Tag: contingency management

Addiction, Drugs, Economy, Mayor Harrell

Harrell Proposes Investing in Evidence-Based Approaches to Addiction as Part of Downtown Revitalization Plan

 

Mayor Bruce Harrell and City Councilmember Sara Nelson

By Erica C. Barnett

Mayor Bruce Harrell issued an executive order Monday expanding Health One to include a new overdose response unit aimed at getting people into treatment, directing the Seattle Police Department to “prioritize enforcing [illegal drug] sales and distribution related crimes to the fullest extent permissible,” and committing the city to “site, explore funding for, and work with the University of Washington Addictions, Drug and Alcohol Institute (UW ADAI), and County partners to establish a post overdose diversion facility where EMS can bring people after non-fatal overdoses to recover, get stabilized on medications, and access resources.”

Currently, when medics revive someone who has overdosed, the person can either agree to go to the hospital, where they’ll get information about treatment, or decline; a post-overdose facility would provide another route for people who would ordinarily decline additional care.

“What’s going to happen now is that [in addition to Fire Department medics], Health One is also going to respond” to overdoses, Seattle Fire Chief Harold Scoggins said at an event announcing the order in Pioneer Square Monday afternoon. “Health One comes with case managers and firefighters who are trained [to] talk to folks and really explain the resources that are available to them. After the fire units leave, the police units leave, Health One will still be on the scene.”

The order also endorses an evidence-based harm reduction strategy called contingency management, which involves providing incentives, such as low-dollar gift certificates, to drug or alcohol users who enroll in treatment and stay clean.

Harrell didn’t have many details about the plan to open a post-overdose response site, such as how it would be funded, who would staff it, or—importantly—why people who overdosed and refused to go to Harborview would be willing to go to a different facility. “Full disclosure: How it’s staffed, how we fund it—that’s the work we’re trying to do now, because in looking at the numbers of fatalities and overdoses, we realize that’s sort of a gap in our treatment scenario,” Harrell said.

The order also endorses an evidence-based harm reduction strategy called contingency management, which involves providing incentives, such as low-dollar gift certificates, to drug or alcohol users who enroll in treatment and stay clean. Contingency management has been especially effective at reducing stimulant use, for which—unlike opiates—there is no drug-based treatment. “We will do what makes sense to get people in treatment,” Harrell said.

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City Councilmember Sara Nelson, who is in recovery and has previously expressed opposition to harm reduction approaches like medication-assisted treatment, called  contingency management a “proven method…  that rewards people who want to stay sober, and get on the path to long term recovery, no matter what their addiction.” After the press conference, she told PubliCola the program already has a funding source: Seattle’s share of a statewide fund that resulted from a settlement in the state’s lawsuit against the three largest opiate distributors.

The executive order also commits the city to “convene a workgroup to map out the various local, county and state programs and services available to treat and respond to the opioid and synthetic drug crisis.”

“This time-limited workgroup will be tasked with identifying gaps in our current systems and making recommendations on how to better coordinate a treatment-first approach to reducing substance abuse disorders and overdose rates. The workgroup will also assess ongoing investments and programs to determine what is working well and how existing investments could be expanded to serve more people.”

As a separate part of the downtown plan, the head of the city’s Office of Economic Development, Markham McIntyre, announced that the city will reopen City Hall Park next to the downtown King County Courthouse, which has been closed and fenced off since 2021 (more “jumbo chess boards”); open up streets to pedestrians  more often for special events, including, “perhaps, on-street pickleball tournaments”; and ask the Washington Liquor and Cannabis Board for “sip and stroll” liquor permits that would allow people to walk around with drinks during events like First Thursday art walks.

Addiction, City Council, legislature, Morning Fizz, Transportation

State Could Eliminate Jaywalking Law; Right-Wing Group Attacks Seattle Council for Addiction Program They Had Nothing to Do With

1. If you’ve ever lived outside the Pacific Northwest, or spent time in virtually any big city elsewhere, you may wonder why the state of Washington still has, and enforces, laws against “jaywalking”—the practice of crossing the street midblock or while the light is green but the road is clear. (“Jay-walking” is an antique slur for a rube who doesn’t know enough to keep out of the road). Crossing the street in an area other than an intersection or against a signal can set you back $68, and you’re far more likely to be targeted if you’re Black; according to a 2017 analysis, more than a quarter of jaywalking tickets issued between 2010 and 2016 went to Black pedestrians, even though just 7 percent of Seattle residents are Black.

This year, legislators plan to propose a bill that would eliminate the specific law against jaywalking—or “crossing not at a crosswalk,” as the state’s 57-year-old jaywalking law describes it—which would make it legal to cross the street as long as it’s safe to do so. During a recent Transportation Choices Coalition-sponsored forum, state Sens. Javier Valdez (D-46) and Marko Liias (D-21), the head of the Senate Transportation Committee, noted that legislators laid the groundwork for getting rid of the jaywalking ban by specifying that pedestrians, like drivers, must exercise “due care” when using roads and sidewalks.

Now, Liias said,  “I don’t think we need a specific violation for jaywalking, because if law enforcement sees someone that’s violating that duty of care, just like if they see any other user [doing so], they already have tools to hold that person accountable. When you look at the history of how these laws were used, it’s clear that there’s been disproportionate enforcement against low-income and BIPOC communities.” Basically, Valdez added, the change would give people the ability to use common sense when crossing the street without risking an automatic penalty. In areas where stoplights are far apart, the rational choice is often to cross midblock rather than walking a quarter-mile or more each way just to get to the other side of the road.

TCC, along with Commute Seattle, the King County Department of Public Defense, and other groups have started a coalition called Free to Walk Washington to support the elimination of jaywalking laws, which would follow similar changes in California, Virginia, Nevada, and Kansas City, MO.

2. Change Washington, a “strategic communications organization” funded by the right-wing organization Project 42, often makes and promotes some pretty outrageous claims about the city of Seattle on its website, which includes cross-posts from Project 42-funded ventures like the podcast of a well-known former local FOX reporter. Last week, though, they got the attention of a Seattle City Council member with a post that not only mischaracterized a well-established addiction management technique called contingency management, but accused the whole city council of proposing a “giveaway to drug addicts”—a claim without even a passing connection to reality. (The post uses the sneering slur “addict” no fewer than seven times.)

Contingency management is a method of helping a person reduce their drug consumption by offering them small rewards, such as money, a gift card, or a small prize, for a negative drug test. In numerous studies, contingency management has been found to be one of the most effective methods for reducing or eliminating drug use, particularly among people whose main drug of choice is stimulants, for which there are no broadly effective medications. There is longstanding, research-backed scientific consensus that contingency management works. Even so, the city council has never proposed funding it.

“The budget that City Council passed last month does not include funding for a contingency management program,” Herbold wrote Change Washington in an email. “I am unaware of any City Councilmember that has a proposal for a contingency management program,” she added, since the city doesn’t fund public health care programs—the county does. King County’s DCHS Behavioral Health and Recovery Division got approval last year to fund a contingency management pilot project.

After mischaracterizing contingency management as a frivolous “giveaway to addicts” that will just give them money to buy drugs and mocking its proponents for supposedly thinking “gift cards cure mental illness,” the conservative group also trashed needle exchanges, which prevent the spread of diseases like HIV and hepatitis, and said a better solution would be to force addicted people into (presumably locked) mental health facilities where they could be “monitored” to make sure they changed their ways. The post ends with a warning to council members about next year’s elections. But it looks like the election disinformation has already started.