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

This story appeared in Seattle Magazine.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The Europe Experience

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

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

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

Morning Crank: Just the Highlights

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

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

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

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

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

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

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

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

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

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

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

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

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

Morning Crank: Why They Didn’t Apply the Racial Equity Toolkit

1. King County Council member Joe McDermott and Jeanne Kohl-Welles have proposed legislation, sponsored by five of the council’s Democrats (Dave Upthegrove’s name is not on the legislation), that would remove Initiative 27—the ballot measure that ban supervised drug consumption sites throughout King County—from the ballot. In its place would be a two-part question that would give voters the ability to say “yes” to safe consumption sites, along with the other seven recommendations that were unanimously adopted by the county’s Heroin and Prescription Opiate Addiction Task Force a little over a year ago. The task force included public health experts, elected officials, cops, and representatives from the King County Sheriff’s Department and Prosecuting Attorney’s Office.

The legislation essentially asks voters to decide whether either  measure—I-27 or the task force recommendations—should be adopted; then, if a voter says “yes” to the first question, which option they prefer.

“If the people are going to have a chance to vote on safe injection sites, I want them to have all the alternatives,” McDermott says. “This is an effort to have a positive alternative on the ballot to address the public health crisis on our streets.”

A group of advocates is suing to prevent I-27 from going on the February 2018 ballot, arguing that state law does not allow voters to veto adopted public health policies. The case will be heard in King County Superior Court on Friday.

2. The committee charged with reviewing the city’s policies around encampment sweeps met last night for the first time in a month to hear from the city’s Office for Civil Rights (which monitors the sweeps to see if rules like a 72-hour notice requirement are being followed), the Department of Finance and Administrative Services, and the Navigation Team itself about how things are going.

Questions that came up during the meandering meeting: Whether SOCR should be in the position of monitoring encampment removals at all, given that they are themselves a city department (the committee is far from the first to raise this issue); whether the committee should have its own encampment removal monitor that answers only to the committee; and why the city did not initially apply its racial equity toolkit to its sweeps policies (Finance and Administrative Services Department director Chris Potter said it was because the city declared homelessness an “emergency.”)

One question I hoped the city might answer (they didn’t) is why FAS, SOCR, the city’s Human Services Department, and the navigation teams don’t share data in a way that enables them to know exactly what happened to each individual person who received “outreach” during an encampment sweep. HSD and the mayor’s office often tout high numbers of “contacts” and “referrals” to services and safer alternative sleeping arrangements as proof that the Navigation Teams are working, but it’s virtually impossible to find out what happened to the people who received these referrals over the long- or even medium term. No single agency or organization tracks people’s progress after the initial contact by the navigation teams, and people count as success stories for the city’s purposes even if they stay in a shelter for one night and move on.

Navigation Team coordinator Jackie St. Louis did provide some information about where the teams were providing referrals to (not everyone who received a referral followed through by showing up at the shelter or other location to which they were referred). The most common locations for referrals were: The new low-barrier shelter run by Compass Housing on First Hill (capacity: 100); the sanctioned encampment in Georgetown (capacity: 70), which does not allow drugs or alcohol; the sanctioned low-barrier encampment at Licton Springs (capacity: 70), which does not require sobriety; and the Navigation Center (capacity: 75), a city-run low-barrier shelter.

That means that most people the Navigation Teams encounter are being referred to either other encampments or low-barrier shelters, not traditional shelters, transitional housing, or behavioral health or addiction treatment centers. The large influx of referrals from encampments could be one reason the Navigation Center is taking longer than that to move people along to the next thing; last month, HSD reported that the city-run center was “finding that mapping out a strategy to get [clients] housed could take more than 60 days.”

3. At an AARP-KOMO TV-sponsored debate last night, mayoral candidates Cary Moon and Jenny Durkan offered their responses to a question about whether the two-thirds of Seattle’s land zoned exclusively for detached single-family houses should be opened up to allow other types of housing. (Former mayor Ed Murray initially proposed allowing duplexes, row houses, and other types of low-density housing in single-family areas as part of the Housing Affordability and Livability Agenda but backed off after homeowners complained that other types of housing would drive down their property values, make it impossible to park their cars, and destroy their neighborhood character). Moon said she wanted to restart the process so that neighborhoods could be involved in determining how to accommodate density while preserving neighborhood “character”; Durkan seemed to suggest that if the city simply made it easier to add mother-in-law and backyard apartments to existing single-family houses, there would be enough density to provide all the “missing middle” housing Seattle needs.

Moon: “I would restart that conversation with communities to say, ‘This is how many folks are moving here. Here are all the tools we could be using, including backyard cottages, mother-in-law apartments, clustered housing, row housing, stacked flats,’ and show folks all the different models for how do we add infill development in neighborhoods, and invite them to be a part of picking what works for their neighborhood. Because if you impose it from on high in Seattle, that doesn’t work. We all feel this right to shape our city, the right to be at the table and help determine what’s the right way to grow with grace. … We’ve got to involve neighborhoods in doing it together in a way that works for their character that they’re trying to protect, for how they live their high quality of life in their neighborhood.”

Durkan: “I’ve got some friends who, for 18 months, have been trying to get a permit for a mother-in-law apartment. If we made it easier for folks to get mother-in-law apartments and real backyard cottages—not these monstrosity[ies] that everyone’s afraid of—we could make almost every single-family lot into a triplex overnight. But we are having impediments, so we need to make it a priority, and the mayor needs to say to the housing and zoning people, ‘We’re going to speed up affordable housing. We’re going to give people the ability to have density,’ and then we’ll move forward.”

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

Michael Roberts: I Support Safe Consumption Because I Don’t Want Other Families to Lose Their Children

This is part 3 in a series of interviews with advocates on both sides of the safe-consumption issue.

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

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

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

This final installment features Michael Roberts, the cofounder of Amber’s HOPE, an addiction awareness and prevention organization named after his daughter, Amber Roberts, who died of a heroin overdose at just 19. Since his daughter’s death, Roberts, who is in recovery himself, has worked to raise awareness of the opiate epidemic and promote substance use disorder prevention. Roberts says he supports safe consumption sites not only because they save lives, but because they provide connections to nonjudgmental treatment and help for people who may be filled with shame and self-loathing because of their substance use. I talked to Roberts by phone last month, just after the second anniversary of his daughter’s death.

Here’s Roberts:

My daughter Amber passed away two years ago. She was 19 and she was at her mom’s house, in her bedroom, and her mom found her in the morning.

When you overdose from heroin, what a lot of people don’t know is you don’t really overdose on one drug. We got the tox reports and there was alcohol and ecstasy along with opiates. But heroin is the one that puts you to sleep.

“This was the girl who I still had to take to the doctor to get shots because she hated needles so much.”

We knew for sure she was doing heroin two weeks before she passed. My birthday’s in June, and she always made time to spend the day with me or do something with me. And when she changed plans at the last minute, to me, that was a red flag. She had recently broken up with her boyfriend, who was one of her best friends since the 7th grade, and I asked her why. She said he was too smothering. Well, he goes to college in Oregon. He plays football. He’s not around. So that was another red flag.

She started smoking pot around junior high, and doing ecstasy and drinking. I knew there was a trend there, so I always kept an eye on it. We always had what we thought was an open communication about drugs and alcohol. I was planning on getting her into detox and into rehab. I’ve been to rehab three times myself, and I’ve always been an advocate for recovery.

The first time I went was in 2000, and it was about 50-50 opiate-related and alcohol-related. Then I went in 2009 and it was like 70 opiate-related and alcohol was the minority. And talking to all these kids that were like a bunch of sports players that got injured—the next thing you know, they’re shooting heroin.

She loved to go to EDM shows and raves. And so she went to Vegas with all of her friends the weekend she passed, and I was planning on taking her to rehab when she got back from Vegas. By now, we knew she was doing heroin. One of her friends finally messaged her mom and said Amber told them. This was the girl who I still had to take to the doctor to get shots because she hated needles so much. So she goes to Paradiso on Friday, and by Saturday she’s calling her mom asking her to come pick her up at the Gorge because she was sick and wanted to come home.

“Sometimes we feel lucky compared to all these other parents who were just going through the struggle of addiction for years and years and years. But we would take that over anything. At least there’s a chance to save them.”

She texted me at midnight that night from her mom’s house to tell me she was fine, and probably died right after.

We found out after she passed that she first tried heroin in February of that year and she died five months later. Sometimes we feel lucky compared to all these other parents who were just going through the struggle of addiction for years and years and years. But we would take that over anything. At least there’s a chance to save them.

Amber was the most loyal person you could ever want as a friend. One of her friends told a story about her. It was like 3 in the morning and she had had a bad day. Amber lives up in Snoqualmie and this girl lives in Lynnwood, and Amber left and got her some candy and took it to her at 4 in the morning. Her laugh was indescribable. She had a great work ethic. She loved her family, her brothers. It was just one of those drugs we never thought that she would do.

When she died—she’s my only child, and now it’s just me. So it’s one of those questions: Either I’m going to go join her now or I have to find something to fight for, just because I don’t want any other parents to feel like this. My getting involved was a way to still work with her, I guess, or keep her name alive so I don’t go crazy. Her mom and I started a heroin and opiate prevention organization called Amber’s HOPE. The premise is to speak to communities and families and just bring awareness to the fact that it’s happening. I lived in Kirkland for all of Amber’s school year, and there were at least three overdoses at her high school in one year. Growing up on the Eastside—I grew up in Issaquah—there tends to be an attitude of,  ‘Not my child’ or ‘My child would never do that.’ I really wanted to sway that view. It takes a lot of time. There’s a lot of bullshit involved in it. I tried to deal with Lake Washington [High School] and it’s like pulling teeth.

You can’t do anything until you break that stigma down. Just look at what the King County Council did with safe consumption sites. [In July, the council barred funding for safe consumption sites through the county’s general fund and prohibited funding the sites through the county’s mental illness and drug dependency tax except in cities that explicitly vote to allow them.] They got scared shitless. They just decided, ‘We’re not going to fund anything.’

Growing up on the Eastside—I grew up in Issaquah—there tends to be an attitude of,  ‘Not my child’ or ‘My child would never do that.’ I really wanted to sway that view.”

If I had the money, I would build [a safe consumption site]. It builds connections. For me, being in my community and a recovering addict. that was the biggest hurdle. You already feel like complete shit. You have no self-worth. Maybe you’ve grown up with your family calling people drunks or junkies and saying, ‘Get a job,’ being judgmental. So are you going to go to your parents or family and go, ‘I need help?’ [A safe consumption site] builds connections and it saves people’s lives. That’s the bottom line for me. Once you’ve gone through what I went through, you will do anything for someone not to go through that.

When I speak at communities around Seattle, this is the idea that scares people. They think it’s going to cause crime. But that crime is already there.

I don’t think you’re going to be able to change people’s minds who think like that. They’re set. Unless something personal happens to that person, they’re not going to change their minds. So I try and be really nonjudgmental towards those people. All I can do is tell my story and explain why I believe what I do, and if they listen, they listen, and if they don’t, they don’t. Once you get into an argument or debate, you lose all credibility, because you’re just not going to win. You just have to go, ‘Okay, imagine if that was your child? How would you feel? How would you deal with this?’  My argument to them is, it could save someone’s life. I mean really, that’s what they do.

Today, just reading the numbers coming out about overdose deaths, we’re looking at 60,000 to 70,000 for this year. It’s not going away, and there’s a lot more even in the last two years. There’s a lot more talk about it, too. It seems like now that taboo  is breaking down more and more. Two years ago. the news barely even spoke of [the opiate addiction epidemic]. Now it’s almost a daily segment, even on the local news.

This is all I work on now. It’ll be 2 in the morning and I’ll go, ‘I can’t do this anymore,’ because whenever I talk about Amber, there I am reliving it again. But I don’t mind it if it helps somebody else not have to go through what we went through.

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

 

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

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

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

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

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

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

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

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

Here’s Lever:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Brad Finegood, King County Opiate Task Force Member: Safe Consumption Sites Will Save People Like My Brother

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

Last week, the King County Elections Department confirmed that initiative supporters had collected enough signatures to qualify for the February 2018 ballot; a last-minute effort backed by Republican King County Council member Kathy Lambert to put the measure on the ballot in November was unsuccessful.

With safe consumption very much in the news this week, I thought it would be a good time to hear from some advocates on both sides of the safe consumption issue. First up: Brad Finegood, a drug policy expert at King County with a mouthful of a title: Assistant Division Director, King County Dept. of Community and Human Services, Behavioral Health and Recovery Division. As deputy director of the recovery division, Finegood was a member of the King County Heroin and Prescription Opiate Addiction Task Force, which released a set of recommendations for addressing the opiate addiction epidemic last year. Those recommendations included promoting safe storage and disposal of prescription medications; wider access to treatment for opiate addiction, including medication-assisted treatment with drugs like suboxone and comprehensive treatment on demand; and wider distribution of naloxone, the overdose-reversal drug.

But by far the most controversial recommendation the task force made was that the county open two supervised drug consumption sites, where users could consume their drug of choice—heroin, meth, cocaine, whatever—under medical supervision. The intent, the task force wrote in its report, was to reduce drug-related health risks and overdose deaths; provide access to treatment and basic health care, reducing drug users’ use of emergency services; and “improve public safety and the community environment by reducing public drug use and discarding of drug using equipment.” Many communities didn’t buy the task force’s logic for recommending the sites (which have been common in many European countries for decades) and have passed city-level laws banning them; in February, King County voters will have their say on Initiative 27, which would prevent the county from opening a supervised consumption site anywhere, including in Seattle, where some communities especially hard hit by the heroin epidemic, such as Capitol Hill, have been open to the proposal.

As a King County employee, Finegood can take no official position on I-27, and we didn’t discuss the initiative explicitly during our conversation. But his longtime support for supervised consumption is no secret. For Finegood, the issue is more than political—it’s personal. A longtime drug counselor who worked extensively in the criminal justice system, he lost his own brother several years ago to a heroin overdose, and believes that a supervised consumption site could save the lives of people like his brother—both by preventing and reversing overdoses, and by reducing the stigma and shame that keeps drug users from reaching out for help. I talked to him at his downtown Seattle office last month.

Here’s Finegood:

Image result for brad finegoodMy brother and I were three years apart and we were always really close growing up. We grew up in a lower-to-middle-class neighborhood with two very hardworking parents and we both had really good educations. We both went to college together at Michigan State. I saw him every single day. But I never knew there was an opiate issue. That was really hidden to me and my family.  I would say, looking back, that there were probably some telltale signs. I’d go over to his house at noon, one o’clock, and knock on the door and he wouldn’t be awake. But I always figured, he was in college, he went out late, it was summertime and he didn’t have school or work.

Then he got married and went off into the working field, and there was a lot that I didn’t know, that was hidden. Some telltale signs of drug use would be marks on people’s arms or track marks or baggy eyes, and I never really saw any of that, so there was no reason to be concerned. A lot of stuff was obvious in retrospect. His wife wanted to gain some space from some of the people that he was involved with, so they moved to the East Coast to get away. Then they ended up getting a divorce and he came back to town and ended up connecting with a person who also had opiate use disorder but also hadn’t used in a long time. So when they connected, they started sharing stories, and saying, ‘Wouldn’t it be fun if we could get high together?’ She was in a different city, but they would rendezvous and go see music and get high.

That happened a couple of times. Then they got together and went on a three-day party binge for New Year’s, and he didn’t wake up on New Year’s Day.

“He cared a lot about his family, and didn’t want to let us down. There’s so much stigma that goes along with having opiate use disorder.”

We didn’t even know there was an opiate problem. And then he passes away and we meet this girl who he had been friends with, and she tells us some stories about what happened. His ex-wife then started telling me stories about past seven years of his life, when I had seen or talked to him every single day, and we started to piece together all these pieces.

It was just utter sadness and a ton of guilt—the guilt of being that close to my brother and not knowing. I was working in a clinic that served people with opiate issues, and I didn’t even know my brother was using under my nose. I think a lot of that was not wanting to let people down. He cared a lot about his family, and didn’t want to let us down. There’s so much stigma that goes along with having opiate use disorder. There was a picture that had been taken maybe two or three months before he died where he just had these raccoon eyes, and I thought, ‘Oh, that makes sense now.’ There was a lot of family system disbelief and denial that that couldn’t happen to us—’not in our family.’

One of my first jobs coming out of college was as a substance abuse counselor. I wanted to be able to help people, but I used to look at it from a criminal justice standpoint. I thought of the criminal justice system as a primary intervention for people, because I thought, people can get arrested and their drug issue could be brought up. I used to say that my brother’s biggest problem was that that he never got arrested. I had worked with so many people in the criminal justice system, and I saw that it could sometimes have a positive effect on people, if they were treated in a therapeutic environment.

You take folks who are struggling with [addiction] issues, and you put them in a confined area with other folks who are struggling with the same issues, and you don’t provide any therapeutic interventions around—then there can be some negative consequences.

I realized some of the unintentional harm that incarceration can cause people when I was working with somebody who had alcohol use disorder. He drank and got a probation violation, so the judge was going to send him back to jail for the weekend. And so I was like, ‘Hey, buddy, let’s make this an intentional experience. It’s lousy that you have to go back to jail for the weekend, but let’s get something good out of this, and you’ll come back next week and we’ll talk about it.’ So he came back the next week, and I was like, ‘So how was it? Did you learn something? And he goes, ‘Yeah—I learned how to make meth!’

That moment has stuck with me, because you realize that even the most well-intentioned intervention might have negative consequences. You take folks who are struggling with [addiction] issues, and you put them in a confined area with other folks who are struggling with the same issues, and you don’t provide any therapeutic interventions around—then there can be some negative consequences.

I was sort of raised [professionally] in the drug court world. Drug court was really the first idea that said there could be a therapeutic approach to working with people that have behavioral health issues. It’s harm reduction compared to sending someone to jail for a long period of time, but on the spectrum of harm reduction it’s not full harm reduction. That concept has evolved very much over the past 15 years to understanding that we have to be able to treat substance use disorder with a public health approach. Our partners in the criminal justice system will be the first ones to tell you, at least most of them, that criminalizing people with substance use disorder has been really unsuccessful.

“In my almost 20 years of working in this field, nobody that I’ve ever met who has opiate use disorder likes having opiate use disorder. They almost always know the risk, but they use anyway.”

The evidence [about safe consumption sites] tells the story, and the evidence is that people do not die when using those facilities. The evidence also says that when people have access to a caring environment,  they’re more likely to be able to move along the path [toward recovery]. When you provide an environment for people to feel safe, where they can come to without stigma, without prejudice, and they know that they can use on site and not die, then they’re going to continue to use that resource.

In my almost 20 years of working in this field, nobody that I’ve ever met who has opiate use disorder likes having opiate use disorder. People with substance use, especially opiate use, disorder use despite the risk of possibly overdosing. They almost always know the risk, but they use anyway. It’s a neurochemical brain disease. My brother is proof of the fact that you can be clean and sober for quite a period of time and that lure to come back is mighty difficult to fight. If you are consistently waiting for people to hit rock bottom, they’re gonna be dead.

“I think that stigma against people who have drug problems is really prejudice and discrimination against people who have drug problems.”

I think that without a doubt my brother would have benefited [from a safe consumption site.] Do I know if he would have used it? No. But do I know that there are people out there who need it and are willing to use it. Our survey from the needle exchange tells us that a significant number of people who use needle exchange services —the vast majority—would use it. And if they are willing to use it, then that means they will not be using it primarily outdoor, often by themselves, in a vulnerable situation. I know very little of the intricacies of my brother’s use, but if there was ever a time when he could have used it to make himself less vulnerable, I would have hoped he would have used it. Does it mean that my brother would be alive right now? No. But one of the things that I can say is that I believe that my brother had a lot of shame associated with his disease, and I believe that shame was because of how we as a society look at people with substance abuse disorder. I used to say, I wish my brother would have become involved with the criminal justice system. Now I wish my brother wouldn’t have felt shame. I think shame killed my brother. I think shame of having a heroin problem and having a drug problem killed my brother, because it kept him from ever wanting to ask for help. It kept him from ever admitting that he had a problem. And it kept him only trusting people that had the same problem. I think that stigma against people who have drug problems is really prejudice and discrimination against people who have drug problems.

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

Morning Crank: Not Making Any Bets

1. Activists seeking to prohibit supervised drug consumption sites in King County will have to wait until next February at the earliest to see their initiative, I-27, on the ballot, a staffer for King County Council chair Joe McDermott confirms. The safe consumption site opponents, who are calling themselves “Impaction,” say they turned in 70,000 signatures last Monday, far more than the 47,000 valid signatures required to put the measure on the ballot.

However, the county elections office has to count and validate all those signatures before the county council can consider the ballot measure. Monday was the last regular county council meeting at which the council could have put the measure on the ballot, which pushes the initiative to the next election, in February. Opponents have cried foul, claiming that the council is deliberately pushing back the election until after the first site has already opened, but they’d have a more compelling case if they hadn’t waited until the last possible week to turn in their ballots—a week, it’s worth noting, when King County Elections is already kind of occupied running a primary election. (In any case, they can probably relax. Given the way the county council has already dragged its heels over funding, much less siting, a safe consumption facility, I’m not making any bets that one will be open within the next six months.)

Last year, the 27-member King County Heroin and Opiate Addiction Task Force unanimously recommended that the county open two supervised consumption sites, one in Seattle and one somewhere else in the county, as a three-year pilot program. Safe consumption sites allow drug users to consume illegal drugs, either by injection or  Europe for decades, also provide basic medical care (for example, wound care and HIV tests), access to housing and other services that help street drug users begin to rebuild their lives; peer support; and access to detox and treatment.

Opponents of the sites say they enable users and contribute to street disorder in neighborhoods. At Insite, a safe injection site in Vancouver, B.C., more than 60 peer-reviewed studies have concluded that Insite has increased the number of people seeking treatment without increasing crime.

2. An election already without precedent in Seattle history may yet turn out to be the most expensive in the city’s history. By this point in 2013, now-Mayor Ed Murray had raised “only” $389,839; his successor  in the “establishment candidate” role, former US Attorney Jenny Durkan, had, as of yesterday afternoon, more than eclipsed Murray with contributions totaling $491,107, plus another $127,100 from the business-backed People for Jenny Durkan PAC. (Mike McGinn, the incumbent in 2013, had raised a relatively paltry $285,912).

In the race for City Council Position 8, the “establishment” candidate, Fremont Brewing owner and former Richard Conlin aide Sara Nelson has raised $144,910—$100,000 less than her 2015 “establishment” stand-in, Tim Burgess, had raised by the same date that year. However, Burgess was a longtime incumbent, not a first-time candidate; and Nelson is getting her own assist from a business-backed PAC, People for Sara Nelson, which has raised $65,000 to spend on her behalf. Jon Grant, who ran in 2015, has reported contributions of $176,822 —dwarfing his total at this point in 2015, $40,013, and eclipsing his total in that campaign, in which he raised just $75,635 in all.

All the mayoral candidates enter tomorrow night’s primary with negative or near-zero balances in their accounts, except one: Nikkita Oliver, who has a balance of $53,165. That looks to me like the sign of someone who expects to make it through the primary tomorrow night.

3. And just to put my own prediction on the record (with the usual caveat that I’m eternally, embarrassingly bad at this): Durkan/Oliver.

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

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.