Tag: Drugs

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.

The C Is for Crank Interviews: Pete Holmes

Pete in front of City Hall
Image via holmesforseattle.com.

If you enjoy the work I do here at The C Is for Crank, including this series of interviews with the candidates for mayor, city attorney, and (later this summer) city council and Port, 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.

City attorney Pete Holmes was first elected in 2009 as a reformer. A bankruptcy attorney who advocated for marijuana legalization and was one of the original members of the Office of Professional Accountability Review Board (OPARB), the body that reviewed disciplinary decisions in police misconduct cases, he challenged then-incumbent Tom Carr from the left, assailing Carr for cracking down on minor crimes like pot possession and waging war against bars and clubs while letting DUI and domestic violence cases molder. Now, Holmes’ challenger, Scott Lindsay, is ripping some pages from the city attorney’s own playbook, accusing him of going soft on police accountability, ignoring the consequences of the opiate epidemic, and ignoring problems in homeless encampments. I sat down with Holmes to discuss his record, his path to reelection, and the case his opponent laid out against him at a Starbucks across the street from City Hall.

Erica C. Barnett [ECB]: Your opponent, Scott Lindsay, got in the race late, and only after his boss, Mayor Ed Murray, was accused of sexual abuse. Were you surprised that he decided to run against you, and how do you respond to his statement that you have little to show for your two terms in office?

Pete Holmes [PH]: [When I ran], I was at that point in my legal career that I finally felt that I just maybe had enough experience in the law to be the city’s lawyer. Back in ’09, when I ran, I had made partner at a major downtown firm; I knew my way in and out of court; I advised big and little clients businesses and individuals; and I really had a sense of what the law was about. All of that readied me for the challenges that lay ahead at the city of Seattle.

“I think Scott wants a job, and I would just urge him not to give up on that ambition, but learn what it’s like to be a lawyer first.”

A candidate for office told me recently that from their perspective, I was a candidate that ran for a specific office with a specific mission and that was absolutely right. It was no surprise to [then-city attorney] Tom [Carr] that I was going to run against him. I had spent the previous three or four years at that point debating with him, trying to get him to do the right thing on transparency and police accountability, trying to work with him, and finally realizing that, you know what, I can’t complain. I need to step up and say, ‘Here’s my vision, and it’s different from yours.’  We had big difference of opinion on police reform, drug policy, things like that, and it was only at that point in my career that I felt like, I know what the practice of law is all about, I feel secure in the knowledge that I’ve learned my craft, and maybe, just maybe, I could presume to be the city’s attorney.

I think Scott wants a job, and I would just urge him not to give up on that ambition, but learn what it’s like to be a lawyer first.

ECB: Lindsay received some surprising early endorsements from two members of the Community Police Commission who had been your allies, Lisa Daugaard and Harriett Walden, who both argued that you had hindered the group’s efforts to increase civilian oversight of the Seattle Police Department. Daugaard criticized you, specifically, for opposing the CPC’s request that it be allowed to refer complaints directly to the city’s Inspector General for investigation, and for your request to delay submitting police reform legislation to the council. Without getting too far in the weeds, what was your issue with the way that the CPC wanted to implement civilian oversight, and why did you seek to start the process over?

PH: The sheer size and scope of the CPC is, I think, the biggest concern. A budget that’s probably close to $2 million annually is something I’m not sure the city can afford. But the really fundamental question I have is, why we have allowed ourselves to forget the fundamental purpose of civilian oversight? It’s to hear what the community thinks about policing services as delivered where they live. I think Lisa would say her theory is that the CPC should be a commission of subject-matter experts—her, term not mine—and my counter to that is, I want all of my expertise, my academic and practical expertise, to be in my command staff and especially my chief of police and my professional overseers, like the [Office of Police Accountability, formerly the Office of Professional Accountability] director, who’s investigating individual misconduct cases, and the inspector general, who’s looking more broadly at policy.

“We’ve had all of these reform efforts that end up with a blue ribbon panel pontificating about the need to get community involvement and things are smoothed over for a little while. So the fact that we’re under federal oversight is our best opportunity and maybe our last opportunity.”

So what role does the CPC serve? It’s to say how well all this expertise is translating into the streets. Is the chief managing appropriately? Is the inspector general managing broad policy themes that need attention? Is the OPA director holding people accountable for the thoroughness of investigations? At the end of the day, we need to know how the guys who have a gun and a badge are interacting with our fellow residents here in the city, and if you’ve got a committee of subject matter experts that are studying established practices and doing all those kinds of things things that I hope the IG and the OPA director and the chief of police are doing, then who’s taking the time to listen to the community?

There’s one person that you ultimately hold accountable for holding your cops accountable, among many safeguards, and that’s your chief of police. So number one, if you have taken all of these policy areas away from the chief, then the chief will say, ‘You know what, I’m sorry that our department is not delivering services to, say, an African-American community the way you think they should, but you took all that power from me and you gave it to this commission of subject matter experts.’ And it’s already difficult enough under our current contracts for discipline to stick. All of the major discipline decisions, all the firings [Police Chief Kathleen O’Toole] has done, with very few exceptions, have been contested, and my office has to defend all those things. So what I worry about is not only would your existing chief finally say, ‘You know, look, I give up,’ but when you have to replace Chief O’Toole, who’s going to come to a city that is so heavily laden with politics and procedure? It’s like, ‘Can I run my department, please?’ It might scare away a good candidate.

ECB: Do you expect that the ongoing effort to comply with the federal consent decree that’s currently still in place at SPD will remain on track, given that Attorney General Sessions has suggested that he wants to pull back on police reform?

PH: What we have to remember is that we would not have made the progress we’ve made to date, including the CPC, but for the federal intervention. We’ve tried over the decades to do reform and have only gotten a little bit of window dressing, and then it goes away. The unions retain their power through a collective bargaining agreement and mayors routinely get worn out and say, ‘Oh, God, please just get it done so I can move on to the next thing,’ and we’ve all inherited decades of that. We’ve had all of these reform efforts that end up with a blue ribbon panel pontificating about the need to get community involvement and things are smoothed over for a little while. So the fact that we’re under federal oversight is our best opportunity and maybe our last opportunity.

Fortunately, we’ve got that so-called judge [federal judge James Robart, whom Trump called a “so-called judge” when he refused to enforce the original travel ban]. I really think Judge Robart is nothing but a no-nonsense judge and he is not going to say his order has been met fulfilled until he believes the order has been fulfilled. Jeff Sessions is not going to tell him when it’s been fulfilled, and for that matter, no one of us city officials is going to do that. I do think that at some point, I’d like to see the unions in front of Judge Robart bringing forth all their concerns so that we can really have comprehensive contract-based reform.

And by the way, it’s not about the size and scope of the CPC that I first broke with Lisa [Daugaard]. They lobbied hard to make me appeal Judge Robart’s decision  [delaying the city’s police reform legislation in 2016] and make them a party to the lawsuit and at some point I just said no.

“At some point, the city has got to be able to negotiate its contracts. It’s got to be able to hire and fire officers. It’s got to be able to appoint chiefs. The [CPC’s] approach is going  to actually confound the ultimate goal of having a well-disciplined, well-trained, and community-respected police force.”

If [the CPC is] telling the council that Judge Robart is stopping [them] from doing [their] work and that the city attorney is letting him get away with it, it’s really hard to go back to the council and explain that we would not be where we are but for Judge Robart and this consent decree. It’s the same pitch that I couldn’t get [former mayor] Mike McGinn to fully appreciate. I remember telling him, ‘Mike, no one’s going to blame you for the police department you inherited, and nobody’s going to forgive you if you let this opportunity go away. So you can either treat DOJ as an invading force or the wind in your sails for reform.’ And we never quite got on the same page, but it’s kind of the same theme that was playing this time around, with the CPC wanting to be permanent, full-throated advocates in front of the judge. At some point, the city has got to be able to negotiate its contracts. It’s got to be able to hire and fire officers. It’s got to be able to appoint chiefs. The [CPC’s] approach is going  to actually confound the ultimate goal of having a well-disciplined, well-trained, and community-respected police force. That’s my concern, and you can’t explain that in a sound bite.

ECB: It seems to me that there’s a fair amount of bad blood between you and Lisa Daugaard.

PH: It’s not bad blood. I believe she sincerely believes in what she’s doing, but she cannot be chief of police and Inspector General and OPA director all in one fell swoop, and you can’t make the Community Police Commission into those bodies. I think fundamentally, who represents the community is really the question. Just because the Community Police Commission has ‘community’ in its name doesn’t mean they own the community.

“When you get to the point where you’ve exhausted a housing-first services approach and you’ve still got someone who says, ‘I like being here stealing bicycles or dealing drugs’ or whatever, then you’ve reached a point where you say that’s not an option. You’re going to be arrested and Pete’s going to prosecute you.”

ECB: Will you extend the Law Enforcement Assisted Diversion program [which gives low-level offenders the opportunity to avoid charges if they accept services and participate in a structured diversion program] to the rest of the city, and is there anything you would like to change or improve about the program?

PH: Intuitively, I am convinced that LEAD is a correct approach. A correct approach—not the correct approach. Because LEAD addresses one small element of the overall population that we need to address. The danger with elevating something like LEAD as the answer, the silver bullet, is that if you’re looking a 360 degree [range of offenders and solutions], LEAD represents only about ten degrees of that arc.

You remember in 2013, when I got that letter from SPD about 28 or so of the so-called hardcore offenders downtown, and they demanded I issue warrants for all of them? I said, ‘No, because you did none of the background work to tell me what their issue is. You can’t just tell me you issued three tickets to them and they didn’t respond. I want to know, are they homeless? Are they drug addicted? What have you done to address their issues?’ And if you’ve done all of that and they’re resisting, they’re just simply refusing our offer, then you’re right. Then we’ll intervene. But you’ve got to show that it’s a credible threat.

Same thing with homelessness. I’ll work with you nine ways to Sunday to figure out what are your obligations when dealing with the homeless encampments, but I’ve got to tell you that when you get to the point where you’ve exhausted a housing-first services approach and you’ve still got someone who says, ‘I like being here stealing bicycles or dealing drugs’ or whatever, then you’ve reached a point where you say that’s not an option. You’re going to be arrested and Pete’s going to prosecute you.

ECB: Since you brought it up, let’s talk about sweeps. How do you think the city’s new Navigation Team, which your opponent takes credit for setting up, is doing at getting people living in encampments into shelter, housing, and services?

PH: I think that the Navigation Team is learning that if they don’t have actual, real resources, they won’t succeed. I don’t mean the Taj Mahal. But the shelters don’t work for a variety of circumstances. We’ve got to meet people where they are. If we’re providing housing that addresses all those areas and it’s refused, then you have to act. You have to say, ‘You can’t stay here,’ and you’re going to make an arrest at some point.

It’s interesting how all our labels are conclusory. If it’s bad, it’s a sweep. If it’s good, it’s an encampment cleanup.

ECB: I would say ‘sweep’ is fairly accurate. I’m not calling it a ‘purge.’

PH: If you’re not, as a practical matter, addressing human needs, if you’re not dealing with their personal effects, then yeah, I guess it is a sweep. But if you are doing that and you’re simply doing a cleanup, that’s a positive sweep. That’s sweeping up the detritus, the non-valuable property left behind that’s just from living and the human condition.

“If you want to avoid the guy passed out on your store or doorstep, if you want to deal with that compassionately and effectively of course we’ve got to have this. And maybe it’s going to be next to [someone’s] home in Laurelhurst.”

ECB: Scott seems to blame you for ending some of the specialty courts that were once available as alternatives to the regular court system, like mental health court and community court. Why were those courts eliminated, what were they replaced with, and how do you think the current system is working?

PH: I think that the defense bar recognized that by opting into community court, they were basically agreeing to a much longer [period of] supervision and interference than if you just simply said, ‘No, I’ll take my chances at regular court.” The defense bar was advising clients not to accept the community court offer because there were too many conditions attached to it. So what the municipal court did was to say that instead of community court being the one place where you opt in [to alternatives to incarceration that include access to services],  we want to make sure that all of those resources are available to all judges in all cases so that they can fashion remedies. In some ways, the municipal court may have expanded community court rather than disbanded it. So Scott doesn’t have the full story. It is in transition. I believe the defense bar would prefer to be working with us, because when we, both prosecutor and defender, see someone who is in the throes of an addiction and of course is making life miserable for everyone around him as well as himself, the last thing we want to do is just throw him in jail.

ECB: How will you support the creation of a supervised drug consumption site in Seattle, and how likely do you think it is that Seattle will accept it?

PH: We got to a state with marijuana where people are finally saying, ‘This actually works pretty well.’ Like the holdout cities that were saying, ‘No way are we gonna allow pot use in our city’—they’re starting to see that Seattle went from over 150 unlicensed, troublesome [medical marijuana] dispensaries to 50 well-lit, well-regulated legal dispensaries. And now they’re saying, ‘I want some of that in my town.’ It’s going to be the same thing with these medical sites We made the decision, wrongfully, to say, we’re going to put public health problems in the criminal justice system. So my role has been to try and slowly release those tentacles and get medical and health care professionals to get responsibility for it. When people say, ‘Where should they be?’ I say, I don’t know, but that’s why I want to hear form the medical professionals. And then I’ll help you with the land use issues and the criminal jurisdiction issues.

ECB: The answer to the question of where a safe consumption site will be located is purely political, though—it’s wherever people will accept it.

PH: I’d say that’s the cynical political answer. I think at some point, once we have helped switch this bad course that we went down of criminalizing public health problems, then I think we’re going to start seeing people get it. If you want to avoid the guy passed out on your store or doorstep, if you want to deal with that compassionately and effectively of course we’ve got to have this. And maybe it’s going to be next to [someone’s] home in Laurelhurst.

In some ways, opioid addiction might even be easier than marijuana legalization, because it cuts across all demographic groups. So what I think you’re discounting is that for every person who says, ‘I don’t want to step over them anymore,’ there’s also going to be a person whose brother is the person being stepped over. We showed a better approach [to marijuana use] than prohibition, and opioids is going to be a tougher one—it’s definitely going to need the medical community more involved—but I get so passionate about it, because you can just see how wrongheaded our traditional approach has been. And I could say, ‘Let’s do this’ and get reelected and start looking at the next office, or I can say, ‘How can I fundamentally change a bad policy?’ That’s not a small order. That’s a long haul.

The C Is for Crank Interviews: Scott Lindsay

Image result for scott lindsay seattle

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.

Scott Lindsay, Mayor Ed Murray’s onetime public safety advisor and a former senior counsel to US Rep. Elijah Cummings in Washington, D.C., was best known, until recently, as the guy the mayor sent to neighborhood and city council meetings to defend his encampment removal policies. Since he announced he would challenge incumbent city attorney Pete Holmes in April, however, Lindsay has won some surprising endorsements from erstwhile Holmes supporters like Harriet Walden and Lisa Daugaard, two members of the Community Police Commission and longtime advocates for police accountability and reform. The CPC soured on Holmes when he proposed delaying police reform legislation earlier this year, on the grounds that it created a CPC that was too large and sprawling to pass muster with the federal judge overseeing the consent decree between Seattle and the federal Department of Justice. Daugaard told me in April that she also felt Holmes had not done enough to advocate for defendants who “serve long sentences on cases with excessive probation, are held in lieu of bail because they are poor, and are made to give up their trial rights to get services.”

I sat down with Lindsay at Zeitgeist Coffee in Pioneer Square last month.

The C Is for Crank [ECB]: As a political unknown running for a fairly obscure office in a mayoral-election year, you’re going to have to make a compelling case against the incumbent. So, lay out the argument against Pete.

Scott Lindsay (SL): The best thing going for Pete Holmes is that he’s kept such a low profile for that office. But when you actually dig under the surface, there’s deep dysfunction in our criminal justice system. The King County Jail is filled with misdemeanor defendants whose underlying issue is homelessness and addiction. Words that have never come out of Pete Holmes’ mouth are in any way talking about heroin or the effects of substance use disorders on the defendant population in the criminal justice system, or actual ways that he could provide leadership to fundamentally start to change the way that we engage with that population. How do we actually change outcomes instead of just going through these cycles of arrest and release? Because the outcomes that we’re getting now have been terrible for defendants stuck in the cycle, and terrible for neighborhoods, and terrible for those who are actually stuck with the consequences of the failures of our criminal justice system.

“Words that have never come out of Pete Holmes’ mouth are in any way talking about heroin or the effects of substance use disorders on the defendant population.”

Let me give you a couple specific examples. So while these were imperfect, at least we used to have specialty courts—mental health court, drug court, which is at Superior Court, and community court. Now, those started with imperfect designs, but rather than provide any leadership about how to really fix them, those courts, in effect, have died on the vine. Referrals into mental health court are way down, and it’s vastly underutilized and may shut down because of underutilization, and community court has been shut down, and Pete Holmes has done nothing to replace it. So now everybody’s just going mainstream. Where are the innovations? Where’s the vision? Where’s the leadership?

Pete has had eight years to lead on a lot of these things, and he’s no longer a leader on many criminal justice issues. He does not have a vision, and after eight years has not articulated a vision, for how we can use our criminal justice system to help address the real public safety issues and social issues and public health issues that we have in the city. We invest a lot of money in our criminal justice system and in the city attorney’s office, and they have more [contact with] people struggling with homelessness and substance use disorders, practically, than our human services department. Our criminal justice system is in effect, by default, one of the largest social service organizations that we have. We just don’t think of it in that way, and it’s not actually producing outcomes that anybody can be proud of.

“The Navigation Team was my idea, and I worked to get that created over the course of a year against a lot of institutional reluctance to do things in very different ways.”

ECB: Until you declared your candidacy with a platform focused on police oversight and accountability, I think it’s fair to say that you were viewed as one of the more conservative members of the mayor’s staff, especially by neighborhood activists who wanted the mayor to do more to clean up homeless camps.

SL: I think I have a reputation as a guy who actually listens, tries to figure out what’s going on, and then tries to come up with innovations and creative resolutions. But I am willing to take on the tough and controversial issues. I’ve been the leader within the [mayor’s] office on supervised consumption—not exactly a law and order topic. I was the leader on the heroin epidemic and asking how we can get more prevention, more user health care, more treatment options. I was the leader on, how do we get much better services to our homeless population and shift from a two-decade-old sweeps policy to a more compassionate approach?

But I also believe, absolutely, that we have some very real public safety challenges in this city, and it doesn’t help anyone to not talk about that in open ways. Up in the north end, we have  a lot of public safety complaints about what’s going on in Mineral Springs Park—needles and drug dealing and tents and other issues—so it’s obviously a real struggle for the neighborhood. At the same time, we had a lot of real people suffering and living in conditions that were tragic for them. We have to have a discussion about how we resolve both of those things and tie them together, rather than talk about homelessness in ways that don’ t actually connect to a lot of what’s happening on the ground.

“It’s the responsibility of the city to step in and intervene and separate out the really bad actors who prey on the weak and vulnerable from people who are struggling with public health diseases.”

ECB: The city has organized a “Navigation Team” made up of cops, outreach workers, and service providers to offer services to people living in encampments before they remove them. The numbers the city released recently show that about 160 people entered an “alternative living arrangement,” which is a big jump from where we were before but a drop in the bucket relative to the total number who need help. What’s your assessment of those results?

SL: The Navigation Team was my idea, and I worked to get that created over the course of a year against a lot of institutional reluctance to do things in very different ways. The idea of taking police officers and having them have a really social service focus, I think, is radical. It took a lot of work to convince all the powers that be that that was the right way to go, and I will absolutely say that 160 people sleeping indoors is an incredible number in 11 weeks, as compared to the success that we historically have gotten out of plain outreach efforts. I would be very surprised if we got 150 people indoors in all of 2016, coming in from hardened, really unsafe situations.

ECB: But not all are indoors—in fact, about half of them were simply moved to other encampments.

SL: Of course, and absolutely, authorized encampments are only a temporary solution, but we have to find some better options. And if you look a little bit deeper at what’s going on at some of the unauthorized encampments, where they’re at a critical mass, you have real predatory behavior and people who are taking advantage of the homeless people, who are the most vulnerable in our city, and exploiting them in terrible ways. That’s exploiting teenage girls, it’s exploiting people with mental illnesses, it’s exploiting people with substance use disorders, and as a result, terrible things happen to those people. It’s the responsibility of the city to step in and intervene and separate out the really bad actors who prey on the weak and vulnerable from people who are struggling with public health diseases, and that’s very often mental illness and most often substance use disorders. As a city, we are absolutely getting crushed by the heroin epidemic, and it is tragic and terrible, and a lot of the folks who are falling into that trap are really young people. If you go and you talk to Youthcare [an organization that works to get homeless kids off the streets], six years ago, they say one in five of the people who came into Orion Center [a youth shelter and drop-in center] were IV drug users. Today, it’s four in five. That’s almost an entire generation that either will be lost, or we have to find ways to help them out of that and break that cycle.

“If you ask SPD about, say, property crime in the north end, they will say that it would be difficult to find one person among 300 [for whom] the underlying cause of their criminal behavior was not a heroin addiction. They would say easily 99 percent if not 100 percent.”

ECB: When the city decided to locate the new low-barrier Navigation Center shelter in the Chinatown International District, they got a lot of pushback from the community, who said they hadn’t been consulted on the decision, and ultimately, the opening was postponed. What did you think of how your boss at the time, Mayor Murray, handled the outreach for the Navigation Center?

SL: It very obviously did not go well. I wasn’t involved intimately in the siting decisions, but that did not go well. I think when you dig into that, I’ve spent more time working on issues within Chinatown and the International District than any other neighborhood in the city, and they have very real issues with street safety and low level crimes associated with people who are struggling with substance use disorders, and we have not, as a city, figured out how to provide them with support. Ultimately, the Navigation Center will be part of that, but we also have to be very clear and articulate what we’re doing to provide relief to that community, which is under a lot of strain. There are a lot of mom and pop business with very slim margins that are open early in the morning and late at night. and they feel under real duress from what’s happening in their neighborhood, and they’re very unhappy about it.

ECB: Do you think the Law Enforcement-Assisted Diversion program, which provides pre-booking diversion for low-level offenders in  part of the center city, should be expanded citywide?

SL: LEAD is exactly the type of innovative program that is addressing people who are struggling with substance use disorder, and most often most of their clients are struggling with homelessness, and the idea is break them out of the criminal justice system, which is completely failing to address the root causes of their behavior, and try and have interventions that can actually break them out of the cycle. Let’s take that in contrast to the rest of our criminal justice system right now. The King County jail, today, is filled with misdemeanant defendants who who are struggling with substance use disorder, many of whom have mental illness, and most of whom are also homeless. We are doing nothing at the misdemeanor level to effectively intervene to break them out of the cycle. We know that incarceration alone as a strategy to change their behavior does not work. We know that not incarcerating them, not taking any action, does not change behavior. So we need to radically rethink what we’re doing to come up with new solutions to intervene, and LEAD is one fantastic example of that strategy, which is, get them at the front end. Get them out of the criminal justice system and intervene with significant behavioral health interventions.

ECB: As I recall, you’ve said before that we need to prosecute drug offenders more, and argued that we’ve effectively legalized heroin in Seattle. Can you speak to that?

SL: Just as a fact right now, the city makes very few drug arrests and our filing standards related to drug arrests are fairly low, so almost no one in the city is being prosecuted for simple possession of heroin or crack or anything else. And I’m okay with that. But if we are going to make that policy decision, then we also have to figure out what are the ways we address actually changing their behavior. When you look at crime maps of Seattle, there is an absolute correlation between where we have major hubs of drug activity—open-air drug markets—and where we have the most criminal activity, from car prowl to burglary to assaults to shootings. So we can say we’re not going to arrest somebody for possession of heroin, and I think that’s right, but at the same time we’re arresting them for property crimes where the underlying root cause of why they’re engaging in property crimes is because they have a heroin addiction. So we’re still interfacing with the same crowd through our criminal justice system, we’re just doing it through different mechanisms. And what hasn’t’ changed, and what’s very frustrating to me, is that our criminal justice systems at the misdemeanor level, but also at the felony level, have not really reoriented or adjusted to focus on public health solutions to these public safety challenges. That is, you have to address the substance use if you’re going to break the cycle of the behavior, and if you’re going to address the substance use, you have to address the homelessness.

Literally right now, just based on King County jail data for repeat offenders in the municipal system, we know that 60-plus percent of them are struggling with substance use disorders. And I swear that that is a significant underreporting, because there are a whole bunch of incentives not to admit to your substance use issues during intake into King County Jail. If you ask SPD about, say, property crime in the north end, they will say that it would be difficult to find one person among 300 [for whom] the underlying cause of their criminal behavior was not a heroin addiction. They would say easily 99 percent if not 100 percent.

ECB: So what’s your policy solution for those problems?

SL: The radical rethink here is to, in effect, focus intense resources through both diversion and/or using the criminal justice system to get people who are struggling with substance use disorders and homelessness the actual help and solutions they need. So how do we do that? One, citywide expansion of LEAD. Two is, we actually need to get defendants who are in the King County Jail the drug treatment that they need, and then when they’re exiting that system, they need to exit into something that is not just reentry back into the system. Right now, our system takes them in, holds them in for a few days, spits them out, waits for them not to show up back in court, and then issues a bench warrant for them. And that goes on and on and on until they have lots of outstanding bench warrants and are never getting the treatment that they need. We need buprenorphine induction available on demand to anybody who wants it in the King County Jail. And then next, we need to make sure that they’re not exiting straight back in to homelessness. And then a third part of the reform piece is simply bail reform. Our system right now is still a money-based bail system. That doesn’t make sense when most of our misdemeanor defendants—non-DUI, non-domestic violence misdemeanor —are impoverished and/or homeless and don’t have the resources to be able to work t through our bail system.

I’ve got a lot of respect for Pete Holmes’ history as an advocate for police reform going back to his days on the police review board in the mid-2000s. He was an early leader. And I also have a lot of respect for the approach he took in insisting on the consent decree as the model for achieving police reform here in Seattle. But Holmes disappeared for a long time from the kind of heart of the discussion, [including] police reform, the consent decree, and the larger civilian oversight and [Community Police Commission] discussion. And when he was absent from those, that’s when I was right in the middle of it as special assistant for police reform to the mayor,  working sometimes until 1 in the morning with CPC leaders, with Lisa Daugaard, with the ACLU, with Harriett, with many others. We hammered out some really significant civil oversight legislative proposals and a detailed plan, and at that point, Holmes came back in and he decided that he wanted  to redo that process, and they started over, and here we are a year and a half later and we’re basically at the same point where we were when I departed. And I departed from this issue because after negotiating in good faith for a year and a half with the CPC, I felt that the rug was being pulled out from beneath us. From my perspective, speaking separately from the mayor’s office, I thought it was particularly unfair for him to have been absent from much of the hard work of those discussions and then come back in and say, ‘Let’s start over and I am going to run a new process and that process is going to look like this.’  I thought that rhere were ways to get to the result that we’re at today faster, and frankly, I think if you go and ask the CPC members—Lisa and Harriett are only two, but I think there are plenty of others—there’s a lot of frustration with the way that Holmes has actually handled police reform over the last two years.

Heroin Task Force Recommends Safe Consumption, but Do Leaders Know What It Means?

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Part 1 of a two-part series on the recommendations of the Seattle/King County Heroin and Prescription Opiate Addiction Task Force. Part 2, which will focus on the task force’s emphasis on medication-assisted treatment and on whether the heroin epidemic is waning, will run tomorrow.

On Thursday, King County’s Heroin and Prescription Opiate Addiction Task Force released a long-awaited list of recommendations  to prevent opiate addiction and reduce harm for people addicted to opiates and heroin.

The headline, of course, is the group’s endorsement of two safe drug consumption sites in King County–one inside and one outside Seattle. The subhead, though, is the task force’s emphasis on “medication assisted treatment” for people addicted to heroin and other opiates, which would make it much easier for people to access maintenance opiate agonists like buprenorphine, which sells under the name suboxone, an opiate that helps reduce cravings for more harmful opiates like heroin, and methadone. (Traditional treatment generally relies on an abstinence-based approach that puts heroin users at a higher risk of relapse, particularly if they lack support systems.) The recommendations also include measures to promote prevention of opiate and heroin use such as education campaigns and drug-abuse screening in schools, and expanded distribution of naloxone, a drug that can reverse the effects of an opiate overdose, to more people, agencies, and institutions.

The proposals, which come with no price tag or timeline, prompted some bold claims on Thursday morning, when task force members gathered at Harborview Medical Center to discuss their impact in a camera-choked conference room. “I think that if we do our job effectively, we should theoretically be able to reduce opiate deaths over time by 80 percent,” said Brad Finegood, head of King County’s behavioral health and recovery division. King County public health officer Jeff Duchin emphasized that addiction is “a medical condition that is treatable and should be treated like other medical conditions,” not a moral failing. And advocates and officials heaped praise on the task force for setting prejudice and stigma aside to come up with nonjudgmental solutions for people with substance use disorders. “What is different and distinct about King County … is always being willing to be oriented toward outcomes of health and safety and following that wherever it goes,” said Lisa Daugaard, head of the Public Defender Association. “It is truly remarkable and unique.”

The political backlash to, say, allowing community clinics to prescribe drugs used mostly by heroin addicts alone could have buried that recommendation, but the task force went even further.

And, by virtually any measure, it is. Any one of these recommendations—wider access to naloxone; increasing the number of physicians and locations authorized to prescribe suboxone; creating a safe-consumption pilot site—could be seen as a radical improvement in itself, especially for a city where heroin addiction is such a visible problem. (According to one estimate, about one in five homeless people in King County suffer from substance use disorder, and the percentage among unsheltered people experiencing homelessness is likely higher). The political backlash to, say, allowing community clinics to prescribe drugs used mostly by heroin addicts alone could have buried that recommendation, but the task force went further and recommended not just wider suboxone distribution, and not just eliminating barriers to getting naloxone, and not just safe injection sites, but all of those things, and more.

It’s an impressively ambitious list of recommendations. But it will remain just that—a wish list—unless the county and its cities, including Seattle, commit firmly to funding all of the proposals on that list, not just the relatively cheap and uncontroversial ones like universal naloxone access and educational pamphlets, and dedicate resources to funding them.

Let’s start with safe consumption sites, which, as I’ve written before, go beyond the safe-injection model pioneered in North America by Insite in Vancouver, to allow supervised consumption of all drugs, including drugs that are consumed by smoking (technically, vaporizing), like meth and crack.

The political challenges facing any kind of supervised drug consumption site are already phenomenal. (In fact, I wrote a four-part series focusing on some of those challenges; part four, which looks at the likely political opposition in Seattle, is here). Opponents will argue that building facilities where law enforcement overlooks consumption of illegal drugs will make Seattle a magnet for drug users, and trash neighborhoods already overwhelmed by needles and crime. (Imagine, for a moment, a proposal to build a safe-injection site in Ballard, where a sober tent encampment proposal was nearly upended by howls of protest from residents, and whose residents turn to Nextdoor and Facebook to condemn addicts as worthless “druggers” and criminals who freely “choose” drug addiction as they rampage lawlessly through neighborhoods filled with upstanding homeowners who got where they are through hard work and willpower.)

Opening just one site could create a situation where the worst-case scenario of concentrated drug use does come true, because every drug user who wants to use the site will flock to a single spot.

Given the inevitable protests, the question will become: Which neighborhood will be the first to accept such a facility? The task force recommends just one safe consumption space as a short-term—three-year—pilot project, instead of multiple sites in the most heavily impacted neighborhoods, which many experts here recommend and which is the standard in Europe. That means putting the site in the neighborhood of least resistance—say, Capitol Hill or the University District—but it also means we won’t get a sense of what the true impact a network of safe consumption spaces would have, and could instead create a situation where the worst-case scenario of concentrated drug use does come true, because every drug user who wants to use the site will flock to a single spot. This could lead the city to declare failure prematurely, before more sites can open.

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From Welcome to Murraysville.

At Thursday’s press conference, Mayor Ed Murray was quick to point out that “if you look at the heat map of where needles are distributed across Seattle, it’s not restricted to one neighborhood.” He added that his experience with homeless encampments has taught hims that when “certain neighbors tend to go sideways on us, that’s not the whole neighborhood. … Will it be easy? Will there be protests? Will there be another website to go along with Welcome to Murraysville that says I’m putting [safe consumption sites] everywhere? That’s going to happen. But I think we’re going to get there.”

If leaders  look to Insite as a model, without understanding the nuances of the term “safe consumption,” they might end up creating a site for needle users only that will do nothing for people who smoke meth and crack, or who smoke other drugs.

Murray said he plans to travel to Vancouver soon to visit Insite, the only safe-injection space in North America. (The comment was apparently inadvertent, and a Saturday press release announcing his trip to Vancouver on September 19 did not indicate whether he still planned to visit Insite.) But he won’t be getting a complete picture of what a safe-consumption site might look like here, and not just because Insite is a single facility, located in a neighborhood where most of the city’s heroin use and crime have long been concentrated.  Insite, critical as it is, isn’t a true safe-consumption site, since it only allows injection, and therefore isn’t the model for what safe-consumption advocates want to see here. (For that, you have to look to Norway, Germany, Spain, or Switzerland, along with other European countries where safe consumption is relatively commonplace.)

Harm reduction means meeting people where they’re at and reducing the harm they do to themselves while they’re in active addiction, and smoking, say, heroin instead of injecting it is one kind of harm reduction. But if leaders like Murray (and the other officials arrayed behind him at Thursday’s press conference) look to Insite as a model, without understanding the nuances of the term “safe consumption,” they might end up creating a site for needle users only that will do nothing for people who smoke meth and crack, or who smoke other drugs.

This isn’t just a theoretical concern. For example, media reports on last week’s announcement have consistently referred to CHELs as “safe-injection sites,” the assumption being that they will be for heroin users to inject heroin under supervision. And the report itself hedges on this question. “Every effort is to be made to ensure that the provision of supplies and space for consuming illicit drugs (NOT tobacco-containing products or marijuana) via smoking (more precisely sublimation, meaning without combustion of the drug itself) and nasal inhalation be incorporated into the CHEL program design,” the report says.

I asked Finegood what “every effort” means, and whether true safe consumption might end up falling victim to political compromise. After a long pause, Finegood responded: “I just don’t know.”

“There was just such an emphasis on it through the task force, to be able to provide that kind of resource and understanding—that we don’t want to move downstream inadvertently and say you can’t come here because you’re smoking,” Finegood told me. “Maybe [not emphasizing other means of consumption more] was an oversight on our part.”

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Safe Space, Part 4: Safe Consumption in Seattle

This is the fourth and final installment in a series about safe injection and safe consumption spaces, Safe Space, which started in Vancouver, B.C. and concludes back at home in Seattle. Read Parts One, Two, and Three. If you like my coverage of harm reduction in cities, urbanism, transportation, drug policy, homelessness, and many other issues, please consider becoming a sustaining supporter by signing up at Patreon; your contributions are what enables me to keep The C Is for Crank cranking and to occasionally travel to places like Vancouver and Boulder to report on what’s happening in other cities and the lessons they have for Seattle.

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Safe injection sites have a distinct advantage over many other harm-reduction proposals: They directly address a crisis that is in the forefront of the middle-class American consciousness, the heroin epidemic. Although safe-injection sites like Insite in Vancouver allow clients to use other drugs—in fact, Insite manager Darwin Fisher estimates that heroin makes up only about 40 percent of the drugs injected at the facility—most people think of them as heroin-injection sites, and therefore an answer to an opioid epidemic that claimed nearly 30,000 lives in the US in 2014 alone.

Safe consumption sites are different. At safe-consumption facilities, which are fairly common in Western Europe but nonexistent in North America, drug users (and, sometimes, alcoholics) are allowed to consume drugs by whatever method they prefer, including shooting, snorting, or smoking. This raises all kinds of logistical questions, which I’ll get to in a minute, but the basic premise is that people who shoot drugs aren’t the only ones at risk of overdose or in need of access to treatment and other forms of assistance; moreover, in general, every other method of consuming drugs is safer than shooting up, so moving users from shooting to, say, smoking is an improvement on the harm-reduction continuum.

Another distinction between Insite and what some harm-reduction advocates would like to see in Seattle is that Insite, as its name suggests, consists of a single site—located in a run-down, hardscrabble part of Vancouver that has no Seattle equivalent. Whereas drug use and sales are concentrated heavily in one area of Vancouver, Seattle’s drug use is decentralized and highly distributed, making a single injection site—a central destination for drug users from all corners of the city—less than ideal. (The neighborhoods around methadone clinics tend to be hotbeds of “disorder” and minor nuisance crimes isn’t because drug users concentrate there, but because a huge proportion of the city’s drug users concentrate there; currently, there are only two methadone programs in the city of Seattle, serving an estimated 2,200 clients, according to Evergreen Treatment Services director Molly Carney, with more clinics outside city limits.)

What may work best for Seattle and its drug-using population, in other words, is a network of small facilities spread throughout the city, where clients can consume drugs not only by injecting but by smoking, snorting, or any other method of ingestion. These sites would be indemnified by the government, blessed with the approval of SPD and the city attorney’s office, and staffed with people who can help drug users access services including treatment, housing, and medical care. Radical–yes. Doable–very possibly.

Patricia Sully, a staff attorney at the Public Defender Association and the coordinator for the harm-reduction group VOCAL-WA, says most drug users probably won’t travel across the city to access a safe-consumption site; they need services where they already are, which means small (or, potentially, mobile) sites in Seattle neighborhoods where drug users already congregate. Unlike Vancouver, “We don’t have one centralized area where all the drug use is concentrated; we have very diffuse drug use. And I think to mitigate the impact on neighborhoods, it’s important that there not be just one [safe-consumption facility so that] people are able to access  this kind of service where they already are.” Paradoxically, the diffuse nature of Seattle’s unsafe drug consumption could allay fears that neighborhoods will become drug-use destinations, Sully says: “There’s a lot of fear that if you had this kind of facility, it’s going to draw all these people, but I think it’s actually fairly unlikely that people are going to bus miles and miles and miles to access the service.”

Darwin Fisher, the manager of Insite, told me on a recent visit to Vancouver that whether a city builds a single, stand-alone facility, as Vancouver has, or many smaller sites, it should make sure drug users don’t have to travel far, because they won’t. “If I’m in withdrawal, I’m not going to travel 20 blocks to where the site is. That’s just not going to happen,” Fisher says. Montreal is proposing a distributed safe-injection system, and “if you were to take a tour of Europe and go to the 90 sites, I think the only consistent thing would be implied in the title (safe consumption). Everything else is negotiable, depending on what the community wants,” he says.

Sally Bagshaw is one city council member who says she would consider multiple safe-injection sites, but is currently inclined to propose placing them in existing public health clinics, which already have a health-care infrastructure in place. “I don’t think a safe injection site, in and of itself, is the model that I want to pursue. I would like to pursue the public health model where you can come in and have a safe injection site, or safe consumption site, [as well as] other options available when you come in the door,” Bagshaw says—a setup where “if you’re sick and tired of being sick and tired, there are other options that are available to you there, whether it’s a prescription for [buprenorphone, a maintenance drug for opiate addiction] or treatment,  and that we also know that there are beds for people that really want to go into detox.” As I’ve reported, there are only a few dozen detox beds available for people withdrawing from alcohol or other substances in King County, a number that is pathetically smaller than the need. People detoxing from alcohol can die, making medical detox an absolute must for serious alcoholics, but supervised detox can help heroin addicts through the process too, and may be less expensive than building full medical facilities; Insite, for example, has 12 private detox rooms for opiate addicts that are medically supervised but are not full medical detox.

Liz Evans, the founder of Insite, said on a recent visit that she does not support the Bagshaw-approved co-location approach, because “if you embed it into an existing health service, the culture of the health service is the dominant culture at that location, and may not necessarily be as welcoming” as a site run by an independent nonprofit like Insite. (Insite, while its own entity, partners with and gets its funding from Health Canada, the Canadian federal health care service.)

Another hurdle North American advocates for safe consumption spaces face is the very notion of safe consumption, rather than injection; particularly, the idea of crack- and meth-smoking rooms attached to safe-injection sites. But Sully says safe consumption is really “not any more radical than safe injection,” and only raises eyebrows because it’s unfamiliar. “When you’ve got people who are outdoors using drugs, it’s going to be preferable for them to be indoors using drugs both for their own health reasons and for public health and safety of the neighborhoods,” Sully says. “I think that for a lot of people in the neighborhoods who are struggling with people using drugs outdoors, whether those people are injecting drugs or smoking drugs is largely irrelevant.”  

Matt Curtis, the program manager at VOCAL-NY, a New York-based harm-reduction group, adds that “unless you’ve done the world’s worst job of explaining a supervised injection facility, and you’ve explained it so narrowly that people are monofocused on that one little thing, I don’t think it’s that much more of a lift to walk people through why other kinds of safe consumption spaces are a good thing.” And both Sully and Curtis point to the issue of racial justice—limiting safe spaces to heroin users, who tend to be white and have middle-class backgrounds, excludes the crack users who were the victims of the harsh, racially biased drug laws of the ’80s and ’90s, which punished crack users much more harshly than those who used powder cocaine. 

“There’s certainly much more openness to this idea because of the response to the heroin epidemic, and you can’t really separate that from race,” Sully says. “The fact that this is affecting white people and middle America and ‘our sons and daughters’ and all these things —we certainly did not see this response to the crack epidemic.” For that reaosn, if the city chooses to focus exclusively on heroin to the exclusion of drugs used primarily by black people, “we have the potential to really exacerbate our racial disparity,” Sully says.

Building safe smoking rooms would be a minor engineering challenge (the rooms would need to be ventilated properly and segregated from the injection areas), but that seems surmountable. Likewise, the fact that people would be using very different types of drugs—including drugs like meth and crack that can make users aggressive and hyper, along with downers like heroin and fentanyl—hasn’t been a problem at Insite, where more than a dozen drugs are included on the login screen at the front desk, with more being added all the time. When I visited, the room was fairly quiet and mellow, even though there were people in the room shooting heroin, meth, cocaine, and other drugs, often in combination. “You still get people who say, ‘God damn it, it’s the coke users who are taking up so much time because they’re tweaking,’ but that’s just griping that happens. There’s nothing special about that,” Fisher says. 

Will Seattle–famous for processing everything to death, largely ruled at the dictates of neighborhood activists who blame homeless drug addicts for everything from property crime to the presence of discarded couches in neighborhoods–manage to transcend its sometimes-wary attitude toward counterintuitive solutions and embrace safe-consumption sites? Advocates insist there are signs that it may. 

For one thing, we already have Law Enforcement Assisted Diversion (LEAD)–a program that partners SPD and human and social services agencies to divert low-level offenders from jail and into community-based interventions, without expecting them to change everything overnight. Since the program began in Belltown, it has expanded through SPD’s West Precinct and will soon include Capitol Hill.

At a Council District 6 public safety meeting Wednesday night, Public Defender Association director Lisa Daugaard said one thing groups like the PDA, which advocates for harm reduction and criminal justice reform, learned doing LEAD is that advocates can’t merely impose their preferred solutions on neighborhoods; they have to engage communities and show them that they take their concerns seriously. Only then can advocates like Daugaard show communities how programs like LEAD (and, by extension, safe consumption sites) can actually help address the problems they perceive, like property crime, drug addiction, and visible homelessness.

“Even if it was ineffective, wrong, unconstitutional, and stupid” to lock people up over and over for minor crimes like drug possession, “we weren’t engaging the central dynamic, which is that it was actually problematic for people to engage in those behaviors,” like aggressive panhandling, public urination, and minor property crimes, Daugaard said. “So, some years back, some folks on both sides of these conversations decided to talk about the issue in a different way … and reframe the conversation in terms of what actually works. And it turns out that if that’s the lodestar of your conversation, it leads to completely different policy choices.”

At a city council-sponsored public forum on safe consumption sites earlier this year, one unlikely advocate, Magnolia neighborhood activist Gretchen Taylor, expressed her tentative support for the idea of safe consumption facilities–if they are closely monitored and accompanied by strategies that reduce crime in the neighborhoods. Cindy Pierce, another Magnolia neighborhood activist who, with Taylor and several others, formed a group called the Neighborhood Safety Alliance last year, has also expressed a willingness to discuss safe-consumption sites if they will reduce crime and other visible signs of homelessness and addiction. Both women traveled to San Francisco with Bagshaw earlier this year to visit that city’s Navigation Center, a low-barrier shelter that does not require clients to come in sober.
Taylor, whose son is a heroin addict, told the panel, “I do understand the wisdom behind Insite and I congratulate you for your victories. Vancouver has identified that years of failed policies have failed people and perpetuated … continued suffering. I totally get that.”
Taylor continued: “The frustration [in Seattle] has not only reduced people who are addicted to ‘junkies’ and ‘addicts,’ but they’re also not considered a viable part of our community whatsoever, and the frustration is leading to serious ramifications. When you say ‘harm reduction,’ I get it, but I think the citizens and the neighbors are going to want to hear about harm reduction for the neighborhoods as well–that most notably being safety and crime reduction for all of us.”
Not exactly a ringing endorsement. But, perhaps, a start.