By Erica C. Barnett
City Councilmember Sara Nelson, a vocal advocate for abstinence-based treatment for addiction, argued publicly yesterday with advocates for harm reduction over their approach, which emphasizes keeping people who use drugs alive and helping them address underlying conditions, such as homelessness and health care issues, without judgment or pressure to quit using drugs. Why, Nelson wanted to know, were these organizations focused on reducing harm from drug user rather than “encouraging” them to understand that total abstinence should be their goal?
“What [is] Public Health… doing to move beyond the harm reduction phase and how much money, if any, do you spend on agencies or for treatment that is geared toward abstinence?” Nelson asked. “And as a corollary of that, I guess the more basic question is, does Public Health agree that it has a responsibility to change behavior beyond meeting people where they’re at? Do you feel as thought’s important to help people change their use patterns in ways that they can go into abstinence-based recovery?”
Nelson’s (rhetorical?) questions came during a presentation by three longtime service providers—REACH, the People’s Harm Reduction Alliance, and the Hepatitis Education Project, along with King County Public Health—about how they have used funding from a small grant aimed specifically at reducing harm related to drug use. For years, the city council has also allocated funds for this purpose but the mayor’s office has refused to spend it.
“We’ve got ‘meeting people where they’re at’ covered, I think, when we’re looking at the treatment services that are provided right now,” Nelson said.
The county, strategic advisor and drug policy specialist Brad Finegood assured Nelson, spends “hundreds of millions of dollars” on abstinence-only services; the point of also funding harm reduction, he said, is to “keep people alive” and give them entry points for services amid an overdose epidemic that claimed more than 700 lives in King County last year. Those services, the direct service providers explained, include handing out the overdose prevention drug naloxone, connecting people to health care, offering medication-assisted treatment, and handing out supplies for safer use, including pipes for smoking drugs rather than injecting them.
Nelson (like many local right-wing commentators) zeroed in on safe smoking supplies, suggesting that providers should measure their success by tracking how many people who take pipes end up in treatment.
“I know it can be controversial,” Hepatitis Education Project program director Amber Tejada responded, but “one of the keys that I see is we want to facilitate the autonomy of people that use drugs. There are folks that don’t want to stop using drugs. There are folks for whom abstinence is not how they measure success in life. … Our mission, what we have been able to do really successfully with this program, is to show that people can use drugs safely, and we can help folks get access to resources if that is something they are interested in.”
Last week, Nelson joined her colleague Alex Pedersen and City Attorney Ann Davison to propose new legislation that would enable the city attorney, rather than the King County Prosecutor, to begin prosecuting people for simple drug possession and public drug use. In 2018, King County Prosecutor Dan Satterburg stopped pursuing charges against people for possession of small amounts of drugs while expanding programs like LEAD that work to provide case management and service connections to people who use drugs.
The legislation, if adopted, would represent a profound change to the city’s approach to drug use and a return to war-on-drugs policies that the region has largely abandoned in favor of more compassionate and evidence-based approaches.
Last year, Nelson inserted language into the 2023-2024 budget to fund “facilities” for abstinence-based residential or intensive outpatient treatment using the city’s portion of a state settlement with opioid manufacturers. However, the language of Nelson’s statement of legislative intent leaves wiggle room for other evidence-based types of treatment, such as medication-assisted treatment or contingency management, as a presentation from council central staff at yesterday’s meeting also made clear.
Yesterday, Nelson expressed her frustration that the “private provider community,” which has “more availability for people who have insurance or can pay out-of-pocket,” has not been directly involved in the group that will make recommendations on what kind of treatment to fund with the money she proposed setting aside.
The point of her budget amendment, Nelson said, was “to establish a pilot program that would allow the city to directly contract with treatment facilities, private or public, in order to [help] people who are at the phase of really wanting to go into rehab, get into rehab, especially if they don’t have medication” as an option, as opioid users do.
“We’ve got ‘meeting people where they’re at’ covered, I think, when we’re looking at the treatment services that are provided right now,” Nelson said.