Category: Addiction

Nelson, Pedersen Vote to Reject City Budget Because It Doesn’t Fund Everything They Want

Councilmember Alex Pedersen and Sara Nelson
Seattle City Councilmembers Alex Pedersen and Sara Nelson

By Erica C. Barnett

Seattle City Councilmembers Sara Nelson and Alex Pedersen voted against the city council’s amended 2023-2024 budget proposal at a council budget committee meeting Monday, joining socialist Kshama Sawant—who votes against the budget every year—in an ideologically split three-vote minority. The budget, which goes to the full council for a final vote tomorrow, requires a six-vote majority to pass; if even one more council member sided with Nelson, Pedersen, and Sawant, the entire budget would fail.

Nelson and Pedersen, who frequently formed a two-vote mini-bloc during the council’s budget deliberations, explained their decision in similar terms: They couldn’t vote for a budget that doesn’t fully fund Harrell’s public safety priorities. “I cannot in good conscience endorse a final budget that, I believe, fails to learn from recent public policy mistakes on public safety and fall short on public safety for a third year in a row,” Pedersen said.

That argument would hold more water if the council had proposed actually cutting SPD’s budget. Instead, the council fully funded SPD’s (and Mayor Bruce Harrell’s) entire hiring plan, and used savings from vacant SPD positions to provide the department with an additional $17 million a year to pay for, among other things, the recruitment and retention proposals Nelson and Pedersen have supported. No other department received this kind of kid-gloves treatment; in fact, many departments face dramatic cuts next year.

The council’s budget also returns the city’s parking enforcement division to SPD, another one of Harrell’s top budget priorities.

“Minor reductions [to proposed new SPD programs] are being emphasized and exaggerated. This is the harmful rhetoric that is likely to continue to negatively impact hiring and retention.”—City Councilmember Lisa Herbold

In contrast to previous years, such as 2020, it’s virtually impossible to make the argument that the council didn’t work with the mayor to craft a budget that retains most of what he wanted—a point Councilmember Lisa Herbold made when she accused her two colleagues of contributing to a “false narrative” about public safety.

“It’s normal to debate budget issues,” Herbold said. “But these false narratives don’t make us safer.”

“Ninety-nine percent of the mayor’s proposed budget is included in this balancing package,” Herbold continued. “SPD hiring is fully funded, and they’ve begun to show some promising trends. Minor reductions to the remaining 1 percent of the budget”—the elimination of new programs, such as a gunfire surveillance system and a marketing consultant—”are being emphasized and exaggerated. This is the harmful rhetoric that is likely to continue to negatively impact hiring and retention.”

Eliminating these new programs from next year’s budget helped the council close a late-breaking general-fund budget shortfall of $4.5 million, on top of the $141 million shortfall announced earlier this year.

Nelson and Pedersen also objected to the council’s decision to eliminate, or abrogate, 80 of the 240 SPD positions that are currently sitting vacant; these vacant positions, which the city will use to augment the budget and fund new SPD spending next year, receive funding every budget cycle. The council’s budget will retain funding for at least 160 of these “ghost” positions going forward, and can add more positions in the future if SPD hiring suddenly skyrockets past the department’s own rather optimistic projections. Nonetheless, both Pedersen and Nelson have characterized this as an example of “defunding” the police. 

Nelson also criticized the council for failing to fund an expansion of the city’s graffiti abatement program and for moving homeless outreach workers out of Harrell’s new Unified Care Team (which the council fully funded) and into the King County Regional Homelessness Authority.

The two council members’ votes against the budget seem even less justified when you consider the concessions the rest of the council made to fund their priorities. 

Nelson, for example, got unanimous approval for a last-minute amendment that commits the city to spend some of the proceeds from a recent settlement with opioid distributors on abstinence-based rehab, marking the city’s first foray into the kind of public health decisions that are usually made by King County’s public health department.

Nelson was elected last year, and is staking out a position on the budget every bit as absolutist as Sawant’s: If the rest of the council doesn’t support her specific priorities, she’ll vote to reject the city’s budget wholesale.

In an op/ed earlier this year, Nelson expressed her view that medication-assisted treatment, such as the use of suboxone (an opioid) to treat opiate addiction, is “not aimed at long-term recovery.” This is the opposite of scientific consensus (the federal government’s substance abuse agency, for example, has a far more expansive definition of recovery that embraces long-term medication), but in line with Nelson’s general opposition to harm reduction programs— like the Public Defender Association’s LEAD and Co-LEAD programs, which provide case management and housing to people with addiction and other behavioral health issues.

Pedersen, meanwhile, managed to wrangle $3.5 million a year for bridge maintenance out of the Seattle Transportation Benefit District tax, which is supposed to fund transit, by arguing that because buses and bikes also use bridges, funding for bridges is a transit investment. That amendment passed 5-4—a major win for Pedersen at the expense of future transit projects.

Nelson was elected last year, and is staking out a position on the budget every bit as absolutist as Sawant’s: If the rest of the council doesn’t support her specific priorities, she’ll vote to reject the city’s budget wholesale. Time will tell if she continues down this all-or-nothing path.

Pedersen, in contrast, has apparently had a dramatic change of heart. Just two years ago, Pedersen wrote in a Seattle Times op/ed that it would be irresponsible for him to vote against the 2020 budget—which included far more dramatic changes than this year’s plan—just because he didn’t like everything that was in it.

“People are yearning for functional government. If the budget does not pass, nothing gets done,” Pedersen wrote. “No budget is perfect. Our constituents have diverse and conflicting views. A budget with positives and negatives is a natural result.”

“And to my constituents who ask, ‘Why did you vote the same way as Kshama Sawant?,” Pedersen concluded,
“I didn’t. She voted No.” This year, so did Pedersen.

Council Budget Eliminates 80 Vacant Police Positions, Preserves Human Service Pay, Moves Parking Officers Back to SPD

City Council budget chair Teresa Mosqueda

By Erica C. Barnett

The Seattle City Council’s budget committee, which includes all nine council members, moved forward on a 2023-2024 budget yesterday that will move the city’s parking enforcement division back to the police department, preserve inflationary wage increases for human service workers, and increase the city’s funding for the King County Regional Homelessness Authority—all while closing a late-breaking budget hole of almost $80 million over the next two years.

Every fall, the mayor proposes a budget and the council “rebalances” it, adding spending for their own priorities and removing items to keep the budget balanced. In November, after many council members had already proposed substantial changes to Mayor Bruces Harrell’s initial budget proposal, the city received news that tax revenues would be even lower than previously anticipated. The biggest unanticipated shortfall came from a decline in real-estate taxes, which pay for long-term capital projects, but other revenues, including parking taxes and money from the sweetened beverage tax, also declined.

Last week, council budget chair Teresa Mosqueda proposed a balancing package that saved money by declining to fund most of the new programs and program expansions Harrell proposed in his budget, while making several substantive policy changes. Among the most controversial: A proposal to eliminate 80 vacant positions in the police department, and a related plan to to keep the city’s parking enforcement officers at the Seattle Department of Transportation (SDOT), rather than moving them back to SPD, while the city decides on a permanent home for the unit.

“Our mayor’s budget did not delete these 80 [vacant police] positions, and if we trust in what the mayor asks for regarding public safety and the budgeting knowledge and skills and best practices of the city budget office, I don’t think we should do anything different here.”—Councilmember Alex Pedersen

The budget the committee adopted Monday night, nearly 12 hours into a meeting that began at 9:30 that morning, will eliminate the 80 vacant positions, while preserving another 160 vacant positions in future years. Vacant positions continue to be funded year after year unless the mayor or council takes action to defund them temporarily and use the money for other purposes, as Harrell’s budget does this year. Both the proposed budget and the one adopted by the committee on Monday use money  that would have gone to the 80 vacant positions to augment the city’s general fund, while using the savings from another 120 positions to pay for new spending within the police department. This week, the council got word that SPD had identified another 40 vacant positions, for a total of 240.

Council member Alex Pedersen opposed eliminating the 80 unfilled police positions, arguing that it would be wrong for the council to go against the “wisdom” of the City Budget Office, the mayor, and police chief Adrian Diaz, who want to keep as many positions vacant but funded as possible.

“Our mayor’s budget … did not delete these 80 positions, and if we trust in what the mayor asks for regarding public safety and the budgeting knowledge and skills and best practices of the city budget office, I don’t think we should do anything different here by abrogating or deleting these 80 positions,” Pedersen said.

Council member Sara Nelson added that eliminating vacant positions as a recurring budget line item could discourage people from applying for jobs at SPD and send a message to existing officers that the city did not support police hiring.

In response, council public safety chair Lisa Herbold pointed out that the budget fully funds the mayor and SPD’s hiring plan, which would increase the department by a net total of 30 officers in the next two years. (This hiring plan assumes a complete reversal, and then some, of current SPD hiring trends). It also keeps the remaining 160 vacant positions on the books, where they will be funded again automatically in 2025. For the city to need the 80 positions the council eliminated Monday, it would have to hire at least 190 net new officers, not counting new recruits who replace officers who leave the department. If that very unlikely scenario came to pass, the council could add funding for more officers—as it has many times in the past.

“It’s really disappointing that … some people seem unwilling to say that the hiring budget is fully funded for the next biennium for the council to act on,” Herbold said. “That would send a positive factual message, rather than … distort what an abrogation of positions would do for the budget.”

Nelson and Pedersen also cast the only votes against a Herbold-sponsored proviso, or spending restriction, requiring the police department to get council approval if they want to use their staffing budget for anything other than salaries and benefits, arguing it was important to give SPD special flexibility to spend their budget how they want to.

“I believe we should stop micromanaging the use of salary savings and exercise some humility going forward because we simply don’t know what needs will need to be met,” Nelson said. “[Extra] overtime, for example, if there’s an earthquake or a mass shooting or something.”

In a last-minute compromise with Harrell’s office, the council agreed to move parking enforcement from SDOT to SPD, as PubliCola reported Monday. The compromise amendment uses administrative savings from the move (almost $9 million a year) to pay for several council spending priorities, including $1 million in one-time funds to support the Public Defender Association’s LEAD and Co-LEAD programs, which Harrell’s budget partially defunded; $1 million to “activate” City Hall Park in Pioneer Square, which has been fenced off since the summer of 2021; and $1 million for RV parking and storage “associated with non-congregate shelter,” among other new spending.

In a separate amendment, the council provided an additional $2 million a year for LEAD and Co-LEAD, which the PDA says still leaves them $5.3 million a year short of what it needs to fully fund both programs. The two programs provide case management and (in the case of Co-LEAD) hotel-based shelter for people involved in the criminal legal system, including many with behavioral health conditions that make it harder to find housing.

Morales had more success with another amendment that would place a budget proviso, or restriction, on $1 million in 2023 spending from the city’s transportation levy, requiring SDOT to spend it replacing plastic bollards that do not actually “protect” bike lanes with concrete barriers that do.

Here are some more highlights from Monday’s meeting, which was the last chance for council members to make substantive changes to the budget; for budget changes the council agreed on prior to Monday’s meeting, check out our coverage of those changes from last week.

• The council turned down proposals to place extra scrutiny on two programs that the council’s more conservative faction, led by Pedersen and Nelson, generally oppose. For example, they voted to remove $1.2 million in funding (all numbers are two-year figures) that Nelson wanted to spend on two full-time city staffers who would evaluate the JumpStart tax, which was just implemented last year.

The council also rejected two proposals by Nelson to apply extra scrutiny to LEAD and Co-LEAD, which take a harm reduction approach to addiction and low-level criminal activity rather than the abstinence-only approach Nelson favors (more on that in a moment). Specifically, Nelson wanted detailed information about the PDA’s subcontracts with REACH, the homeless outreach provider, and the basic details of both programs.

“What services are provided to the clients of LEAD?” Nelson asked Monday. “Which contractors do what for which program?”  because they do receive so much funding?” Additionally, Nelson proposed an amendment that would require quarterly reports on LEAD and Co-LEAD clients’ shelter and housing “acceptance” rates. Continue reading “Council Budget Eliminates 80 Vacant Police Positions, Preserves Human Service Pay, Moves Parking Officers Back to SPD”

King County is on Pace for a Record Year of Overdose Deaths

Overdoses in King County, 2012 (L) and 2021 (R)
Overdoses in King County, 2012 (L) and 2021 (R)

By Andrew Engelson

Tricia Howe, who directs an outreach program for drug users at REACH, Evergreen Treatment Services’ homeless outreach program, had firsthand experience of King County’s overdose crisis earlier this summer. In a matter of weeks, there were two overdoses outside REACH’s Belltown office.

“One of our case managers came into my office and said, “I think there’s somebody outside who doesn’t look like they’re breathing,” Howe said. “I grabbed a whole bunch of Narcan out of my drawer and ran outside.”

The man’s lips were blue, Howe said, and he wasn’t breathing, though he did have a pulse. She gave him a standard dose of naloxone nasal spray (Narcan), which can reverse the effect of opioids and restore a person’s breathing, but he failed to revive. So Howe gave him a second dose. “He took one deep breath, but was still not responsive,” she said. As Howe was preparing to administer a third dose, first responders arrived, put the man on oxygen, and he finally started breathing.

Based on the man’s response, fentanyl was almost certainly involved. The drug, which is up to 50 times more potent than heroin, can cause overdoses even among frequent opioid users. According to Howe, because fentanyl is cheaper to manufacture, it is quickly replacing heroin and oxycontin as the primary drug available to people who use opioids.

Data from the Washington State Patrol shows that the share of fentanyl in King County drug seizures has climbed dramatically, from around 10 instances in 2018 to more than 100 in 2021. Howe said that all of the counterfeit oxycodone (OxyContin) pills her staff have recently tested have been positive for fentanyl.

“It’s so available now and people are actually seeking it out at this point, where that was not the case before.” According to Howe, because fentanyl is cheaper to manufacture, it is quickly replacing heroin and oxy, and is making overdoses more common and more difficult to reverse. 

Though former mayor Ed Murray expressed early support for what would have been the first such sanctioned site in the US, Jenny Durkan’s administration showed little enthusiasm for supervised consumption. Durkan downgraded the plan in 2019 to a single site in a mobile van, citing concerns about the Trump administration’s legal action against a proposed consumption site in Philadelphia. 

A 2017 study showed that 83 percent of fentanyl overdoses in Massachusetts required a second dose of naloxone. Howe notes that overdoses of heroin or oxy were easier to reverse than fentanyl. “In the past, you could definitely expect the person to wake up and almost walk away,” says Howe.

Seattle and King County are in the midst of a severe overdose death crisis that began to spike during the pandemic and shows no sign of abating. People without shelter are particularly at risk. A ten-year study published in September by the King County Medical Examiner’s Office and Public Health Seattle-King County found that that accidental deaths nearly quadrupled  between 2012 and 2021 among people living unsheltered, and that overdoses now account for 71 percent of such deaths. 

As of last week, according to King County Public Health, there had been at least 710 fatal overdoses in the county this year. Of those, at least 473 involved fentanyl. That number has already eclipsed last year’s 708 overdose deaths, including 385 caused by fentanyl.

“When we first started our heroin and opioid task force in 2015, there were three fentanyl overdose deaths,” said Brad Finegood, a strategic advisor at the public health department. “The numbers have grown exponentially.”

Drug users tried to avoid fentanyl when it first arrived on the West Coast, Finegood said, but that attitude has dramatically shifted, and now people are actively seeking out fentanyl. According to a Pew study published in 2019 on drug use in San Francisco, more than half of opioid drug users now actively seek it, despite the dangers. Complicating matters, fentanyl is either smoked or vaporized and then inhaled, so traditional initiation barriers have fallen away.

“For younger people who are experimenting with drugs,” Finegood said, “that makes it much more feasible because they don’t have to use a needle.” Public Health and REACH have had to counter the misinformed belief that fentanyl is safer because it’s smoked rather than injected.

According to the US Department of Justice, most fentanyl originates in China and is made into pills or powders by cartels based in Mexico. Batches of fentanyl that are poorly blended can result in what Finegood calls the “chocolate chip cookie effect,” in which pockets of higher concentrations cause accidental overdose.

A young man named Ian who was living in an encampment near the Home Depot in the Bitter Lake neighborhood said in August that he had no choice but to start using fentanyl. Originally from Wasilla, Alaska, Ian said he first became addicted to opioids while taking Oxycontin for pain. “Then oxy disappeared,” he said. In 2016, the CDC advised doctors to lower prescription levels of oxycodone and this, combined with the Drug Enforcement Agency’s recent crackdown on illegal and fraudulent prescriptions, has made medical-grade pills rare.

Ian said that in the absence of oxy, he did heroin for a while. “Then that disappeared. Now it’s all fetty.”

Half a dozen people at the encampment told me they use fentanyl and know many others who do. Nearly everyone had witnessed overdoses and several said they knew people who’d died.

“Everyone’s doing fetty,” said Jessie, who’s 26 and has been using drugs, including meth, since she was 11 years old. She didn’t live in the Bitter Lake camp, but was helping a friend pack up their belongings before the city came to sweep the site. “I’ve been sober, but it didn’t last,” she said. When asked if she’d seen friends overdose, Jessie said, “Yeah, of course.”

The transformation of fentanyl from risky outlier to the opioid of choice in King County mirrors national trends. In 2021, fentanyl accounted for the majority of overdose deaths in the U.S, though methamphetamine continues to be a close second, both nationally and locally. 

Although Seattle, King County, and the cities of Renton and Auburn formed an opiate overdose task force in 2015, local leaders have shelved a key recommendation from the task force’s report: establishing two supervised consumption sites in King County. 

Seattle could have been home to the first such sanctioned site in the U.S., following the lead of Vancouver, B.C. and 200 other sites currently operating elsewhere in Canada, Europe and Australia.

Though former mayor Ed Murray expressed early support for what would have been the first such sanctioned site in the US, Jenny Durkan’s administration showed little enthusiasm for supervised consumption. Durkan downgraded the plan in 2019 to a single site in a mobile van, citing concerns about the Trump administration’s legal action against a proposed consumption site in Philadelphia. 

“It’s a no-brainer. If you don’t want people to use right in front of you and you don’t want needles all over your parks, then you’ve got to give people a place where they can go.”—Tricia Howe, REACH

Even as the Biden administration changed course and said it would consider allowing sites, neither Durkan nor Mayor Bruce Harrell followed through on the scaled-back plan. Earlier this year, New York City moved past Seattle and opened two safe consumption sites that have already succeeded in preventing 500 deaths.

Kris Nyrop, who spent two decades working on HIV prevention among drug users in Seattle and helped design Seattle’s Law Enforcement Assisted Diversion (LEAD) program, says the window for action in King County is quickly closing.

“We have two years,” Nyrop said. “Biden is not going to prosecute if Seattle moves forward. So how do we get Mayor Harrell and a majority of the council behind this?”

In fact, Councilmember Lisa Herbold added $1.1 million to the 2021 Human Services Department budget to create safe consumption spaces in existing social services facilities. The city did not move forward on that approach and Harrell’s proposed 2023-2024 budget does not fund it. 

Instead, Mayor Harrell has vowed to crack down on people who sell and use drugs, in a highly publicized effort to target “hot spots” such as the intersection of 12th and Jackson in Little Saigon. Anyone walking through the area today can see that this short-term strategy was ineffective at reducing public drug use and sales in the area.

Howe said that the only effective way to reduce visible drug use on the street isn’t more policing, but sanctioned consumption sites. “It’s a no-brainer. … If you don’t want people to use right in front of you and you don’t want needles all over your parks, then you’ve got to give people a place where they can go.”

In the absence of sanctioned sites, Public Health has been quietly moving forward on other, lower-profile strategies aimed at empowering drug users to consume drugs as safely as possible. 

In addition to social media campaigns to educate young people about the extremely high risks of fentanyl pills (“blues”), Finegood says Public Health is doing more targeted educational outreach to users about safer consumption practices. 

This includes training drug users to recognize the symptoms of overdose, encouraging people not to use alone, and making the overdose reversal medication naloxone widely available. Finegood said Public Health has set up the first mail-order naloxone program in the country, and is working extensively with local pharmacies to offer the drug free, without a doctor’s prescription. “We’ve also set up a couple naloxone and fentanyl tester vending machines,” Finegood said. Continue reading “King County is on Pace for a Record Year of Overdose Deaths”

Opioid Settlement Payouts to King County Cities Range from a Few Thousand Dollars to Millions

Map of fatal overdoses in King County, 2021; data available on King County’s overdose information site.

By Erica C. Barnett

Today is the deadline for cities and counties across the state to sign on as participants in the state’s $518 million settlement with the nation’s three largest opioid distributors, and it now appears all but certain that enough jurisdictions will sign agreements that the state will be able to keep the funds. As we reported earlier this week, the settlement—the result of a case Attorney General Bob Ferguson brought against the big pill distributors for their role in fueling opiate addiction—won’t be finalized unless all of Washington’s counties, and most of its cities, agree to participate.

The settlement will be split evenly between the state and local jurisdictions, with cities and counties receiving payouts worth a total of up to $203 million over the next 17 years based on a calculation that considers three factors—the number of deaths from opioid overdoses, the prevalence of opioid use disorder, and the quantity of opioids shipped to each jurisdiction—equally. Cities and counties have to spend the money on treatment, prevention, harm reduction, and other programs designed to reduce the harm of opiate addiction.

At a meeting of the Burien City Council this past Monday, council members expressed disappointment in both the size of the city’s allocation and the fact that cities won’t be able to receive their funds in a lump sum, which would provide more spending flexibility.

Some cities have been disappointed by the amount they’re set to receive. Burien, where there several dozen overdoses (from all causes) in 2021, stands to receive around $55,000 from the settlement, paid out in chunks of $2,700 per year after a first-year lump sum of around $5,400.

According to Attorney General’s Office spokeswoman Brionna Aho, the distribution of funds was “negotiated by the local governments. The state was not a party to those negotiations and had no part in deciding how much each city or county would receive.”

At a meeting of the Burien City Council this past Monday, council members expressed disappointment in both the size of the city’s allocation and the fact that cities won’t be able to receive their funds in a lump sum, which would provide more spending flexibility.

“I do know that this is not much allocation to our city, and honestly I was disappointed that there was not more information shared from the Attorney General’s Office,” Councilmember Jimmy Matta said at the meeting. “At the same time, I know that the attorney general [fulfilled] his obligation as the attorney for the state.” Council members suggested that they might use the money to buy more doses of the opioid-reversal drug Narcan, or pool it with other jurisdictions to get more bang for the buck.

According to Burien City Manager Adolfo Bailon, there was never any question that the city would sign on to the settlement. “I think they were just interested in learning how the money can be distributed in a different way,” Bailon told PubliCola.

“We’re just grateful that something’s being done,” he added. “I am sure that we can put it to use some way or another.”

Other cities in King County will receive larger or smaller amounts based the formulas in a memorandum of understanding between the cities. Issaquah, for example, will receive about $380,000; Kent, around $1.1 million; and Seattle a little over $12 million. The smallest payout in King County will go to the city of Newcastle, which will receive a total of around $6,700. King County, which directly funds treatment and other services, will receive just over $28 million.

Seattle’s “High Utilizers Initiative” Targets Frequent Offenders for Prosecution. Could It Be Put to Better Use?

By Erica C. Barnett

Six months ago, City Attorney Ann Davison announced a new initiative that would target so-called high utilizers of the criminal justice system—people with more than 12 misdemeanor referrals in the last five years—by subjecting their actions to greater scrutiny, excluding them from community court, and keeping them in jail for months, much longer than current misdemeanor booking restrictions allow.

Since launching the High Utilizers Initiative in February, the city attorney’s office has filed charges against people on the list 82 percent of the time, compared to a 63 percent charging rate for all misdemeanor cases so far this year. In 2021, under former city attorney Pete Holmes, the office charged people meeting the new “high utilizer” standard just 58 percent of the time. The initiative was also supposed prioritize this group for mental health services and treatment.

So far, the initiative has resulted mostly in more charges for people on the list, although the city attorney’s office says additional policy proposals are coming.

“We are declining fewer cases for this population than for the overall population,” deputy city attorney Scott Lindsay said. “I think it tells us that this effort is doing exactly what Ann said it would do: For individuals who are repeatedly having a significant disruptive impact on their neighborhood, we are trying to make sure that they are not slipping through the cracks.”

The initiative also allows the city to keep people on the list in jail for longer, bypassing rules that have prohibiting most misdemeanor bookings. “When somebody has a record of 35, 40 criminal cases and then they have a new property destruction case in Ballard and they’re saying you can’t do anything about that, that doesn’t make sense,” Lindsay said.

Critics of the high utilizers initiative argue, citing considerable research, that repeatedly jailing people who are homeless and suffer from significant behavioral health conditions does not reduce crime and makes the people being incarcerated sicker and less likely to be able to thrive in their communities. Anita Khandelwal, director of the King County Department of Public Defense, said the people on the high utilizers list “should not be subject to jail booking or prosecution for misdemeanor offenses; instead, they should be introduced to service providers who can develop community support and housing options without the hindrance and destabilization caused by repeated jailing and prosecution.”

“It’s hard to overstate the cruelty—and futility—of incarcerating a person who is not able to understand what is happening or to assist their attorney. What’s more, incarceration is destabilizing and leads to an increased risk of a person dying by suicide—as we have repeatedly seen happen at the King County Jail over the past year.”—Anita Khandelwal, director, King County Department of Public Defense

Lisa Daugaard, co-director of the Public Defender Association, whose programs serve people involved in the criminal legal system, said creating a list of people who are frequently arrested for misdemeanors isn’t a “good thing nor a bad thing by itself. It could be helpful if it caused local authorities to come up with a plan for these people’s situation, which is highly likely in need of a plan or support or intervention.”

So far, Daugaard acknowledges, the focus has been on the enforcement side.

“If they are choosing to file against people on the list more often, to me, that means we’re not getting busy making plans proactively for people who we already know are in difficult situations,” she said. “There should be a lot of energy pushing for programming and placement options that just don’t exist for this population right now—and they would have a lot of allies.”

PubliCola obtained a copy of the most recent high utilizers roster, from July, and reviewed the recent criminal and legal histories of each of the 111 people on the list. Two things stand out right away. First, the vast majority of people on the list are either homeless or show signs of housing instability; fewer than 10 had consistent residential addresses in the Seattle area. Second, most “high utilizers” show signs of major behavioral conditions, including addiction and mental illness.

In many cases, people’s behavioral health issues were so severe that a Seattle Municipal Court judge has recently questioned their ability to understand the charges against them and participate in their own defense, a process used to determine, among other things, if a case can proceed. Nearly half, or about 54, have been ordered to undergo a competency evaluation within the last year, and 30 have been found incompetent multiple times—a high bar that requires not just a transient lack of understanding (which might be caused by drug use) but a profound underlying mental health condition.

Prosecuting such people, Khadelwal says, is pointless and counterproductive. “It’s hard to overstate the cruelty—and futility—of incarcerating a person who is not able to understand what is happening or to assist their attorney,” Khandelwal said. “What’s more, incarceration is destabilizing and leads to an increased risk of a person dying by suicide—as we have repeatedly seen happen at the King County Jail over the past year.”

Katie landed on the high utilizers list after racking up more than two dozen separate charges in the last five years—everything from tampering with a fire alarm to vehicle prowling to pedestrian interference, for walking in the middle of busy Rainier Avenue South. She spends most of her time in Ballard, despite restraining orders and arrests and people warning her, over and over, to stay out of the area. She has a connection to the neighborhood—it’s where her family once lived, she has told officers and court officials and anyone who will listen, and where her “street family” lives now.

Mostly, Katie’s charges involve stealing from, screaming at, and harassing employees and patrons of businesses and institutions in Ballard’s commercial core, including retail stores, a car dealership, and the Seattle Public Library. Typically, she will enter a business, yell and knock things down, and run off with random items, such as pile of Starbucks paper cups a barista set outside one day. For just one person, people familiar with Katie say, her impact is tremendous; she might enter a single business multiple times a day, causing havoc and running out only to return a few hours later.

Katie has also assaulted people directly—pulling an earring off a waitress who told her to go away, attacking an employee at St. Luke’s Presbyterian Church, which offers daily meals from its building across from the Ballard Commons. St. Luke’s is among at least half a dozen Ballard businesses that have a no-contact order barring Katie from coming within 1,000 feet of their property—an almost unprecedented move for a church whose institutional mission includes serving Ballard’s homeless population. Earlier this year, because of her status as a “high utilizer,” she was detained for nearly five months at the King County Jail; when she got out, she went straight back to Ballard, where she was promptly arrested—not for harming anyone, but for simply being there.

This time, the city attorney’s office didn’t seek to keep Katie in jail , and she was released two days after her arrest. But her months-long stay in jail had consequences she was still living through. During that period, her name had come up on a waiting list for housing, but no one noticed; as a result, she missed a crucial deadline and fell off the list. Now, after case conferencing that included representatives from the city attorney’s office, she’s staying in a tiny house in a neighborhood across town. But she’s still barred from most of Ballard, which will make it hard for her to avoid arrest in the future.

Despite her erratic behavior, Katie has been found competent at least once, after two previous incompetency findings. Her most recent evaluation, in February, concluded that she was competent to stand trial as long as she stayed away from drugs—a conclusion that shows one of the limits of “competency” as a measure of behavioral health.

Peter, another “high utilizer” who has been found incompetent to stand trial repeatedly, most recently in July, frequents the University District, where his name is on a private list of high-impact individuals maintained by the University District Partnership (UDP), which represents businesses in the area.

“There may be a reason to incarcerate a person to keep them away from everybody else and stop them from doing that [behavior] for some period of time. But does state punishment itself cause a positive change in people? I think the answer is clearly, no, it does not.”—Daniel Malone, Director, Downtown Emergency Service Center

Peter—also a pseudonym—has been arrested repeatedly for walking into businesses, stealing small items—a can of Campbell’s chicken and dumpling soup, an Ace bandage, a bottle of A&W root beer—and threatening employees who catch him or tell him to leave. He says things like, “If you stop me, I have a gun and I will kill you,” and “fuck you, I’ll kick your ass,” and “if you call the police, I will murder you,” according to police reports. On occasion, he’s taken a swing or tried to “head butt” a clerk. Once, he grabbed a “small pink pen knife” from a homeless woman’s cart and pointing it toward a Safeway clerk, Other than the pen knife, which he returned to the woman who owned it, police reports do not indicate that has ever been caught carrying a weapon.

Peter is also, as his many incompetency findings make clear, profoundly disabled, to the point that he’s frequently incapable of carrying on a coherent conversation. He may be “terrorizing” a neighborhood, but he’s also lost in his own delusions of money, grandeur, and persecution; it’s hard to imagine him understanding the nature of the charges against him, much less sitting still in front of a judge and testifying in his own defense.

“We have a lot of clients who are just so gravely disabled that you’re not going to get the same result if you tell them to do something” the way you would with most people, said Ailene Richard, the North Seattle LEAD supervisor for the homeless outreach organization REACH. “They’re not internalizing information in the same way. You have to ask people, what is your motivator? Why do you keep stealing things? Even to do that takes relationship building and trust building.”

The UDP participates in case conferencing—a process that involves sitting down with representatives from Mayor Bruce Harrell’s office, neighborhood organizations, LEAD, REACH, and the city attorney’s office and figuring out how to address and assist people who are having a negative impact on local residents and businesses. But for cases like Peter’s, UDP president Don Blakeney says, they’re at a loss.

“What is the solution for someone who is having a negative impact on the neighborhood but is not really a great candidate for behavioral change?” Blakeney said. “Those kind of people on the list are going to be hard [to deal with]—they can’t keep impacting the neighborhood the way they do because it’s terrifying of folks who are stuck in one place,” such as behind the counter at a retail store. “If you get to a point in the neighborhood where people are doing that every day, it has a cumulative impact.”

The Downtown Seattle Association, which supported previous efforts to crack down on drug dealing and sales of stolen goods such as the short-lived Operation New Day, also supports the high utilizers initiative. But the group’s CEO, Jon Scholes, says simply arresting people and releasing them back into the community without health care and housing won’t address the impact high utilizers have on the neighborhood or help them access the services and housing they need. “There’s very few people in our constituency who want to lock up mentally ill people forever—they they want to reduce the impact [and] they want a better outcome.”

Unlike the University District and SoDo neighborhoods, which have access to case conferencing, Scholes said the city and service providers “haven’t set that kind of table with us and other [business] groups. We’ve never set aside the housing and other services that are really needed for this population. …A list is just a list if there’s no meaningful intervention that’s being offered.”

Both Katie and Peter, along with many others on the high utilizers list, are connected with case managers from groups like REACH and LEAD, which work with unhoused people facing charges and those who have co-occurring behavioral health conditions, including mental illness and addiction. But identifying appropriate housing and services for people with huge, sometimes lifelong, challenges takes time, even years, and in the meantime, the prescription from the city attorney’s office often prioritizes immediate neighborhood demands. 

And even some homeless service providers say there are times when jail is justified. Staffers for the Downtown Emergency Service Center, which has provided (or currently provides) shelter or housing for many of the people on the high utilizers list, call police when a client assaults another client or threatens guests or staff—as happened earlier this month, when a man on the list exposed himself to residents and staff at DESC’s Hobson Place apartments.

“When I first heard about the so-called high-utilizers program,” Municipal Court Judge Damon Shadid said, he hoped Davison’s office would “gather certain information on people who are having a high impact on the community” and “figure out how to address them in a useful way. That is not what happened. Instead, we were handed a list of people who we were told were not eligible for the primary diversion program at the court, and we were not offered a solution other than the primary solution of putting people in jail.”

“We’re supposed to [call police] not just when we’re upset at a lack of compliance or cooperation, but when it’s reached a point where we’re unable to manage the situation safely and effectively,” Malone said. “There may be a reason to incarcerate a person to keep them away from everybody else and stop them from doing that [behavior] for some period of time. But does state punishment itself cause a positive change in people? I think the answer is clearly, no, it does not.”

Richard said going in and out of jail all the time can cause “tremendous” harm—”jail is not a therapeutic place.” At the same time, jail can provide “a sort of break from everything they’re usually doing,” she added. “Sometimes if we’ve had trouble finding that client, that’s a way we can contact them. It is sometimes the only opportunity that we have to be able to meet with certain folks who we have not been able to find on outreach.”

Seattle Municipal Court Judge Damon Shadid oversees community court, an alternative to mainstream criminal court that offers access to services such as mental health and addiction treatment, occupational therapy, and life skills classes. He says the city attorney’s office needs to demonstrate, with clear evidence, that jail is helping not just businesses and neighborhood residents but the people who are being jailed over and over again with few visible results. “If they’re going to charge these people more, they need to prove that they’re having a positive impact.” So far, he said, they haven’t done so.

Instead, Davison took action early in her term to specifically deny access to community court to anyone on the list, arguing that people who commit the same offenses repeatedly need strict accountability, not treatment and classes. Davison, and Lindsay, especially objected to the fact that community court is a “release first” model, which gives people who enter the program the benefit of the doubt instead of, as Khandelwal put it recently, keeping people in jail “simply because they are too poor to post bail.” Continue reading “Seattle’s “High Utilizers Initiative” Targets Frequent Offenders for Prosecution. Could It Be Put to Better Use?”

County Plans Emergency Walk-In Centers for Behavioral Health Crises

King County Executive Dow Constantine, flanked by Sheriff Patti Cole-Tindall and state Rep. Nicole Macri
King County Executive Dow Constantine, flanked by Sheriff Patti Cole-Tindall and state Rep. Nicole Macri

By Erica C. Barnett

On Thursday morning, King County Executive Dow Constantine announced his plan to introduce a plan to expand services for people experiencing behavioral health crisis as part of his 2023 budget proposal in September. The plan will attempt to address the worsening shortage of short- and long-term treatment for people with behavioral health conditions and substance use disorder. As of this year, Constantine said, the county has lost a third of its residential behavioral health care beds, “and it would have been more but for our intervention. And more facilities are potentially closing their doors in the months ahead.”

Currently, there is only one 16-bed crisis stabilization unit—the Downtown Emergency Service Center’s Crisis Solutions Center—in the entire county. A person in crisis who needs help right away can call 911 or the new 988 mental health crisis line, but people who need immediate, intensive intervention generally have nowhere to go but emergency rooms, which are ill-equipped to deal with behavioral health crises, or jail.

:I’m glad we’re here to be talking about potentially expanding [the crisis] system, but we can’t just expand it. We need to fix what is broken. And if I’m being honest with you, I am part of what’s broken, and every other behavioral health worker, because the system has put us in an impossible situation.” —DESC registered nurse Naomi Morris

Gesturing toward the King County Correctional Facility across the street from the county building where the press conference was taking place, Constantine noted that of about 1,530 people in the county jail, more than 600, or two in five, are in some kind of treatment for behavioral health conditions. Many of those have been jailed for crimes that are often related to mental health conditions and poverty, such as theft, trespassing, and assault.

“We cannot accept having the county jail as the main place for people to get behavioral health care. And right now, the fact is that the jail across the street is the second largest behavioral health facility in the state of Washington. We can’t accept relying on law enforcement to solve what is ultimately the health care challenge,” Constantine said.

Constantine did not provide any details about the scope or cost of his plan, which the county is working on as part of a coalition with other elected officals—including state Rep. Nicole Macri (D-43), Seattle Mayor Bruce Harrell, and King County Councilmember Girmay Zahilay—and health care providers. However, he did indicate that in addition to new walk-in crisis centers, it will include better pay for behavioral health-care workers, such as Naomi Morris, a registered nurse who works for DESC.

“I’m glad we’re here to be talking about potentially expanding [the crisis] system,” Morris said, “but we can’t just expand it. We need to fix what is broken. And if I’m being honest with you, I am part of what’s broken, and every other behavioral health workerm because the system has put us in an impossible situation.” Morris said a coworker recently had to take unpaid leave to deal with the trauma caused by their job as a case manager and found themselves unable to meet their basic needs because “the amount of money they make [is] barely above what the clients we serve get.”

Earlier this year, the King County Regional Homelessness Authority asked the city to pay for salary increases for people who work for agencies like DESC; the KCRHA also funds its own in-house outreach team and pays them significantly more than nonprofit employees doing similar work.

Amid Rising Fentanyl Deaths, Seattle Libraries Prohibit Overdose Reversal Drug

Public naloxone rescue kit in Boston, MA
Public naloxone rescue kit in Boston, MA

By Erica C. Barnett

The Seattle Public Library has advised library staff not to carry or use naloxone, the overdose-reversal drug sold under the brand name Narcan. As a matter of policy, the library does not stock Narcan or train workers to use it.

In an email to library staff last week, a representative from the union that represents most library employees, AFSCME 2083, wrote that “the City has been very clear that they believe Good Samaritan protections do not apply to public employees administering Narcan. In light of that liability concern, we have now been informed that any employees who administer Narcan on duty may be subject to discipline, unless they are explicitly directed to do so.”

“While these employer directives are in effect—in particular the new directive NOT to administer Narcan—Local 2083 cannot support member administration of Narcan on the job,” the email continued.

The union, which did not respond to a request for comment, sent the email to its members after an unidentified library staffer informed their boss that they were bringing Narcan to work. The drug, most commonly administered as a nasal spray, temporarily reverses the effects of an opiate overdose by blocking the effects of the opiate and causing an overdose victim to start breathing again.

“[The city attorney’s] legal guidance is that a staff member, who is in a paid capacity as Library employee, is likely not covered by the law and would subsequently expose themselves and the Library to liability for injury or death resulting from inappropriately administering Narcan.”—Seattle Public Library spokeswoman

Washington State’s original Good Samaritan law, adopted in 1975 and amended several times since, says that “Any person, including but not limited to a volunteer provider of emergency or medical services, who without compensation or the expectation of compensation renders emergency care at the scene of an emergency … shall not be liable for civil damages resulting from any act or omission in the rendering of such emergency care.”

A separate law adopted in 2015 created a “standing order” allowing “any person or entity” to obtain a prescription for opiate reversal medication, such as Narcan, and use it for overdose reversal without threat of criminal or civil liability for administering overdose-reversal drugs or for any outcome that happen as as result.

A spokeswoman for the Seattle Public Library, Elisa Murray, said the library asked the City Attorney’s Office if library workers would be protected by the Good Samaritan laws. “Their legal guidance is that a staff member, who is in a paid capacity as Library employee, is likely not covered by the law and would subsequently expose themselves and the Library to liability for injury or death resulting from inappropriately administering Narcan.” Murray said the initial advice came from former city attorney Pete Holmes’ office and was subsequently confirmed by the office of current City Attorney Ann Davison.

“Bringing medicine to the workplace with the intent to administer it while working is outside of a staff member’s assigned work duties and against the Library’s direction related to Narcan,” Murray continued. The library has no plans to train staffers to use Narcan or stock the drug at library branches, “based on the Seattle Fire Department’s medical support expertise and response times.” In other words, it’s up to the Fire Department, which—like the police department—is facing staffing shortages, to respond to overdose calls on time.

The library gave a similar explanation for its decision not to stock naloxone back in 2020, when then-mayor Jenny Durkan handed out hundreds of naloxone kits to local businesses and schools in response to an uptick in overdoses from fentanyl, an opiate that is many times more potent than heroin. On Tuesday, the King County Council declared fentanyl a public health crisis. Last year, the county medical examiner confirmed that nearly 400 overdose deaths involved fentanyl; so far this year, the number of confirmed fentanyl deaths is 272. Overall, opiates have been implicated in nearly 450 deaths this year.

The Seattle Public School District stocks naloxone at every school and trains school nurses, security staff, and school administrators in how to administer the drug.

As public agencies go, SPL is in some ways an outlier. Staff at other public agencies in Seattle carry naloxone, as do other public libraries around the country, including Everett’s public library system.

For example, the Seattle Public School District stocks naloxone at every school, according to SPS prevention and intervention manager Lisa Davidson. The district also trains school nurses, security staff, and school administrators—along with anyone else who wants training—in overdose response. Most schools have multiple “designated trained responders,” according to Davidson, and district policy allows individual employees to get their own prescriptions for naloxone and use it as long as they’ve been trained to do so.

The school district’s policy also notes that under the state’s “standing order” law, “a person who possesses, stores, distributes, or administers an opioid overdose reversal medication is not subject to criminal or civil liability or disciplinary action if they acted in good faith and with reasonable care.”

The King County Library System’s naloxone policy, however, is similar to Seattle’s: “staff are not permitted to administer Narcan,” , KCLS spokeswoman Sarah Thomas said, and are supposed to call 911 if they see a patron in medical distress “KCLS does not have a policy on Narcan use,” Thomas said. Continue reading “Amid Rising Fentanyl Deaths, Seattle Libraries Prohibit Overdose Reversal Drug”

Proposal Would Prevent Mayors from Burying Complaints Against Police Chief; Nelson Cherry-Picks Study to Claim Forced Treatment Works

1. The actions of Seattle Police Department officers during the protests against police brutality in 2020 led to more than 19,000 complaints against officers and then-police chief Carmen Best, which the city’s Office of Police Accountability subsequently consolidated into just 143 cases.

Most of those cases are now resolved. About 10 are still being processed, with “completion” rates, according to the OPA’s Demonstration Complaint Dashboard, between 75 and 90 percent. Just three complaints remain stalled at 50 percent complete. All are from 2020, and all three name former police chief Carmen Best as a subject.

City law empowers the OPA, which is an independent office within the police department, to decide whether investigating a complaint would create a conflict of interest, which the office did in these three cases involving Chief Best. Because the three complaints would have essentially investigating the boss, OPA referred them to then-mayor Jenny Durkan, who initially wanted the Office of the Inspector General, an independent police accountability agency, to do the investigation.

When the OIG declined, the case went back to the OPA, which asked to assign the investigation to an outside agency. Instead of acting, Durkan apparently sat on the complaints against Best, leaving them to languish until her successor, Bruce Harrell, forwarded them to an outside agency. Harrell’s spokesman, Jamie Housen, said the administration found out about the languishing cases in January and referred them to an external investigator late that month.

Legislation filed by city councilmember Lisa Herbold would prevent the mayor and OPA director from burying complaints against the police chief in the future by setting up a formal process, and deadlines, for the OPA to refer complaints against the police chief to an outside investigator.

Under the proposed new process, which Harrell supports, if the OPA decided a complaint against the police chief merited an investigation, the bill would require the OPA director to decide whether the complaint should be investigated by the city’s Department of Human Resources or an entity completely outside the city.  The OIG would review OPA’s recommendation and decide where to route the complaint, based on a process laid out in the legislation. The proposal would also give the OIG a stronger oversight role in complaints and investigations involving the police chief.

The first of the three cases the city failed to investigate involves Chief Best’s claim (later retracted) that armed people were running an extortion racket at the Capitol Hill Autonomous Zone (CHAZ) during the protests. As the South Seattle Emerald reported this week, Best apparently knew the claim was a hoax when she repeated it to officers in a videotaped statement to officers working at the protests.

The second unresolved case accuses Best of lying about errors made by Seattle police and fire officials that prevented emergency responders from reaching a man who had been shot in the protest zone; Best told reporters (falsely, according to reporting by KUOW) that protesters had blocked the path of emergency vehicles, contributing to the man’s death.

The final case involves the police department’s use of tear gas against demonstrators in early June, 2020, after Seattle Federal District Judge Richard Jones granted a temporary restraining order against the department.

One goal of the bill is to “protect against any abuse of discretion that might occur if the Mayor or OPA Director are involved in the complaint or seek to conceal the complaint” in the future, according to the bill text.

A spokesperson for the OPA declined to comment for this story. The outside investigation into the three cases is reportedly wrapping up.

2. City Councilmember Sara Nelson told a constituent in an email last week that her own experience going to treatment convinced her that mandatory treatment is an effective response to homeless people who commit crimes because of their addiction—and “less expensive than most housing options,” too.

The email, which Nelson forwarded to all her council colleagues, came in response to a constituent who sent a link to a study finding that out of 160 people in an employment-based treatment program, the 131 who were required to go to treatment by a court were more likely to complete treatment than the 29 who went voluntarily.

“If a person stays sober for even six months, that’s less expensive than most housing options and far less deleterious to a person’s ability to find future housing and employment than having a record.”—City Councilmember Sara Nelson

“I’m not surprised by its argument that mandating (or ‘stipulating’ as used in the paper) treatment is more effective than commonly thought because I’m in recovery myself and when I went to a residential treatment program, I met many people who were in treatment for the first time and only because court-ordered,” Nelson wrote, adding that about half of the people she kept up with from treatment were still sober.

“A month of private in-patient or 6 months of outpatient treatment costs about $10,000,” Nelson continued. “If a person stays sober for even six months, that’s less expensive than most housing options and far less deleterious to a person’s ability to find future housing and employment than having a record. And treatment leads to better health outcomes than jail.” Continue reading “Proposal Would Prevent Mayors from Burying Complaints Against Police Chief; Nelson Cherry-Picks Study to Claim Forced Treatment Works”

Barriers to Access, Changing Drug Trends Hinder Jail-Based Treatment Program

The number of patients in the King County jail’s opioid use disorder treatment program has nearly tripled since the start of 2021.

By Paul Kiefer

The number of patients in the King County jail’s opioid use disorder treatment program has nearly tripled since January 2021, reaching a high of 156 people by March 31. That trend is showing no sign of slowing, particularly as both Seattle’s mayor and city attorney suggest using the jail as an entry point into addiction treatment as part of the city’s new public safety strategy.

At a press conference last month, Mayor Bruce Harrell commented that “one of the best times to treat someone with drug and alcohol problems, unfortunately, could be when they’re arrested.” Two weeks later, Seattle City Attorney Ann Davison launched an initiative to prioritize booking “high utilizers of the criminal justice system” into jail, ostensibly to “intervene” in their behavioral health crises before finding them treatment opportunities.

But the growing number of patients, staffing shortages at both the jail and community-based care providers, and changes in the landscape of drug use in King County limit the jail’s ability to address the ever-worsening addiction crises that sent overdose deaths skyrocketing in the past three years.

King County’s jails first began offering medication-based treatment for opioid addiction in 2018, allowing patients who had existing prescriptions for buprenorphine—an opioid used to manage and treat addiction—to receive their prescriptions while in jail. In 2019, the jail began connecting new patients to buprenorphine, and in March 2021, Jail Health Services removed a cap on the number of patients allowed in the treatment program, opening buprenorphine access to anyone with a moderate to severe opioid addiction experiencing serious withdrawal in jail.

The program only offers short-term treatment. When a patient is scheduled for release, jail health staff meet with them to develop a plan for continuing their treatment outside of jail; that plan can include a next-day appointment at a medical or addiction treatment provider, a shelter referral, or a seven-day supply of buprenorphine, along with a separate supply of the overdose-reversing drug naloxone. In theory, jail health staff can also offer a “warm hand-off” to community-based addiction treatment providers when their patients leave the jail—a way to start a patient’s release on the right foot.

“When people lack housing and other basic needs, immediately when they’re released from jail, they often go back into survival mode. If we can provide some sort of outreach at the time of release, and if we build trust with people by showing up when we promised to show up, we find that people are much more willing and able to follow through with a care plan.”—Michelle Conley, director of integrated care for REACH

Until January 2021, jail health staff weren’t alerted when a patient was scheduled for release, making “warm hand-offs” difficult. Then, during the COVID-19 pandemic, a staffing shortage left the jail’s opioid treatment nurses stretched too thin to connect their patients to community-based healthcare providers when they leave jail. Sharon Bogan, a spokeswoman for King County Public Health, which oversees Jail Health Services, says that two of the five positions on the opioid use disorder treatment team are currently vacant, leaving the remaining staffers to handle excessive caseloads. The ideal ratio of health staff to patients in the treatment program, she added, is 1 to 25, meaning that the jail could need to add positions to the treatment team if the number of patients grows.

For now, says Michelle Conley, the director of integrated care for REACH, the jail’s release plans for patients in the opioid use treatment program are often at risk of falling apart from the outset. “There are a lot of providers who can and do receive people from the jail, but there’s often a disconnect in terms of getting someone to treatment,” she said.

“A large part of that,” Conley added, “is because Medicaid does not reimburse the costs of going to the jail picking a patient up and transporting them to housing or medical care.” Conley also noted that after leaving jail, a person may need to reactivate their Medicaid benefits to pay for prescriptions and doctor’s visits—a process that can take days or weeks.

Without a direct hand-off to a care provider, Conley said, people leaving jail may not have an easy way to make it to an appointment at a treatment facility or clinic. “When people lack housing and other basic needs, immediately when they’re released from jail, they often go back into survival mode,” she said. “If we can provide some sort of outreach at the time of release, and if we build trust with people by showing up when we promised to show up, we find that people are much more willing and able to follow through with a care plan.”

For people leaving jail, the medications used to treat opioid use disorder are available both through appointments and through a daytime hotline run by the nonprofit healthcare provider NeighborCare. Dr. Matt Perez, a primary care clinician for NeighborCare, says that the current system is a vast improvement from the recent past. “Up until about 10 years ago, the jails offered no treatment for addiction whatsoever, so people were just going into withdrawal and leaving with nothing,” he said. And while about one-fifth of buprenorphine patients at his clinic—including people leaving the jail—don’t show up for their appointments, Perez says that his ability to coordinate with jail health staff to provide buprenorphine to people after their release is improving.

But while no care providers dispute that giving people in jail access to medications like buprenorphine is better than nothing at all, some addiction treatment specialists say that the current medication-based treatments for opioid addiction offered to people in jail don’t match current trends in drug use. Dr. Cyn Kotarski, the medical director for the Public Defender Association in Seattle, says that the spread of fentanyl as a cheaper and more potent replacement for opioids like heroin has rendered current medication-based treatments ineffective at best and counterproductive at worst.

“It takes time for medical research to catch up to realities on the ground,” she said. “Drug use has changed so significantly in Seattle in the past three to five years—in other words, since we first started offering medication-assisted treatment for opioid use disorder to people in jail—that if we don’t try to rework our approach, we’re going to wind up offering only an obsolete program.”

One key problem, she said, is that standard doses of buprenorphine are substantially less potent than fentanyl, so fentanyl users who suddenly transition to buprenorphine in jail often experience serious and painful withdrawal—a problem that was less pronounced before fentanyl dominated the opioid market. “The vast majority of patients I see say they’re scared to take buprenorphine because of the withdrawal symptoms,” she said. “And as word spreads that switching the buprenorphine makes you sick, that creates a dangerous narrative. If we don’t set up our treatment programs properly, we can end up with a general consensus among people using opioids that buprenorphine is harmful because we’re not using the medication in a way that’s appropriate for fentanyl.”

But changing the dosage of buprenorphine to better match the strength of fentanyl would require experimentation—something that jail health staff can’t do. “Because of the strict controls around drugs to treat opioid use disorder, people are very hesitant to make any changes to dosage unless they get directions from above,” Kotarski said. Continue reading “Barriers to Access, Changing Drug Trends Hinder Jail-Based Treatment Program”

Harrell Says He’ll Implement Key Provisions of “Compassion Seattle” Measure, Clear Encampments

By Erica C. Barnett

At a press conference a few hundred yards from an encampment in Woodland Park on Thursday morning, mayoral candidate Bruce Harrell said that if elected, he would implement the key elements of Charter Amendment 29—the “Compassion Seattle” ballot measure. A King County Superior Court judge tossed the initiative last week, agreeing with opponents that things like budgets and land use policy are outside the scope of local ballot measures, but the campaign appealed to the state court of appeals, whose ruling could come tomorrow.

Harrell’s “Homelessness Action Plan” would require the city to spend 12 percent of its general fund on homelessness, build 2,000 new emergency housing (shelter) beds within one year, create individualized “service plans” for every person experiencing homelessness, and, as Harrell put it, “ensure that our city parks, playgrounds, sports fields, public spaces, sidewalks, and streets remain open and clear of encampments.” These proposals are all identical to provisions of Charter Amendment 29, which Harrell supported.

At Thursday’s event, which was billed as a press conference but resembled a campaign rally, Harrell fielded questions primarily from a large group of supporters rather than the assembled press. “If and when you become mayor, how soon can we as Green Lake citizens expect to see these encampments gone?” one supporter asked. “I will say January or February, because I work with a sense of urgency,” Harrell responded.

“They are not mean-spirited people. They’re simply asking a very fundamental question: Can our parks be safe again? … Can our children play like they once did?”—Bruce Harrell

Another asked how he’d respond to critics who say that his plan would mean sweeping encampments without providing services. “Look at my record,” Harrell responded. “There are no dog whistles. I don’t have a dog whistle. And I say, how dare people say that, when my wife and I’ve been doing this for for 20, 30 years.”

Harrell also reiterated his proposal to create a city-run program that would give people the opportunity to volunteer or give tax-exempt donations to nonprofits working on homelessness, which he also described at a press conference outside an encampment at Bitter Lake in Mune. “Everyone can chip in—it could be clothing, it could be resume assistance, it could be anything that exhibits an effort to help the problem,” he said.

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Harrell said he understood why Green Lake residents are fed up with people living in the park, where the largest concentration of tents and RVs is located in triangle of land bordered roughly by Aurora Ave. and a portion of West Green Lake Way. The city closed the street to traffic as part of the Stay Healthy Streets program during the early months of the pandemic, and some residents blame the closure for the proliferation of tents. “They are not mean-spirited people. They’re simply asking a very fundamental question: Can our parks be safe again? … Can our children play like they once did?”

His plan for removing people from parks, however, remains vague; in response to another supporter’s question about how he would deal with “the majority of the people that are camping here [who] don’t want assistance,” Harrell said he would deal with people “on a case by case basis,” depending on their needs.

“I have the executive authority [as mayor] to direct mental health counselors and housing advocates down here, I have the executive ability to bring down individualized case management experts down here, [and] I have the ability to once again allow traffic and then have a conversation with the community to see what kinds of improvements down here can be made.”

But his promise—which would put the city at cross purposes with the new regional homelessness authority, which is taking over all the city’s contracts for homelessness-related services next year—came with a hard edge. “I just think that there has to be consequences for that kind of action,” Harrell said, referring to people who don’t accept the services or shelter they’re offered, “because many people—and I’m very close to the world of people struggling with drug and alcohol treatment, people that have challenges—many of them are in denial. Many of them do not know what they need. They just do not.” Continue reading “Harrell Says He’ll Implement Key Provisions of “Compassion Seattle” Measure, Clear Encampments”