It has been nearly two months since local elected leaders announced the formation of a King County Heroin and Prescription Opiate Addiction Task Force to address the regional and national heroin epidemic, and Seattle leaders have talked of establishing safe consumption sites for drug users around the city. Could Capitol Hill — a neighborhood that experiences a high number of drug overdoses — get a safe consumption site?
Safe consumption sites, which would be a first for Seattle — let alone the United States — may end up getting the green light from county’s task force. Brad Finegood, co-chair of the heroin task force and assistant division director of the King County Behavioral Health and Recovery Division, told CHS that the task force is considering safe consumption spaces and including them in their final set of recommendations that they will present to regional leaders later this year. The task force is made up law enforcement, representatives from the criminal justice system, public health and addiction experts, as well as homeless and drug policy reform advocates.
“There’s no other such facility that’s sanctioned and operating [in the U.S.],” said Finegood. “It’s definitely something that we are trying to be thorough in vetting.”
While alien to the United States, supervised drug consumption sites have a three-decade long history in other nations. The Netherlands, Germany, and Switzerland opened what were then dubbed “Drug Consumption Rooms” or DCRs, back in the 80s and 90s to address public order issues associated with open-air drug use by providing addicts and users (mostly targeting users who inject) with low-threshold access to a supervised space to consume pre-obtained illicit drugs, clean equipment, emergency care in the case of overdoses (namely application of the heroin overdose antidote, Naloxone), and referrals to healthcare and drug treatment services if desired by the user. DCRs served as a public health response intending to prevent overdose deaths, reduce disease transmission, and connect addicts with health and drug treatment services. Spain, Norway have since then joined the pack and opened their own DCRs (a safe injection site has also opened in Sydney, Australia), and last year, France moved forward with opening pilot DCR’s in three cities.
“There is no evidence to suggest that the availability of safer injecting facilities increases drug use or frequency of injecting. These services facilitate rather than delay treatment entry and do not result in higher rates of local drug-related crime,” a summary report of DCR implementation in Europe by the European Monitoring Center for Drugs and Drug Addiction reads.
Closer to home in Vancouver, Canada, health workers opened Insite — North America’s first safe injection site — in the city’s Downtown Eastside neighborhood back in 2003 to address concentrated public drug use and high HIV infection rates with a harm-reduction, public health-minded approach. And, after more than a decade in operation and more than 30 independent studies on the impacts of Insite, the research indicates that fatal overdoses in the neighborhood went down along with drug-related crime and public order in the neighborhood improved. Use of HIV-risk behaviors like syringe sharing declined alongside neighborhood HIV infection rates, and intake at local drug detox treatment facilities went up, and there was no noticeably increase in drug use or drug trafficking in the area.
In addition, Insite has never lost a user to an overdose on its premises since its founding despite experiencing around thirty overdoses per month.
“They [Insite] haven’t had any overdose deaths, and that’s amazing,” said Finegood.
“The public health arguments are absolutely irrefutable,” said Kris Nyrop, national support director for the Law Enforcement Diversion Program (otherwise known as L.E.A.D), Public Defender Association drug addiction expert, and safe consumption proponent.
Outside of the county’s official heroin task force, most everyone is just starting to dip their toes in the issue. But drug policy reform advocates have been ramping up their calls for safe consumption sites. Last month, Vocal-WA, a group of grassroots activists who are promoting safe consumption sites, brought the founders of the Insite to Seattle to give presentations around the city (including one to city council) on the project and its impact. Vocal-WA held a rally calling for safe consumption sites that also allow for smoking.
The Capitol Hill Community Council has endorsed safe consumption sites and plans to support Vocal-WA’s lobbying efforts, in addition to conducting outreach with other neighborhood councils.
“We’ve heard lots of anecdotes about public drug consumption [in Capitol Hill], people are finding needles on the ground,” said Zachary Pullin, president of the council.
The anecdotes are supported by empirical evidence of broader trends. Annual reports of drug abuse trends in King County released by the University of Washington’s Alcohol and Drug Abuse Institute (ADAI) show that drug abuse (primarily of heroin and methamphetamine), fatal overdoses and drug treatment admissions have been on the rise while prescription opiate abuse has been steadily declining (back in 2012, changes in state law made it harder to access prescription opiates like Oxycodone, which experts have attributed to the increase in abuse of street heroin). Last year’s ADAI report for 2014 showed that there 314 overdose deaths in the county, the largest number since 1997, with 156 of those caused heroin, up from 99 the year before and 29 in 2009. Capitol Hill has been dubbed a overdose hub by researchers and experts.
“For us as a council, to represent all of our neighbors, we want to advocate for things that increase everybody’s quality of life. And when we’re talking about neighbors, we’re not just talking about homeowners or renters, we’re talking about people experiencing homelessness or addiction,” Pullin said.
Local proponents argue there is a legal path for safe consumption. Patricia Sully, an attorney with the Public Defender Association, says there is legal precedent for the King County Department of Health to protect drug consumption sites by declaring a public health emergency. In Washington, health departments in Tacoma and Spokane used their authority to establish needle exchanges in the 80’s and 90’s, actions which were ultimately held up by the courts after legal challenges claiming the exchanges violated state law outlawing the distribution of drug paraphernalia (Washington state law has an exception for individuals seeking to use a sterile needle to prevent the spread of bloodborne diseases).
“Public health departments have a longstanding capacity to take action in the name of public health,” said Nyrop. “The precedent has already been set in WA state.”
Last year, the governor of Indiana declared a public health emergency to allow a county health department to implement a needle exchange to combat rising HIV infection rates despite a state ban on exchanges.
Ultimately, success of any attempt to establish safe consumption sites in Seattle will require the cooperation of local public agencies, including law enforcement and the county prosecutor, the local judicial office that has the authority to prosecute felony drug charges.
“[They would need] an agreement with law enforcement not to arrest people for possession of drugs and an agreement with the prosecutor not the prosecute,” said John Schochet, deputy city attorney at the City Attorney’s office. “That’s the primary issue.
But it appears that local law enforcement and judicial agencies have expressed either support or openness to the concept of safe consumption.
King County Sheriff John Urquhart has said that he wouldn’t arrest drug users going to safe consumption sites, and doubled down on his stance in a conversation with CHS. “I don’t really have any problems with a safe injection site if that’s what’s decided [by local leaders],” he said. “This is a pretty radical change. but it appears to have worked in Vancouver.”
King County Prosecutor Dan Satterberg said that while he has concerns over the potential backlash from neighborhoods and residents as well as using up political capital needed for other strategies like increasing the number of regional methadone clinics and boosting drug treatment services, he will not get in the way of attempts to establish safe consumption spaces.
“For the past thirty years, law enforcement and the criminal justice system have been asked to solve this problem [drug use and addiction] and it’s not working. It’s time for the public health experts to come forward and law enforcement should look at ways to support the strategies they identify and not get in the way,” Satterberg told CHS. “I’m willing to let the experts try things to help people.”
“It [safe injection sites] will save lives. There’s no doubt about it,” said Satterberg.
Seattle law enforcement is more hesitant to get on board for the time being, at least publically. Seattle Police Department spokesperson Sean Whitcomb said in a statement provided to CHS that Chief Kathleen O’Toole would “need to hear more about the research before commenting on the efficacy of safe injection.”
Resistance from neighborhoods is another hurdle for the movement for safe consumption sites, mainly in locating any proposed sites. County prosecutor Satterberg pointed to vocal opposition from Renton residents to the proposed construction of a Methadone clinic as cause for concern.
Pullin of the Capitol Hill Community Council is more optimistic. “I don’t think people are or would be dramatically opposed to this,” he said. “I’m not getting the impression that anybody [in Capitol Hill] is opposed to that right now. The issue is so on the forefront of people’s minds.”
Other neighborhoods might prove less welcoming, an obstacle which Pullin says the community council is ready to take on.
“Our charge as the Capitol Hill Community Council is to take the lead with working with neighbors and residents in Capitol Hill and having conversations with folks and community groups across the city and really make the case for it,” said Pullin.
“You don’t need to share the same reasons for supporting this but at least you and I are on the same page in agreeing that what’s happening out on the street is not good.”
Nyrop reminisced on a community meeting on Capitol Hill he attended years ago where a local father became extremely agitated over public drug use at Cal Anderson park. “He just said ‘I don’t want to see it and i don’t want my kids to see it.’”
To Nyrop, the converging interests of drug policy reformers and neighbors fed up with public drug use is one of the keys to making safe consumption sites a reality.
“You don’t need to share the same reasons for supporting this but at least you and I are on the same page in agreeing that what’s happening out on the street is not good.”
During Insite’s presentation before council last month, a lead organizer in the Neighborhood Safety Alliance—a vocal neighborhood group that has protested RV camping, public drug use, and the presence of homelessness in residential neighborhoods like Ballard and Magnolia—expressed during public comment that she would be open to the concept of safe consumption sites.
“We need to convince the public this is a good idea, and by we I mean the government,” said Sheriff Urquhart. “Society will be better off with these safe injection sites and there’s the heavy lifting that needs to be done.”
UPDATE: While Capitol Hill has been identified by proponents as a neighborhood that warrants a safe consumption site, proponents envision several such sites spread across the city in different neighborhoods. “A lot of people agree that scattered sites make sense for Seattle. Instead of a highly concentrated location, we know drug use is happening citywide,” said Sully. She identified Pioneer Square, Belltown, and the University District as some other potential neighborhoods. Nyrop said that somewhere along Aurora in North Seattle would also be a good location. “Parts of downtown, Capitol Hill the University District, Ballard and up Aurora, strike me as logical places to go ahead and put a smaller scale [site] in comparison to Insite, because we don’t have any area of town that’s going to generate the Insite [user] volume,” said Nyrop.
Down at City Hall, council members seem supportive but cautious. A mostly full council—council members Tim Burgess and Bruce Harrell were absent — was receptive to the Insite founders’ presentation.
Since then, however, some council members have been reluctant to jump into the debate. Burgess declined to comment and a staffer in council member Sally Bagshaw’s office told CHS that she is waiting on the official recommendations from the heroin task force before wading into the subject (Bagshaw is the chair of the council’s human services and public health committee. Following the Insite presentation, after noting her belief in a housing-first strategy for homelessness and addiction, Bagshaw said that “there’s going to have be some places where [homeless addicts] can use [drugs].” It was reported that both council members Deborah Juarez and Lorena Gonzalez expressed support for safe injection sites at a Seattle University forum on public health and drug policy last month.
District 3 representative Kshama Sawant said that while her office is still doing research and learning from experts in the field, harm reduction strategies like safe consumption sites are both a moral and practical approach. “We need to provide safe consumption sites for people who are dealing with drug addiction issues because the first statement you make by doing that is that you’re not shunning them,” Sawant said. “Harm reduction strategies [also] have a better record of leading to sobriety than programs that require abstinence from the get-go.”
Mayor Ed Murray is deferring to the task force as well. “At the kick-off event of the opiate task force with Executive Dow Constantine, the mayor said he was open to the idea of safe injection sites if the experts believed the sites would save lives or help get people on the road to treatment and recovery,” read a statement sent from the mayor’s office.
Shilo Murphy, founder of the People’s Harm Reduction Alliance needle exchange in the University District, heroin addict, and member of the county task force, said that the task force is giving local leaders a convenient way to both show support for a progressive initiative but also avoid throwing their weight behind the concept and risking political capital. “I think that the task force is giving people political cover to support consumption rooms,” said Murphy. “There’s no guarantee that consumption rooms will be a recommendation of the task force.”
Sully believes Seattle is ripe territory for bringing the first safe consumption sites to the United States, citing broad local support for L.E.A.D, a program which gives police officers the option to funnel low level drug and prostitution offenders to social workers instead of into jail cells.
“We’re well situated for an intervention that is harm reduction based,” said Sully. “We have law enforcement agencies that have done a lot of innovative things that no one else in the country has done [i.e LEAD].”
“We’re in uncharted territory for sure but I think this gets to the reason why if every local elected official stood together on this, the chances of this coming undone are greatly diminished,” said Nyrop. “What is great about LEAD is that no one entity or individual owns [it], and therefore no one entity or individual is responsible for lead if something bad happens. We all mutually benefit or suffer [from backlash]. They can support each other.”
But what about the feds? Promising research and friendly attitudes among local leaders to the harm-reduction philosophy aside, the war on drugs in the United States is ongoing. Possession of heroin (alongside other commonly consumed street drugs like methamphetamine and crack cocaine) is still very much illegal at the federal level. Despite recent efforts from former U.S. Attorney General Eric Holder to remove mandatory minimums for nonviolent drug offenders, possession of heroin—a schedule one controlled narcotic—can constitute a Class B felony. Distribution of drug paraphernalia is similarly illegal at the federal level, though this past January, congress loosened regulation preventing the federal government from funding syringe exchanges.
Finegood said that the task force is aware of the looming federal preclusion and is weighing that factor in its vetting process.
Sheriff Urquhart said that he doesn’t expect interference from the federal government, citing Washington state’s so far unchallenged legal recreational marijuana system. “I don’t think the federal government is going to weigh in on this at all. They’ve got bigger fish to fry.”
For the time being, Urquhart’s prediction seems right. A spokesperson for the Western Washington District branch of the U.S. Attorney’s Office declined to comment on the local conversation surrounding safe consumption sites. “We don’t have anything to say at this time.”
There’s still a debate to be had locally over what any pilot safe consumption site would look like. “With all of our elected officials and political leaders, there’s still a lot of work to be done just sort of education on the different models and what safe consumption spaces are,” said Sully.
There’s questions of where the sites should be located (in what neighborhoods, and whether they should be located in or near existing health clinics, syringe exchanges, and other facilities), what organization should operate the sites, and what array of medical and social services — aside from the baseline of providing a space to shoot up and clean equipment, and emergency overdose treatment — will be offered on site.
One sticking point on the task force may prove to be whether to endorse safe injection sites or safe consumption sites — the latter would allow users to smoke as well as inject substances.
“People [on the task force] seem to be quite receptive with reservations and stipulations with the idea of safe injection,” said Nyrop, citing task force meetings that he’s sat in on. “But there seems to be a lot of resistance [to safe consumption sites].”
Finegood cited the state’s indoor smoking ban as an obstacle safe consumption sites would need to get around. “But we don’t want to perversely move people towards injection,” he added.
Proponents of general drug consumption sites argue that the facilities need to allow for all types of drug users to in order to both equitably benefit the broader population of addicts in addition to make a bigger dent in reducing public drug use, a source of complaints for residents and businesses.
“We know that crack cocaine enforcement is one of the driving forces of racial disparity in our criminal justice system,” said Sully. Crack cocaine is primarily smoked and by users who are disproportionately african american. Conversely, heroin users are predominantly white. Additionally, African Americans have historically been significantly overrepresented in Seattle’s drug-related arrests due to law enforcement’s focus on crack cocaine. “Who gets left out [with safe injection sites] is people who are smoking their drugs. That can really exacerbate racial inequities.”
“A lot of what drives community residents and business concerns about this is outdoor visible drug consumption,” said Nyrop. “If you really want to address the public safety issues, move drug use indoors and out of site, whether it’s smoking or injecting.”
Despite the disagreements, those CHS spoke with believe the task force is full-heartedly attempting to adopt a compassionate, public-health approach to regional drug use and addiction.
“Everyone on the task force, and this is something that is very beautiful to see, desperately wants to solve the problem of getting drug users love and support and getting them to a safe and stable place. There’s disagreements on how to do that” said Murphy. “But everyone is there to solve the problem and not to grandstand and build careers.”
The steady embracing of harm-reduction as the new mindset with which to address drug addiction is a welcome change of tune for those who have been through the wringer of addiction and life as an addict amidst the war on drugs. “Most people on the streets, they just want somewhere to lay their head and be safe,” said Turina James, a LEAD program participant, former heroin addict, and member of Vocal-WA at a rally and vigil the group held two weeks ago at City Hall park in downtown. “They have addictions, but most people that are addicted really want help, they just don’t know how to get it. They’re lost souls.”
“If we want less users, let’s stop punishing people and start focusing on people’s trauma,” said Murphy. “Is it the only fix? No. We need more supportive drug treatment, more methadone clinics. But we need them to stop people dying and get them off the street.”