Insite founder Liz Evans and Portland Hotel Society manager Coco Culbertson at the Rainier Hotel in Vancouver
Yesterday, I gave a brief account of my recent trip with state Sen. Mark Miloscia and city council member Lisa Herbold to Vancouver, B.C., where we visited Insite, North America’s only supervised injection site for illegal drugs, a zero-eviction women’s housing project eviscerated by government budget cuts, and a prescription heroin clinic. After the trip, I sat down with Miloscia, who is running for state auditor, to talk about his impressions of the trip and his own views about the role of government in responding to addiction.
Miloscia, a Republican, has said publicly that he plans to introduce legislation preempting King County from moving forward with two supervised drug-consumption sites recommended by a county task force on opiate addiction. A former B-52 pilot with, as he puts it, “18 nukes on my wing,” Miloscia says he had a religious awakening during his time in the service and became a pacifist; his political views also did a 180, and he became a vocal opponent not only of abortion rights and the death penalty, but of drug decriminalization, which he previously supported.
The C Is for Crank [ECB]: Did anything you saw in Vancouver surprise you?
MM: A few things surprised me. One is the passion and compassion of Liz [Evans, the founder of Insite] and the people there. Two, I think in the big scheme of things, we’re not that far apart. She gets the failures of the system absolutely, and I’m the same way. She said she’s a disrupter, and so am I, because we both recognize the evils and the shortfalls of the current system. It’s not working. That’s why I got into government, why I ran for office–because the human services and criminal justice side is a complete failure, and we don’t want to fix it, and people die. It’s mind-boggling to me.
The first question out of the first reporter [at KING 5, which did a brief story about the visit] was, ‘What struck you there?’ And I said, ‘That street.’ [East Hastings Street, where Insite is located, has long been Ground Zero for the drug trade in Vancouver]. I never saw that many drug addicts on one street. I grew up in New York City, but that was horrible. I saw that need, our brothers and sisters dying on the street. And then you have that clean, very well-maintained facility, government-run, and it’s like, we’re contributing to that. We’re not helping them. They’re already on death’s doorstep. They’re dying right there, and we should be helping them five years before they get to that point.
ECB: But Insite does save lives. The data, which Liz and the other Insite staff cited to you, prove that it saves lives that would have been lost to overdoses, HIV, or wound infections.
MM: You’re absolutely right. Maybe they are. But I talked to Liz about this and Liz admitted that it’s just a little patchwork process in the entire homeless heroin addiction system, which is completely broken. It’s like, stupid government! What are they doing? Do something! They have all the money, all the authority, and they’re blowing it.
“The entire way our planet operates is about telling people what to do. Criminal justice, societal pressure—everything is about telling people what to do. Now, when they have an addiction, when the drug takes over their life, that’s when they need that more than ever before.”
And she said that she hated the government getting involved, because it’s gold-plated and ineffective and the compassion goes away when bureaucrats are running it. And ultimately it doesn’t work. I believe there’s got to be accountability and prevention, because once they get into that… What’d she say, it’s going to cost $30,000, $24,000 a year? I can’t remember what figure she gave but it was an insane act of money. We’ve got, what, 50,000, 40,000 addicts in King County? Do the math.
ECB: But they’re already costing us money. The highest number I heard for any service while we were in Vancouver was around $25,000 for someone to use the prescription heroin program, and the director pointed out that that was still much cheaper than jail, which can cost as much as $150,000 a year.
MM: And that’s why I’m a big believer in any sort of diversion program at all. You need to be able to identify people as being a danger to self or a danger to others, and once you do that, you can force people into treatment.
ECB: Liz told you that there’s no evidence to suggest that forcing people into treatment works—it just gets them off the street for a few days or weeks, at huge expense, just like jail. What do you say to that?
MM: That is a crock. The entire way our planet operates is about telling people what to do. Criminal justice, societal pressure—everything is about telling people what to do. Now, when they have an addiction, when the drug takes over their life, that’s when they need that more than ever before, and the question is getting them into a treatment that works. And to be honest, it’s almost a lifetime of treatment they need, because 30 days is the worst type of treatment. You might as well not even try. You might as well get them into detox and then kick them out onto the street. And that’s what we’re not fixing.
ECB: If 30 days of treatment isn’t enough, and that costs tens of thousands of dollars already, how are you going to pay for more intensive treatment for more people?
MM: You’ve got to focus on prevention. That’s the only way you rightsize the problem. Do an analysis of why people are turning to drugs. If you want to solve the problem rather than just maintain it, slow the growth. To solve any problem, it’s all about preventing the causes. That’s where it’s cheaper. That’s where you get results. And that’s, to be honest, where the bulk of the money needs to be spent. We’re triaging now. If we do everything in a system-wide manner, yes, there’s a way I see her program working–if it’s just a temporary stair-step program to get people into treatment. I try not to get visibly angry over the destigmatization of drugs and ‘It’s all about choice’–but that’s the wrong approach. It’s hard for people to choose to get out of their addiction. It’s carrots and sticks, for all of history–that’s how you motivate people. If you have no stick, you’ll never get a person to the point [of entering treatment] unless they hit literally rock bottom and are at death’s doorstep.
ECB: But if every addict decided they wanted to get into treatment tomorrow, we’d be thousands of beds short. And we don’t currently have the capacity to put every heroin addict on Suboxone or methadone. Are you in favor of funding treatment on demand?
MM: What I believe is when people want treatment now, you get them treatment now. So yes, that’s where you probably get your most success. If I was going to put money into triage, absolutely, get that right now. But do the math. We’re going to need $5 billion. And that’s why we’ve got to do prevention and stop it.
“I try not to get visibly angry over the destigmatization of drugs and ‘It’s all about choice’–but that’s the wrong approach. It’s hard for people to choose to get out of their addiction.”
ECB: Will you concede that you’re never going to stop from using drugs and doing dumb stuff through prevention, though? You can conceivably reduce it, but it’s going to be above zero, because people are going to continue to use drugs. What do you do with the people who are going to still use drugs and end up getting addicted?
MM: I’m going to slightly disagree with your assumption, because at the end of the day, this whole discussion we’re having is a distraction from, what is our plan to cut heroin drug use down from 50,000 down to a manageable 1,000? [It needs to be] done right, with a huge cultural stigmatization–this is controversial when I say it–and going after the root causes.
“I firmly believe that just like with homelessness, literally half the money we’re spending is spent on ineffective programs, wasteful programs, and we don’t get results because we don’t measure that.”
I started having that conversation with Liz, I said, ‘Why do people start using drugs?’ And she said, ‘Pain, broken relationships.’ That’s just another name for religion, family, community: Those networks that keep people sane and that stabilize people before it reaches the state of, you’re living in the Jungle with your heroin buddies and part of a gang. When you‘re part of a strong community like that, it’s really hard to move there. The societal, community, family, pressure prevents you from going there. The bottom line is that’s what it takes for people to get out of their addiction. You’ve got to develop that support structure around them.
A nurse at the Crosstown Clinic in Vancouver, where addicts come several times daily to inject prescription heroin.
ECB: You’ve said you don’t want a safe injection or consumption site in King County. Why do you want to interfere with local control by passing legislation making Seattle’s desire to experiment with that model impossible?
MM: Part of the reason is, if you look at where Canada’s going, with medicinal heroin, they’re still not getting rid of the root causes. They’ve still got a heroin epidemic going on, so they’re not solving the root problem. So while in the short term, I believe it slowed the deaths–instead of it taking you five years to die on the streets, it’s now taking you ten years–at the same time, it’s not solving the underlying root causes that ultimately lead to addiction.
ECB: Have you read the heroin task force report?
MM: Yeah, ten times already.
ECB: It seems to me that they’re trying to do exactly what you’re saying you want.
MM: There’s a lot of good things in there. But we know how task forces are done, and there’s really nothing in there that I haven’t seen before. It’s all the same stuff. And anybody who’s been involved in this knows that the problems haven’t changed from the 80s. It’s the same problems. The solution is the same thing. But government never does it. Government screws up the implementation every single time. But they get to spin that report and say, ‘Oh, we’re doing something.’ But does the system, the boots on the ground, really change?
ECB: The task force is only recommending safe consumption sites for two years, as a pilot project. Why not let them try and see what happens?
MM: OK, so let’s think. We’re going to take this radical change. If we scale it up, we’re going to need to do 80 sites in King County alone. Then we’ll do medicinal heroin and we’re going to continue down that path.
ECB: But nobody’s talking about doing that here.
MM: They’re doing it in Canada! It’s the next step. It doesn’t work unless you go to the next step. That’s why everybody wants to put it in that little silo: ‘Oh, this is all we’re doing.’ But no, no–if we want to change the system, we have to have real reform. How does this scale up and look systemwide? And then when you look at that you go, ‘All our resources are going into this, it doesn’t work, per se, and we’re ignoring the key factor of prevention.’
ECB: What do you think does work?
MM: Show me the numbers. No one talks about efficiencies or effectiveness. I firmly believe that just like with homelessness, literally half the money we’re spending is spent on ineffective programs, wasteful programs, and we don’t get results because we don’t measure that. But that’s the data I want. I want to know that, ‘Okay, Mark, if you do this program systemwide, it’ll save “X” lives.’
ECB: But the only way to get data on harm reduction is to do harm reduction.
MM: Oh, true, right. But what I’d like to see is, let’s fix the $1 billion we’re spending right now, which we know at least half a billion of it are wasteful, are ineffective, are not getting results. Let’s design a plan to focus on prevention, versus, let’s get distracted and put us on the path to, frankly, legalization and decriminalization.
ECB: What do you think of the LEAD program, which diverts people committing drug crimes out of the jail system?
MM: Oh, it’s fantastic.
ECB: But that involves not arresting people.
MM: As long as they get them in a treatment plan, I’m fine. Do harm reduction and treatment, I’m fine. But there’s got to be no choice. It can’t be, ‘Well, I’m going to do this for ten years.’ It’s like Housing First. I’m for Housing First, but after 30 days, pick a time, you’ve got to get with the program. Come up to me with programs that get them from Point A to Point B. Show me the data. I know behavior modification and I know this: Human behavior has been the same for as long as we’ve been on this planet. Carrots and sticks.
ECB: Do you have an opinion on long-term buprenorphine treatment?
MM: I want to see an efficient, effective, ethical program that works, that gets results. So I’m not opposed to it, but it’s a different focus from just giving you free government help and, we’re just waiting for a light bulb to magically turn on, versus being in a program where you’re monitored with ankle [bracelets], diversion programs, all that stuff. I want to be part of that solution. I think that’s the way to go, with that public stigma. And people don’t like doing this, but you have to scare the kids and scare the adults.
ECB: I grew up in the age of Just Say No and it didn’t work. Neither did DARE. Both of those programs were geared toward trying to scare kids.
MM: Of course it didn’t work. Those are government-run programs. When the program doesn’t work, you know that within 45 days of the program starting and you change the program. But that doesn’t stop you from trying to find a program that scares people and stigmatizes them. Look at Korea. Look at Japan. There’s all kinds of cultures where it does work. But it takes thought. It’s all about culture and attitudes, so people don’t turn to drugs. There’s a whole science about why people turn to drugs or do self-destructive behaviors, and it brings us back to the family and religion discussion, or the values discussion, or the culture discussion. That’s the heart and soul of how people decide to avoid listening to the little devil on their shoulder versus the angel on their shoulder. That’s just human nature. We all struggle. All of us deal with the choices that we make.
ECB: Was your mind changed by anything that you saw or heard in Vancouver?
MM: Like I said, Liz completely shocked me. She gets the problem and the gets the solution and she admits that her thing isn’t solving the problem. She’s trying to break up the system. But the practice per se of clinics–I think, no. My opinion didn’t change at all. I still think it’s a distraction from us working on the really tough issue.
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