Tag: fentanyl

Addiction, Drugs, Health, homelessness

Planned Overdose Recovery Center Will be Run by DESC, Located on Third Avenue
Photo of DESC's Morrison Hotel building on Third Avenue in downtown Seattle, with people hanging around on the sidewalk outside.
DESC’s Morrison Hotel building on Third Avenue in downtown Seattle

By Erica C. Barnett

The Downtown Emergency Service Center, which operates shelters, housing, and mobile crisis response teams, will operate a new opiate overdose response center, serving up to 20 people a day, inside its Morrison Hotel building on Third Avenue in downtown Seattle. DESC director Daniel Malone says the new facility will share the second floor of the Morrison, which housed the agency’s congregate shelter prior to COVID, with an expansion of DESC’s existing outpatient behavioral health clinic and serve people looking for services and a place to physically recover immediately after an overdose.

Currently, if someone overdoses in Seattle and emergency medical services (EMS) responds, they generally face two options: Go to the hospital in an ambulance, or walk away. A post-overdose stabilization site would create a third option where people could rest, receive IV fluids or medication to get them through the early stages of withdrawal, and initiate treatment for opioid use disorder. Patients could also access DESC’s outpatient behavioral health clinic, which connects patients with psychiatric care, counseling, and case management.

Methadone—an opiate that effectively replaces more harmful drugs like heroin and fentanyl, allowing people to resume normal lives—remains one of the most highly regulated drugs in the nation; patients typically have to show up in a physical location to take a single dose at a specific time every day, although lawmakers temporarily loosened those restrictions during COVID. Buprenorphine, which works by partially occupying the brain’s opiate receptors, is more widely accessible, and a new injectable form of the drug, trademarked Sublocade, lasts a month.

“It’s extremely important to us to make sure that we won’t have that kind of chaotic and disruptive activity happening on the sidewalk in front of the building, and part of our plan is to really enhance our capacity to have a much stronger presence to help ensure that the environment is calm and conducive to people coming and going safely.”—DESC Director Daniel Malone

“Methadone introduces a set of additional regulatory complications that the other medicines don’t have, but methadone would be an important tool in the toolbox,” Malone said.

Between January and July of this year, according to data from the King County Department of Public Health, emergency medical services responded to 2,546 nonfatal overdoses in Seattle, out of 4,918 countywide. Both fatal and nonfatal overdoses have increased steadily over the past five years, as fentanyl—a powerful opioid first developed as a pain medication in the 1960s—has worked its way into the street drug supply.

Funding for the new facility would come from the city of Seattle, King County, private grants, and the University of Washington’s Addictions, Drug & Alcohol Institute (ADAI). In July, the King County Council approved spending $2 million in unspent CLFR (federal COVID) funds to help renovate the second floor of the Morrison to accommodate the expanded outpatient center and the opiate recovery site.

The city of Seattle is expected to provide another $2 million for construction, out of $7 million in unspent federal funding that Mayor Bruce Harrell announced as part of his plan to “invest $27 million toward facilities, treatments, and services to address the opioid crisis.” As we’ve reported, the $27 million is actually $7 million in unspent federal grants for capital projects, plus a little over $1 million a year from state settlements with opiate manufacturers and distributors. That million dollars could could help fund the day-to-day operations of the new overdose recovery site over the next two decades, but it won’t be enough to keep the new site open full-time, Malone said.

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“If there’s not enough money to [operate] 24/7, then some version where it’s only open certain hours may have to be implemented,” Malone said. Overdoses happen at all hours, so having only a part-time facility “would seriously limit the ability of this facility to meet all the community’s needs over the course of the day.”

Harrell expressed support for a post-overdose recovery center back in April, when he signed an executive order expressing the city’s commitment to site and “explore funding for” a new facility “where EMS can bring people after non-fatal overdoses to recover, get stabilized on medications, and access resources.” However, his office would not comment on the plan to open the site on Third Avenue, and would not confirm that DESC was the intended recipient of the funds Harrell announced last month. “There is [a request for proposals], and no decisions have been made,” Harrell spokesman Jamie Housen said. “It is a competitive process, and we expect DESC will apply.”

King County just approved spending $2.2 million in unspent federal COVID relief dollars to help renovate the site, which used to house DESC’s congregate shelter, last month.

Map of Morrison Hotel and DESC’s current behavioral health drop-in center

The Morrison Hotel, which also includes 190 permanent supportive housing units, is located directly across from the King County Courthouse. The sidewalk around the building’s Third Avenue entrance is often occupied by people who are unhoused, have untreated behavioral health conditions, or are actively using and selling drugs, making the building a target of frequent complaints and a perennial subject for conservative local media such as KOMO News, which infamously blamed DESC for crime on Third Ave. in its followup to the agitprop film “Seattle Is Dying.”

In addition to funds for the overdose site itself, King County approved $200,000 for a “client engagement team” that will “manage client presence and prevent conflicts on Third Avenue in front of DESC’s renovated facility,” according to a King County Council memo.

“It’s extremely important to us to make sure that we won’t have that kind of chaotic and disruptive activity happening on the sidewalk in front of the building, and part of our plan is to really enhance our capacity to have a much stronger presence to help ensure that the environment is calm and conducive to people coming and going safely,” Malone said. The new staff will “be present not just inside, but in the immediate external sidewalk area… to connect with people who are out there and deal with anything that may be happening that is contributing to an undesirable environment.”

Judges and other courthouse officials have complained for years about safety issues around the courthouse, which also borders City Hall Park—a compact greenspace that recently reopened after a lengthy closure. King County Superior Court Judge Patrick Oishi, who has repeatedly raised alarms about the safety of jurors and courthouse staff, told PubliCola he hopes the opioid recovery center will have a positive impact on the street scene around the courthouse.

“Although it is difficult to predict what impact an opioid recovery center will have on the courthouse area, the Court commends Mayor Harrell, the City of Seattle, and King County for taking critical steps to address this significant public health crisis,” Oishi said. “It is our hope that responding to the opioid crisis will enhance public safety in the courthouse area.”

Addiction, City Council, Crime, Drugs, Mayor Harrell

Council Declines to Fast-Track Law Empowering City Attorney To Prosecute Drug Users

By Erica C. Barnett

The Seattle City Council narrowly rejected Councilmember Andrew Lewis’ proposal to fast-track a bill empowering City Attorney Ann Davison to prosecute people for drug possession and public use, voting to allow the bill to go through the regular committee process. The impact of the vote is that the council will take up the bill after they return from the regular August recess, allowing council staff the time to draft amendments and analyze the latest version of the legislation.

Councilmembers Sara Nelson and Alex Pedersen introduced the first version of the drug criminalization bill last April, after the state adopted legislation making drug possession and public drug use a gross misdemeanor. Initially, Lewis voted against the legislation, citing Davison’s unilateral decision to abandon Seattle Community Court, but he has since become one of the bill’s most vocal advocates, arguing that the work of Mayor Bruce Harrell’s fentanyl task force will produce policy and legal alternatives to the traditional arrest-and-prosecution system.

While the bill says diversion and other options are the “preferred” alternatives to arrest, it does not require diversion or lay out the kind of circumstances in which diversion would be appropriate. Instead, it directs SPD to develop “guidance on diversion” as part of policies that will “state that diversion and referral to services is the preferred response to possession and public use while acknowledging that arrests are warranted in some situations.”

The latest version of the bill includes 13 additional “whereas” clauses, along with eight new findings about the state of the drug crisis in Seattle. It also adds a new section to the Seattle Municipal Code stating that, in the future, police will adopt policies governing arrests for drug possession and public drug use, and that those policies will state that alternatives like diversion and treatment “are the preferred approach” when police make arrests under the new law.

At a committee meeting to discuss the drug criminalization bill Monday afternoon, council members discussed several issues with the legislation that PubliCola pointed out two weeks ago.

First, while the bill says diversion and other options are the “preferred” alternatives to arrest, it does not require diversion, provide funding for alternatives to arrest, or provide examples of circumstances in which diversion would be appropriate. Instead, it directs SPD to develop “guidance on diversion” as part of policies that will “state that diversion and referral to services is the preferred response to possession and public use while acknowledging that arrests are warranted in some situations.”

Beyond this, the ordinance delegates to individual officers the authority to decide whether a person poses a threat, based on “the totality of the circumstances and the officer’s training and experience,” which is essentially the current system, augmented by some new training on what constitutes a drug-specific threat.

“The standard mirrors the practical thought process that officers ordinarily apply in the field when deciding whether to make an arrest, and it allows for it encourages officers to exercise discretion,” mayoral advisor Andrew Myerberg told the council. If a person is only a “threat to self,” the bill says officers should “make a reasonable attempt to contact and coordinate efforts for diversion, outreach, and other alternatives,” but leaves that decision, too, up to individual officers.

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“The fundamental goal of this ordinance and executives overall approach to the synthetic opioid crisis is to increase the proportion of individuals suffering from addiction who seek and accept treatment services,” Myerberg said.

Councilmember Teresa Mosqueda pointed out the obvious: The mayor’s office has not proposed funding for addiction, treatment, or diversion programs. “It seems important that the resources be sufficiently invested into the alternative strategies so that people are not being given a false promise that there will be a diversion strategy [but] we don’t have those resources,” Councilmember Teresa Mosqueda said. “And where will that funding come from?” 

The law does not address private use of illegal drugs inside people’s homes.

Second, while Harrell has stated (and mainstream media outlets have inaccurately reported) that the bill includes $27 million for treatment and other alternatives to arrest, the bill never mentions money or spending priorities. In fact, as council budget chair Teresa Mosqueda noted repeatedly on Monday, the “new” $27 million is a combination of $7 million in grant funding the city didn’t spend in previous years, plus $1 million a year from two state settlements with opioid manufacturers and distributors. Harrell has indicated he wants to use the money to stand up and staff the proposed opioid response center he announced in April. That would leave no additional funding for programs like LEAD, REACH, and We Deliver Care, to which Myerberg said police could direct people who break the new law.

“When I’m talking to officers in the field about this [harm to others] concept, I guess there is a concern that it is an additional layer of complexity and standard that would be put on [officers. Personally I believe that the council should have incorporated state law, and then if some council members and others wanted to add policy or funding, they could have done that shortly after adopting the ordinance.”—Councilmember Alex Pedersen

At Monday’s meeting, Pedersen and Nelson raised concerns that the bill would create ambiguity and introduce new challenges for police officers that would make it harder for them to do their jobs.

“When I’m talking to officers in the field about this [harm to others] concept, I guess there is a concern that it is an additional layer of complexity and standard that would be put on” officers, Pedersen said. “Personally, I believe that the council should have incorporated state law into our Seattle Municipal Code and then if some council members and others wanted to add policy or funding, they could have done that shortly after adopting the ordinance.”

Myerberg said the legislation isn’t “asking [officers] to reinvent the wheel.” While it is Harrell’s “intent” to steer people toward diversion and treatment, officers will still get to make the calls they consider appropriate in all cases, including arrest if they believe it’s necessary to prevent harm or get someone to go into treatment or crisis care. “[Harrell is] asking them to do what they already do,” Myerberg said. “The executive remains clear that such a decision will be within the discretion of the officer. It will be fact-specific and individual-dependent.”

In late July, the Seattle Police Officers Guild “applauded” the new legislation, saying it would help “restor[e] public safety to the city.” This suggests that, at the very least, SPOG —which has a history of opposing substantive police reforms—does not expect the bill to cause major disruptions to officers’ usual way of doing business.

Including a preference for diversion in the police manual could lead to incremental change. But without significantly more funding, it’s unlikely to result in different outcomes, either for people using drugs in public or the general public witnessing public drug use.

Myerberg noted Harrell’s personal commitment to encouraging alternatives to arrest and prosecution, which stem partly from his direct experience as a Black man growing up in Seattle during the drug war. But intent is not the same thing as law; mayors come and go, and their lasting impact isn’t meaning well, but pushing through tangible, legally binding changes that last longer than a single administration. 

Addiction, City Council, criminal justice, Mayor Harrell

Fentanyl Task Force Agrees on Need for Evidence-Based Court Alternatives—With One Notable Exception
Photo by Andrew Engelson

By Erica C. Barnett

A task force convened by Mayor Bruce Harrell to come up with proposals to address illegal drug use in public spaces has been meeting for several weeks to discuss how Seattle’s court system can address a potential influx of cases from the City Attorney Ann Davison’s office. This summer, the council is expected to pass a new law empowering Davison’s office to prosecute people who use drugs in public by aligning Seattle’s municipal code with a new state law making public drug use or simple possession a gross misdemeanor, rather than a felony.

The city council rejected the proposal last month; Councilmember Andrew Lewis, who cast the deciding vote, plans to bring the measure back this summer and vote for it, a switch he says he feels comfortable making now that the task force’s work is underway. Only one of three sub-groups had met as of last week: The one focused on how the court will respond to a potential influx of new drug cases.

After just a couple of meetings, there appears to be broad consensus (with one exception that I’ll get to in a moment) in favor of expanding the Vital program, which provides intensive services to people with behavioral health issues, including addiction, and LEAD, a program run by Purpose Dignity Action (formerly the Public Defender Association, or PDA) that offers services and case management to people before they are arrested.

Even Davison, who unilaterally withdrew the city from community court earlier this year—ending a program that allowed some people to avoid charges by participating in short-term programs—is reportedly open to expanding programs that divert drug users away from jail.

The idea, according to Councilmember Andrew Lewis, is to focus on “things that fall way short of the court” level and “keep things as far away from the court as possible,” since the court has essentially no extra capacity to take on a flood of new drug cases.

The task force includes representatives from Davison’s office, the PDA, Seattle Municipal Court, and—since last week—the King County Department of Public Defense, which was excluded from Harrell’s initial list.

The group, according to Lewis, generally agrees the city should focus on “things that fall way short of the court” level and “keep [cases] as far away from the court as possible,” since Seattle Municipal Court has essentially no extra capacity to take on a flood of new drug cases.

“This conversation is really laying bare that a lot of policy discussions are based on assumptions that aren’t true,” Lewis said. “It really did call out that we could arrest everyone downtown for smoking fentanyl and the King County Jail wouldn’t be able to book them—so where does that leave us?”

The exception to this consensus, according to multiple sources, is City Councilmember Sara Nelson, who has expressed support for a new local misdemeanor drug court that would push people into long-term treatment instead of diversion or services based on harm reduction, such as medication assisted treatment and focused case management. Nelson—who has objected to funding PDA-run programs in the past—supports an abstinence-only approach to addiction and has argued that programs that provide methadone and suboxone to opiate addicts are “not aimed at long-term recovery.”

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King County has a special drug court for people facing felony drug-related charges; defendants who opt in must go through a rigorous, abstinence-based program that includes mandatory treatment, frequent drug testing, and regular court appearances. The program is high-risk and high-reward: If a defendant completes the program, which lasts a minimum of 10 months, the charges are dropped. If they don’t, the judge can find them guilty and sentence them for their original felony, which could mean a long jail sentence.

For misdemeanors, the reward at the end of the process would be comparatively minuscule—the dismissal of low-level charges that don’t usually lead to jail sentences in the first place. It’s unclear how many, if any, misdemeanor defendants would opt in to such a court; currently, every drug court in Washington state is focused on felony-level offenses.

The group Harrell announced last month includes two other task forces, in addition to the one focused on the courts, that will discuss treatment and enforcement.

Lewis said that now that the work groups are meeting to discuss the best way to respond to public drug use, the legislation making public use a gross misdemeanor in Seattle is “almost a Macguffin”—a device that gets the plot going, but isn’t particularly significant in itself.

PDA co-director Lisa Daugaard agrees with that assessment. In an op/ed for PubliCola last month, she said the city’s primary focus should be on investing in evidence-based approaches to drug use and homelessness, regardless of whether the council gives Davison the authority to prosecute drug users.

Addiction, City Council, Courts, Drugs, Mayor Harrell

Harrell Vows to Pass New Drug Law, Creates Work Group to Find Solutions to the Fentanyl Crisis
Seattle City Councilmember Andrew Lewis takes questions from reporters after yesterday’s press conference

By Andrew Engelson

Yesterday, following last week’s city council vote rejecting a bill that would have given City Attorney Ann Davison the power to prosecute people for drug possession and public use, Mayor Bruce Harrell announced the creation of a 24-member “Fentanyl Systems Work Group” tasked with finding and implementing solutions to the opioid overdose crisis. In King County, 462 people have died of overdoses involving opioids this year alone.

In a press conference at city hall on Monday, Harrell said he was committed to passing a new drug possession and public drug use ordinance that would align the Seattle Municipal Code with a statewide “Blake fix” law passed by the legislature in May, which set drug possession and public use as gross misdemeanors. 

“We will pass a law that allows our department to make arrests,” Harrell said. “But we will do that with compassion, to protect people when we have to.” Talking about how the war on drugs harmed his own community, Harrell wiped away tears and briefly stepped away from the podium.

“I believe in my heart, the people that are using drugs, many of them are sick,” Harrell said. “They’re not healthy. We’re not going to go out and fill our jails with sick people.”

The Seattle Police Department is already authorized to arrest people for drug use and possession under the statewide law, although King County Prosecutor Leesa Manion would have to agree to prosecute those cases, which she has said she will not do. Currently, few people are arrested or prosecuted under existing felony drug laws.

When pre-booking or pre-trial diversion don’t work or aren’t appropriate, Councilmember Andrew Lewis said he would support a new therapeutic court “where there would basically be a court-supervised check-in treatment regime—which is basically King County Drug Court.”

The work group will include municipal judges (including former community court judge Damon Shadid), several city council members, Davison, Police Chief Adrian Diaz, department directors, and representatives from service providers, diversion programs, community groups, and racial justice organizations.

Councilmember Sara Nelson, one of the sponsors of the drug possession bill, was adamant that the council pass a law soon. “I don’t want to see any infringement upon the city attorney’s prosecutorial discretion,” Nelson said after the press conference. “And I don’t want anybody telling the mayor what he’s going to do, what he’s going to direct his officers to do.”

Councilmember Andrew Lewis, who cast the deciding “no” vote last week, has said that in order to vote for a new bill granting the city attorney new authority to prosecute misdemeanor drug crimes, he wants to see a replacement for community court, more funding for prefiling and pre-arrest diversion programs like LEAD, and other “necessary treatment and diversion programs.”

“I’m looking forward to hearing from everybody,” Lewis told PubliCola. “We’ve got two judges who are on this task force. We’ve got the city attorney’s office on this task force. I think that we can work through whatever differences we have to get a plan in place to have a successor therapeutic court.”

Community court has been the primary alternative to Seattle’s mainstream municipal court system since 2020. Though Lewis said he’s committed to finding a replacement for the court, he added that he’s actually more invested in diversion programs that target people before they get arrested in charged, such as LEAD for adults and Community Passageways for youth.

Lisa Daugaard, co-director of Purpose Dignity Action (formerly the Public Defender Association), which runs the pioneering pre-booking diversion program LEAD, said the debate over adding drug possession and public use to Seattle’s municipal code is something of a distraction, since diversion programs have existed as an option for more than a decade and will continue to.

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“Since 2012,” Daugaard said, “we’ve had a framework in Seattle where even when there is legal authority to arrest, book someone into jail, refer them to prosecution, and prosecute them, our local law enforcement agencies and prosecutors have very often chosen not to do that, in preference for a pre-booking diversion framework where people get a warm handoff to harm reduction-based care.”

Daugaard says arrests for drug-related offenses in Seattle have plummeted in the past two decades and aren’t likely to increase. “The incidence of stops, searches, and arrests for drug crime fell over a decade from being at the very top of the reasons that people have course of contact with law enforcement to outside the top ten,” she said. “And that was not an accident.”

When pre-booking or pre-trial diversion don’t work or aren’t appropriate, Lewis said he would support a new therapeutic court “where there would basically be a court-supervised check-in treatment regime—which is basically King County Drug Court.” Participants in drug court, which lasts a minimum of 10 months, must check in frequently, stay sober, and meet other court-mandated requirements in order to have their charges dropped.

“We know that pre-file diversions are probably best for the overwhelming majority of people,” Lewis said. “But there is a small group of people where those interventions have not been successful, and they need a little bit more accountability and a little bit more structure. And that can definitely be provided by a therapeutic court.”

Daugaard says the more critical issue is finding sufficient funds for recovery services for people with substance use disorder, especially those without shelter. Though one selling point of the state’s drug possession bill was supposed to be an increase in funding for services and treatment, Daugaard says what the state actually provided is insufficient to deal with the scope of the problem statewide.

“The population in each region that it can serve is a small fraction of the total number of people who are using drugs in a way that could either be life threatening or problematic for their stability.” Addressing drug use in Seattle will require an injection of local resources beyond what the city has provided so far—something the council will have to grapple with during its annual budget deliberations this coming fall.

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.

Drugs, Health, legislature, public disclosure

Bill Would Expand Access to Fentanyl Testing, PubliCola Updates Seattle Employee Directory
Image source

1. As King County hit a demoralizing new record of 1,019 overdose deaths in 2022—a jump of nearly 30 percent over the previous year—a Republican state senator has introduced a bill that would make it easier to access test strips that can indicate the presence of fentanyl in drugs.

As PubliCola has reported, fentanyl is now the default opioid for drug users in King County, a trend that has driven the huge spike in overdoses. Even people who don’t seek out opioids can be at risk, because drugs like cocaine and methamphetamine can be contaminated with fentanyl. Test strips, which can detect the presence of fentanyl in a small amount of a drug, are an essential part of harm reduction efforts, but state law still classifies them as prohibited “drug paraphernalia,” limiting their availability.

Last year, GOP state senator Jim Honeyford, R-Sunnyside, filed a bill that would have changed that designation, but it died in committee. This session, Sen Ron Muzzall, R-Oak Harbor, reintroduced the legislation.

Muzzall told PubliCola that while substance abuse has always been an area of concern for him, it’s also a personal issue. Muzzall is friends with Skagit County Commissioner Lisa Janicki, whose son Patrick died of a fentanyl overdose in 2017 after becoming addicted to pain pills. Muzzall says he knew Janicki’s son and that his death made a deep impression. 

“When a mistake like that leads to having to bury your child.. . well, that emptiness never goes away,” Muzzall said. “And that was a tragedy that was brought about by a prescription of Oxycontin. The liability lies with the pharmaceutical industry that led up to that. And it’s just invading our communities.”

Janicki has been a vocal advocate for Attorney General Bob Ferguson’s successful lawsuit against opioid manufacturers, which will add $476 million to the state’s harm reduction and treatment efforts over the next 17 years. 

The fentanyl test strip bill is an essential part of those efforts, Muzzall said. “It’s just silly that we don’t make these as easily accessible as possible,” he said. “This bill will take the criminality out of providing them.”

Muzzall, who says fatal overdose is a behavioral and mental health crisis that will likely cost the state a billion dollars to address, is working alongside Democratic Sen. Annette Cleveland of Vancouver on a number of bills to address the issue, and hopes to successfully move the test strip bill through committee this time around.

“If an individual is compassionate, bipartisanship comes easily,” he said.

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2. In 2021, then-mayor Jenny Durkan’s information technology department took the public-facing directory of city employees offline, removing a vital resource that allowed members of the public and journalists (as well as city of Seattle employees themselves) to contact people who work at the city. Public employees’ contact information is a matter of public record, and keeping this information secret violates a long tradition of transparency that persists in other government entities across the state, from King County to the entire State of Washington.

Durkan, who falsely claimed the directory would be online again in a matter of months, is no longer in office, but her successor, Bruce Harrell, has made no moves to restore this resource. The former city employee directory website is now a static page with links to a list of the city’s official media relations officers, the websites of various city departments, and the city’s data portal (which does not contain the directory).

Because we believe the city directory is a valuable public resource, PubliCola has taken it upon ourselves to maintain an updated database of city employees and their contact information ourselves. Here’s the latest searchable and downloadable version, with information current as of January 5, 2023. We will continue maintaining and updating this database until and unless the city of Seattle decides to put theirs back online.

—Andrew Engelson, Erica C. Barnett

Addiction, Drugs, Health

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.

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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” →

Addiction, Drugs, Health, Schools

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.

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“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” →

Addiction, criminal justice, Drugs, human services

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.”

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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” →