A Seattle Library Employee Was Stuck With a Needle. Should Branches Make Changes to Deal With the Opioid Epidemic?

This story originally appeared on Seattle Magazine’s website.

Late last month, a Seattle Public Library custodian was rushed to a hospital after being stuck with a needle while cleaning out a trash can in the women’s restroom at SPL’s Ballard branch.

The needle was tucked inside a sanitary napkin container, with the point facing out, according to Seattle Public Libraries spokeswoman Andra Addison. Addison says this is the first time she’s aware of that a library employee has been pricked by a needle at any of the branches.

The opioid epidemic has led to a dramatic, highly visible uptick in public drug use in the city, including on city-owned property such as parks and public libraries. But despite rising rates of opiate use and overdose deaths (219 of a record 332 drug-use deaths in King County in 2016 were opioid-related), the Seattle library system does not allow sharps containers—sealed medical-waste bins to discard used needles—in any of its public restrooms. Instead of offering public sharps containers, the library trains its staffers on how to dispose of needles when they come across them, and provides extra-thick gloves, blue “pinchers” (to pick up the needles), and small plastic containers for sharps disposal.

Addison says there’s a simple reason that the library doesn’t provide sharps containers for drug users: “We don’t allow illegal drug use in the library. It’s against our rules of conduct.” Providing sharps containers would be a tacit acknowledgement that people are using drugs at the library in violation of those rules.

Even if the library did provide sharps containers, Addison adds, “that doesn’t mean [people are] going to use it. People will still probably put needles in places where they don’t belong.” Another concern, Addison says, is that “people do break in [to sharps containers] to get needles. … If they pull them off [the wall], there will be a big mess.”

But other libraries, both across the country and right here in King County, have taken a different approach. The King County Public Library system has sharps containers branches in Burien, Renton, and Bellevue, locations where library staffers reported finding needles on bathroom floors and flushed down toilets.

The county system doesn’t allow people to use illegal drugs on their premises either, says Melissa Munn, the community conduct coordinator for King County libraries, but they also realize that “we don’t have any control over it. We can’t stop what’s coming in our door every day. We just can’t. And people use drugs—that’s just the fact—and people sometimes use drugs in our restrooms. That’s also a fact.”

As Munn sees it, providing safe places for people to dispose of their needles so that other people don’t get exposed to drugs or communicable diseases is a public-safety measure, not an endorsement of illegal drug use.

“People are going to use drugs, and they’re going to use drugs in lots of places. [King County Libraries] can’t solve the drug problem, but we can provide a place for them to dispose of their needles so that they’re not putting other people in harm’s way.”

As for drug users breaking in to sharps containers to steal used needles, Munn says, “we have never experienced damage to any of these containers.”

Since last year, a Seattle Public Utilities pilot program has made sharps containers available at a handful of locations (including three park restrooms) around the city. According to Julie Moore, a spokeswoman for the city’s department of Finance and Administrative Services, there are no sharps containers in other publicly accessible city buildings managed by FAS, including City Hall, the Seattle Municipal Tower, or fire or police stations.

Addison says the library’s administrative services division (which sets policies for library buildings, such as whether they will offer sharps containers), discussed providing sharps containers at one point, but determined that “we just really don’t have the need for it.” However, she adds, “the world is changing,” and “it’s not something we wouldn’t consider” if the need arose.

Advocates say Seattle is already far past that point. “We hear from librarians all the time, because [drug use] happens in libraries, so it is disappointing that there are not more proactive resources available,” says Patricia Sully, the coordinator for the drug policy group VOCAL-WA. Both Sully and a representative from REACH, a street outreach group that works with homeless people struggling with addiction, were surprised to learn that the library has a policy prohibiting sharps containers. “We’re not nearly as far along as we thought,” Sully says.

Meet Seattle’s Reformer-in-Chief, Lisa Daugaard

This story first ran in the print and online editions of Seattle Magazine.

Image credit: Hayley Young, Seattle Magazine

It’s a little before 10 a.m. in the courtroom of King County Superior Court Judge Veronica Alicea-Galván, and the crowd is getting restless. Dozens of spectators, many wearing red scarves to indicate their opposition to supervised drug consumption sites, are murmuring quietly, waiting for Alicea-Galván to emerge from her chambers. Advocates say the sites—safe spaces for people to consume illegal drugs and access medical care and treatment—will save lives and put drug users on the road to recovery; opponents say they will enable drug users and lead to crime.

What’s at stake today is a ruling on an initiative, filed by Bothell City Council member Joshua Freed, that would preemptively ban the controversial sites throughout King County.

Suddenly, Lisa Daugaard, the 5-foot-2, 51-year-old director of the nonprofit Public Defender Association (PDA), which advocates for criminal justice and drug policy reform, bounds from her seat in the second row and makes a beeline for Freed, who is sitting at the defendants’ table. Before Freed can process what’s happening, Daugaard is pumping his hand, politely forcing the antidrug activist (he once told KVI-AM’s Dori Monson that safe consumption sites would make Seattle a magnet for the nation’s heroin users) into a bit of friendly courtroom small talk.

Daugaard’s friendliness is strategic. “I always go talk to the opposite side,” she says, laughing. “It’s a way of saying, ‘I’m not afraid of you. I get where you’re coming from.’”

For Daugaard, who has spent decades waging legal battles on behalf of people with few advocates in the criminal justice system, maintaining an open dialogue with the “opposite side” is a key part of the formula that has helped her win some of the most significant political and legal victories for civil rights in Seattle of the past 20 years.

The era isn’t long past when Seattle police officers set up “buy-and-bust” operations (undercover stings in which an officer buys drugs from a suspect, then arrests him) to put addicts behind bars, arrested people for sitting on the sidewalk and seized people’s cars for failing to pay their parking tickets. Today, that kind of draconian enforcement is unheard-of, and Daugaard is a big part of the reason why.

As Seattle has shifted leftward (from a place where people were arrested for smoking weed in parks to one where the big drug debate is about safe consumption sites), Daugaard’s focus has shifted, too. Instead of fighting on behalf of individuals against overreaching police, she’s advocating for policies that “advance the common interests of people who have suffered a lot of harm as a consequence of traditional policing,” such as progressive drug policy reform, and fighting against homeless encampment sweeps and for increased civilian involvement in how the Seattle Police Department conducts its business.

Daugaard cut her teeth as an activist during the South African apartheid era, when she was a grad student at Cornell. She found defending activists arrested and expelled during the anti-apartheid movement more interesting—and transformative—than writing her thesis on the criminalization of homelessness, and she decided to go to law school to pursue “a career trajectory where [activism] was the work rather than a distraction from the work.”

She has been at the center of many of the key civil rights battles of the past two decades, starting in the early 2000s, when thousands of low-income Seattleites lost their cars due to an initiative called “Operation Impound.” Daugaard, then a founding attorney of the PDA’s Racial Disparity Project, which worked to promote police accountability and reduce racially biased policing, says it took her a while to connect the dots between the thousands of seemingly routine license suspensions and the impoundment cases she came across through her work. The cases seemed unrelated—a litany of individual injustices.

“I knew the relationship between race, poverty and the justice system, but before I worked in public defense, I hadn’t realized the systematic way in which people of color were being deprived, as a generation, of the ability to drive,” Daugaard says. Over time, however, Daugaard started to see a pattern: Poor people, overwhelmingly people of color, were losing their licenses over moving and equipment violations or unpaid parking tickets, then losing their cars under a city law that allowed the city to seize the car of anyone caught driving it whose license had been suspended. This fed a cycle of poverty, as people who couldn’t afford to pay their tickets lost their cars, and then, with no way to get to work, their jobs.

 

“She’s an organizer, an analyst, an advocate, a strategist, an academic, an orator, a social worker and a spin doctor. You don’t come across that very often.”—Seattle City Council member Lisa Herbold

 

Supporters of Operation Impound presented the issue as a simple question of personal responsibility, but Daugaard, along with a community group called Drive to Survive, reframed the impoundment law as an assault on the rights of low-income people and people of color. They packed public meetings with people who had lost their cars, putting a human face on what had been a fairly obscure administrative issue. And they won. By the early 2000s, Operation Impound was a thing of the past.

This kind of no-holds-barred, uncompromising activism earned Daugaard accolades from unlikely corners. “Nobody I’ve met in my professional career can negotiate as effectively, and has the stamina and persistence that Lisa has,” says Scott Lindsay, a former candidate for city attorney who worked as a criminal justice adviser to former Mayor Ed Murray. City Council member Lisa Herbold, who worked with Daugaard on numerous issues when she was an aide to former council member Nick Licata, describes her as the full package. “She’s an organizer, an analyst, an advocate, a strategist, an academic, an orator, a social worker and a spin doctor. You don’t come across that very often,” Herbold says.

Daugaard’s status as a child prodigy—she started classes at the University of Washington at age 12, leaving at age 17 to study at Cornell and earn a law degree at Yale—is one of the first things people mention when talking about her. But her longtime employee and close friend Patricia Sully, who works at the PDA running a drug policy group called VOCAL (Voices of Community Activists and Leaders), argues that it’s the least interesting thing about her. The two met shortly after Sully graduated from law school, when they were both working with legal teams defending clients arrested during the Occupy Seattle protests. What’s most unusual about Daugaard, Sully says, is her ability to relate to a wide variety of people. “There’s no one I’ve met who is as comfortable being in a board room and talking to people in suits, and walking straight from that board room into an encampment and having a totally authentic relationship to the people in that encampment.”

Daugaard hasn’t always been so comfortable working both sides of the fence. In her early days as a public defender, some issues just seemed black and white—you either supported taking away people’s cars because they were poor or you didn’t.

But in 2005, when the PDA was fighting the police department over buy-and-busts, an SPD precinct commander challenged Daugaard to come up with a better plan, and she realized she didn’t have one. “That was a wake-up call for me,” she says. Instead of fighting the cops, she realized she needed to work with them; and instead of dismissing neighborhood concerns about public safety, she needed to find a solution that addressed those concerns.

That epiphany led to the development of a program that has become a model for criminal-justice reform around the nation. Law Enforcement Assisted Diversion (LEAD), which began as a grant-funded pilot project in Belltown and has expanded throughout downtown and to the Chinatown/International District and the East Precinct area (Capitol Hill, the Central District and Little Saigon), gave beat cops the opportunity to offer people engaged in drug activity an alternative to arrest.

“Ten years ago, she might have thought [prosecutors] were the enemy, and now we’re important partners. She’s a formidable adversary, but she’s an even better friend.” —King County Prosecutor Dan Satterberg

 

Instead of cycling through jail again and again, those people can enroll in LEAD, where they are connected to mental health and drug counseling, housing assistance, and education and job opportunities, among other services. Crucially, LEAD doesn’t require that participants stop engaging in whatever criminal behavior made them eligible for the program; instead, it gives people stuck in the cycle of addiction opportunities to access a better life, while recognizing that transformation doesn’t happen overnight. The program has been shown to reduce recidivism by as much as 60 percent. It’s also made arrests for minor drug possession essentially a thing of the past. “It’s a genuine paradigm shift,” Daugaard says.

King County Prosecutor Dan Satterberg, initially a LEAD skeptic, says Daugaard didn’t just convince him to give her long-shot proposal a try; she changed his mind about how the criminal justice system should respond to drug-related offenses. “She’s taught me a lot about harm reduction and how a community-based response can be a lot more effective than just dragging someone into the courtroom, where we don’t have the tools to change people who are in a drug-dependent state,” Satterberg says. “Ten years ago, she might have thought [prosecutors] were the enemy, and now we’re important partners. She’s a formidable adversary, but she’s an even better friend.”

Today, Daugaard believes that the way to reach consensus on contentious issues is to identify the 90 percent of the issue on which both sides agree—the “goals and values” that underlie the two sides’ common search for a solution. As for the 10 percent where there’s fundamental disagreement? Set that aside, Daugaard says, and “by the time you’re done, the 10 percent has been transformed. That’s the formula, and it always works.”

It certainly worked with LEAD. Since the program launched in 2011, the question for the city hasn’t been whether to expand the program outside central Seattle, but which neighborhood will get it first.

Daugaard believes her 90 percent approach will work with safe drug consumption sites, too. The common ground is a shared desire to do something about the opioid epidemic; the experiment will be a single safe consumption site in a neighborhood that supports it; and the measure of success will be how quickly other parts of the city and region start clamoring for safe consumption sites of their own.

Sully says working for Daugaard has changed her attitude toward political adversaries. “People have legitimate concerns, and we need to actually grapple with that,” Sully says.

But Daugaard’s willingness to compromise has its limits, and it has caused friction with some allies.

As co-chair (from 2013‒2016) and now a commissioner of the Community Police Commission (CPC)—the civilian group charged with overseeing the implementation of police reform in Seattle—Daugaard says she saw the city make good strides toward police accountability. However, she has clashed with city attorney Pete Holmes over the role of the CPC and how much power it should have over the police department. Holmes, Daugaard says, “inexplicably chose not to work in support of the approach to the police reform process that community leaders wanted to take.”

The police-accountability issue helped drive a wedge between the longtime allies, so much so that during last November’s election, Daugaard endorsed Holmes’ opponent, Scott Lindsay (Holmes was reelected). While Holmes is quick to acknowledge Daugaard’s success in pushing through reforms like LEAD, he takes issue with what he calls a “take-no-prisoners approach” once she’s decided how things should go.

“If you’re not completely on board with every element of her program, then you’re the enemy,” he says. As for her endorsement of his opponent, Holmes says: “People are going to have to think that if you’re going to work with Lisa, remember that she may turn on you, even if it’s a good-faith disagreement.”

Daugaard says her dispute with Holmes wasn’t personal, and she doesn’t regret her endorsement. “I did so for specific reasons based on how the last four years actually went,” she says bluntly. Despite Holmes’ dark assessment of the way she does business, Daugaard does not think the relationship is beyond repair. “I have told him I’m glad to work with him during his new term,” she says. “Hopefully, he will prove I was wrong.”

Morning Crank: “Clearly An Undisclosed Pledge”

1. Last week, former mayoral candidate Cary Moon wrote her campaign a check for $207,000, bringing the total she contributed to her own campaign to nearly $400,000—the largest amount spent by any self-financed candidate in Seattle history.

The campaign for now-Mayor Jenny Durkan now argues that the contribution confirms what they predicted in two complaints they filed last year, alleging that Moon was engaging in a campaign-finance “shell game,” accepting a loan-on-paper from her campaign consultant Moxie Media with a promise to pay Moxie back after the campaign was over.

Shortly before the November election, the Durkan campaign filed a complaint with the Seattle Ethics and Elections Commission against the Moon campaign, charging that Moon had unlawfully contributed tens of thousands of dollars to her own campaign within 21 days of the election, in violation of a state law prohibiting candidates from giving more than $5,000 to their own campaigns within that period, or had promised to repay a large loan to her campaign during that period, which, they argue, would also violate a city election rule prohibiting vendors from extending credit to campaigns in a way that is outside the “ordinary course of business.” A week later, the campaign filed a separate, similar complaint at the state Public Disclosure Commission, charging that the campaign’s final report before the election “clearly indicates that Moxie Media is relying on Ms. Moon to cover debts that are clearly beyond the pace of their other fundraising efforts. The increase in debt by $77,459.18 [over the last two weeks of October] is clearly an undisclosed pledge from Ms. Moon and is over 15 times the amount that Ms. Moon can pledge during the 21 days before the election.”

According to the SEEC complaint, “A close look at the Moon campaigns [sic] filings indicates that one of two things, both illegal, is going on: either her campaign’s vendors are making tens of thousands of dollars in illegal in-kind donations to her campaign, or Moon is contributing (or promising to contribute) tens of thousands of  dollars to her own campaign in direct contravention of the 21-day self-contribution limit,” the complaint alleges.

The complaints zeroed in on tens of thousands of dollars campaign consultant Moxie Media spent in the final weeks of the campaign on up-front expenses like postage, which can’t be deferred until after the campaign is over. In the last two weeks of October, according to the Seattle Ethics and Elections Commission, the campaign’s debt increased by more than $85,000, to $186,000 (the election was November 7). This amount of last-minute debt, the Durkan campaign suggests, violates the spirit of the ban on late contributions. “If these actions by the Moon campaign and Moxie Media are acceptable, then there are essentially no limits to the amount that a campaign consultant can spend out of their own funds on media, mail or other paid communication buys on behalf of a wealthy candidate for whom they work, under the assumption that the candidate can reimburse them for all of those up front payments after election day, when campaign contribution limits (like the 21-day restriction on candidate self-contradictions [sic]) no longer apply,” the state complaint says.

Moon’s camp says the loan (or pledge) was completely within the normal course of business, and notes that Durkan’s own debt increased by about $45,000 in the same period, to $98,000. They also point out that the debt was hardly a secret—the campaign reported it on every election filing.

Moxie Media’s Lisa MacLean did not return a call for comment.

Although consultants are allowed to extend credit to candidates for 90 days, the complaint charged that the Moon campaign and its consultant, Moxie Media, were aware that the debt would ultimately be paid by Moon, not other campaign contributors. At the time of the complaint, October 25 of last year, the campaign was reporting more than $125,000 in debt, which was almost as much as Moon had raised from individual donors at that point in the race, raising questions about her ability to generate enough in donations after the election to pay back that debt without using her own money. By the end of November, three weeks after Moon had lost the election, campaign finance reports indicated her campaign was $206,000 in the red.

If the SEEC tosses the complaint, the Durkan campaign says, it will essentially be saying that there is are no limitations on campaign contributions by self-financed candidates, opening the floodgates for candidates to make massive loans to struggling campaigns in the hopes that a big last-minute financial push will make up for a lack of grassroots support. (The PDC will consider the campaign’s complaint, too, but on a much slower timeline because the agency is working its way through a huge backlog caused primarily by a single conservative activist who has filed dozens of complaints against local Democratic Party districts alleging various reporting violations.)

But officials with the SEEC and the state PDC say this is the direction the courts seem to be going already. In addition to Buckley v. Valeo, in which the Supreme Court ruled that limiting a candidate’s spending on her own campaign violated the First Amendment, there’s Family PAC v. McKenna, in which the Ninth Circuit district court ruled that a 21-day limit on large contributions to ballot initiatives (though not individual candidates) was unconstitutional.

The direction the courts are going, in other words, is in favor of unlimited spending and contributions by wealthy candidates to their own campaigns. This may mean more self-financed campaigns in the future, but it may also mean more laws meant to encourage candidates to raise their money from individual donors, like the initiative that provided each voter $100 in “democracy vouchers” to spend on city council campaigns this past election. There’s also the distinct possibility that Moon—a candidate whose consultant, Moxie Media, bragged was “well-resourced” before she had even declared she was running—was simply an outlier in Seattle politics: A progressive candidate with deep pockets who failed to win the imagination of the public (Moon received 1,088 individual contributions to Durkan’s 4,210) yet was able to eke out a second-place primary election finish in a very crowded (21-candidate) field. A big test for the viability of non-wealthy candidates will come in 2021, when democracy vouchers go into effect for mayoral candidates. Although vouchers do not include restrictions on self-financing, they do place other limitations on candidates, such as spending limits, in exchange for public funds.

2. At 10:00 this morning, the state Senate Health and Long-Term Care Committee will hold a public hearing on a bill, SB 6150, that would update the state’s current abstinence-first approach to opiate addiction and require the state Department of Social and Health Services (DSHS) to promote the use of medication-assisted treatment and other evidence-based approaches to opiate addiction. Currently, state law says explicitly that there is no fundamental right to medication-assisted treatment for addiction, that total abstinence from all opiates should be the “primary goal” of any opiate addiction treatment, and that if a doctor does prescribe medication, it should only be a stopgap measure on the way to total abstinence.

Overwhelming evidence has concluded that medication-assisted treatment with opiates is effective at saving lives, reducing the harm caused by buying and consuming illegal drugs, and reducing or eliminating the use of harmful opiates. There is still some debate about whether people should continue taking replacement drugs like suboxone for the rest of their lives—they are opiates, and do cause dependency—but there’s no question that punitive, abstinence-only policies result in more deaths and ruined lives than compassionate, evidence-based approaches like medication-assisted treatment, and it’s high time that state law reflected that.

The bill would also declare the opiate epidemic a public health crisis, seek a waiver from federal Medicare and Medicaid rules to allow opiate addiction treatment in prison, and develop a plan for purchasing and distributing naloxone, the overdose-reversal drug, throughout the state.

If you enjoy the work I do at The C Is for Crank, please consider becoming a monthly Patreon subscriber or making a one-time contribution via PayPal. All the content on this site is free, and I don’t run ads, which means that your contributions are what makes my work here possible.

If you enjoy the work I do here at The C Is for Crank, please consider becoming a sustaining supporter of the site or making a one-time contribution! For just $5, $10, or $20 a month (or whatever you can give), you can help keep this site going, and help me continue to dedicate the many hours it takes to bring you stories like this one every week. This site is funded entirely by contributions from readers, which pay for the time I put into reporting and writing for this blog and on social media, as well as reporting-related and office expenses. Thank you for reading, and I’m truly grateful for your support.

Best of Crank 2017: County Presses Pause on Safe Consumption Sites

Over the next couple weeks, I’ll be hard at work meeting a big deadline (finishing up my book—eek!), so I’m re-running some posts that represent the best of The C Is for Crank in 2017. The posts I’ve chosen include breaking news, longer features, endorsements, and editorial pieces that capture the year in local news.

Of all the recommendations that came out of the King County Heroin and Prescription Opiate Addiction Task Force, by far the most controversial was the suggestion that the county authorize two supervised drug consumption sites (known euphemistically as Community Health Engagement Locations, or CHELs), where drug users could consume illicit substances under medical supervision. The idea was to prevent people from dying of overdoses, and to provide drug users with basic first aid and medical services as well as access to detox and substance use disorder treatment. In July, the county council tapped the brakes on the proposal, voting to only allow supervised consumption sites in cities that explicitly voted to allow them, and cut off access to funding for the sites, effectively “killing” supervised consumption, in the words of one longtime drug-policy reform advocate, until the end of 2018.

This post ran on July 18.

County Presses Pause on Safe Consumption Sites

Two weeks ago, rejecting the unanimous recommendation of the King County Heroin and Opiate Prescription Addiction Task Force, the King County Council voted to prohibit funding for supervised drug consumption sites except in cities that explicitly approve them—a sop to suburban cities and rural areas where residents are vehemently opposed to the sites and a slap in the face for the task force, which recommended a pilot project that would include one supervised consumption site in Seattle and one somewhere else in the county. (The county refers to supervised consumption sites by the clunky acronym CHELs, for Community Health Engagement Locations).

The council also voted to prohibit the county from funding safe consumption sites anywhere outside Seattle, and barred spending any of the county’s general fund on a Seattle site. As a result of those restrictions, any money for the pilot project would have to come from the county’s Mental Illness and Drug Dependency levy—a tax that generates about $66 million a year but is already largely spoken for. The supervised consumption pilot was never supposed to be funded entirely through the MIDD, and supporters say that as the cost estimate for the pilot has ballooned to more than $1 million, the likelihood that it can be funded MIDD dollars alone is virtually zero.

“EFFECT: Restricts the General Fund Transfers to DCHS and Public Health such that 86 no General Funds can be used to establish CHEL sites. Restricts the MIDD  appropriation such that no MIDD funds can be used to establish CHEL sites outside 88 the city of Seattle.” – King County budget amendment barring county spending on safe consumption sites outside Seattle

Kris Nyrop, who wrote an op/ed for the Stranger comparing the council’s move to the “state’s rights” politics of the 1980s, says the vote “effectively kills” safe consumption sites, at least for the next two years, because “The MIDD dollars are all already accounted for until the fall of 2018” and because “the [King County] health department has dithered so long on this that they have given the opposition time to really organize” against it.

Supervised consumption sites, where addicts can use illegal drugs under medical supervision in a location that also offers medical care, detox, and referrals to treatment, are common in Europe but almost unheard-of in North America, where more puritanical attitudes toward addiction have made them controversial. The idea behind supervised consumption is that it keeps people from dying of overdoses and treatable conditions (like wound infections), prevents disease transmission via dirty needles, and gets people who may not have seen a doctor in years into the health care and social service system, providing a lifeline toward housing, treatment, and recovery.

 

“We haven’t yet done the work that we need to do at the council to understand the proposal, the benefits, or the criteria for when and where these [safe consumption sites] make sense.” – King County Council Democrat Claudia Balducci

 

The sites are controversial for obvious reasons: Intuitively, giving drug addicts a safe place to consume dangerous, illegal drugs seems like condoning their behavior. (This view assumes that addiction is a choice and ignores the fact that forcing people into treatment, an alternative that safe consumption opponents frequently suggest, is cost-prohibitive and doesn’t work, but it’s ultimately an emotional argument, not a rational one.)

“Trust me, you don’t treat alcoholism by inviting alcoholics to the bar,” Republican county council member Reagan Dunn, who has been public about his own struggles with addiction, said before the vote. “Fifty-six percent of my constituents said they are extremely against these sites. Only 20 percent of people indicated they were open to considering these sites.” Dunn said he was concerned about the county’s liability if users OD and die inside the facility (in almost 15 years, not one person has died at Insite in Vancouver) and worried that the sites would become magnets for heroin dealers. He suggested that Seattle should be a test case for the site, “before we take the show on the road” to suburban areas that don’t have the same capacity to provide treatment and emergency services.

Republicans weren’t the only ones arguing that safe consumption sites should be limited to the state’s largest city. Suburban Democrats like Claudia Balducci (a former Bellevue City Council member) and Dave Upthegrove, who represents South King County, argued that the county would be overstepping its authority if it opened a safe consumption site where residents opposed the idea. “One of the things that always drove us crazy at the city level was when higher levels of government told us what to do at our city,” Balducci said. “I come from a city that has decided this is not what they want in their city. It doesn’t fit the needs or the desires of their community…. [Safe consumption sites] work best in locations where there’s a lot of street drug use,” she added.

Public Defender Association director Lisa Daugaard, who sat on the heroin task force, argues that “it sets a dangerous precedent to withhold funding for health services from residents of towns whose elected officials have ideological problems with those medical strategies. … The health and well-being of people who live in Kirkland and Kent affect that of people in Seattle, and vice versa.”

Larry Gossett, a Seattle Democrat, scoffed at the implication that drug addiction—particularly heroin addiction—is a problem restricted to big cities like Seattle. Noting that, nationally, heroin and opioid addiction is largely a rural and suburban problem, Gossett said, “I do not understand this concept that people who live outside of Seattle and in suburban and rural areas are different than people who live inside of cities.” Council member Rod Dembowski, whose district includes Shoreline, Kirkland, and Woodinville, added, “There is a serious rural crisis going on, with people dying every day, and I don’t think it’s fair to the citizens of my district to say, ‘No, you don’t get to have return on your investment’ if such a facility would serve their needs. … I don’t think the public health of the 2.1 million residents of this county should be decided based on fear.”

On the  phone last week, Balducci defended her vote, arguing that the budget amendment is a temporary pause, not a permanent spending prohibition. “We haven’t yet done the work that we need to do at the council to understand the proposal, the benefits, or the criteria for when and where these [safe consumption sites] make sense,” she said. “We have to do a little more background work and figure out, what are these [safe consumption] sites and who do they serve.” Balducci also suggested that a huge debate about safe consumption sites could blow up her ongoing efforts to establish the first permanent men’s shelter on the Eastside in Bellevue. “We are facing a really tremendous backlash about that, and one aspect of the opponents’ position is that this is just the camel’s nose under the tent and they’re going to legalize heroin next and [addicts] are going to be out in all the neighborhoods.”

Of course, they’re already there.

Daugaard, who still holds out hope that the council could reverse its decision during the ongoing budget process, says that if they don’t, “it will be very difficult to keep the promise that the heroin task force made to neighborhood leaders in Seattle: that Seattle would not be left alone to respond to this need, which is fundamentally unfair given the widespread use of heroin and opiates throughout the county.  Waiting until 2019 to move forward inevitably will mean avoidable overdose deaths, and no solution to drug use in unsupervised public sites like bathrooms and parks.  Hopefully we all can agree that the status quo is unacceptable. Waiting is not a plan.”

If you enjoy the work I do here at The C Is for Crank, please considerbecoming a sustaining supporter of the site! For just $5, $10, or $20 a month (or whatever you can give), you can help keep this site going, and help me continue to dedicate the many hours it takes to bring you stories like this one every week. This site is funded entirely by contributions from readers, which pay for the substantial time I put into reporting and writing for this blog and on social media, as well as costs like transportation, phone bills, electronics, website maintenance, and other expenses associated with my reporting. Thank you for reading, and I’m truly grateful for your support.

Best of Crank 2017: The Other Drug Epidemic

Over the next couple weeks, I’ll be hard at work meeting a big deadline (finishing up my book—eek!), so I’m re-running some posts that represent the best of The C Is for Crank in 2017. The posts I’ve chosen include breaking news, longer features, endorsements, and editorial pieces that capture the year in local news.

As the heroin and opiate addiction epidemic continued to command attention on the local and national level, this story shone a spotlight on a local drug crisis that still hasn’t been covered anywhere else—a dramatic spike in deaths from methamphetamine overdoses that highlights the need for supervised consumption facilities, staffed with professionals who can reverse and treat overdoses, for all illicit drugs, not just heroin.

As King County Grapples With Heroin, Another Lethal Drug is on the Rise

As political leaders focus their attention on the ongoing epidemic of heroin and prescription opiate addiction—an epidemic that claimed 132 lives in King County in 2015, the last year for which statistics are available—another drug crisis may be developing right under their noses.

Since 2010, according to data just released by the University of Washington, the number of deaths related to methamphetamine has risen steadily throughout Washington State—from 1.8 deaths per 100,000 state residents in 2010 to 4.9 per 100,000 in 2015. In King County, the number of meth-related overdoses increased by 257 percent between 2003 and 2015. Dr. Michael Sayre, the medical director for the Seattle Fire Department and a Harborview-affiliated emergency medicine doctor, calls the uptick in meth ODs “the most significant trend in drug-related mortality” in the region.

Caleb Banta-Green, a researcher with the University of Washington’s Alcohol and Drug Abuse Institute and a member of the King County Heroin and Prescription Opiate Addiction Task Force, says one reason for the uptick in meth use is the fact that “cocaine availability has tanked in the last five years.” Meanwhile, meth has become more potent and readily available than ever before. People appear to be using meth as a cocaine substitute, even though, according to Banta-Green, the two drugs are quite different—cocaine is shorter-lived and less intense than meth, which can provide 20 times the dopamine hit and last many hours longer.

“You don’t hear a lot of people saying, ‘I use cocaine because it helps me stay at my job longer.’ You do hear people say that about methamphetamine,” Banta-Green says.

So why haven’t you read about this emerging epidemic? One of the reasons may be simply that, unlike for opiates, there aren’t any particularly effective medical interventions for meth overdoses or addiction. When someone overdoses on heroin, for example, emergency responders, or even a lay person with the right equipment, can quickly reverse the overdose by giving the victim a shot of Narcan, a drug that restores heart function and breathing. There is no similar drug for meth ODs, which overload the cardiovascular system with adrenalin and can lead to heart failure, stroke, seizures and hyperthermia (overheating). A stimulant overdose “definitely requires medical attention,” Sayre says. “It’s not something that a layperson or even a medically trained person without the proper resources can appropriately manage.”

So why haven’t you read about this emerging epidemic? One of the reasons may be simply that, unlike for opiates, there aren’t any particularly effective medical interventions for meth overdoses or addiction.

Methamphetamine addicts seeking treatment face a similar dearth of medical (as opposed to behavioral) treatment options as those with other addictions. While heroin addicts have the option of medication-assisted treatment with methadone or buprenorphine (Suboxone), two prescription opiates that serve as replacements for more harmful drugs like heroin, there is still no medication-assisted treatment for stimulants like meth. Drug replacement therapy with other stimulants like Adderal (a drug that’s very closely related to meth) doesn’t appear to work and can be dangerous to users who already have high blood pressure and enlarged hearts; and although two antidepressants, buproprion (Wellbutrin) and mirtazapine (Remeron) have shown some promise in reducing meth use in chronic users, neither has been widely tested or shown impressive results.

“I’m not very optimistic that we’re going to get a good medication any time soon,” says Dr. Andy Saxon, who directs the Center of Excellence in Substance Abuse Treatment and Education at the Veterans Administration in Seattle.

Instead, Saxon says that the best treatment he’s found for meth addiction is a behavioral approach called contingency management, where users are given rewards with some monetary value if they stop or reduce their use. The VA, for example, uses what Saxon calls the “fishbowl technique.” Veterans who pass a drug test get to pull a card from a fishbowl (or more than one card if they’ve passed several tests in a row); the reward on the card could be anything from verbal reinforcement (“Nice work”) to a $100 gift card for the VA store. The idea is to replace the hit of dopamine produced when a user takes a drink or a hit with a monetary reward, since both rewards act on the same pleasure center in the brain. Other moderately effective treatments include cognitive behavioral therapy, relapse prevention, and motivational interviewing, all mainstays of traditional treatment programs.

None of those treatments is particularly effective (according to Saxon, about half the people who are in the VA’s behavioral treatment programs manage to reduce their use), and all are significantly more expensive than medication-assisted treatment for opiates, which may consist of nothing more than a prescription for a replacement drug. Nor is it easy to reach meth addicts, particularly those who are homeless or living in marginal housing; unless they are injection users or use other injection drugs like heroin, meth users aren’t coming in to needle exchanges, and they typically leave emergency rooms with little more than a recommendation to seek further treatment and a “good luck.”

Sayre suggests a few solutions that could help meth users in the immediate and long term. First, he says, the state needs to do everything it can to ensure that users in crisis feel safe seeking help. Existing “Good Samaritan” laws, which shield people seeking medical help for an overdose from prosecution, should be expanded to cover people who are on parole, on probation, or who have outstanding warrants. Second, existing outreach programs, such as needle exchanges, should provide incentives for meth users to come in and access their services, such as providing new, unbroken meth pipes. (The People’s Harm Reduction Alliance, which runs a needle exchange in the University District, already does this.) And third, “maybe we need to think more seriously about offering safe spaces and more help for people who are tweaking”— overstimulated on meth—where they can get access to treatment and other services.

As it happens, the county has already proposed creating such a space. It’s called a community health engagement location (colloquially known as a safe consumption site). But it’s generated significant controversy, and is currently the subject of an initiative designed to ban all such facilities across the county.

2018 City Budget Passes Without Head Tax. Now What?

Seattle may be rolling in tax revenues thanks to an economic boom that just won’t quit, but this year’s budget process played out like a recession-year knock-down-drag-out battle. It started when the council’s new budget chair, Lisa Herbold, proposed a budget that presumed the council would agree to a head tax on large employers (and made their top-priority projects dependent on the tax). When the tax failed on a (somewhat predictable) 5-4 vote, council members were left scrambling to come up with a new “Plan B” that would preserve their top priorities. This plan—call it Plan C—included deep cuts to incoming mayor Jenny Durkan’s office, without commensurate cuts to the legislative branch, whose budget included some literal padding in the form of $250,000 for new carpet in council members’ offices.

Over the weekend, though, council members decided to have mercy on the mayor, reducing the proposed cuts to her office by half (and sacrificing their top-dollar carpet in the process). That change would have meant less new funding for the Human Services Department, but a last-minute amendment by council member Kirsten Harris-Talley increased HSD’s funding by dipping into the budget for the Department of Construction and Inspections, which administers permits and inspects buildings (including rental housing) for code compliance. That change, along with numerous other last-minute amendments, happened almost in the moment, and council members who hadn’t seen the proposed changes before today appeared to be reading them on the fly in the moments before voting them up or down. The public, meanwhile, had no way to read or absorb many of the proposed amendments unless they were physically in council chambers, where staffers made hard copies of (some of) the amendments available as the council discussed and voted on them.

Council member Kirsten Harris-Talley

The debate over how much additional funding the council should allocate for HSD—which administers all the city’s grants for homeless services, a job that has grown in scope as the city’s budget for those services has increased—broke down along somewhat surprising lines. On the center left-to-socialist spectrum of Seattle politics, HSD’s mission is strictly centrist, and its director, Catherine Lester—appointed by former mayor Ed Murray in 2015—is a staunch defender of that mission. This year, HSD rebid all its homeless service provider contracts under a new system known as “performance-based contracting”—a process critics say favors large, established service providers that prioritize people who are easier to house at the expense of smaller, scrappier groups that focus on more challenging clients. The agency’s job next year will be to administer those projects and implement Pathways Home, a controversial plan developed in collaboration with Ohio-based consultant Barb Poppe. In 2016, Poppe did a report that concluded that Seattle already has plenty of resources to house every person living outdoors, a conclusion many (including this blog) have contested.  Pathways Home, which is based on that report, directs HSD to shift spending away from transitional housing programs that provide long-term assistance and toward more “cost-effective” solutions like  “rapid rehousing”—short-term rent subsidies to move people directly from homelessness into market-rate apartments. Critics of this approach have argued that expecting people to move from homelessness to full self-sufficiency in a matter of months is unrealistic in a city  where the average one-bedroom apartment now rents for around $1,800.

Murray and Lester butted heads with the left wing of the council (as well as many homeless advocates) over rapid rehousing, performance-based contracting, and Pathways Home, but you wouldn’t know that from this month’s budget debate, in which HSD was often portrayed as a direct social service provider rather than a contract administrator. (This happened a lot earlier in the process, too, when hundreds of thousands of dollars were shifted from the Department of Finance and Administrative Services to HSD). On Monday, Harris-Talley described Lester as “a jewel of the community” and said she had “deep concerns about what has happened in regards to HSD, how that department has been treated.” It was disappointing. she added, “to see a department with a black woman at the helm” taking on significant additional responsibility without a commensurate amount of additional funding. It’s unclear whether Durkan—who supports Pathways Home—will appoint her own HSD director or keep Lester on board.

Comic Sans and public opinion in the ladies’ room.

The employee hours tax tax isn’t dead. In fact, several council members attempted to forcibly resurrect it yesterday, by proposing a budget amendment that would have required the council to pass the head tax after going through the motions of a four-month process to come up with a sustainable revenue source for homelessness. The five council members who voted against the head tax, unsurprisingly, weren’t interested in committing in advance to the same tax they just rejected, and they (also unsurprisingly) prevailed, inserting language into the amendment that commits the council instead to coming up with “progressive taxes” of some sort that will yield at least $25 million for homeless services. Any proposal they come up with will likely include a head tax, because the council’s taxing authority is quite limited, and council members made that clear. That didn’t stop the crowd from screaming “Bad!” and “Shame!” and booing council members so loudly they had to repeatedly stop the proceedings. (A couple of people were kicked out). Sawant, too, repeatedly denounced her council colleagues, as she has throughout the budget process, as “corporate politicians” kowtowing to their masters at the Chamber of Commerce. This kind of rhetoric definitely riles up the base, but it doesn’t win any currency with people like Rob Johnson, an earnest liberal who fought (against Herbold!) to ensure that supervised consumption sites were fully funded in this year’s budget, a position that I’m betting scored him zero points in his Northeast Seattle council district.

Social service and safe consumption site advocates line up hours early for yesterday’s 2pm council meeting—as they do whenever they know council member Kshama Sawant has invited her supporters to “pack city hall”

A cynical observer might point out that by keeping the discussion over the head tax alive, council members who did not prevail last week got another opportunity to make rousing speeches and rally the base on Monday. The council’s resident (official) socialist, Kshama Sawant, has encouraged her supporters (on social media and through her official city council email list) to “pack city hall” for every budget discussion and vote, and they have done exactly that, showing up at every budget meeting to wave red “stop the sweeps” signs, applaud Sawant’s lengthy speeches (one of many she made yesterday stretched nearly 15 minutes) and shout down council members who voted against her proposals.

A word about the screaming. It may be directed at the three women and two men who vote the “wrong” way, but it has the effect, in the moment, of shutting down all discussion. When you use brute verbal force against political opponents (both those on the dais and those who are scared to speak because, well, they’re worried about screamed at) it goes beyond merely “disrupting business as usual.” It’s disrespectful, counterproductive, and, most importantly, intimidating—social service advocates whose programs are in the budget still show up (hours early, to get ahead of Sawant’s supporters) to speak at council meetings, but otherwise, public comment is overwhelmingly dominated by a single set of voices. People who used to show up don’t show up. Dissent—the normal give and take of democracy playing out in public—is almost literally drowned out when one side asserts their right to own a public space by shouting everyone else out of the room. This year, I was disturbed to hear council members explicitly equate “the people here in the room today” with “the community” at large. Most of the 700,000 people in Seattle, and indeed most of the much smaller group of people who have an opinion about the 2018 city budget, weren’t represented in council chambers, and rarely are. This, even under ordinary circumstances, is perfectly understandable—most people have to work during the day, for one thing—but council members should take that into account, and not conflate “people with time to sit in council chambers day after day” with “a representative sample of the community at large.”

It will be interesting to see what happens to the council’s left wing—Lisa Herbold, Kshama Sawant, and Mike O’Brien—once council member-elect Teresa Mosqueda takes office, replacing Harris-Talley, next week. Mosqueda defeated the far left’s preferred candidate, Jon Grant, and will not be a reliable vote for the Sawant wing of the council, who couldn’t muster a majority for the head-tax-based budget even with Harris-Talley on the council.

Sawant, who represents council District 3 (which includes Capitol Hill and the Central District), was the only council member to vote against the budget—as she has since her election in 2013.

If you enjoy the work I do here at The C Is for Crank, please consider becoming a sustaining supporter of the site! For just $5, $10, or $20 a month (or whatever you can give), you can help keep this site going, and help me continue to dedicate the many hours it takes to bring you stories like this one every week. This site is funded entirely by contributions from readers, which pay for the substantial time I put into reporting and writing for this blog and on social media, as well as costs like transportation, phone bills, electronics, website maintenance, and other expenses associated with my reporting. Thank you for reading, and I’m truly grateful for your support.

After Two-Year Gap, Detox Center Will Open on Beacon Hill

King County Executive Dow Constantine stands next to a detox bed at the soon-to-open Recovery Place.

The new detox and inpatient treatment center that will open later this year on Beacon Hill doesn’t look like much from the outside. A low-slung institutional building surrounded by a black iron fence and fronted by a small parking lot, it looks somewhat out of place in a residential neighborhood where brightly colored townhouses have sprouted like dandelions in recent years.

Even from the inside, you have to squint to imagine the transformation—from what Valley Cities Behavioral Health Care CEO Ken Taylor called a “ghastly” institution, run by Recovery Centers of King County, into a modern, brightly lit facility with fitness rooms, two large kitchens, and rooms for group meetings and private counseling.

The opening of the new facility, called Recovery Place, marks a significant milestone for detox and treatment in King County—the restoration of 32 beds for people needing medical detoxification from alcohol, heroin, and other drugs, and the first residential detox center in King County where people can access treatment for addiction and mental health issues simultaneously. (Most treatment centers do not deal with dual diagnoses).

The city’s Navigation Center, a new low-barrier shelter less than a mile away, will direct clients to Recovery Place, which will also take patients directly from emergency rooms and (eventually) on a walk-in basis. In addition to detox and a traditional two-to-four-week inpatient treatment program, the center will offer medication-assisted treatment with drugs like buprenorphine to heroin and opiate addicts. “We’re embracing a harm-reduction approach as much as an abstinence-based approach,” Milena Stott, Valley Cities’ director of inpatient services, said.

Valley Cities CEO Ken Taylor in the detox wing of Recovery Place

The last tenant to occupy the building, Recovery Centers of King County, went bankrupt and shut down abruptly in 2015, and since then, the 27 detox beds they provided have been distributed all over King County through contracts with institutions like Fairfax Hospital in Kirkland and the Seadrunar long-term treatment center in Georgetown.  Before RCKC closed down, Taylor said, the building “was dark and damp, and all throughout the central corridors there was plumbing and electrical running literally right down the middle of the corridor.” Outreach workers told me last year that RCKC was known for treating clients rudely and asking “inappropriate” personal questions in earshot of other patients; the new facility, in contrast, will have private consultation rooms. After RCKC closed, the building itself was taken over by squatters and stripped bare, with everything from the toilets to the copper wiring stolen and carted away.  Morgan Irwin, a Republican state representative (R-31) and Seattle Police Department officer who was on hand for yesterday’s tour, said that the last time he was inside the building, which is on his beat, “It was literally flashlight and gun out.”

The building cost $4 million to buy, plus $9 million to renovate. A million dollars of the budget to buy and fix up the building came from King County; the rest came from a combination of state and grant money and a $4.5 million loan that Valley Cities took out from Bank of America to cover the remaining costs. The state’s capital budget, which remains in limbo, is supposed to provide about $2 million toward the cost of repaying the loan, but Taylor said Valley Cities “is going to be able to repay the loan” ion its own if state funding doesn’t come through. “We’re very fortunate. Not every agency can do that.” Ongoing operations will cost about $5 million a year; that funding will come from the state and federal governments as well as from patients’ insurance payments. RCKC went bankrupt, King County Human Services Department director Adrienne Quinn told me, in part because of unfavorable state reimbursement rates, which she was quick to add have been addressed.

Contrary to common belief, not every person with addiction needs detox, although medication can ease the suffering and make it less likely that people withdrawing from opiates, for example, abandon treatment. (Severe alcoholism does require detox because going cold turkey can cause seizures, DTs, and fatal heart conditions.) Buprenorphine, and other opiate substitution medications, can help short-circuit the withdrawal process and get opiate addicts on a path to stability. “I hope that everyone for whom buprenorphine is appropriate will elect to do that,” Taylor said, “but sometimes it takes them time to get to that point.”

If you enjoy the work I do here at The C Is for Crank, please consider becoming a sustaining supporter of the site! For just $5, $10, or $20 a month (or whatever you can give), you can help keep this site going, and help me continue to dedicate the many hours it takes to bring you stories like this one every week. This site is funded entirely by contributions from readers, which pay for the substantial time I put into reporting and writing for this blog and on social media, as well as costs like transportation, equipment, travel costs, website maintenance, and other expenses associated with my reporting. Thank you for reading, and I’m truly grateful for your support.

Families of Opiate Epidemic Victims Reach Different Conclusions on Safe Consumption Sites

This story appeared in Seattle Magazine.

For months, there had been red flags. In the past, 19-year-old Amber Roberts had always made plans with her father, Michael Roberts, for his birthday. But this year, she canceled at the last minute without explanation.

A few weeks earlier, the former Lake Washington High School student had broken things off with her longtime boyfriend, who lived in Oregon, claiming he was “smothering” her. And friends who partied with her had noticed changes, too. Earlier that month, one of them had texted Amber’s mom telling her that Amber—the girl who still hated needles so much that she took her dad with her when she had to get a shot—had been doing heroin for the past several months. Alarmed, Amber’s mom contacted Roberts, and they made a plan to get their daughter into treatment as soon as Amber returned from Paradiso, a two-day music festival held every year at the Gorge.

But Amber had a friend drive her home from Paradiso early, complaining that she was sick. (Roberts believes she was in heroin withdrawal.) She left her mom’s house for a while, then came back and went upstairs, telling her mom and stepdad she was feeling fine. Roberts still remembers the last text he got from his daughter. “She texted me at around midnight to say she was fine,” he recalls. “And she probably died right after that.”

Heroin can kill slowly or quickly. Many people live through overdose after overdose—saved, in many cases, by the overdose reversal drug naloxone—and experience periods of recovery interspersed with periodic relapses. Others, like Amber, use the drug for just a short time—in Amber’s case, about four months—before taking a last, fatal dose. Sometimes, Roberts says, he feels lucky compared to parents who watch their kids struggle with addiction for years and years. Then he remembers his daughter’s loyalty, her “indescribable laugh” and her love for her family, and he says, “We would take that [struggle] over anything, because at least there would be a chance to save her.”

Since Amber’s death, Roberts, who lives in Kirkland, and Amber’s mother, Kristen Bretthauer, have started Amber’s HOPE (Heroin, Opiate Prevention and Education), a group that works to raise awareness of opiate addiction among teenagers. He’s also become an outspoken advocate for supervised consumption sites—places where users can inject or smoke their drug of choice under medical supervision, with access to wound care, detox and treatment referrals, and overdose reversal and prevention. The goal of supervised consumption isn’t to “cure” addicts. But, as Roberts says, it “can save people’s lives. That’s the bottom line for me. Once you’ve gone through what I went through, you will do anything for other parents not to have that experience.”

So far, there’s only one supervised injection site in North America: Insite, in Vancouver, British Columbia, which has an average of 514 injection-room visits every day, according to program founder Liz Evans. (Insite’s facility only caters to injection drug users; most safe consumption sites also allow people to smoke drugs as well as inject them.) But the sites are common across Europe and they could soon be coming to King County. Last year, the 27-member King County Heroin and Prescription Opiate Addiction Task Force, which includes political leaders, medical experts, drug-policy reform advocates and the mayors of several suburban cities, recommended that the county open two supervised consumption sites as a three-year pilot project, including one in Seattle.

King County Executive Dow Constantine and Seattle Mayor Ed Murray convened the task force last year in response to sharp increases in both opioid addiction and overdose deaths. In 2015, the last year for which finalized data is available, 132 people died of heroin overdoses in King County, up from 99 just two years earlier. Meanwhile, since 2015, heroin, rather than alcohol, is the primary reason people enter detox programs in King County. The recommendation for supervised consumption sites was just one of the task force’s eight proposals, which also included increased access to medication-assisted treatment with buprenorphine, a drug that reduces opioid cravings; widespread distribution of naloxone, a nasal spray that can reverse overdoses; and increased spending on prevention programs. But of all the recommendations, safe consumption has been by far the most controversial.

Opponents, such as state Senator Mark Miloscia, who represents Federal Way, argue that safe consumption sites enable users and normalize drug use; he believes drug users need to “hit rock bottom, where they’re looking death in the eye…that’s how you change behavior.” Miloscia, a conservative Republican who has sponsored legislation that would ban safe consumption sites as well as a bill banning all homeless encampments in Seattle, argues that shame, not acceptance, is what keeps people from using drugs. Proponents counter that safe injection sites keep drug users alive—by offering medical care, teaching safer injection practices and monitoring users for overdoses—and provide them with tools and services that help them reintegrate into society, even if they aren’t ready to quit.

“These spaces are not just about drug use—they’re about really connecting folks to community and not just kicking them back out onto the street,” says Patricia Sully, an attorney with the Seattle Public Defender Association (PDA) and the coordinator for Voices of Community Activists and Leaders (VOCAL-WA). VOCAL-WA, which operates under the umbrella of the PDA, is a grassroots group of low-income people, drug users and community advocates who work to promote harm reduction. “Drug treatment itself might not be the only thing people need. Many people need connections to mental health services. Many, many people need connections to housing. And we know that all of those things really make a huge impact in someone’s quality of life,” Sully says.

Harley Lever is a neighborhood activist who ran for mayor in this year’s race and  founded the group Safe Seattle, which advocates against safe consumption sites. HeImage result for harley lever seattlesays the problem with that point of view is that the sites “could never scale to the enormity of the problem,” which is only growing as drugs like fentanyl make street heroin more unpredictable and lethal. “If you said, ‘What’s going to save more lives?’ I think the science will back me up and say widespread distribution of naloxone is going to save far more lives” than safe consumption sites, Lever says.

Safe Seattle advocates for naloxone distribution, but their main contribution to the debate over safe consumption sites has been advocating Initiative 27, which would ban safe consumption sites throughout King County. Editor’s note: Opponents of the initiative won a court ruling that could keep the initiative off the ballot, but proponents are expected to file an appeal. In the meantime, the King County Council has passed an alternative ballot measure to replace I-27 if proponents win on appeal; that measure would ask voters whether they support voting on supervised consumption sites at all, and, if they say yes, whether they support or oppose the sites.

Lever, like Roberts, came by his views on addiction the hard way. Two of his brothers, along with countless friends and relatives back in his hometown of Boston, have been addicted to heroin, and several have wound up in jail or died. One of Lever’s brothers has been clean for years; the other, an Army veteran who has spent years in and out of Veterans Administration (VA) rehabs, is now homeless and living, Lever says, on “borrowed time.”

“[My brother] has OD’ed four times in the last year, and every time he was saved by naloxone,” Lever says. “He’s been in this constant cycle of being in treatment, getting sober, living in sober housing—and then, almost every single time, right when he gets his check [from the VA], he goes and spends it and he’s back in that cycle.”

Although one of his brothers quit “cold turkey” and “turned his life around,” Lever has slim hopes for his homeless sibling. “We’ve tried everything. It’s been 15 years, and he’s been so lucky to survive, but we know one day we’ll get the call,” he says. The VA has provided Lever’s brother with a place to stabilize himself and access health care and treatment, and it has probably helped him stay alive this long. But it hasn’t gotten him sober.

While one argument against safe consumption sites is that anything that allows addicts to continue using is the wrong solution to the opioid crisis, there are other objections.

Some who are opposed to safe consumption sites say the sites will bring crime and addiction to neighborhoods where drugs and crime were not previously a problem, or worry that the sites simply enable addicts to “slowly kill themselves by taking drugs and harming their bodies,” as Republican King County Council member Kathy Lambert, who represents Sammamish, Redmond and Issaquah, said back in June.

But the Vancouver Insite experience has proven otherwise. Insite founder Evans says the amount of street disorder around the facility has declined significantly since it opened in 2003, and that Insite staffers have reversed more than 6,000 overdoses; in 14 years, not one person has died at the site. Vancouver’s Downtown Eastside, where Insite is located, is a rough-edged but gentrifying neighborhood near the city’s Chinatown that has been plagued by drugs and crime for decades. Seattle has no real equivalent, since drug use here is more widely distributed throughout the city, which is one reason advocates here have argued for more than one safe consumption site.

That information, however, doesn’t sway opponents like Lever.

“The compassionate side of me says we shouldn’t be [pushing I-27], but the strategic side of me says we should, because we should be focusing on better solutions than safe injection sites.”

Ultimately, the initiative may be unnecessary. In June, a majority of the King County Council voted to prohibit funding in the amended 2017–2018 budget for supervised drug consumption sites except in cities that explicitly approve them, and to bar county funding for any site outside Seattle. The vote effectively means that a safe consumption site couldn’t open until 2019 at the earliest, because the only potential funding source for a site in Seattle, the countywide Mental Illness and Drug Dependency tax, is already spoken for.

Officials in Seattle have not identified a specific site, but City Council and County Council members who represent the city, such as King County Council member Jeanne Kohl-Welles of District 4 (which includes Ballard, Fremont, Crown Hill and Wallingford), have said it will not be in any neighborhood that doesn’t want it, making Capitol Hill a more likely location than, say, Magnolia.

Dave Upthegrove, a Democratic County Council member who represents Burien and other South King County suburbs, says that while there is a lot of misinformation about the risk of safe consumption sites, “people’s emotions are real, and we need to be respectful of people’s fears.” He adds, “Even folks who have experienced heroin addiction in their own families are divided.” He fully supports the sites, however, and supports Seattle becoming the first city in the region to have them.

Roberts, who has been open about his own struggles with addiction, believes that the fears people have about drug users can only be addressed by destigmatizing addiction; more people also need to understand that even “good people” can get swept up by addiction. “There tends to be an attitude of ‘My child would never do that’; I really want to sway that view,” he says. “In one year, there were at least three overdoses at Amber’s high school. There’s just not enough awareness of the problem.”

With the dramatic increase of overdose deaths, he says, “there’s not going to be anyone around to deal with it anymore.”

Although Roberts and Lever—both King County residents whose families have been devastated by the impact of heroin addiction—have reached vastly different conclusions about how to solve the problem, they agree on this point.

“What I fear most is we’re going to die our way out of this epidemic,” Lever says.

The Europe Experience

Safe consumption sites are still rare in the United States, but they have a long history in Europe, where the first supervised injection site opened in Bern, Switzerland, in 1986. Since then, more than 75 such sites have opened across the continent: in Germany, the Netherlands, Spain, Norway, Luxembourg, Denmark, Greece and France.

Although the services offered by safe consumption sites vary slightly from country to country (some are strictly safe injection sites; others provide medically assisted treatment right on site), the basics are the same: They include a safe space to consume illegal drugs indoors and under medical supervision, clean needles, basic medical care, and connections to addiction treatment and other health and social services.

Numerous studies across Europe have concluded that safe consumption/injection sites not only reduce risky behavior, such as sharing needles, but lower the number of overdose deaths in cities. Safe consumption sites also have been found to reduce the number of violent, property and nuisance crimes associated with street drug use, and increase the number of people who get into treatment—a result that holds true in North America, too, where more than 60 peer-reviewed studies have concluded that Insite, the safe consumption site in Vancouver, British Columbia, has increased the number of people seeking treatment without increasing crime.

Morning Crank: Just the Highlights

1. The HIGHLIGHT of last night’s mayoral debate at Seattle University, which I live-tweeted (Storify here): When “establishment” candidate Jenny Durkan, an activist for LGBT rights before she became a US Attorney under Obama, turned to her opponent Cary Moon and said, “Part of me wants to say, when did you get woke, because I’ve been working on these issues for 20 to 30 years in this city.” Durkan was responding to Moon’s sound bite about sharing power with all races and genders to create an racially and socially equitable city government.

2. The HIGHLIGHT of King County Superior Court judge Veronica Alicea Galván’s ruling against proponents of Initiative 27, which would have barred safe consumption sites throughout King County: The section explaining exactly why restricting the county’s spending power by banning safe consumption sites “impinges on the legislative authority of the county,” goes beyond the authority of local initiatives by attempting “usurp state law,” and conflicts with a state supreme court ruling that upheld the right of local public health authorities to respond to public health crises like the opiate epidemic. “Accordingly, I-27 in its entirety extends beyond the scope of local initiative power,” the ruling concludes.

3. The HIGHLIGHT of my conversation about the proposed First Avenue Streetcar with former Transportation Choices Coalition director-turned council land use chair Rob Johnson yesterday was his exasperated response to streetcar critics who say the city should return $50 million in federal money because it’s unclear where ongoing funding for streetcar operations will come from:

“All these capital projects come with a level of risk. … How come we’re not having those same discussions about Lander Street [a $123 million overpass project that was planned long before it received full funding]? We always pick on transit projects to ask these fundamental structural questions, but we never do that for road projects. We didn’t spend 25  minutes talking about Lander today. Instead, we spent 25 minutes talking about the streetcar. … It feels like this project is being singled out unfairly. So if my colleagues are going to continue down that path, we need to do it for all these other major capital projects.”

If you enjoy the work I do here at The C Is for Crank, please consider becoming a sustaining supporter of the site! For just $5, $10, or $20 a month (or whatever you can give), you can help keep this site going, and help me continue to dedicate the many hours it takes to bring you stories like this one every week. This site is funded entirely by contributions from readers, which pay for the substantial time I put into reporting and writing for this blog and on social media, as well as costs like transportation, equipment, travel costs, website maintenance, and other expenses associated with my reporting. Thank you for reading, and I’m truly grateful for your support.

Republicans Show Up, Business Community Sits Out, Hearing on Supervised Consumption Sites

King County Superior Court Judge Veronica Alicea-Galván gave no obvious indication this morning which way she plans to rule on a lawsuit challenging I-27, an initiative that would ban supervised drug consumption sites countywide, but afterward, the attorney representing safe-consumption opponents seemed perturbed. “As the plaintiff’s attorney [Knoll Lowney] pointed out, they only have to succeed on one of their claims; we have to succeed on multiple claims.” Stokesbury was referring to the fact that initiative opponents are claiming I-27 violates five different rules that govern local initiatives, including a rule that says that urgent public health decisions must be made administratively (that is, by a non-legislative body like the King County Board of Health), not legislatively, and that the King County Charter itself prohibits voters from undoing budget decisions by referendum. (I covered some of the other legal arguments on Twitter). Alicea-Galván plans to rule on the lawsuit by the end of the day Monday, and both sides have said they will appeal if they lose.

Earlier this year, the King County Council voted to prohibit funding for safe consumption sites except in cities that explicitly approve them; since then, Bellevue, Federal Way, Auburn, and other cities have passed legislation banning the sites wihtin their boundaries. After the hearing, I asked Stokesbury why, if cities have the right to ban sites already, I-27 proponents want the right to prohibit cities like Seattle from allowing them. “We live in a regional area,” Stokesbary said. “Some folks might live in a city but work in a different city. I don’t know if we want to go back to an era where cities aren’t connected.” Stokesbary also suggested that allowing supervised heroin consumption, in particular (safe consumption sites would cover all drugs, but opponents refer to them as “safe injection sites”) would make it “harder to dissuade people from using heroin,” in the same way, he said, that legalizing marijuana has made marijuana use more common.

Without going too deep down that rabbit hole, I noticed something … odd about the safe-consumption opponents who packed the courtroom today and spilled into an overflow room down the hallway. No, not their maroon scarves, or the baseball caps they were required to remove in the courtroom, nor even their tendency to guffaw and cough loudly when they disagreed with a point as if they’d never been inside a courtroom.

What was weird was that there were so many of them—far more than the handful of familiar faces who reliably turn out to midday hearings about supervised consumption sites. There was, it turns out, a reason for that: The state Republican Party—headed by Susan Hutchison, who remains one of Trump’s most stalwart local supporters—sent out an email to its members urging them to show up in King County Court today, and to “wear baseball caps to be identified as pro-I-27.” (Whoops.)

“Polls show that citizens overwhelmingly reject heroin injection sites as a danger to society,” the email alert says. “Unlike the city of Seattle, we want compassionate solutions to TREAT the opioid addiction epidemic.” 

The other thing about the crowd that jumped out at me this morning was who wasn’t there: Representatives from business groups in Seattle, which have effectively sat out the whole debate over supervised consumption sites. That’s notable—and represents a significant shift from just a few years ago. Groups like the Downtown Seattle Association and the  Chamber of Commerce, which were initially skeptical of another harm-reduction program called Law Enforcement Assisted Diversion, came around to that program when it became clear that throwing drug users in jail wasn’t solving the problem of downtown drug use and disorder. Supervised consumption sites, radical as they may seem now, will serve a similar purpose: Meeting drug users where they are and offering them alternatives instead of locking them up and pretending that will fix the problem.

If you enjoy the work I do here at The C Is for Crank, please consider becoming a sustaining supporter of the site! For just $5, $10, or $20 a month (or whatever you can give), you can help keep this site going, and help me continue to dedicate the many hours it takes to bring you stories like this one every week. This site is funded entirely by contributions from readers, which pay for the substantial time I put into reporting and writing for this blog and on social media, as well as costs like transportation, equipment, travel costs, website maintenance, and other expenses associated with my reporting. Thank you for reading, and I’m truly grateful for your support.