1. When Mayor Ed Murray announced his $275 million homelessness ballot measure last week, he noted several times that the measure included “5,000 new treatment slots” for homeless people struggling with addiction, accounting for about $20 million over the five-year life of the levy. If the image that pops into your mind is beds in a residential treatment facility like the Betty Ford Center, think again: The treatment in the levy proposal consists primarily of programs that expand access to buprenorphine, also known as Suboxone—a prescription opioid that reduces cravings in people who are addicted to heroin and other opioids—and “housing with intensive outpatient substance use disorder treatment,” also focused on expanding buprenorphine distribution.
Suboxone is a drug that allows people who are severely addicted to heroin or other opiates to stabilize on a less-harmful opioid drug under the supervision of a medical professional, without having to go to a clinic to receive medication every day, as methadone patients do. Increasingly, health departments and addiction experts are recommending long-term buprenorphine use for people with severe addictions, because it reduces cravings for street drugs like heroin that can lead to overdoses and dangerous lifestyle choices. (Suboxone itself has been shown to be addictive). However, no prescription alone can address the many factors that lead a person to start abusing drugs in the first place, such as trauma, abuse, depression, mental illness, and despair. And buprenorphine doesn’t address addictions to non-opiate substances at all, including alcohol addiction, which kills about 88,000 people each year (compared to about 33,000 deaths from opioid abuse) and is endemic among people experiencing homelessness.
Curious about the precise breakdown of those 5,000 “treatment slots,” I asked the levy campaign for more detailed information. Here’s the breakdown they provided. Of the 5,000 slots over five years, 3,600 would consist of expanded access to buprenorphine, through new clinics, transportation to and from buprenorphine providers, and a new access point for people seeking treatment to find a provider in their area. That accounts for about $1.6 million of the approximately $4 million in new annual spending.
Another $540,000 a year would subsidize rent for about 300 formerly homeless people in “Oxford-style” sober housing—self-managed houses where people with substance use disorders live together in a sober, supportive environment. It’s unclear at this point what measures the city would take to monitor the quality of the sober housing it subsidizes, but Kaushik says the city will take steps to ensure the providers are legitimate.
The remainder—about $2 million—would pay for two programs: A low-barrier, residential inpatient treatment center serving 16 people a year, and an intensive outpatient program, with case management, serving about 300 formerly homeless people who would receive housing subsidies from the city. (The treatment would not be located in or tied to the housing itself).
When I asked about the relatively small amount of money for treatment in his levy proposal last week, Murray pointed out that treatment was “a new line of business” for the city and is typically funded by King County. Given that millions of people seeking treatment are likely to lose health care coverage under Trump’s health care “reform,” the city might need to get used to being in the treatment business.
2. Another question that nagged me about the mayor’s levy proposal had to do with the “landlord liaison” program that will be funded through the levy. I wondered if the city still needed a program to match landlords with tenants just coming out of homelessness, given that the city now has a law banning housing discrimination based on a tenant’s source of income. (A tenant paying with one of the short-term rent vouchers funded by the levy, for example, could not be turned away because he had a voucher). City council member Sally Bagshaw, perhaps the most vocal elected proponent of the program, told me the landlord liaison program would go much further than helping renters get access to housing; it would also provide landlords with a financial “backstop” by promising to pay for any damages tenants cause, to provide case management, and to respond quickly to emergencies or landlord concerns.
“Let’s say we put Bob in [a unit], and we know Bob has some bipolar issues. If he’s stabilized, he’s fine’ if he goes off his meds, he’s not,” Bagshaw says. “Let’s pretend, for the sake of argument, that Bob does trash the place. We will have an insurance pool and we will say to the landlord, when Bob leaves, if he has trashed the place, if he puts his hand through a wall or puts a stick of dynamite down the toilet, we will come in and pay to fix the place back up.” Bagshaw says the goal of the program would be to identify 1,000 units around the city whose landlords would agree to participate in the program.