October Subscriber Drive: Become a CHS subscriber at $1/$5/$10 a month

‘Infancy’ — Officials still gathering data to determine where safe consumption sites can be located

An Insite "supervised injection site" in Vancouver, B.C. (Image: Seattle.gov)

An Insite “supervised injection site” in Vancouver, B.C. (Image: Seattle.gov)

At the end of January, King County Executive Dow Constantine and Seattle Mayor Ed Murray announced they were moving forward with all of the Heroin and Prescription Opiate Addiction Task Force recommendations to battle the heroin epidemic at a local level, including launching two safe consumption sites.

Officials are currently gathering data and information and meeting with communities to determine where the two sites, one slated for Seattle and one for greater King County, should be located.

Brad Finegood, assistant division director at King County Behavioral Health and Recovery Division, told CHS the process is in its “infancy.”

“There are so many things to undertake in an effort like this where A) there’s none in the U.S. and B) there’s so many community groups to discuss it with,” Finegood said.

Finegood said those working on the consumption sites are considering data such as where overdoses are occurring.

“You want to locate it where it’s going to have the most public health impact,” he said.

A lot of Finegood’s work right now is squashing rumors about locations for the sites.

CHS explored the possibility of a safe consumption site on Capitol Hill last year after the neighborhood was dubbed an overdose hub by researchers and experts. The Capitol Hill Community Council has endorsed safe consumption sites.

Finegood told CHS the county doesn’t have a target date for when the two proposed sites will be operating.

While there is an urgency to getting the sites operating, the county also wants to have sites that work well.

“This would be the first in the country, so we want to make sure we do it right,” Finegood said.

Patricia Sully, an attorney with the Public Defender Association working with VOCAL Washington, said the organization wants to ensure the county moves forward with the sites and all of the recommendations, but ensure they implement them well.

The sites won’t just provide people with a safe place to use, they will also help people get assistance with fighting addiction, and help with finding housing and job training. In its report because the sites would provide more than a place to consume heroin the task force refers to the proposed pilot sites as Community Health Engagement Locations.

Along with looking at the data, Finegood said the county is also having a lot of community conversations, talking with people both for and against the sites, and standing up for prevention efforts.

VOCAL, which set up a mock safe consumption site on Capitol Hill and participated in the task force, along with the Capitol Hill Community Council and Seattle First Baptist Church is continuing its education about safe or supervised consumption sites. On March 22 at the church at 1111 Harvard Ave, the groups are holding a screening of the documentary “Everywhere But Safe,” which “explores public drug use, and the role harm reduction and supervised consumption spaces can play in saving lives.”

Safer Is Better: Reducing Harm, Saving Lives, & Building Bridges

Following the film, a panel will discuss harm reduction and safe consumption sites. Panel members include: Thea Oliphant-Wells, a recovering opiate user, David Sapienza, director of addictions medicine at the Seattle Indian Health Board, Karen Hartfield, program manager for HIV/STD at Public Health — Seattle & King County, Michael Roberts, founder of Amber’s HOPE, Kris Nyrop, the Law Enforcement Assisted Diversion national support director at the Public Defender Association, Lisa Etter Carlson, cofounder of the Aurora Commons.

Wednesday’s event is just one of many VOCAL has been organizing for about 18 months.

The heroin epidemic has affected many, including the church where the event is being held — two people have fatally overdosed right outside its doors, Sully told CHS.

“It’s not a theoretical issue,” she said, many have struggled with addiction themselves or have family or friends who have.

The recommended safe consumption sites have sparked controversy and some including state Sen. Mark Miloscia, R-Federal Way, are pushing against it. His bill to prevent drug consumption sites passed the Senate and is now in the House Health Care & Wellness Committee.

“We certainly think that it’s disappointing and a shame that a state senator would disregard the science and evidence for safe consumption spaces,” Sully said but doesn’t expect the bill to get out of the House.

In the meantime, VOCAL is planning another series of public events. The hope is to bring representatives of Vancouver, British Columbia’s supervised injection site, Insite, as well as from other similar sites in Europe to learn about different models.

The founders of Insite — a non-governmental organization which operates a sanctioned and supervised space where heroin users can obtain clean needles, shoot up in a safe environment, and get connected to health and drug detox services —came to Capitol Hill last spring to discuss the facilities.

In its most recent report (PDF), the UW Alcohol and Drub Abuse Institute said heroin has been the most common drug in county overdose deaths for two years running. 132 people OD’d on heroin in King County in 2015.

 

Subscribe and support CHS Contributors -- $1/$5/$10 per month

20 thoughts on “‘Infancy’ — Officials still gathering data to determine where safe consumption sites can be located

  1. I’m skeptical that these sites will be effective at helping people get off drugs, find housing, or enroll in job training. It’s likely that 99% of the time a user will come in, shoot up, and leave as soon as possible. Exactly what social services will be available? Will they be available 24/7? How will these services be assessed and tracked? I’m guessing that the staff will just hand out a pamphlet and hope for some kind of result.

    • Well, if Mayor Murray applies the same principles as in his approach to the homelessness crisis, then the injection centers will be required to collect data, and if they do not show performance in getting people off heroin, their funding will be taken away and replaced with limited-time vouchers that pay a fraction of the cost of expensive free-market trap houses.

    • They worked in Vancouver, and there’s data readily available to prove it.

      Wikipedia link: https://en.wikipedia.org/wiki/Insite

      No one wants to be complicit with people using heroin, not even the heroin users. While it may begin as recreational (though statistics point heroin use beginning with painkillers), heroin quickly becomes a life-consumer endeavor.

    • I realize to the average person who’s never experienced addition OR worked with those types of individuals, can be very confused and skeptical over this type of set-up.

      However, there is proof it WORKS and people to come. No one WANTS to be an addict; and everyone working to help those that are addicted would like to help keep them alive until they can receive the help they need.

      These safe places help addicts, and help build trust between addict/social worker and get help get people clean.

      Here’s hoping this program gets off the ground and helps save lives, which enables to opportunity for cleaner and healthier lives.

  2. Calling these Safe Consumption sites is Orwellian double speak. There is no safe place to inject heroin. Operating government injection sites makes the city complicit in the violent heroin trade.

    Some people will be revived at the site, but that doesn’t mean the site will reduce overall deaths or do anything to reduce use of heroin. Spend the money on a treatment facility instead.

    • These are known also as safer consumption sites and as supervised consumption sites.

      Providing alternatives to alleys and public restrooms for people with substance use disorder does not make anyone complicit in any trade.

  3. If a person overdoses at that site, they can be injected with naloxone and an ambulance called (naloxone only works for 1/2 or so). The problem is, the vast majority of drug use will occur outside these drug consumption sites.

    In King County, 23,000 IV drug users inject roughly 69,000 times per day. The area of use of a drug consumption site is limited to 5-7 blocks. Therefore 99.8% of drug consumption occurs elsewhere. Speak Out Seattle would rather we distribute naloxone to every addict and person in the community and teach people how to use it and monitor the person until the ambulance arrives. This will save far more lives on its own.

    Mayor Murray recently said we’ve done everything we can. We have not created detox and treatment for those who are asking for it every day. This is a priority for people seeking a way out.

    The King County Task Force on Opioids and the City of Seattle have glossed over the fact that these sites are illegal and the drugs themselves are illegal. At a time the AMA is in jeopardy and the funding for medicaid that has covered so many over the past years, and the fact that the R’s are talking about busting the marijuana industry here, how wise is it to jump into the brave new world of drug consumption sites?

    Stick with evidence-based needle exchanges. Expand medicated assisted treatment — that is evidence based in the USA. Sorry guys but there is nothing on any level of US policy that states drug consumption sites are evidence-based in the USA. We would much rather our government spend the $5-6 Mil slated for these two pilot sites on naloxone and detox/treatment.

    Speak Out Seattle!

    • J. Box wrote, “The problem is, the vast majority of drug use will occur outside these drug consumption sites,” and encouraged others to speak out.

      The problem you described, J., is related only to the topic at hand–supervised consumption sites–in that SCSs reduce that problem. Did you mean to argue for more of these sites, so that a smaller portion of drug use is likely to occur outside of them (e.g., in parks, alleys, restrooms, etc.)?

  4. Insite in Vancouver is still controversial. The 3 million+ it gets in annual funding is 3 million dollars treatment funding is not getting. Even those involved in services for the downtown east side are not in agreement over Insite. Project forward a decade and compare probable outcomes of total monies spent on harm reduction vs the same amount spent expanding treatment space. In Vancouver volunteers and volunteer doctors are roaming the back lanes with narcan and saving multiple overdose victims daily.Even with Insite in Vancouver over 600 people died from overdose in BC last year. But ambulance services speak of responding to the same people more than once in a day. Treatment is where the money needs to go. I do not believe Seattle will win a fight with the Feds over an injection site.

    • Sean: Treatment programs like that to which you referred do no good for people who are dead. We cannot and should not force people into any particular treatment, for substance use disorder or for other conditions. We can reduce the harms associated with drug use, and we can stand by to offer various assistance if and when people want help.

      Can you cite a source for your claim that InSite‘s annual funding would be dedicated to drug treatment programs if it was not allocated to InSite? Are you aware that directly above InSite is OnSite, a facility that offers medically supported detox, transitional housing, and more?

  5. Hi, Phil. No, we are not arguing for more drug consumption sites. If you had a drug consumption site on every corner like Starbucks, people would still die outside these sites. This kind of site-based model is not effective if your goal is saving lives–the most lives. Is that your goal?

    Vancouver is struggling with this problem. We can learn from them. We can both agree we need to treat people with compassion. We can also agree that forced treatment is unsuccessful. I’m going to bet you are also for access to narcan to stem overdose deaths. That is many things that we have in common so far. Hopefully.

    So how about this: are you for access to services that allow a person a way out? So are we.

    InSite to OnSite has very low success rates to detox. InSite’s 2015 stats: .176% entry to detox based on visits, and 7.2% based on clients. That second stat is not solid because we all know people go into detox multiple times. InSite will not share any treatment numbers. I have written to them. For a 15-year-old organization, you would think they would share if their numbers were good.

    So what does work? Best, cheapest, evidence-based in the USA so we don’t get the feds breathing down our neck? Detox and treatment. Do you have any idea how many people suffering from substance abuse disorder are asking for this in Seattle as we speak? Don’t make up a shiny new answer which is proven to have low success rates. Give people what they are asking for: detox and treatment. Treatment on Demand! Speak Out Seattle!

    • Thank you, J Box….I agree completely. And thanks for debunking the notion (often claimed here) that Vancouver has had significant success at getting people off drugs. They have not.

    • In response to J.’s comment, “The problem is, the vast majority of drug use will occur outside these drug consumption sites,” and encouragement to speak out, I asked if J. then advocates an increase in the planned number of supervised consumption sites, since this would seemingly improve the described problem, further decreasing the ratio of accidental overdoses where assistance is unlikely to be available (e.g., alleys, parks, public restrooms, etc.) to accidental overdose in a supervised facility where people can and will help.

      J. responded, stating that some unspecified group of people do not support such (“No, we are not […]”), but provided no explanation of this apparent contradiction.

      J. went on to argue that with a hypothetical, wildest-possibility, density of supervised consumption spaces (which I will take for the sake of argument to refer to an environment of maximum potential benefit to the community of the decision by public health departments and elected leaders of Seattle and King County to create such facilities) people “would still die outside these sites.” I think that was meant to be either A) a comparison of the area’s current rate of deaths due to accidental opiate overdose to an estimation of the future rate with the advantage of max-public-benefit SCS density, or B) a comparison of the rate of deaths outside of sparsely-located SCS facilities to the rate of deaths outside of densely-located SCS facilities.

      Either way, I don’t read anything in J.’s comments refuting the idea that community benefit will come from us offering these facilities–from us lowering the public and private harm associated with some people’s use-disorder-related drug use by 1) offering those people a place to administer their drugs that is safer than their current locations of choice or necessity and 2) engaging with them and offering a variety of alternative help should they desire it.

      This feels like the long-settled arguments over syringe exchange. We established syringe exchanges decades ago in this area, they are effective, and offering SCS’s is the next logical step.

      We are experiencing a public health emergency. In favor of the establishment of supervised drug consumption spaces, I see support coming from a a wide array of subject matter experts (e.g., Washington Academy of Family Physicians, King County Medical Society, UW schools of of Nursing and of Public Health, American Public Health Association, Infectious Diseases Society of America, HIV Medicine Association, AIDS United, ACLU of Washington, Mayor of Seattle, King County executive, County prosecutor, County sheriff, AIDS support organizations, drug policy reform organizations, homeless advocates, and on and on and on.) That is a ringing chorus of endorsement from people whose opinion I look to on related matters. As for those opposing SCS’s, I see mostly emotion-laden hyperpole, hand-waving, and Trump-style misdirection. I think that even if I was not already following this issue closely, I could make a well-advised decision to say yes to SCS.

    • Hi, Phil.

      In King County, 23,000 IV drug users inject 69,000 times per day. One drug consumption site is expected to monitor 200 injections per day (0.3% of total injections). The vast majority of drug consumption (and overdoses) would take place outside these sites. Meth is in addition to this.

      In Vancouver, if you visit the area around InSite, you will notice there is a concentrated population of people who suffer from substance use disorder. For such a concentrated population of users, many of which are what would be termed “chronic,” this sort of makes sense in terms of having a specific site available for people who have proved to be resistant to all forms of treatment. That is not yet the case here. We do have people who are resistant to treatment, but we should not lump everyone together and call a drug consumption site an intake facility. There are so many things wrong with that it would take an hour sitting face-to-face to get through the list.

      You may have noticed that Vancouver is struggling with new heroin use among younger people (aka, the party scene,) and these young people are overdosing and dying all over the greater Vancouver metropolitan area.

      We (SOS members) know medical providers in Vancouver who are attempting to respond to this new crisis, even as they scramble to increase the number of drug consumption sites in the local East Hastings Street area.

      Their response to these new younger users has been to increase naloxone distribution and teach people how to administer it, to monitor their friend until an ambulance can arrive.

      We want to *start* there, with naloxone distribution and treatment on demand for anyone who presents.

      In Manchester, NH, every fire station is open 24/7 to anyone who presents for help. After they are greeted by the fire department, a treatment provider comes and asks them, do you want to go to detox? The entry into detox is just under 50% That is an amazing number. People are driving across state lines to get to those fire stations.

      In North Seattle, at the Aurora Commons, the people who run that openwelcoming place tell us that every single day people ask for detox AND DON’T GET IT. That is not o.k.

      What I’m presenting is not politics–it’s policy. $5-6 mil over three years for those pilot sites could be spent on medicated assisted treatment and other forms of evidence-based treatment. (Evidence-based in the USA which is indeed where we live.)

      BTW, I did specify the group. We are not amorphous. The group is Speak Out Seattle! You can go to the website and check it out.

      These issues don’t care about your litmus test based identity politics.

      You can point your finger and call us Trump and histrionic and lacking data all you want.

      Our family members, friends, and colleagues are suffering and dying and we are coming together to fight for what we believe in.

      We include people who think of themselves as socialists, Bernie Sanders supporters, pantsuit wearing Dems, Independents, Republicans–who cares about that when people are suffering?

      And we actually do take the time to read. We have debated toe to toe with Task Force members.

      Maybe it’s you who has not read so widely, who follows the body politic of your local region to the letter, who makes sure that litmus test is taken before you enter into a conversation with another citizen, who blames first and is critical of anyone else who does not look like you?

      What’s your level of understanding of drug consumption sites, other than as a forceful progressive(?) cheerleader as so many of you have turned out to be?

    • J., your organization’s name includes an exclamation point? I thought you were just exclaiming.

      Who are your organization’s institutional members? What are your members’ qualifications for making recommendations regarding public health, city and county administration, and enforcement of law?

      Of course Vancouver’s InSite is located in an area with a significant population of people with substance use disorder (the downtown east side, “the poorest postal code in Canada,” which had serious problems since well before InSite’s time). That is where an SCS is needed.

      In Seattle–hardly the poorest of anything–there is no such concentration, and this is why experts repeatedly recommend focusing not on establishing a single SCS, but a series of them, in Seattle and beyond, so that these facilities are available to people in need without travel that would likely present obstacles to use.

  6. I support SCS, and I’m a public health graduate student. I’ve looked over the evidence in great depth. It is not a complete solution, it must be paired with other efforts, but it is an evidence-based solution that has been successful across the world. Addiction is an extraordinarily difficult and complicated problem — our community members should not die while they are fighting their addiction. I care about lives, about the people we have lost to overdose in this county and beyond, and that’s why I support SCS.

  7. As a medical student focusing on addiction and someone who worked in mental health and addiction research for 8 years, I appreciate folks’ interest in this issue. However, this issue is too grave – it is literally life and death – for us to go off what we think feels right or what our gut instinct tells us.

    Several of you are referencing Insite and all these supposed problems with it. I worked in the downtown eastside with many other care providers, physicians, and the residents themselves. And it is clear that Insite is a key tool in their fight against the harms of injection drug use. Is it the only solution? Absolutely not. And it’s disingenuous to point to the problems that Vancouver continues to has as a sign that Insite has somehow failed. The BC Supreme Court reviewed all the data for Insite in 2008 when the Harper administration was trying to shut the facility down. And they ruled AGAINST the government, saying that Insite MUST stay open because it is so successful. And most of the public health officials in BC are advocating for more safe consumption spaces.

    So again, while I appreciate the fact that people seem to be passionate about this issue, I think we should defer to the experts. The ones who have worked extensively with these patients. Who have spent their careers researching these issues. The ones who have a full grasp of the data. To do anything less would be a disservice to the folks we are all trying to help.

    And we also need to listen to the users themselves, instead of us paternalistically telling them what is best for them. And every injection drug user that I have ever worked with has said that safe consumption spaces are a vital service for their community.

    • I do appreciate your comments, Tim Kelly. I also appreciate that you believe the “experts” should decide. I agree we need to listen to the users themselves instead of paternalistically telling them what is best for them. Maybe we should ask the users. How to go about this? First, secure a thesis from a Masters Degree Student and suggest he study Interest in a Safe Injection Facility Among Injection Drug Users in King County. Completed by Derek Low, UW, in 2014 with Caleb Banta-Green as Committee. Ask people at needle exchanges who inject, “would you use a safe injection site?” Record answers. Do not ask about unmet detox or treatment needs. Check. Do not study the coverage of these facilities vs. where the users actually use. Just say we need more. Study cost savings only within the context of reduced HIV/HPV potential infections. Do not compare this with needle exchanges which are already doing this job, or study other cost factors, such as cost of increased policing around the facilities. Check. Convene a body of politicians and secure consent, having already determined the outcome. Do not film the meetings. Do not hold a public hearing in Seattle. Check. Seed articles in the press to build up support, while keeping the information general and emotive. Do not tell anyone these sites are illegal and are not evidence based in the United States. Check. Get the politicians lined up for press conferences. Check. So I guess we are at the funding part of this story. That is of course unfolding as we speak.

    • I think the conspiracy theory undertones of your reply, your use of quotations around the word experts, and your continued reference to these sites not being evidence based “in the United States” does more to undercut your own message than any possible retort I could come up with.

    • It’s funny. People don’t wring their hands and doubt plumbers, electricians or car mechanics when they lay out a problem and a suggestion to fix the problem, so why, when it’s a controversial issue, like climate change or drug addiction, do people get all up in arms and start doubting the experts in these fields, especially when these experts lay out all the studies, facts and evidence to support solutions.

      It also really boggles my mind how far people will go to convince themselves that someone is wrong, despite all evidence to the contrary, just because they don’t care for the solution.

      For example, some of the doubters, when you ask them their solutions, you get “concern troll” answers like J. Box’s, where basically their answers are: (1) to “think of the children/users/taxpayers/whatever”, (2) the solution from elsewhere won’t work because it didn’t solve the problem 100% and/or (3) we need to further force study the issue until it just dies in bureaucracy.

      Then you have people like Bob Knudson, who have already convinced themselves the solution won’t work for whatever reason, then read unsubstantiated posts, filled to the brim with uncited facts, like J. Box’s and that becomes their evidence needed that their original hunch was correct, because look at all those numbers J. Box’s threw out and how well written their post is!

      Who knows what their actual motivation is, but it doesn’t matter because meanwhile, the initial problem still rages, because we end up doing nothing.

Leave a Reply