Category: Drugs

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”

In Reversal, Library Will Allow Staff to Use Narcan on a Voluntary Basis

Diagram showing how to administer Narcan to an overdosing personBy Erica C. Barnett

In a sudden reversal of longstanding policy (and after three years of dogged coverage by PubliCola), the Seattle Public Library announced Wednesday that it will stock its 26 library branches with Narcan (naloxone), a nasal spray that can reverse opiate overdoses. Each branch will get one two-dose kit of Narcan, and the downtown branch will get one for each floor, with a few left over for later distribution, a library spokeswoman told PubliCola.

Library staff who want to administer Narcan if someone overdoses will be able to go through voluntary training in how to administer the drug. Untrained staffers won’t be allowed to give the drug, according to the library’s announcement, meaning that if someone overdoses at a library with no trained staff, “there is no guarantee that a patron who overdoses on Library grounds will receive naloxone.”

This policy contrasts with other Seattle departments. Frontline Seattle parks workers, such as lifeguards, parks concierges, and park rangers, all carry Narcan and can use it without special training. Other library systems also supply Narcan to workers and the public. In Chicago, for example, all library staff are trained to use Narcan and the library distributes kits for free to anyone who wants one.

The library spokeswoman said she could not provide any details about why the department changed its policy. A blog post announcing the change said only that “over the last few months,” the library went through “a careful review process, which included updated guidance on liability from the City Attorney’s Office and an examination of other City departments’ practices.” We have reached out to City Attorney Ann Davison’s office for more information on the change.

In July, as we exclusively reported, a staffer asked if it would be okay for him to carry Narcan at work. At the time, the library said it had been advised by the city attorney’s office that employees who administered the drug would be unprotected by the both state’s Good Samaritan law, which protects people who voluntarily render emergency care, and a separate law protecting Washington residents from liability specifically for administering Narcan. Any library employee who used Narcan to try to reverse an overdose, a union representative told staffers in an email, could be subject to discipline.

A spokeswoman for the library said that the library is “requesting that staff not use their own supply of Narcan while at work during this interim period” before staffers have gone through training. “After staff volunteers are trained, we may revisit that.” The spokeswoman said the library is “in conversations about training with several organizations.”

Previously, the library had varying reasons for not stocking Narcan, which works by restoring breathing in an overdosing person. Back in 2020, a library spokeswoman told PubliCola that putting Narcan in libraries would require bargaining with the library union, for example.

People die of opiate overdoses when they stop breathing, and emergency responders often prefer to perform rescue breathing or provide oxygen to an overdosing person because naloxone can send people into rapid withdrawal, an extremely unpleasant side effect that, in practice, sometimes leads people to refuse additional care. Narcan, however, is extremely simple to administer—you squirt it into one nostril—and can save a person’s life during the period after they stop breathing but before medics arrive.

According to the King County Department of Public Health, there have been at least 42 likely overdoses in or outside public libraries in King County since 2019, including 16 inside library branches. Since 2017, at least eight people have died of drug-related causes at libraries in King County, half of them in Seattle.

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.

Cities Could Lose Out on Opioid Settlement Funds, Non-Police Response Pilot Moves Forward

1. Cities and counties around the state stand to lose more than $500 million in funds for treatment, overdose prevention, diversion, and education on opioid misuse in a settlement between the state attorney general’s office and the three largest opioid distributors earlier this year, if holdout cities fail to sign on to the settlement by this Friday.

The settlement, which resulted from a lawsuit filed by Attorney General Bob Ferguson in 2021, will only be distributed to cities and counties if at least 116 of the 125 eligible jurisdictions, including all 39 Washington counties, sign a form agreeing to participate in the settlement. As of last Friday, 100 jurisdictions had signed on, including all but five counties—Adams, Kitsap, Pierce, Skagit, and Snohomish.

Cities in the Puget Sound region that have not agreed to participate in the settlement yet include Auburn, Burien, Everett, Mercer Island, Renton, and Tacoma. According to a letter the head of the AG’s Complex Litigation Division sent to local officials last week, cities can choose to hand their settlement money over to a regional body for distribution, send it to their county, or spend it themselves according to a list of approved uses.  

A spokesperson for the attorney general’s office did not respond to a request for additional information late last week.

2. The city just moved one step closer to setting up an alternative for some calls that are currently dispatched through the 911 system, when Mayor Bruce Harrell’s office and the city council signed a “term sheet” laying out formal steps toward standing up a comprehensive response system for calls that do not require a police response. These calls could include “person down” calls, wellness checks, and low-priority “administrative calls” that currently go largely unanswered.

Among other longer-term commitments, the agreement—signed by Senior Deputy Mayor Monisha Harrell and Esther Handy, the council’s central staff director—says the city will establish a work group to develop a pilot program by next January that can be implemented in 2023, a year  before Harrell’s office has said they’ll be ready to propose and start implementing a more comprehensive plan to use alternative responders for some non-emergency calls. The term sheet requires the mayor and council to come up with “basic costing information” by October 14 so the council can consider the plan during its fall budget deliberations.

As PubliCola reported in July, the council already passed a supplemental amendment to this year’s budget identifying $1.2 million in funding for a civilian response pilot, using the money from former mayor Jenny Durkan’s since-abandoned “Triage One” proposal. Councilmember Andrew Lewis, a longtime proponent of Eugene, OR’s CAHOOTS alternative-responder model, estimated that it would cost a little under a million dollars to fund a three-person pilot program for one year.

Ban on Narcan Continues Amid Overdoses at Libraries; Harrell’s Pick for SDOT Director Answers Council Questions

1. Last month, we reported on the Seattle Public Library’s directive telling staff not to carry or use Narcan, or naloxone—a nasal spray that can restore breathing in people overdosing on opioids—because of potential liability issues.

The state’s Good Samaritan law exempts people who provide emergency care from civil liability, but a library spokeswoman said City Attorney Ann Davison’s office advised the library that library staffers were “likely” not covered by the law. King County Public Libraries, which operates outside Seattle, also bars staff from using Narcan.

Public libraries are among the only indoor places where people experiencing homelessness can go during the day without being expected to make a purchase or explain why they’re there. They’ve also been the location for dozens of fatal and nonfatal overdoses in recent years. According to data provided by the King County Department of Public Health, there have been at least 42 likely overdoses in or outside public libraries in King County since 2019, including 16 inside library branches. Since 2017, at least eight people have died of drug-related causes at libraries in King County, half of them in Seattle, including at least four involving opiates like heroin and fentanyl.

Bans on using Narcan force library staffers to call 911 and wait for emergency responders to arrive, adding several potentially fatal minutes to the time an overdosing person is unconscious and not receiving oxygen to their brain.

A review of recent fire department reports for overdoses at Seattle Public Library branches shows that it takes emergency responders between three and five minutes to arrive on the scene of an overdose and start administering aid. These reports also show that on at least one occasion, back in April, someone at the downtown Seattle library revived a patron with Narcan, the drug library staffers were formally barred from using just three months later.

The ban on using Narcan is based on the belief that library staffers, unlike other Washington state residents, are not protected under the state’s Good Samaritan laws when they administer aid. By that standard, library staffers shouldn’t be able to offer first aid to patrons experiencing minor medical emergencies, or attempt to assist people experiencing heat stroke when they come to the library to cool off in the summer. And yet they manage to do both. Why are overdoses categorically different?

2. Greg Spotts, Mayor Bruce Harrell’s nominee to lead the Seattle Department of Transportation, submitted detailed answers this week to a list of questions from the city council’s transportation committee about his goals for his first year, plan to get Vision Zero back on track, and ideas about how to create a more equitable transportation system. Spotts’ responses t check off a lot of boxes for people who support urbanism and alternatives to driving alone.

For example, in response to a question about creating “connected safe spaces for people to move throughout the city” without a car, Spotts noted that in many cases, “pressure to preserve just a few curbside parking spaces stands in the way of conveying cyclists safely across a busy intersection. Too many of our bike and pedestrian routes have discontinuities that render the route significantly less safe, useful and attractive than it could have been.” In 2019, former mayor Jenny Durkan killed plans to build a protected bike lane along a dangerous stretch of 35th Ave. NE after neighborhood and business groups argued that removing a few curbside parking spaces would devastate businesses in Wedgwood and Ravenna.

However, Spotts also hedged a bit when talking about commitments to new bike infrastructure, responding to a question about whether he would support creating new protected bike lanes as part of road resurfacing projects with an artful dodge. “I fully intend to support projects and routes as called for in the Council-approved Bicycle Master Plan; and will be engaging with staff, subject matter experts, and community as these projects are developed and constructed,” he wrote. As the Urbanist has reported, the city is currently working to integrate all its transportation related “master plans” into a single mega-plan, a move that some advocates worry could further reduce the city’s commitments to nonmotorized transportation.

He also ducked questions about whether parking enforcement officers belong at SDOT and if he would commit to removing the large concrete “eco-blocks” that business owners place illegally in the public right-of-way to keep people living in oversize vehicles from having a place to park. (Councilmember Sara Nelson, whose own business, Fremont Brewing, continues to flagrantly violate this law, is not on the transportation committee).

 

Previous SDOT directors learned the hard way that specific commitments can be tough to implement if they conflict with what their boss, the mayor, wants—which is probably why, when asked about equity in transportation investments, Spotts said only that Seattle’s most deadly streets for cyclists and pedestrians, Rainier Ave. S and Aurora Ave. N., “can potentially be reenvisioned to meet community needs.” Harrell has made it clear that his top transportation priorities include maintaining and repairing basic infrastructure like streets and bridges, not big-reach projects like protected bike paths connecting every part of the city.

Seattle will hear more from Spotts next month, when the transportation committee considers his nomination again after the council returns from summer recess.

Council Committee Passes Pared-Down Package of Cannabis Social Equity Bills

Black Seattleites have been disproportionately prosecuted for cannabis-related offenses, including in recent years.

By Erica C. Barnett

On Tuesday, the city council’s finance committee approved several pieces of legislation from Mayor Bruce Harrell aimed at improving access to the cannabis industry for Black Seattle residents and other people “disproportionately harmed by the federal War on Drugs,” including “social equity licenses” intended to reduce barriers to entry for people historically excluded from the legal pot industry, which is overwhelmingly dominated by white men.

The new licenses would go to businesses with owners who have lived in “disproportionately impacted” areas or who have been previously convicted, or have family members who were convicted, of a drug-related crime.

The city can’t create new state cannabis licenses, which are distributed (and limited) by the state Liquor and Cannabis Board, but they can set standards and fees for cannabis businesses operating in the city. The new local licenses would work in tandem with forthcoming LCB rules that will give priority to cannabis license applicants who have been convicted of cannabis-related crimes in the past; Seattle is expected to gain two new cannabis licenses after the LCB issues its decision.

The council also passed legislation that would require new licensees who buy existing cannabis businesses to retain existing workers for at least 90 days and to preferentially hire former employees for at least six months.

The biggest debate on Tuesday involved several amendments to a third bill that, among other intention-setting provisions, mandates a future “cannabis needs assessment” to “provide demographic information about workers currently employed in Seattle’s cannabis industry; determine the highest training needs of those workers wishing to advance in the cannabis industry and become owners; and include recommendations about whether and how to fund such training,” according to a memo from council central staff.

The legislation also proposes an advisory committee made up of “workers, industry members, and community members impacted by the federal War on Drugs” to review that assessment and recommend future policies to the council.

Initially, Mosqueda named UFCW’s training program in an amendment describing “the type of organization that should conduct the Cannabis Needs Assessment,” but a later version of that amendment, which passed Wednesday over opposition from Nelson and Pedersen, said the assessment should be conducted by an unspecified nonprofit “with expertise in the roles and functions of jobs within the cannabis industry.”

Councilmembers Alex Pedersen and Sara Nelson voted against the bill, arguing that it was designed to hand the contract for the needs assessment to the United Food and Commercial Workers 3000 (formerly Local 21) which has lobbied the council heavily on this issue.  “I’m asking for an honest and transparent needs assessment to be conducted, not one that stacks the deck for a particular interest [group],” Nelson said.

Initially, Mosqueda named UFCW’s training program in an amendment describing “the type of organization that should conduct the Cannabis Needs Assessment,” but a later version of that amendment, which passed Wednesday over opposition from Nelson and Pedersen, said the assessment should be conducted by an unspecified nonprofit “with expertise in the roles and functions of jobs within the cannabis industry.” The needs assessment and the work of the task force could lead to future proposals, such as training requirements for workers in cannabis sales, production, and processing jobs.

Originally, UFCW suggested a new “cannabis equity tax” that the union estimated would raise $5 million a year, primarily for “workforce development and training.” Earlier this year, a representative from UFCW told PubliCola that they hoped to win the contract to do this training work, which would include medical training for budtenders who are “operating as de facto pharmacists.”

The UFCW-backed proposal, which Mosqueda’s committee discussed extensively earlier this year, would have been more prescriptive about hiring, requiring all cannabis businesses to make a “good-faith effort” to ensure that half their workers currently lived in distressed ZIP codes and requiring that at least 10 percent of employees at each business had a past cannabis-related arrest or conviction, or have an immediate family member who met that criteria. That plan was never part of a formal proposal, but it did inform the ongoing debate about what the city should do to promote equity in cannabis.

Although the suite of bills from Harrell’s office represented a dramatic step-down from those proposals, representatives from the existing cannabis industry expressed concerns in a letter to committee members last week. Among them: What happens if a company that processes cannabis into one kind of product sells its license to a different kind of processor, but has to retain all its employees for six months under the new law? “Regulation that impacts hiring must respect the individual who is needed and qualified for a job, and not a one-size-fits-all approach,” the Washington Cannabusiness Association wrote.

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”

How Seattle’s Crackdown on Crime Ensnared a Homeless Man and Made His Struggle With Addiction Worse

Photo of downtown Seattle Target exterior
The downtown Seattle Target where, according to police and prosecutors, a homeless man stole dozens of bottles of liquor in less than a month, resulting in a felony charge for “organized retail theft”

By Erica C. Barnett

Here’s how charging documents describe Trey Alexander, a 40-something Black man who was recently charged with organized retail crime for stealing liquor from a Target store in downtown Seattle: A “career criminal” and “chronic shoplifter” whose offenses over the past 15 years have included theft, drug possession, and criminal trespass. (Trey Alexander isn’t his real name; we’re calling him that to protect his anonymity.)

In a statement seeking felony charges against Alexander in March, SPD officer Zsolt Dornay wrote that Alexander had stolen “at least $2,398 worth of alcohol” over several weeks in late 2020 and early 2021. Previous efforts to rehabilitate Alexander had been unsuccessful, Dornay wrote: While under the supervision of the state Department Corrections (DOC), Alexander “failed to comply with [mandatory conditions] on at least twenty-two (22) occasions.” Before moving to Seattle in the mid-2000s, Alexander had “done two prison stretches” in another state—emphasis in the original.

Most of this is a matter of public record, taken from a report Dornay wrote for the court in March. (If you recognize Dornay’s name, it might be because he has a history of violent and unprofessional behavior, including one case that led to a civil rights lawsuit and a payout of $160,000). And  there’s a lot that Dornay’s narrative leaves out—details that contradict the picture of a remorseless criminal.

For instance: Nearly  every time he was arrested, Alexander gave the address of a homeless shelter as his home address—usually 77 South Washington, the Compass Center shelter in Pioneer Square. In reality, he lived in a tent. With no job, prospects, or ties to a supportive community, he drank heavily and didn’t have a lot of reasons to stop; when he “failed to comply” with program requirements, what that meant is that he continued to drink in spite of the consequences, which is a fundamental part of the definition of addiction. In the months before and after the prosecutor filed charges against him, the city had swept his encampment at least four times—most recently in April, when they threw away the cell phone that connected him to his case manager, whose job includes making sure he shows up in court. 

“They throw people away.”—Brandie Flood, director of community justice, REACH

Even with all these challenges, Alexander was making progress. In mid-2021, a few months after his final arrest, he enrolled in the LEAD program, which provides case management and helps clients navigate the criminal legal system. Since then, he has not reoffended, and he finally got approved for housing earlier this year. But he also failed to show up for his arraignment in drug court, twice; now, he’s facing a warrant and the potential of five years in prison, plus a fine of up to $10,000.

“You’re trying to be functional, and you’re doing well, and then this comes up… and you’re not getting any credit for the progress you’ve made,” said Brandie Flood, the director of community justice at REACH, which provides case management for LEAD clients like Alexander. “It’s a real setback.”

In recent months, Seattle and King County officials, including City Attorney Ann Davison and Mayor Bruce Harrell, have promised to crack down on “prolific offenders” who they argue are contributing a sense of danger and “disorder” in downtown Seattle. Elected officials, pollsters, and news media often conflate these crimes with homelessness, implying that homeless people are inherently dangerous or that arresting people for shoplifting and street level-drug sales will reduce visible homelessness in Seattle’s parks and streets. In March, Harrell announced “Operation New Day,” a series of emphasis patrols focused on criminal activity at Third and Pine downtown and at 12th and Jackson in the International District. Days later, Davison announced she would pursue harsher punishments for people, like Alexander, who have been arrested repeatedly for low-level crimes.

Alexander isn’t on Davison’s official “high utilizers” list, which includes people who have been accused of 12 or more misdemeanors in the past five years. (Prior to his two felony charges, Alexander was accused of 10 misdemeanors in the past five years). But his offenses fall under another category city and county officials have also vowed to target: Organized retail theft. The name is a misnomer. Although it implies crime rings trafficking in stolen goods, “organized retail theft” also includes lone individuals, like Alexander, who steal items worth a total of $750 or more over a period of six months. A single theft of a high-ticket item can be charged as “organized retail theft”; so can stealing dozens of bottles over a several weeks.

Ordinarily, shoplifting is handled by the Seattle Municipal Court, which has the option of moving cases to community court, a therapeutic option that provides access to services without requiring defendants to admit to a crime. (Davison got the court to make this option unavailable to those on her “high utilizers” list earlier this month, and advocates anticipate this will be just one of multiple steps to exclude certain offenders from less-punitive options.) Once a case is elevated to a felony, it goes across the street to the King County Courthouse, where the primary alternative to “mainstream” prosecution is drug court—a program that requires participants to get sober, attend treatment and recovery meetings, submit to frequent drug tests, and pay restitution, all while staying out of trouble for the duration of the program, which lasts a minimum of 10 months.

Despite his “failure to comply” with similar programs 22 times in the past, the prosecuting attorney’s office referred Alexander to drug court. Anita Khandelwal, the director of the King County Department of Public Defense, says drug court works well for people with deep community ties, an outside support system, and stable housing; it is designed to fail people who are homeless, still drinking or using heavily, and don’t have a supportive community to help them stay sober.

“In criminal court, it’s likely he’ll walk away with a conviction, incarceration, and another record of failing a court-based program,” Khandelwal said. “What we’re doing with this individual is more of the stuff that has already not worked for him.”

Leesa Manion, the chief of staff to King County Prosecutor Dan Satterberg and a candidate for the position, argues that drug court “was designed precisely for individuals like [Alexander]—people who need help, people who are acting out because of this substance use disorder and need structure to be successful. I don’t think we should judge Mr. [Alexander] because he has not been successful in the past.” Manion said that, if elected, she would continue to send cases like Alexander’s to drug court.

” In criminal court, it’s likely he’ll walk away with a conviction, incarceration, and another record of failing a court-based program. What we’re doing with this individual is more of the stuff that has already not worked for him.”—King County Department of Public Defense director Anita Khandelwal

While waiting for Alexander to show up for his first arraignment date last month, I watched dozens of drug court participants face King County Superior Court Judge Mary Roberts, whose tough-love approach combined supportive comments about defendants’ progress with admonishments (and, in one case, jail time) to those who weren’t meeting the conditions outlined in the drug court handbook. “I’m glad that you’re taking responsibility for your actions,”  Roberts told a man who was caught taking cough syrup that contained alcohol, but added, “You knew what the consequences would be.” Continue reading “How Seattle’s Crackdown on Crime Ensnared a Homeless Man and Made His Struggle With Addiction Worse”

Seattle Shuffles Scooter Share Deck, Library Invests in Social Services, Campaign Forms to Fight Potential Cannabis Tax

1. Bird, a scooter provider that’s already ubiquitous in cities across the country, will soon enter the Seattle market, while Spin and the venture-backed sit-down scooter company Wheels will no longer be seen on Seattle streets. In addition to Bird, Link and Lime will continue as scooter providers in Seattle.

The Seattle Department of Transportation announced the scooter shuffle on its website last week, just weeks after publishing the results of a controversial, nonscientific survey concluding that more scooter riders are injured while riding than previously reported.

The city will also permanently permit a new bikesharing company, Veo, whose low-slung bikes have vestigial pedals but function more like a sit-down scooter, with a throttle that allows riders to propel them while using the pedals as footrests.

Seattle’s relationship with scooters (and bikesharing) has long been ambivalent. In 2020, two and a half years after banning scooters entirely, the city took a baby step forward by issuing permits to three companies for 500 scooters each. Since then, the city has expanded its scooter permits to allow each of three providers to put 2,000 scooters on the streets; Lime, which provides both e-assist bikes and scooters, has a fourth permit for a total of 2,000 bikes and scooters.

According to SDOT’s scoring matrix, Spin narrowly lost out to Bird, Link, and Lime after scoring slightly lower on two measures: Parking (which includes policies the company implemented to make sure people parked correctly and how it responded to improperly parked scooters) and “operations and equity,” which included a number of factors such as how the company responds to complaints and its efforts to place scooters in “equity areas” outside the center city, including southeast and far north Seattle.

According to the city’s scooter data dashboard, Wheels scored particularly poorly compared to other companies, including Spin, at providing equitable access to its scooters.

Veo, which operates like a scooter but is classified as a bicycle, poses what SDOT spokesman Ethan Bergerson calls “interesting questions” for the city. Unlike traditional scooters, Veo devices are legal on sidewalks; because they aren’t classified as scooters, they also occupy one of just three potential bikeshare permits, which could limit the number of shared e-bikes allowed on city streets in the future, if other companies decide they want to enter the Seattle market.

“The bike/scooter share landscape is very dynamic and has shifted considerably since the bike share program began in 2017,” Bergerson said, and now includes “more companies offering devices which combine some of the features of bikes and some of the features of scooters. … If this market trend continues, it may make sense to consider how to adjust our permits to reflect the changing technology and industry trends.”

2. The Seattle Public Library is ending its contract with the Downtown Emergency Service Center, which for more than five years has provided a part-time “community resource specialist” to connect patrons to food, social services, and shelter, and hiring its own social service specialists.

The new hires include an assistant managing librarian at the downtown branch to oversee the work; a new social services librarian who will “work with information staff to maintain current information and contacts, coordinate the Bus Ticket program, and act as a link between our regular information services and our Community Resource Specialists,” according to library spokeswoman Elisa Murray; and two new in-house community resource specialists, including one who will focus on outreach to youth and young people.

“While this new model doesn’t necessarily provide patrons more time with on-site staff, we do think we can maintain more partnerships with this model, which we hope will lead to increased opportunities for patrons to access the supportive services they need,” Murray said.

For years, libraries (including Seattle’s) have debated whether, and to what extent, library staffers should be responsible for connecting patrons not just to library materials, but to social services and resources outside the library’s direct control. By hiring staff to oversee some of this work, SPL is making a more direct investment in the the theory that libraries can and should do both.

3. A new independent expenditure group representing marijuana retailers, called People for Legal Cannabis, just filed with the Seattle Ethics and Elections Commission, reporting $16,000 in debt to the polling firm EMC Research. The group’s intent: To fight off potential legislation, first reported by David Hyde at KUOW, that would impose an additional sales tax on weed sales in Seattle. If the legislation, currently being floated by the United Food and Commercial Workers Local 3000, passes, the group could propose a referendum to overturn the law.

According to a presentation first posted on KUOW, which PubliCola obtained independently, the UFCW’s still-nascent proposal would impose a “cannabis equity tax” of 25 cents a gram on flower; $2.00 per half-gram of high-potency concentrates; and a penny per milligram of THC in everything else. The money would fund a paid “cannabis equity commission”; “workforce training” for cannabis workers; and a “cannabis equity fund” that would “prioritize the needs of those most impacted by the War on Drugs,” which locked up millions of Black and brown Americans for possessing and consuming weed. Continue reading “Seattle Shuffles Scooter Share Deck, Library Invests in Social Services, Campaign Forms to Fight Potential Cannabis Tax”

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”