Safe Seattle’s Harley Lever: Safe Consumption Sites Can’t Scale to the Size of Seattle’s Heroin Problem

This is part 2 in a series of interviews with advocates on both sides of the safe-consumption issue.

Earlier this week, a coalition of public health experts and people who have lost loved ones to overdoses announced that they are suing to block Initiative 27, which would ban supervised drug consumption sites throughout King County, on the grounds that public health decisions are outside the scope of the initiative process. The group, called Protect Public Health, argues in their lawsuit that under state law, King County and its public health department are responsible for making public-health policy decisions for the county, and “[i]t would be antithetical to this scheme to allow citizens to delay or override urgent action on a public health crisis merely by raising sufficient funds to qualify a referendum or initiative.” (You can read the full complaint here.)

Last week, the King County Elections Department confirmed that initiative supporters had collected enough signatures to qualify for the February 2018 ballot.

With safe consumption very much in the news this week, I thought it would be a good time to hear from some advocates on both sides of the safe consumption issue.

Today, my conversation is with Harley Lever, one of 21 candidates for mayor in the recent primary election and a leader of the Facebook group Safe Seattle, which organizes on policies related to homelessness and drug addiction. Safe Seattle has been vocal about their opposition to proposals that would reduce penalties on people who live on Seattle streets, in tents, or in their cars or RVs, and in favor of more frequent and punitive encampment “sweeps,” in which homeless people living in tent encampments are forced to move from place to place. Safe Seattle says it supports increasing access to shelter and services and providing treatment on demand, but that people who refuse to leave their encampments or RVs and relocate to shelters or treatment should be fined, jailed, or forced to move along. Most recently, they have opposed legislation proposed by city council member Mike O’Brien that would give people living in their vehicles immunity from some traffic laws and fines if they enter a program that puts them on a path to permanent housing; the proposal would also enable the city to set up potentially dozens of small “safe lots” around the city where vehicle residents could park without punishment or parking fines. Arguments against the legislation range from “I have to follow the law, so why shouldn’t they?” to “if RVs become legal everywhere, I guess I’ll just sell my house and go live in one tax-free.”

Safe Seattle has also been supportive of Initiative 27, arguing that safe consumption sites will increase crime and open drug use in the surrounding neighborhoods, and that they will only enable drug users to keep using instead of seeking treatment. Many of Safe Seattle’s writers and commenters have argued that forcing people into drug treatment is an effective way to get people into recovery, and that if Seattle does allow a safe consumption site, IV drug users will congregate around the property and use (and overdose) outside, littering neighborhoods with needles and the bodies of overdosed addicts.

Lever, however, he says opposes safe consumption sites for more complicated reasons: He doesn’t believe they can scale up to the size of the city’s opiate and heroin problem. He says he’d rather see the city spend its money on widespread access to naloxone, the overdose-reversal drug, and detox and treatment on demand, than on sites that might save a few lives but won’t effectively address the underlying epidemic. Like King County Public Health’s recovery division deputy director Brad Finegood, Lever’s knowledge of the toll drug addiction takes on users is personal: Two of his brothers have been addicted to heroin, and one is currently homeless and living with active addiction in Boston. I talked to Lever by phone last month; his comments have been edited for clarity and to remove the names of his family members.

Here’s Lever:

Image result for harley lever seattleOur story is the same story that’s happened to scores of people from my hometown, as well as throughout Boston. People just started using OxyContin recreationally. You have a couple of beers, have a Xanax, and it makes you feel really good. No one ever contemplated the level of addiction that it would create. Before the city or state even realized what was happening, we started seeing break-ins at pharmacies and crime spiking, because Oxy 80s sold for 80 bucks on the streets, and as people got progressively more addicted, they started stealing. It just skipped my high school class by about nine years.

The state of Massachusetts and a lot of pharmacies started smartening up about what was going on and did everything they could to restrict access to Oxy, and as it became more difficult to access, people started switching to heroin, and my brother was one of those. He got off heroin temporarily, but he went into the Army, where he started thriving, which was good. The only problem was, they made him a medic, which is a stupid thing for person to do who has documented addiction disorder. He did really well for three tours in Iraq, and then he went to Afghanistan and we think our cousin started sending him OxyContin, so he came back addicted.

“[My brother] is homeless. Fortunately, because he’s a veteran, he can get access to VA help. He overdosed four times last year, and every time he was saved by a person who had naloxone.”

My cousin eventually got arrested and is currently serving a five-year term in federal prison, and his family’s pretty much been tossed on their heads. Both of his kids were born addicted to opioids. They still have developmental delays and issues even now. His wife still struggles with opioid abuse disorder. And then, most recently, in August of 2016, my cousin’s ex-husband died of heroin overdose. So just in our immediate family, we’ve seen a lot of the devastation.

On a larger scope, I have a lot of friends who are either dead or are actually still addicted to heroin or in prison. This is an ongoing problem in our community.

[My other brother] has totally turned his life around. There are a lot of stories like this too, where people went down the wrong path but were able to get out of it and stay out of it. He went down dark path, but you would never know it looking at him. He went cold turkey. I think that he realized the path he was going down was not a good one. We’ve never talked about it, but I assume that, like many people gripped with addiction, he hit a rock bottom and he turned his life around.

“I don’t necessarily think a safe injection site will make the situation worse. My issue with the safe consumption site, in the context of Seattle, is that it can’t scale to the size of the problem.”

[My brother] is homeless. Fortunately, because he’s a veteran, he can get access to VA help. He overdosed four times last year, and every time he was saved by a person who had naloxone. He’s been on suboxone, methadone, and Vivitrol. I think the problem with him is, he’s done it for so long that his impulse control mechanism in his brain is really shot. He’s been in this constant cycle of being in treatment, getting sober, living in sober living—and then almost every single quarter, right when he gets his [benefit] check, he goes and spends it and he’s back in that cycle.

I don’t necessarily think a safe injection site will make the situation worse. My issue with the safe consumption site, in the context of Seattle, is that it can’t scale to the size of the problem. We have 23,000 opioid-addicted IV drug users in King County. On average, they inject three times a day. So you have 69,000 injections a day. The two [proposed] safe consumption sites can only supervise 500 injections combined, so we have choices. Either we can scale up and offer [274] other facilities to supervise all the injections, or we can do what saves my brother consistently and have widespread distribution of naloxone and layperson training. For the $3 million it will cost to fund these two safe consumption sites, we could literally give every single one of the 23,000 addicts 47 prescriptions of naloxone. What we should be doing is having a CPR crowdsourcing model, where we teach lay people to reverse overdoses.

“[Canada] and other countries that have these systems in place have government-run health care. They can provide access to detox and rehab on demand. We don’t have that.”

I don’t think they really ever contemplated fentanyl. It used to be that you could use black tar heroin for a long time and not risk overdosing like you see with fentanyl. What I fear most is that we’re going to die our way out of this epidemic. Fentanyl is not as prevalent here yet as it is on the east coast or up in B.C., but it’s going to make its way here. I just fear those 23,000 opioid addicts we have here are going to die and never get a chance to recover.

We have to actually look at the recovery system here in Washington State. We don’t have access to detox or rehab on demand. One of things I hear a lot of proponents talking about is how they do all these great things [at Insite in Vancouver and other safe consumption sites around the world], but [Canada] and other countries that have these systems in place have government-run health care. They can provide access to detox and rehab on demand. We don’t have that. We might have a bed available to you in nine to 12 weeks, which is a lifetime for detox. We’re also looking at months for rehab. We need to fix that structure. I think that’s a critical component.

“The compassionate side of me says we shouldn’t be [banning safe consumption sites]. The strategic side of me says, yes, we should, because we should be focusing on better solutions than safe injection. “

They do have HIV testing and hepatitis C testing. I think that’s absolutely a great point. But we also can do that with our navigation teams. I was talking to Daniel Malone from DESC and we both agree that if we have a mobile van where they can meet with opioid addicts where they reside, that would be a more strategic, cost-effective approach [to dealing with certain health problems common to opioid addicts].

The compassionate side of me says we shouldn’t be [banning safe consumption sites]. The strategic side of me says, yes, we should, because we should be focusing on better solutions than safe injection.  I recognize that a lot of people do it out of hatred towards drug-addicted people. What I always say to someone who hates an addict is: You are going to have an addict in your family. And once you do, this whole mantra of ‘They chose to stick a needle in their arm’—well, they did it under the influence of withdrawal and pain and sadness and different types of trauma.

Some people say, ‘I had to hit rock bottom. I had to be threatened with jail. I had to have these pressures.’ I think [tough love] absolutely works with some people. I think it would be silly to say that only tough love works, because there’s some very stubborn people out there. I’d probably be one of them, because I’m a bit hard-headed at times.

Honestly, I don’t think my brother will ever recover. My mother has said the same thing I’m just waiting for the call. We wish it was different. It’s been 15 years and he’s been so very lucky to survive, but we know, based on just the trajectory and frequency of his overdoses, he’s on more than borrowed time.

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