using local vernaculars and techniques. Member of 16-student visiting team. Collaborated with host community’s chief and elders on design; built in conjunction with 16 community members from rural Abrofo-Odumase village, Ghana.

EU Special Studies | Amsterdam and London Summer 2017

Comparative study of public health systems of The Netherlands, United Kingdom

OTHER WORK EXPERIENCE

Volunteer Service Dog Trainer | 2020 - Present

Foster and train service dogs for mobility, psychiatric, autism, seizure, diabetic alert and assistance.

Registered Yoga Teacher | 2018 RYT 200 Certification

Cerebral Palsy of Massachusetts, Inc. | 2016 Personal Care Attendant

Allison Springer Eventing LLC. | 2015 - 2016

Gap Year Post High School. Co-manager of 20+ horse professional training barn based in Virginia competing across the United States.