As an addiction medicine physician in Portland, I witness every day how deeply intertwined addiction and homelessness are. Many of my patients struggle not only with substance use but also with the daily trauma of living on the streets. Mayor Keith Wilson has focused much of his administration on expanding shelter beds, arguing that this will ease the city’s homelessness crisis. However, the evidence and experiences of those directly affected tell a different story.
It’s no surprise that Portland’s shelters often have empty beds. Many unhoused individuals avoid them because they feel unsafe, fear bedbugs, or worry about losing their possessions. Others are unwilling to be separated from partners, friends, or pets — the only “family” they may have left. Expanding the number of overnight-only shelters does little to resolve these barriers or the underlying reasons people become homeless in the first place.
Decades of research have shown that real progress against homelessness comes from providing permanent, stable housing, not temporary fixes. The “Housing First” approach — which prioritizes giving people homes before addressing other needs — consistently leads to better outcomes in health, safety, and employment. Without a stable place to live, recovery from addiction or mental illness becomes nearly impossible.
Also Read
Criminalizing homelessness only makes matters worse. While Mayor Wilson claims that enforcing the camping ban is not “criminalization,” the reality is that fines, citations, or jail time for sleeping outdoors punish people for having nowhere else to go. These actions push vulnerable residents deeper into poverty and trauma rather than helping them find stability.
People living unsheltered are not choosing this life out of defiance or laziness; they are doing so out of desperation. Portland’s homelessness crisis reflects systemic failures — rising rents, a shortage of affordable housing, and limited access to treatment and support services. True compassion means addressing these root causes instead of pushing people out of sight.
If Portland truly wants to solve homelessness, it must shift from punishment to partnership — from short-term shelters to long-term housing. The city should invest in affordable housing, expand mental health and addiction treatment programs, and create pathways for people to rebuild their lives.
How we treat the most vulnerable among us defines who we are as a community. Portland must choose empathy over enforcement and lasting solutions over quick political wins. Let’s focus on giving people a real chance to heal and thrive — starting with a safe, permanent place to call home.
