Street medicine teams in Phoenix are taking healthcare to the streets, but new local laws are making their work harder. In this Under the Lens series, we look at why this approach is vital and under threat.
The early morning routine in Phoenix
Perla Púebla and her team visit encampments in Phoenix before the sun comes up. When temperatures climb past 115 degrees, people living on the streets wake up early to avoid the heat. Púebla’s team follows this schedule to provide care to the city’s homeless residents.
Púebla, a nurse practitioner, works alongside medical coordinator Brenda Madril and behavioral therapist Maritza Arias to provide essential services to homeless individuals. Upon arriving at their destinations, they offer medical check-ups, hydration, and naloxone. Although not everyone accepts their help initially, Púebla and her team are equipped to treat wounds, administer IV fluids, and prescribe medication from the comfort of their medical van.
Púebla is part of Circle the City, a nonprofit organization dedicated to providing healthcare to homeless individuals. Her team employs a unique approach known as street medicine, which has been gaining momentum since the 2000s. This method involves delivering healthcare and social services directly to people experiencing homelessness, allowing them to receive support on their own terms.
According to an article by Washington University in St. Louis, the core principle of Street Medicine is to “reach individuals where they are, rather than expecting them to conform to the norms of traditional healthcare settings.” This approach enables healthcare providers to connect with homeless individuals in their own environments.
The importance of street medicine and medical outreach has never been more pressing, as local policies aimed at criminalizing homelessness have increased in recent years. These policies restrict where homeless individuals can reside and access essential services, including bans on camping or panhandling in public areas, mandatory treatment for substance use and mental health issues, and limitations on aid distribution from outreach services.
The National Coalition for the Homeless views the criminalization of homelessness as a civil rights issue, arguing that such policies exacerbate the problem by hindering “life-sustaining activities” and imposing criminal records that make it difficult for individuals to secure housing and employment.
Restrictions on care in city parks
One of these policies has recently taken effect in Púebla’s backyard. Earlier this year, the city of Phoenix passed an ordinance restricting the distribution of food and medical care in city parks without a permit. As part of the law, which took effect in June, the city only issues two permits per park each month. The ordinance completely bans needle exchanges in parks.
Providers in this field often rely on a patient-led approach, which focuses on minimizing negative health impacts rather than requiring total abstinence. This philosophy stands in contrast to proposals for involuntary treatment of people who use substances on the street. A clinical director for the Street Medicine Institute says forcing drug users to stop can create more harm than good.
When people are taken out of their environment and forced into treatment, the factors and stressors in their lives do not change. When they return, they do not have any additional support but go back to the same environment, where they will probably use again. By then, the patient has lost tolerance for the drug they used and the drug supply has likely changed, leading to a higher risk of overdose.
The importance of trust and preparation
Providers must earn patients’ trust before they can offer care. Teams often spend weeks providing hygiene supplies and services without asking for anything in return. A project manager in Chicago notes that a psychiatrist brought fresh chocolate chip cookies and art supplies to build a relationship with a patient who loved sweets and drawing.
Adapting to sweeps and displacement
Research shows that displacement increases the risk of overdose and death. A 2025 report from the California Street Medicine Collaborative, USC Street Medicine, and the Street Medicine Institute explains these risks. The report recommends that practitioners anticipate sweeps to help patients plan relocation and find storage for documents.
