County: Widely Reported Data Point in “Prolific Offenders” Report Was Wrong

Earlier this year, Scott Lindsay—a former adviser to Ed Murray who unsuccessfully challenged city attorney Pete Holmes in the 2017 election—published a report in collaboration with the Downtown Seattle Association and other downtown groups called “System Failure.” The report, which was featured prominently in the viral KOMO 4 special “Seattle Is Dying,” highlighted 100 so-called “prolific offenders,” including 87 who had been arrested in Seattle more than four times in a 12-month period and another 13 who Lindsay felt had “a particularly high impact on public safety,” as SCC Insight reported.

The report included one particularly startling statistic: More than 30 percent of the time, “prolific offenders” were released from King County jail onto the streets at midnight, when social services and shelter are unavailable. “For homeless individuals struggling with substance use disorders and mental health conditions, this practice can be hazardous to the individual and to the immediate surrounding neighborhood,” Lindsay reported. The statistic was reported by most major local outlets, including Crosscut, KING 5,  and the Seattle Times, which said the practice “put[s] at risk those who are homeless and struggling with substance-abuse disorders and mental conditions.”

“It’s not up to  me to correct publicly the inaccuracy of the information they’re making public.”—Consultant Tim Ceis, who worked on the “System Failure” report

The real number of people being released from King County jail onto the streets at midnight, according to the county’s Department of Adult and Juvenile Detention? Zero.

“We researched the past year and determined that no inmate was released out of custody from DAJD facilities at midnight,” says Captain Captain Lisaye Manning, a spokeswoman for the King County Department of Adult and Juvenile Detention. “The terminology of ‘released’ refers to being released from the King County Jail and transferred custody to a different agency, not released out of custody to the streets. There are some occasions that those outside agencies aren’t available until late evening or early morning hours.”

Screen shot from “System Failure” Report

 

Manning said Lindsay and his fellow researchers should have used the county’s public booking database to determine when and why people were released from custody (and to whom). Instead, Lindsay apparently used used the county’s Jail Inmate Lookup System, a blunter instrument intended to help people look up information about specific inmates. That system does not specify the reason an inmate was released or whether he or she was released into the custody of another agency.

“The Executive’s Office conveyed to the report’s author, Scott Lindsay, that he did not use correct data in his evaluation,” Capt. Manning says.

Alex  Fryer, a spokesman for King County Executive Dow Constantine, confirms that Constantine’s office told a consultant who helped Lindsay on the report, Tim Ceis, that the information in the report was wrong. DADJ provided The C Is for Crank with a link to what Fryer calls “the correct database, showing that we’re not putting people out on the streets of Seattle” at midnight. Fryer adds that Lindsay’s error was understandable, given that the jail list is the county’s public-facing database of inmate information. Ceis confirms that the county did inform him and Lindsay “that the information that we were seeing was inaccurate, for whatever reason,” but says he saw no reason to correct the record, since the errors, in his opinion, were the county’s.

“Their record-keeping and what they were putting out there in the jail records was not accurate,” Ceis says.  “It’s not up to  me to correct publicly the inaccuracy of the information they’re making public.”

Lindsay responded at 5:30 this evening to an email I sent three hours earlier. However, his response did not include answers to my questions about the apparent data discrepancy. I have sent him a more detailed list of questions and will update this post if I hear back.

Public Defender Association director Lisa Daugaard, who has said that the “System Failure” report should have been called “Systems Failure,” to emphasize that the justice system is not the only system failing chronically homeless people, says that if the county isn’t releasing people onto the streets at midnight, that’s a welcome change from something that “has been a problem in years past.”

Daugaard says that if the county isn’t, in fact, releasing prolific offenders into downtown Seattle at midnight, that just “underscores my feeling about the takeaways from the report —it’s less that the criminal justice system is failing, as that the criminal justice system, operating in the ways it inevitably does, is not the right system to address these problems, except at the margins and when other systems”—such as health care and housing—”have gaps.” Why, Daugaard asks rhetorically, “is this group [of “prolific offenders”] not prioritized in the large investments that have been made in each of those systems in recent years?”

Support The C Is for Crank
Hey there! Just a quick reminder that this entire site, including the post you’re reading, is supported by generous contributions from readers like you, without which this site would quite literally cease to exist. If you enjoy reading The C Is for Crank and would like to keep it going, please consider becoming a sustaining supporter. 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 my full-time job. Help keep that work sustainable by becoming a supporter now! If you don’t wish to become a monthly contributor, you can always make a one-time donation via PayPal, Venmo (Erica-Barnett-7) or by mailing your contribution to P.O. Box 14328, Seattle, WA 98104. Thank you for reading, and I’m truly grateful for your support.

Tech Addiction Is On the Rise In Seattle—But Why?

Photo by Hayley Young for Seattle magazine

This article appeared in the June 2019 issue of Seattle magazine and was produced in collaboration with Crosscut. A full version of this piece is available at Seattle magazine’s website. 

Laura and Dave Johnson* had always known that their older son, Eric, was different than other kids. Diagnosed with severe ADHD at a young age, Eric was smart, sensation-seeking and focused—the kind of kid, his mother says, who has “a brain for coding,” and is “smart in a way that we don’t understand yet.”

If he wasn’t racing his mountain bike downhill, he was bouncing parkour-style off the sides of downtown buildings or watching television with an intensity that unnerved his parents. “He could watch TV all day long,” says Laura Johnson.

Then, like most of his peers, Eric discovered video games—Mario Kart, Splatoon (a third-person game in which players splatter each other with ink), The Legend of Zelda. After that, Johnson says, things were never the same. Unlike most kids and adults who play video games, Eric, now 15, didn’t seem to have an “off” switch. By the time he was in middle school, games were all he could think about. It was like the games were doing the same thing for him that mountain biking did, Johnson says. “He likes that tactile [sensation] and he needs his brain to go fast and he needs feedback from something.”

The Johnsons live in a comfortable brick Tudor in Seattle’s Broadview neighborhood. There’s one TV in their house and just two computers: a desktop in the basement that Dave uses for work and Laura’s laptop. The idea that video games could become a problem, much less an addiction, was completely alien to them. Over time, though, they began to realize that their son’s fascination with games and other screens resembled an addiction. “He rushes through other things if he knows there’s ‘game time’ in his future,” she says. “And that ‘game time’ is on his mind [until] he gets it—regardless of what we are doing.”

While gaming—or tech—addiction is uncommon (and the label “addiction” remains controversial), Eric is not alone. Dr. Dimitri Christakis, director of the Center for Child Health, Behavior and Development at Seattle Children’s Research Institute, estimates that between 5 and 12 percent of young adults show signs of gaming disorder; a 2017 paper in the American Journal of Psychiatry, meanwhile, put the number at less than 1 percent of the general population.

Games (and social media such as Instagram and Twitter) have an additional characteristic that makes them habit-forming: They provide that kick of dopamine at unpredictable intervals, providing an incentive to stay glued to the screen.

The jury is still out on whether tech addiction is more prevalent in places like Seattle, where a higher-than-average number of people work in the tech industry, but anecdotal evidence suggests there could be a correlation. Hilarie Cash, the founder of a Fall City–based inpatient tech addiction treatment program called ReStart, says that when she started treating people for gaming disorder, back in the mid-1990s, most of her patients were adults working in the tech industry; today, she says, many of her clients have parents who work in the industry and who “tend to be very surprisingly oblivious to the impacts of screens on child development.”

Experts generally agree that too much screen time can inhibit kids’ ability to focus, develop social skills and engage in activities that don’t produce an immediate reward the way screens do. Cash also points to school districts in large, highly connected cities that, she says, have “drunk the Kool-Aid and are trying to get tablets and computers in the hands of every student, even in elementary school.”

In recent years, there has been significant interest in recognizing gaming disorder as a formal diagnosis, spurred largely by an international uptick in people seeking treatment for the disorder. Last year, the World Health Organization officially recognized gaming disorder as a condition in its International Classification of Diseases, and the American Psychiatric Association, which publishes the Diagnostic and Statistical Manual of Mental Disorders (DSM), has recognized “internet gaming disorder” as a “condition for further study” for possible future inclusion in what’s often called the bible of psychiatry. The state of research remains in its infancy, however, and experts disagree on everything from the best course of treatment to whether compulsive gaming should be classified as an “addiction” at all.

For the Johnsons, their attempts to curtail Eric’s obsession with gaming began by trying to restrict his access to technology. They established boundaries, one after the other—no games until he’d done something creative, or no more than an hour of gaming a day—but Eric broke every rule. “I tried so many different scenarios,” Johnson says. “No boundaries ever worked. Nothing ever worked.”

Over the course of Eric’s seventh-grade year, this “very smart, very savvy…fascinating” kid transformed into a person his parents barely recognized—a kid who spent all his time “speedrunning” (playing through games as fast as possible) and throwing fits when his parents tried to restrict his access to games. “He would run away,” Johnson recalls. “He jumped out of the car once while it was moving.” After the Johnsons took away his smartphone, Eric stole money from his brother, who is three years younger, got off the bus on the way to school and bought a second phone. (Then, when they took that phone away, he did it again.)

Over the course of Eric’s seventh-grade year, this “very smart, very savvy…fascinating” kid transformed into a person his parents barely recognized—a kid who spent all his time “speedrunning” (playing through games as fast as possible) and throwing fits when his parents tried to restrict his access to games.

At their wits’ end, the Johnsons sought advice from Ann Steel, a counselor who specializes in gaming addiction. Following her advice, they sent Eric to a wilderness camp on the Olympic Peninsula—an increasingly common, if still unproven method of treating kids whose gaming or screen time starts to negatively impact their lives—shortly before his 13th birthday. On his final night before he left for camp, Eric stole his mom’s laptop and stayed up all night surfing the web, like someone getting a last fix before going to rehab. After 10 weeks in the wilderness, Johnson says, Eric “did seem clearer in his head.” On the other hand, the day after he returned, he broke Johnson’s windshield.

Last year, after doing more research about its options and hiring an education consultant, the family sent Eric to Cherry Gulch, a therapeutic boarding school outside of Boise, Idaho, that offers individualized education and treatment to kids struggling with various issues, from grief to ADHD to digital addiction. Johnson says her son is doing well. After a year at Cherry Gulch, she says, “his growth has been huge. The most growth we’ve had in his 15 years of life.”

Still, it’s unclear what his parents will do when Eric graduates from Cherry Gulch this summer, and how they’ll keep him from slipping back into his old habits when he returns. He’s just coming to terms with the fact that he has an addiction to gaming and screens, Johnson says. “He isn’t quite at the acceptance phase.”

The notion that it’s possible to be addicted to video games, or any type of technology, has gained mainstream acceptance in recent years. Like gambling—the only behavioral addiction currently included in the DSM—video games seem to trigger some of the same chemicals in the brain as alcohol and illicit drugs, including dopamine, the so-called “reward neurotransmitter” of the brain. But games (and social media such as Instagram and Twitter) have an additional characteristic that makes them habit-forming: They provide that kick of dopamine at unpredictable intervals, providing an incentive to stay glued to the screen.

Think of it as a lab experiment, says Christakis. “If you try to condition a rodent to push a lever when a stimulus comes, and they get a reward every time, it doesn’t create an obsession,” Christakis says. Make the rewards unpredictable, and the rats are “much more likely to become compulsive. The reward could come at any second, and they might miss it if they aren’t paying attention.”

Gaming also gives people something of value that they may be missing in their lives—whether a person is a smart kid craving stimulus and mental challenges, like Eric, or an adult who lacks a sense of accomplishment in life. Alok Kanojia, a Boston psychiatrist who specializes in gaming disorders and says he was once addicted to video games himself, says, “People will play 40, 60, 100 hours of World of Warcraft”—a massively multiplayer online game, or MMO, in which people cooperate and compete with each other in real time— “and they derive a sense of value out of it. You may feel like you’re no one in the real world, but you’re someone in the game.”

Read the rest of this story at Seattle magazine.

Morning Crank: The Council Takes a Closer Look at the “Prolific Offenders” Report

1. Six of the seven District 2 city council candidates participated in a forum at the Georgetown Ballroom last night, and I livetweeted the whole thing. Check out the thread to find out what committee Ari Hoffman wants to chair, when Tammy Morales last called 911, why socialist Henry Dennison won’t answer yes/no questions… and also a lot of information about the candidates’ plans are for addressing homelessness, environmental racism, and how they would counter displacement in South Seattle.

2. City council members Lisa Herbold and Lorena Gonzalez invited leaders of several of the business groups that funded a recent report on so-called “prolific offenders” Wednesday, and raised questions about the methodology behind the report and some of its conclusions.

Mike Stewart, the head of the Ballard Alliance, said he and other business leaders got the idea for the report after they “started to realize that things are changing a lot” for business owners, who he said are dealing with a level of crime they’ve never experienced before. “It feels like  many of the instances of the criminal behavior that happens seems to be coming from many of the same people—so an individual might commit a crime in a business district one day and the next week, they’re back again,” Stewart said.  Erin Goodman, the head of the SODO Business Improvement Area, added, “One individual in our sample is quite simply terrorizing the Ballard business district. … In a single day in 2018, he shoplifted from five stores in a two-hour period, brazenly pushing a shopping cart full of the stolen items from store to store.”

These bookings include charges for failure to appear or comply with terms of release, which made up 41% of the charges in a King County assessment of its “Familiar Faces” program, which deals with a similar population.

The report, “System Failure,” was put together by former mayor Ed Murray’s public safety advisor, Scott Lindsay. It highlights the booking histories of 100 individuals, hand-picked by Lindsay and characterized in the report as “roughly representative of a larger population of individuals who are frequently involved in criminal activity in Seattle’s busiest neighborhoods.” Every person on Lindsay’s list had four or more bookings into King County Jail over a 12-month period and had “indicators” that they were chronically homeless and had a substance use disorder.

The criteria Lindsay used for his list are similar to those used in King County’s Familiar Faces initiative, which, in 2014, identified 1,252 people with four or more annual bookings (94 percent of them with a substance use disorder or behavioral health issue, or both), except that Lindsay chose to zero in specifically on frequent offenders who are homeless, which Familiar Faces does not. Just 58 percent of the people on the 2013 Familiar Faces list had indicators that they were homeless. By hand-picking a list of offenders who are homeless (and by choosing to highlight the stories of mostly people who moved to Seattle from elsewhere), Lindsay’s report feeds into the common, but unsupported, belief that most people who commit property crimes are homeless and that homeless people from across the country come to Seattle to mooch off the city’s generosity.

Support The C Is for Crank
Hey there! Just a quick reminder that this entire site, including the post you’re reading, is supported by generous contributions from readers like you, without which this site would quite literally cease to exist. If you enjoy reading The C Is for Crank and would like to keep it going, please consider becoming a sustaining supporter. 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 my full-time job. Help keep that work sustainable by becoming a supporter now! If you don’t wish to become a monthly contributor, you can always make a one-time donation via PayPal, Venmo (Erica-Barnett-7) or by mailing your contribution to P.O. Box 14328, Seattle, WA 98104. Thank you for reading, and I’m truly grateful for your support.

Gonzalez and Herbold pressed the “System Failure” funders on some of the methodology in their report, including the fact that Lindsay determined the number of crimes each person had committed using police reports, complaints, and charging documents, without looking at anything the person said in their own defense or tracking whether they were ultimately found guilty. Goodman, from the SODO BIA, acknowledged that “some of these folks could have gone through the criminal system and been found innocent,” but added, “This is simply a snapshot based on bookings. [Lindsay] clearly states that it does not say how the case was adjudicated.”

Goodman expressed frustration that so many people were let out of jail within hours or days of being arrested; that so few of the people found incompetent to stand trial because of mental illness were subject to involuntary commitment; and that “there was zero accountability in the system for consequences for failure to comply with court-ordered release conditions.” Those conditions, according to the report, included things like appearing at every court date; abstaining from drugs and alcohol; submitting to random drug tests; and going to abstinence-based inpatient or outpatient treatment.

Underfunding services and then complaining that they aren’t working “is like sprinkling a little bit of salt over a giant bowl of soup and then [saying], ‘Oh, salt doesn’t work,'” Public Defender Association director Lisa Daugaard said.

One issue with these kinds of conditions is that there simply isn’t enough available capacity—in other words, funding—for the services that do exist to serve clients with mental health and substance abuse challenges. The Law Enforcement Diversion Program, for example, recently expanded with funding from the recent Trueblood court settlement to provide a vastly expanded suite of services (including mental health care, transitional housing, and intensive case management) to people whose competency to stand trial has been called into question. That funding will serve about 150 people who would not have previously been eligible for the program. But, as Public Defender Association director Lisa Daugaard, who was also at the table, pointed out, there are likely thousands of people who could benefit from similar services, while the total capacity for all such programs is in the hundreds. Underfunding services and then complaining that they aren’t working “is like sprinkling a little bit of salt over a giant bowl of soup and then [saying], ‘Oh, salt doesn’t work,'” Daugaard said. “We are not right-sizing the things that are effective.”

The other, related, issue with expecting people to comply with court conditions is that those conditions are often unreasonable. As long as the underlying issues that are causing someone to shoplift or act aggressively or loiter in the doorway of a business aren’t addressed, telling people to show up to day reporting or abstain from their drug of choice is a losing strategy. It’s little wonder that 100 percent of the people Lindsay chose for his report  failed to comply with the conditions imposed by the court.

Goodman’s frustration is understandable: Her group represents businesses in an area of the city with the highest concentration of people living in RVs, many of them with substance use disorders, untreated mental illness, or both. But there’s little point, experts say, in trying to force people into treatment when they aren’t ready. “If the clients aren’t ready, they aren’t ready, and therein lies the challenge,” Heather Aman, a deputy prosecutor at the city attorney’s office who works with LEAD clients, told me recently. “Anyone who isn’t addressing their substance use or mental health issues has an impact on their community, because there’s not an ability to force individuals to [get help or treatment] until they’re ready. And what do you do with the person that needs to be ready? That’s the million-dollar question.”

Morning Crank: A Dramatic Turnaround

1. All Seattle Public Library restrooms will soon be equipped with containers for needle disposal, following a six-month pilot program at the library system’s Ballard, Capitol Hill, University, and downtown branches. The library initiated that pilot after an employee at the Ballard branch was stuck with a needle while removing the trash from the women’s restroom, as I exclusively reported in March.

The decision marks a dramatic turnaround in library policy from just seven months ago, when library spokeswoman Andra Addison said that the library had no plans to install sharps containers for drug users (and diabetics) to dispose of used needles, because “We don’t allow illegal drug use in the library.”  The King County Public Library system preceded the Seattle library in installing sharps containers at branches in Burien, Renton, and Bellevue—branches where library staffers kept finding used needles on the floor, in toilets, and in trash bins.

Addison says it will cost about $2,000 to install the containers—the same ones used in the King County system—in all 60 library restrooms., and about $7,000 to empty and maintain them.  “The Library has ordered the additional sharps containers and we hope to have them installed over the course of November,” Addison says.

According to data provided by the library, the sharps containers at the downtown, Capitol Hill, Ballard, and University branches continue to be the most heavily used. Between the week of April 20 and the week of October 12, 912 sharps were discarded at the Central branch library, 348 on Capitol Hill, 234 in Ballard, and 194 in the University District.

Support

2. The city of Seattle won on two counts in the lawsuit filed by the owners of the Showbox on Friday, when King County Superior Court judge Mary E. Roberts ruled that legislation expanding the Pike Place Market Historic District to include the music venue did not constitute an illegal land use decision or a taking of private property. However, Roberts did agree to hear claims on two other, arguably more substantive, questions: Did the “Save the Showbox” legislation violate the state appearance of fairness doctrine, which requires officials to keep an open mind on so-called quasi-judicial land use decisions (like zoning changes for a specific property)? And did the city violate the property owners’ constitutional rights by dictating the use of the building as a music venue?

The owner of the building in which the Showbox is located, Roger Forbes, sued the city last month after the city council passed, and Mayor Jenny Durkan signed, “emergency” legislation making the two-story building part of the Pike Place Market Historical District. (The Showbox itself—that is, the venue that rents the building—is owned by the international behemoth Anschutz Entertainment Group).  The law, known as the “Save the Showbox” bill, prevented Forbes from selling the property to a developer, Onni, that had planned to build a 44-story apartment tower on the block. (The city had in fact just upzoned the block, along with the rest of First Avenue, specifically to encourage this type of development).

If the city violated the use of fairness doctrine, it will mean that all the public hearings and rallies and open discussions about the importance of  “Saving the Showbox” as a music venue—of which there have been many—were illegal, because the council should have remained neutral and refrained from holding public hearings. (Not only did the council hold public hearings, its members made signs, staged concerts, and even drafted public comments for private citizens in favor or the proposal.) If the court finds that the city violated Forbes’ rights by dictating the use of the Showbox property it will mean that the legislation thwarting Forbes’ plan to sell and develop the property was unconstitutional, and could open the city up to monetary claims.

The city is arguing that the “Save the Showbox” legislation—whose first section calls the Showbox “a significant cultural resource to Seattle and the region” whose loss “would erode the historical and cultural value of the Pike Place Market neighborhood”—in no way prevents Forbes or any future owner from shutting the Showbox down and using the property for another purpose. Forbes, pointing to the plain text of the legislation and the fact that the law gives the Pike Place Market Historical Commission the right to dictate every aspect of how the building is used, from the tenants down to the font, size, and materials used in its signage, says that’s absurd.

Forbes’ attorney noted that the city has only responded to one of the attorney’s ten public disclosure requests, making it difficult, he argued, to know “all the violations of the appearance of fairness doctrine.” For example, he said, “we just learned by happenstance that the cc staffers were writing public comments”—because of information that I obtained through my own disclosure request and reported on this site.

In dismissing the Showbox owners’ takings and land use claims, Roberts said that neither claim was ripe for consideration—in the case of the land use claim, because the owner of the property and the developer, Onni, had not filed a permit to develop the property by the time the legislation passed, and in the case of the takings claim, because the city has not issued any final decision about what kind of development is allowed on the property.

Roberts also rescheduled the remaining counts for early next fall.

Three Takeaways From the Final One Table Meeting

This post originally appeared on Seattle magazine’s website.

Last Friday marked the long-awaited, and final, meeting of the One Table regional task force on homelessness—a group of political, nonprofit, business, and philanthropic leaders formed last year to come up with an action plan to address the root causes of homelessness in King County.

Did they do it? Not exactly. One Table’s final work product—a list of recommendations and general timelines (“within one year,” “in 3-10 years,” etc.) with no dollar figures or chains of responsibility for implementation—hasn’t changed substantially since April, when the group last met to discuss a set of “recommended actions.” Those actions include things like funding long-term rental subsidies, expanding opportunities for behavioral health jobs for people of color, creating training programs for high-wage jobs aimed at vulnerable communities, and expediting permits for affordable housing.

With that in mind, here are five key takeaways from the eight-month One Table process.

1. Nothing to see here.

Several media relations folks mentioned to me that they didn’t really publicize the final One Table meeting because, frankly, there wasn’t much news, and that was evident from the opening remarks by King County Executive Dow Constantine and Seattle Mayor Jenny Durkan. Constantine touted the fact that he was moving up the timeline for issuing $100 million in housing bonds that will be paid back by future proceeds from the county’s hotel/motel tax, which will make the money available slightly earlier but does not represent new funding. (Those funds can only be used for “workforce housing” near transit stops, so it won’t directly impact people living unsheltered or in deep poverty anyway). And Durkan, whose “deal” with Amazon on an employee hours tax that would have brought in $75 million a year for housing and shelter fell through almost instantly, touted her innovation advisory council—a group of tech companies that will advise the city on homelessness, but have not committed any funding to implement whatever “solutions” they come up with—as well as several upcoming Pearl Jam charity concerts and the potential for building modular housing. None of this was news, and it set the stage for a two-hour meeting where basically nothing was announced.

Support

2. It’s the housing, stupid.

One Table members broke up into small groups—that is, many small tables—to discuss “root cause” areas including affordable housing, behavioral health, criminal justice, child welfare, and employment. They had half an hour to come up with a list of “solutions.” I sat in on a table that included Plymouth Housing director Paul Lambros, Seattle Housing Authority director Andrew Lofton, and Chief Seattle Club director Colleen Echohawk. Their primary recommendations? “Build and maintain more affordable housing.” This, they said, could include increasing the federal low-income housing tax credit (not likely given the current Administration’s mission of dismantling HUD and federal programs that benefit the poor), providing incentives for banks to fund construction and ongoing maintenance of low-income apartments; and making it clear to the public that, as Gates Foundation program officer Kollin Min put it, “there’s a direct correlation between the lack of housing and homelessness.”

Other groups came back with the same conclusion: Preventing homelessness and preserving existing affordable housing were important, but the region just needs more funding for housing. A similar conclusion emerged out of the groups focused on behavioral health: Without money for mental health care and substance abuse treatment, and funds to build housing for people when they get out of treatment so they don’t end up right back where they were, addressing “root causes” will be impossible. “Ultimately, the need is housing and money,” a report back from one of the behavioral health tables concluded.

3. Tribalism over regionalism.

It’s pretty clear that for all the lofty talk of “regional solutions,” the leaders of the One Table task force remain starkly divided over what will constitute the right solutions for different parts of the county and who’s to blame. Auburn Mayor Nancy Backus reiterated the points she and the leaders of four other suburban cities made in a letter urging her fellow One Table leaders to support a plan to force homeless people “who refuse treatment” into forced lockdown detox using a state law designed to allow family members to intervene on behalf of people who pose an imminent threat to themselves. “We know these individuals. We might see them on a regular basis. They’re familiar individuals and they’re not willing to accept help. At some point in time, we need to be able to say, you are going to get help,” Backus said. And she touted a church-run food bank in her cities that requires people who are capable of working to “pick up a rag and soap” or clean up garbage as a condition of receiving food.

“The cities outside of Seattle have different needs,” Backus said. “What works for Auburn, what works for Bellevue, isn’t going to work for the city of Seattle, and we have to realize that.” That is pretty much the opposite of a “regional” approach, and is unlikely to fly with the leaders of bigger governments like King County and Seattle who tend to balk at ideas like forced treatment and unpaid labor.

What will become of One Table’s recommendations remains unclear. Rachel Smith, Constantine’s chief of staff, told the group that the county has hired consultant Marc Dones with the Center for Social Innovation to “guide our work with expertise” as the county comes up with an implementation plan for the recommendations. For now, One Table’s work is concluded—and an action plan to address the root causes of homelessness remains unfinished.

Afternoon Crank: Bad News for Sound Transit, a Good Idea From Sound Transit, and Grandstanding on Forced “Treatment”

Morning Crank: By the Numbers

Auburn Mayor Nancy Backus, King County Executive Dow Constantine, Seattle Mayor Jenny Durkan.

1. $1 million: The amount of money Mayor Jenny Durkan said Pearl Jam has agreed to donate from the proceeds of two reunion shows in August to support the cause of ending homelessness .

2. 75: The number of people appointed to serve on One Table, a group of business, civic, nonprofit, activist, and elected leaders from around the region that is charged with coming up with solutions for the “root causes” of homelessness, identified as a lack of affordable housing, inadequate access to behavioral health treatment, negative impacts on kids in foster care,  criminal history that impacts many people’s ability to find housing and employment, and “education and employment gaps making housing unattainable and unaffordable.” The committee met for the first time on Monday morning.  They sat at many different tables.

3. 200,000: The approximate number of people in King County who live below the federal poverty level, currently $16,240 for a two-person household).

4. 29,462; 24,952 The number of people King County says became homeless in 2016, and the number who exited homelessness that year, respectively. After a press conference following the One Table event Monday, King County Department of Community and Human Services director Adrienne Quinn acknowledged that the number of people who are no longer listed the county’s Homeless Management Information System doesn’t necessarily reflect the number of people who are currently housed, either permanently or temporarily; 11,767 of the 24,952 recorded “exits” are listed as “destination not reported,” which means that they could be in jail, in an institution, in drug or alcohol rehab, or on the street. The only criteria for an “exit” from homelessness is that a person hasn’t sought any housing or services in King County in the past three months. “Exits from homelessness” also include hundreds of people who left the shelter system voluntarily to go back on the street; those are listed, paradoxically, as an exit from homelessness into the category “unsheltered.”

5. 35,000: The approximate reduction between 2007 and 2016 in the number of housing units that were affordable to eople making less than 50 percent of the Seattle area median income, which was $33,600 for an individual, $48,000 for a family of four, last year.

6. Three: Number of times reporters asked King County Executive Dow Constantine and Seattle Mayor Jenny Durkan if they planned to dissolve All Home, the agency that nominally coordinates efforts to address homelessness throughout the county, and replace it with a regional agency that would have the authority to actually implement policies, which All Home (whose director, Mark Putnam, recently resigned) does not.

7. Zero: Number of times either official answered the question directly. (Constantine also deflected questions about whether there would be a tax measure on the next November ballot to fund whatever solutions the group proposes.)

One (metaphorical) table.

8. 94: The percentage of people who have been booked into jail four or more times in the past year who suffer from some behavioral health condition, according to Brook Buettner, who manages the county’s “Familiar Faces” initiative.

9. $250. The amount Seattle CityClub, the civic engagement organization that holds monthly “Civic Cocktail” panels at the Palace Ballroom, is charging for its “Civic Boot Camp” on “Housing the Homeless,” part of a series of immersive, one-day trainings that take people who want to get involved in Seattle’s civic life on a deep dive into a single issue. Past boot camps have covered immigration, livable neighborhoods, and the waterfront. The high price of entry raised the eyebrows of some advocates for Seattle’s homeless residents, who wondered if that money would be going to agencies that provide housing and services or into CityClub’s coffers.

Diane Douglas, CityClub’s executive director, says the admission fees pay for scholarships for people who can’t afford to pay full price, stipends for the people who give presentations to the boot campers, food purchased from neighborhood businesses, and to rent space for the day from organizations working on the issue. In the case of the homelessness boot camp, she says, it makes more sense to spend the remainder of the fee supporting CityClub’s mission to get people engaged in the community by volunteering, campaigning for candidates, or donating to groups that provide direct services than to donate the proceeds directly to those groups. “When we survey people six months or a year later, we know that they’re volunteering more, they’re donating money, they’re communicating with elected officials,” Douglas says. “The purpose is really to get them engaged in the community. It’s a substantial amount of money for a day of training, but the idea is to leverage all those people so they’re all giving $250, so they’re volunteering, so they’re voting on the issues and causes that they’ve learned about.”

10. 77.4 cents: The amount a woman currently earns in Seattle for every dollar made by a man doing equivalent work, according to a presentation the Economic Opportunity Institute gave to the city council’s Housing, Health, Energy, and Workers’ Rights committee last week. Non-white women make significantly less than white women across the board, with black women, on average, earning the least; the wage gap is largest, at 29.3 percent, between Asian-American men and women.

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.

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.

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

Image Credit: SBSArtDept

This story originally appeared at Seattle Magazine.

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.