By Erica C. Barnett
City Councilmember Sara Nelson, a vocal advocate for abstinence-based treatment for addiction, argued publicly yesterday with advocates for harm reduction over their approach, which emphasizes keeping people who use drugs alive and helping them address underlying conditions, such as homelessness and health care issues, without judgment or pressure to quit using drugs. Why, Nelson wanted to know, were these organizations focused on reducing harm from drug user rather than “encouraging” them to understand that total abstinence should be their goal?
“What [is] Public Health… doing to move beyond the harm reduction phase and how much money, if any, do you spend on agencies or for treatment that is geared toward abstinence?” Nelson asked. “And as a corollary of that, I guess the more basic question is, does Public Health agree that it has a responsibility to change behavior beyond meeting people where they’re at? Do you feel as thought’s important to help people change their use patterns in ways that they can go into abstinence-based recovery?”
Nelson’s (rhetorical?) questions came during a presentation by three longtime service providers—REACH, the People’s Harm Reduction Alliance, and the Hepatitis Education Project, along with King County Public Health—about how they have used funding from a small grant aimed specifically at reducing harm related to drug use. For years, the city council has also allocated funds for this purpose but the mayor’s office has refused to spend it.
“We’ve got ‘meeting people where they’re at’ covered, I think, when we’re looking at the treatment services that are provided right now,” Nelson said.
The county, strategic advisor and drug policy specialist Brad Finegood assured Nelson, spends “hundreds of millions of dollars” on abstinence-only services; the point of also funding harm reduction, he said, is to “keep people alive” and give them entry points for services amid an overdose epidemic that claimed more than 700 lives in King County last year. Those services, the direct service providers explained, include handing out the overdose prevention drug naloxone, connecting people to health care, offering medication-assisted treatment, and handing out supplies for safer use, including pipes for smoking drugs rather than injecting them.
Nelson (like many local right-wing commentators) zeroed in on safe smoking supplies, suggesting that providers should measure their success by tracking how many people who take pipes end up in treatment.
“I know it can be controversial,” Hepatitis Education Project program director Amber Tejada responded, but “one of the keys that I see is we want to facilitate the autonomy of people that use drugs. There are folks that don’t want to stop using drugs. There are folks for whom abstinence is not how they measure success in life. … Our mission, what we have been able to do really successfully with this program, is to show that people can use drugs safely, and we can help folks get access to resources if that is something they are interested in.”
Last week, Nelson joined her colleague Alex Pedersen and City Attorney Ann Davison to propose new legislation that would enable the city attorney, rather than the King County Prosecutor, to begin prosecuting people for simple drug possession and public drug use. In 2018, King County Prosecutor Dan Satterburg stopped pursuing charges against people for possession of small amounts of drugs while expanding programs like LEAD that work to provide case management and service connections to people who use drugs.
The legislation, if adopted, would represent a profound change to the city’s approach to drug use and a return to war-on-drugs policies that the region has largely abandoned in favor of more compassionate and evidence-based approaches.
Last year, Nelson inserted language into the 2023-2024 budget to fund “facilities” for abstinence-based residential or intensive outpatient treatment using the city’s portion of a state settlement with opioid manufacturers. However, the language of Nelson’s statement of legislative intent leaves wiggle room for other evidence-based types of treatment, such as medication-assisted treatment or contingency management, as a presentation from council central staff at yesterday’s meeting also made clear.
Yesterday, Nelson expressed her frustration that the “private provider community,” which has “more availability for people who have insurance or can pay out-of-pocket,” has not been directly involved in the group that will make recommendations on what kind of treatment to fund with the money she proposed setting aside.
The point of her budget amendment, Nelson said, was “to establish a pilot program that would allow the city to directly contract with treatment facilities, private or public, in order to [help] people who are at the phase of really wanting to go into rehab, get into rehab, especially if they don’t have medication” as an option, as opioid users do.
“We’ve got ‘meeting people where they’re at’ covered, I think, when we’re looking at the treatment services that are provided right now,” Nelson said.
Why is it necessary to keep the fentanyl addicts alive at the cost of billions of tax payers dollars and collateral economic damage? Let’s be honest here.
It’s funny to watch such a blatant scofflaw like Sara Nelson take such a “tough on crime” pose. She is just another one of those wealthy, pampered Seattle white people who are so offended when something pops their bubble of comfort and creeps into their fantasy world that they want ever more severe laws and harsher punishments. Keeping the poors out of sight is an existential crisis for them. Of course, when they break the law it is entirely justified, so just don’t mention it.
or maybe as someone who as actually been through addiction and recovery she realizes what a bunch of bullshit the carrot is. You have to have been an addict to understand, helping people die on the street from their addictions is only compassionate abstractly, in reality, these people need to be forced into help or saved from themselves through incarceration. The halflife of someone on the street smokin’ the blues is about a year.
Also consider the harm addicts do to the public. Most need to steal, become drug dealers or prostitute themselves to support their habit. Harm reduction should consider reducing harm to the non-addicted public too!
You are SO RIGHT! About time the harm being done to those of us being preyed upon by these desperate folks gets some attention.
Glad we have Sara Nelson to ask the tough questions that we all want answered. Has the harm reduction method worked? We have exponentially more overdoses than ever before. Its not working so let’s try spending our money on treatment and see what that does.
(BTW calling commenters who don’t agree with harm reduction “right wingers” is intimidation. Reporting should be trying to present the facts not creating an echo chamber of only like opinions).
I can’t believe this needs to be said, but abstinence based addiction treatment doesn’t work. It is categorically impossible. If the addict can simply abstain, they’re not an addict. Addicts can’t “just stop”, no matter how much help they get. Because they have an addiction! Harm reduction and social services is about getting the addict in a better, more stable head space so that actual treatments can have a chance of working.
Jail does not help that at all.
I watched this presentation, including the Q-and-A session. I would take strong exception to Erica’s use of “argued” to describe Nelson’s engagement (not that this rhetorical sleaziness surprises me). She’s got a different perspective from that of her colleagues and she’s trying to hold presenters accountable, from that perspective, without getting rudely shut down by Herbold. It’s a tough row to hoe! For the record I support harm-reduction approaches but I thought Nelson’s question about the “want to stop or reduce” data was reasonable — and more incisive than is typical for these forums — and I also found the presenter’s response both humane and thought-provoking. “Argued”? No.
Where Publicola fails is its obsession with addiction. It’s all about drugs and booze here. As a guy with well over 10 years of experience as a volunteer tutor in a local high school, I see families struggling against the high cost of living all the time. Seattle is mean city, short on mercy, the way I see it.
Poor people deserve help, a way forward, a place to thrive. Sometimes addiction is involved, but often it’s not even a factor. These are just people working low paying jobs trying to say afloat. Nobody helps them. So if you’re making pizza for a living, riding the bus, barely getting by in life being a good, lawful citizen, expect no help in Seattle. If you’re a thief, a liar, and a drug addict…. a loser…. everything is geared to you. And fuck! you don’t even have to try.
Exactly! We reward maladaptive behavior and expect it to change–absurd! As you say, there is plenty–so much–unmet need to support people flogging their every waking minute to survive; people who aren’t smoking it or injecting it or gulping it down. Let’s help them!
Nelson also fails to realize that there aren’t anywhere near enough treatment beds for those that want them, nor is there housing for people after a 28-day rehab, which effectively dumps them right back on the street where they were before. The only way to solve the problem is with a lot more housing, treatment on demand and continued social services and support. Until we can do that, and for those few that would decline such help; we have harm reduction.
Councilmember Nelson should refrain from drunksplaining from her newfound pulpit.
I really like Sara Nelson. She has such an honest approach to everything she does. Thank you Council Member Nelson for all that you are doing to help Seattle as a whole.
I wonder if “abstinence-based treatment” extends to the all the drunks she has fostered at her own brewery. Maybe we should shut that neighborhood nuisance down so so we can make sure her overly besotted customers “understand that total abstinence should be their goal.”
Actually, yes. Jerks who refuse to get off the sauce also don’t deserve to get cash from the public in perpetuity either. Thanks for pointing that out.
Oh, you thought you were making a gotcha point? Oh, sorry. Nope.
Back in the 1950s, most of the homeless were alcoholics. Of course, back then there weren’t a lot of public dollars for them, either. Instead, we just hadn’t zoned places for them to exist – SROs, cage hotels, for example – out of existence. Now we have, so it’s much more dangerous to be an addict; and now, of course, many drugs other than alcohol are available.
Because abstinence doesn’t work. That is the point of harm reduction. How can anyone be that uninformed?
Perhaps you haven’t heard Sara Nelson speak before….
Touché
This: “show that people can use drugs safely” is the problem. There is NO WAY to use those drugs safely. The very fact that we have policy advocates pushing this BS is why so many are, yes, reverting to the “war on drugs” era. Which, BTW, did in fact lower crime, even though it was applied horribly unevenly.
Finally, some sense!
This choice bit: ““I know it can be controversial,” Hepatitis Education Project program director Amber Tejada responded, but “one of the keys that I see is we want to facilitate the autonomy of people that use drugs. There are folks that don’t want to stop using drugs. There are folks for whom abstinence is not how they measure success in life. … Our mission, what we have been able to do really successfully with this program, is to show that people can use drugs safely, and we can help folks get access to resources if that is something they are interested in,”
UNBELIEVEABLE! The drug users have plenty of autonomy–they get a free pass to litter themselves and their bodily excreta all over our public places with no accountability, we buy them pipes to smoke their drugs with, for the love of all goodness, what else??
There is no safe drug use. Every use is a gamble with one’s life, and when done in public, an affront to decency and respect for self and others. I realize there are people that become addicted unintentionally and want to beat their addiction as quickly as possible. Give those folks the resources in the form of free mandatory inpatient treatment or intensive outpatient treatment with strong accountability measures in effect from day 1 throughout. Those that don’t want to stop–get out of our sight. I’ve got other important priorities, such as hungry children, that are far more important that supporting a drug user’s use.
Nelson and Davison were elected as pushback against this “let’s coddle the addict” trend. I’m glad to see they’re doing their jobs.
“There are folks that don’t want to stop using drugs. There are folks for whom abstinence is not how they measure success in life.”
And right there is the attitude that will kill public support. Basically, these folks feel that if some jerk wants to use all their life, it’s incumbent upon the boring normies of society to open their wallets and pay for them. Get them a nice place to live and use. Pay up for food and healthcare. Cough up for safe drugs, needles, and pipe.
In perpetuity you boring normies!
No one objects to helping people along the way. Most folks know they will relapse. But losers who just wanna use? Yeah, bleep ’em.
She’s great. Nelson is by far the most effective person on the City Council.
Says the robot.