A Conservative and a Liberal Walk Into a Safe-Injection Site


The weekend before last, I took a second trip up to Vancouver, B.C. to visit Insite, North America’s only safe-injection site and, as such, the likely model for two proposed safe consumption sites (which will include space for people who smoke meth, heroin, crack, and other drugs as well as injection stations) in King County. (The sites are among many recommendations that came out of the county’s heroin and opiate addiction task force.) I visited Insite previously over the summer, when program manager Darwin Fisher gave me a tour of the facility and the Downtown Eastside neighborhood that surrounds it. That time, Insite was open for business, and a steady stream of clients filed through; each told the staffer at the desk her code name and what drugs she was bringing in, and settled into one of 13 mirrored booths that line one wall of the tidy facility. I watched as drug users fresh off the streets searched for veins in their feet, did their makeup, washed their hands for what might’ve been the first time in days.

This time, I wasn’t alone, and I wasn’t visiting during business hours. Instead, I was playing third wheel to an unlikely pair of elected officials—uberliberal Seattle city council member Lisa Herbold, and conservative Republican state Senator (and candidate for state auditor) Mark Miloscia. Herbold, a supporter of safe consumption sites, invited Miloscia along in hopes of getting him to see the ways that Insite has benefited the surrounding neighborhood, and to view harm reduction through a more sympathetic lens. Miloscia has said he plans to propose legislation that would bar all cities from authorizing safe consumption sites—a sort of companion bill to his proposal to prevent Seattle from relaxing its policy on encampment sweeps.

Over the course of a long morning and part of the afternoon, Miloscia, Herbold, and I toured Insite, wandered around the Downtown Eastside, talked harm reduction over lunch with City of Vancouver urban health planner Chris Van Veen and Insite founder Liz Evans, and toured a clinic that prescribes heroin to addicts who don’t respond to methadone or suboxone, two common drugs prescribed as part of treatment for heroin addiction. We also visited the Rainier Hotel, a zero-eviction apartment building for women that used to be a thriving, successful drug treatment center; in 2013, thanks to what Evans calls the government’s “culture of bureaucracy,” it lost public funds for its addiction programs and is now single-room occupancy housing.

Fisher, Evans, and Coco Culbertson, a manager at the Portland Hotel Society, the nonprofit that runs Insite, walked a very curious (and at times visibly distressed) Miloscia through the admission process (more on that here), and explained the benefits of the services Insite provides. “Coming in here from the street, where you’re going to get water wherever you can find it”—that is, from a puddle in an alley— “it’s like going from the third world to the first world in a sense, because of that running water,” Fisher said. Deaths from HIV, overdose, and soft-tissue injury infections have declined dramatically in the surrounding neighborhood and in Vancouver as a whole, and detox admissions have increased (to 400 a year, according to Fisher), because Insite builds trust with its clients and doesn’t judge them, Fisher explained. Later, Evans would say that harm reduction programs like Insite have had an unanticipated side effect: Because people are no longer dying so young, “we’re treating chronic conditions in a population that’s aging ten years more than they would have 20 years ago. That’s incredible. We’re seeing chronic health conditions win a population that used to just die.”

Miloscia, who stared, aghast, at the drug users displaying goods for sale, shooting up, and chilling out on the sidewalks around Insite as Evans explained how programs like Insite and the Rainier Hotel save money, peppered the Canadians with questions: How do you know this is working? (They have data and studies that say it is). Why not just focus on prevention? (Prevention is just one pillar; you need to deal with people after they get addicted as well). And: “When do we say, enough is enough, and you have to rejoin society?”

That question was really at the heart of Miloscia’s objections to the Canadian experiment: Why coddle people who will continue to stay addicted, according to Evans, an average of 14 years, instead of just shaming them for their bad behavior, pushing them toward their own “rock bottom,” and if all else fails, forcing them into treatment? This is a fundamental difference in philosophy between those who advocate for harm reduction and those who believe in prevention and punishment. Evans and the other advocates argued that not only does forcing people into treatment not work, blaming and shaming only pushes people further into the shadows—and further away from help. “We would like to believe that forced treatment works, but it does not,” Evans said over lunch. “If we make people feel their life matters… their outcomes are going to be way better than if we push them further away.

“We have been so ingrained with this belief that telling people that what they’re doing is wrong and bad works, but it doesn’t work. In 25 years, I have never seen a drug user stop using because we told them they were wrong and bad.”

Miloscia is a firm believer in stigmatizing drug use and forcing people into treatment. He thinks it works. But what Miloscia really believes in, he says, is prevention—”scaring” parents and kids, in his words, into never picking up a drug in the first place. Tomorrow, I’ll have a post-Vancouver Q&A with Miloscia in which the conservative senator talks about what he learned from Vancouver, what he thinks of King County’s current approach to addiction, and whether anything he saw changed his mind.

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6 thoughts on “A Conservative and a Liberal Walk Into a Safe-Injection Site”

  1. Thanks, once again, for writing about this issue. It’s one that deserves a lot more attention especially considering the misinformation surrounding drugs, addiction, and harm reduction.

    That said, please don’t lump prevention and punishment together. Real prevention is not about scaring parents or kids or anyone. In fact, the last 30 years of prevention research shows that scare tactics don’t prevent drug use. Anyone who is currently conducting any sort of activities that are meant to scare people into not using drugs is wasting their time, at best.

    Prevention programs in Seattle that I know of are not using scare tactics. Prevention programs that receive state and federal funding must use evidence-based and best practice prevention activities that have nothing to do with scaring anyone. Now, there might be activities conducted by other groups that do use scare tactics, but they certainly shouldn’t be considered prevention activities.

    You may already know this, but UW’s Social Development Research Group is an international leader in evidence-based prevention research and program development. Their website is a great resource for getting an idea of what prevention is all about: http://www.sdrg.org.

    1. Inga, could you provide links to some of the local evidence-based drug use prevention programs to which you referred?

      1. Here are two drug use prevention coalitions in Seattle that have websites:

        Seattle PEACE Coalition: http://www.sespeacecoalition.org and their “206 Rising” campaign: http://www.206rising.org.

        Prevention WINS coalition: http://www.preventionworksinseattle.org

        Another coalition serves Central Seattle but I think they don’t have a website. Coalitions are based on the evidence-based prevention program developed by the UW Social Development Research Group called Communities That Care – http://www.sdrg.org/ctc.asp

        King County provides funding for drug prevention programs through their Department of Community & Human Services: http://www.kingcounty.gov/depts/community-human-services/mental-health-substance-abuse.aspx. They fund the PEACE coalition and the Central Seattle coalition and, I think, one more in Seattle — but I’ve been out of the loop for a few years and haven’t kept up.

        King County also funds prevention programs through the Mental Illness & Drug Dependency (MIDD) program. http://kingcounty.gov/depts/community-human-services/mental-health-substance-abuse/midd-plan.aspx

        I’m most familiar with the prevention programming funded by MIDD at Eckstein Middle School. The funds are used to pay for a mental health professional who, among other things, teaches evidence-based prevention programs to students (Life Skills Training: https://www.lifeskillstraining.com for students and Guiding Good Choices for parents: http://www.blueprintsprograms.com/factsheet/guiding-good-choices).

        Seattle Public Schools provides some schools with prevention resources but it’s my understanding that they lost most of their drug prevention-related funding: http://www.seattleschools.org/cms/One.aspx?portalId=627&pageId=14485

        Most recently, Public Health – Seattle & King County launched a Youth Marijuana Prevention Program: http://www.kingcounty.gov/depts/health/smoking/youth-marijuana-prevention.aspx

      2. Thanks!

        A quick spin through the Seattle P.E.A.C.E. Coalition and WINS Coalition sites suggests to me that the former is rather heavily focused on cannabis use, which is generally a bad idea for younger people, but otherwise not known to be dangerous. Potential use by children of alcohol, nicotine, or prescription opioids would seem more urgent concerns for parents. The link to NIDA is a red flag for me–any connection to the U.S. government’s drug policy suggests a lack of focus on reality. And nobody seems to reference Marcia Rosenbaum’s wonderful Safety First: A Reality-Based Approach to Teens and Drugs!

        But the messaging of both organizations does seem significantly more reality-based than what I remember being pushed upon me as a child in the 1980s. When I was later faced with the facts in a college psychology class, I realized that I had been strongly misled, if not lied to, and got right to work checking out what I’d missed. I soon became a harm reduction advocate, well before I ever heard of the term. Other people of my generation and I almost certainly would have been better off without the scare-mongering, hyperbole, and lies promoted by D.A.R.E. and similar programs.

        (Note to King County Health Department: Marijuana is not a verb. You cannot prevent a plant. Does anyone proofread this stuff?)

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