Tag: Harley Lever

Families of Opiate Epidemic Victims Reach Different Conclusions on Safe Consumption Sites

This story appeared in Seattle Magazine.

For months, there had been red flags. In the past, 19-year-old Amber Roberts had always made plans with her father, Michael Roberts, for his birthday. But this year, she canceled at the last minute without explanation.

A few weeks earlier, the former Lake Washington High School student had broken things off with her longtime boyfriend, who lived in Oregon, claiming he was “smothering” her. And friends who partied with her had noticed changes, too. Earlier that month, one of them had texted Amber’s mom telling her that Amber—the girl who still hated needles so much that she took her dad with her when she had to get a shot—had been doing heroin for the past several months. Alarmed, Amber’s mom contacted Roberts, and they made a plan to get their daughter into treatment as soon as Amber returned from Paradiso, a two-day music festival held every year at the Gorge.

But Amber had a friend drive her home from Paradiso early, complaining that she was sick. (Roberts believes she was in heroin withdrawal.) She left her mom’s house for a while, then came back and went upstairs, telling her mom and stepdad she was feeling fine. Roberts still remembers the last text he got from his daughter. “She texted me at around midnight to say she was fine,” he recalls. “And she probably died right after that.”

Heroin can kill slowly or quickly. Many people live through overdose after overdose—saved, in many cases, by the overdose reversal drug naloxone—and experience periods of recovery interspersed with periodic relapses. Others, like Amber, use the drug for just a short time—in Amber’s case, about four months—before taking a last, fatal dose. Sometimes, Roberts says, he feels lucky compared to parents who watch their kids struggle with addiction for years and years. Then he remembers his daughter’s loyalty, her “indescribable laugh” and her love for her family, and he says, “We would take that [struggle] over anything, because at least there would be a chance to save her.”

Since Amber’s death, Roberts, who lives in Kirkland, and Amber’s mother, Kristen Bretthauer, have started Amber’s HOPE (Heroin, Opiate Prevention and Education), a group that works to raise awareness of opiate addiction among teenagers. He’s also become an outspoken advocate for supervised consumption sites—places where users can inject or smoke their drug of choice under medical supervision, with access to wound care, detox and treatment referrals, and overdose reversal and prevention. The goal of supervised consumption isn’t to “cure” addicts. But, as Roberts says, it “can save people’s lives. That’s the bottom line for me. Once you’ve gone through what I went through, you will do anything for other parents not to have that experience.”

So far, there’s only one supervised injection site in North America: Insite, in Vancouver, British Columbia, which has an average of 514 injection-room visits every day, according to program founder Liz Evans. (Insite’s facility only caters to injection drug users; most safe consumption sites also allow people to smoke drugs as well as inject them.) But the sites are common across Europe and they could soon be coming to King County. Last year, the 27-member King County Heroin and Prescription Opiate Addiction Task Force, which includes political leaders, medical experts, drug-policy reform advocates and the mayors of several suburban cities, recommended that the county open two supervised consumption sites as a three-year pilot project, including one in Seattle.

King County Executive Dow Constantine and Seattle Mayor Ed Murray convened the task force last year in response to sharp increases in both opioid addiction and overdose deaths. In 2015, the last year for which finalized data is available, 132 people died of heroin overdoses in King County, up from 99 just two years earlier. Meanwhile, since 2015, heroin, rather than alcohol, is the primary reason people enter detox programs in King County. The recommendation for supervised consumption sites was just one of the task force’s eight proposals, which also included increased access to medication-assisted treatment with buprenorphine, a drug that reduces opioid cravings; widespread distribution of naloxone, a nasal spray that can reverse overdoses; and increased spending on prevention programs. But of all the recommendations, safe consumption has been by far the most controversial.

Opponents, such as state Senator Mark Miloscia, who represents Federal Way, argue that safe consumption sites enable users and normalize drug use; he believes drug users need to “hit rock bottom, where they’re looking death in the eye…that’s how you change behavior.” Miloscia, a conservative Republican who has sponsored legislation that would ban safe consumption sites as well as a bill banning all homeless encampments in Seattle, argues that shame, not acceptance, is what keeps people from using drugs. Proponents counter that safe injection sites keep drug users alive—by offering medical care, teaching safer injection practices and monitoring users for overdoses—and provide them with tools and services that help them reintegrate into society, even if they aren’t ready to quit.

“These spaces are not just about drug use—they’re about really connecting folks to community and not just kicking them back out onto the street,” says Patricia Sully, an attorney with the Seattle Public Defender Association (PDA) and the coordinator for Voices of Community Activists and Leaders (VOCAL-WA). VOCAL-WA, which operates under the umbrella of the PDA, is a grassroots group of low-income people, drug users and community advocates who work to promote harm reduction. “Drug treatment itself might not be the only thing people need. Many people need connections to mental health services. Many, many people need connections to housing. And we know that all of those things really make a huge impact in someone’s quality of life,” Sully says.

Harley Lever is a neighborhood activist who ran for mayor in this year’s race and  founded the group Safe Seattle, which advocates against safe consumption sites. HeImage result for harley lever seattlesays the problem with that point of view is that the sites “could never scale to the enormity of the problem,” which is only growing as drugs like fentanyl make street heroin more unpredictable and lethal. “If you said, ‘What’s going to save more lives?’ I think the science will back me up and say widespread distribution of naloxone is going to save far more lives” than safe consumption sites, Lever says.

Safe Seattle advocates for naloxone distribution, but their main contribution to the debate over safe consumption sites has been advocating Initiative 27, which would ban safe consumption sites throughout King County. Editor’s note: Opponents of the initiative won a court ruling that could keep the initiative off the ballot, but proponents are expected to file an appeal. In the meantime, the King County Council has passed an alternative ballot measure to replace I-27 if proponents win on appeal; that measure would ask voters whether they support voting on supervised consumption sites at all, and, if they say yes, whether they support or oppose the sites.

Lever, like Roberts, came by his views on addiction the hard way. Two of his brothers, along with countless friends and relatives back in his hometown of Boston, have been addicted to heroin, and several have wound up in jail or died. One of Lever’s brothers has been clean for years; the other, an Army veteran who has spent years in and out of Veterans Administration (VA) rehabs, is now homeless and living, Lever says, on “borrowed time.”

“[My brother] has OD’ed four times in the last year, and every time he was saved by naloxone,” Lever says. “He’s been in this constant cycle of being in treatment, getting sober, living in sober housing—and then, almost every single time, right when he gets his check [from the VA], he goes and spends it and he’s back in that cycle.”

Although one of his brothers quit “cold turkey” and “turned his life around,” Lever has slim hopes for his homeless sibling. “We’ve tried everything. It’s been 15 years, and he’s been so lucky to survive, but we know one day we’ll get the call,” he says. The VA has provided Lever’s brother with a place to stabilize himself and access health care and treatment, and it has probably helped him stay alive this long. But it hasn’t gotten him sober.

While one argument against safe consumption sites is that anything that allows addicts to continue using is the wrong solution to the opioid crisis, there are other objections.

Some who are opposed to safe consumption sites say the sites will bring crime and addiction to neighborhoods where drugs and crime were not previously a problem, or worry that the sites simply enable addicts to “slowly kill themselves by taking drugs and harming their bodies,” as Republican King County Council member Kathy Lambert, who represents Sammamish, Redmond and Issaquah, said back in June.

But the Vancouver Insite experience has proven otherwise. Insite founder Evans says the amount of street disorder around the facility has declined significantly since it opened in 2003, and that Insite staffers have reversed more than 6,000 overdoses; in 14 years, not one person has died at the site. Vancouver’s Downtown Eastside, where Insite is located, is a rough-edged but gentrifying neighborhood near the city’s Chinatown that has been plagued by drugs and crime for decades. Seattle has no real equivalent, since drug use here is more widely distributed throughout the city, which is one reason advocates here have argued for more than one safe consumption site.

That information, however, doesn’t sway opponents like Lever.

“The compassionate side of me says we shouldn’t be [pushing I-27], but the strategic side of me says we should, because we should be focusing on better solutions than safe injection sites.”

Ultimately, the initiative may be unnecessary. In June, a majority of the King County Council voted to prohibit funding in the amended 2017–2018 budget for supervised drug consumption sites except in cities that explicitly approve them, and to bar county funding for any site outside Seattle. The vote effectively means that a safe consumption site couldn’t open until 2019 at the earliest, because the only potential funding source for a site in Seattle, the countywide Mental Illness and Drug Dependency tax, is already spoken for.

Officials in Seattle have not identified a specific site, but City Council and County Council members who represent the city, such as King County Council member Jeanne Kohl-Welles of District 4 (which includes Ballard, Fremont, Crown Hill and Wallingford), have said it will not be in any neighborhood that doesn’t want it, making Capitol Hill a more likely location than, say, Magnolia.

Dave Upthegrove, a Democratic County Council member who represents Burien and other South King County suburbs, says that while there is a lot of misinformation about the risk of safe consumption sites, “people’s emotions are real, and we need to be respectful of people’s fears.” He adds, “Even folks who have experienced heroin addiction in their own families are divided.” He fully supports the sites, however, and supports Seattle becoming the first city in the region to have them.

Roberts, who has been open about his own struggles with addiction, believes that the fears people have about drug users can only be addressed by destigmatizing addiction; more people also need to understand that even “good people” can get swept up by addiction. “There tends to be an attitude of ‘My child would never do that’; I really want to sway that view,” he says. “In one year, there were at least three overdoses at Amber’s high school. There’s just not enough awareness of the problem.”

With the dramatic increase of overdose deaths, he says, “there’s not going to be anyone around to deal with it anymore.”

Although Roberts and Lever—both King County residents whose families have been devastated by the impact of heroin addiction—have reached vastly different conclusions about how to solve the problem, they agree on this point.

“What I fear most is we’re going to die our way out of this epidemic,” Lever says.

The Europe Experience

Safe consumption sites are still rare in the United States, but they have a long history in Europe, where the first supervised injection site opened in Bern, Switzerland, in 1986. Since then, more than 75 such sites have opened across the continent: in Germany, the Netherlands, Spain, Norway, Luxembourg, Denmark, Greece and France.

Although the services offered by safe consumption sites vary slightly from country to country (some are strictly safe injection sites; others provide medically assisted treatment right on site), the basics are the same: They include a safe space to consume illegal drugs indoors and under medical supervision, clean needles, basic medical care, and connections to addiction treatment and other health and social services.

Numerous studies across Europe have concluded that safe consumption/injection sites not only reduce risky behavior, such as sharing needles, but lower the number of overdose deaths in cities. Safe consumption sites also have been found to reduce the number of violent, property and nuisance crimes associated with street drug use, and increase the number of people who get into treatment—a result that holds true in North America, too, where more than 60 peer-reviewed studies have concluded that Insite, the safe consumption site in Vancouver, British Columbia, has increased the number of people seeking treatment without increasing crime.

Safe Seattle’s Harley Lever: Safe Consumption Sites Can’t Scale to the Size of Seattle’s Heroin Problem

This is part 2 in a series of interviews with advocates on both sides of the safe-consumption issue.

Earlier this week, a coalition of public health experts and people who have lost loved ones to overdoses announced that they are suing to block Initiative 27, which would ban supervised drug consumption sites throughout King County, on the grounds that public health decisions are outside the scope of the initiative process. The group, called Protect Public Health, argues in their lawsuit that under state law, King County and its public health department are responsible for making public-health policy decisions for the county, and “[i]t would be antithetical to this scheme to allow citizens to delay or override urgent action on a public health crisis merely by raising sufficient funds to qualify a referendum or initiative.” (You can read the full complaint here.)

Last week, the King County Elections Department confirmed that initiative supporters had collected enough signatures to qualify for the February 2018 ballot.

With safe consumption very much in the news this week, I thought it would be a good time to hear from some advocates on both sides of the safe consumption issue.

Today, my conversation is with Harley Lever, one of 21 candidates for mayor in the recent primary election and a leader of the Facebook group Safe Seattle, which organizes on policies related to homelessness and drug addiction. Safe Seattle has been vocal about their opposition to proposals that would reduce penalties on people who live on Seattle streets, in tents, or in their cars or RVs, and in favor of more frequent and punitive encampment “sweeps,” in which homeless people living in tent encampments are forced to move from place to place. Safe Seattle says it supports increasing access to shelter and services and providing treatment on demand, but that people who refuse to leave their encampments or RVs and relocate to shelters or treatment should be fined, jailed, or forced to move along. Most recently, they have opposed legislation proposed by city council member Mike O’Brien that would give people living in their vehicles immunity from some traffic laws and fines if they enter a program that puts them on a path to permanent housing; the proposal would also enable the city to set up potentially dozens of small “safe lots” around the city where vehicle residents could park without punishment or parking fines. Arguments against the legislation range from “I have to follow the law, so why shouldn’t they?” to “if RVs become legal everywhere, I guess I’ll just sell my house and go live in one tax-free.”

Safe Seattle has also been supportive of Initiative 27, arguing that safe consumption sites will increase crime and open drug use in the surrounding neighborhoods, and that they will only enable drug users to keep using instead of seeking treatment. Many of Safe Seattle’s writers and commenters have argued that forcing people into drug treatment is an effective way to get people into recovery, and that if Seattle does allow a safe consumption site, IV drug users will congregate around the property and use (and overdose) outside, littering neighborhoods with needles and the bodies of overdosed addicts.

Lever, however, he says opposes safe consumption sites for more complicated reasons: He doesn’t believe they can scale up to the size of the city’s opiate and heroin problem. He says he’d rather see the city spend its money on widespread access to naloxone, the overdose-reversal drug, and detox and treatment on demand, than on sites that might save a few lives but won’t effectively address the underlying epidemic. Like King County Public Health’s recovery division deputy director Brad Finegood, Lever’s knowledge of the toll drug addiction takes on users is personal: Two of his brothers have been addicted to heroin, and one is currently homeless and living with active addiction in Boston. I talked to Lever by phone last month; his comments have been edited for clarity and to remove the names of his family members.

Here’s Lever:

Image result for harley lever seattleOur story is the same story that’s happened to scores of people from my hometown, as well as throughout Boston. People just started using OxyContin recreationally. You have a couple of beers, have a Xanax, and it makes you feel really good. No one ever contemplated the level of addiction that it would create. Before the city or state even realized what was happening, we started seeing break-ins at pharmacies and crime spiking, because Oxy 80s sold for 80 bucks on the streets, and as people got progressively more addicted, they started stealing. It just skipped my high school class by about nine years.

The state of Massachusetts and a lot of pharmacies started smartening up about what was going on and did everything they could to restrict access to Oxy, and as it became more difficult to access, people started switching to heroin, and my brother was one of those. He got off heroin temporarily, but he went into the Army, where he started thriving, which was good. The only problem was, they made him a medic, which is a stupid thing for person to do who has documented addiction disorder. He did really well for three tours in Iraq, and then he went to Afghanistan and we think our cousin started sending him OxyContin, so he came back addicted.

“[My brother] is homeless. Fortunately, because he’s a veteran, he can get access to VA help. He overdosed four times last year, and every time he was saved by a person who had naloxone.”

My cousin eventually got arrested and is currently serving a five-year term in federal prison, and his family’s pretty much been tossed on their heads. Both of his kids were born addicted to opioids. They still have developmental delays and issues even now. His wife still struggles with opioid abuse disorder. And then, most recently, in August of 2016, my cousin’s ex-husband died of heroin overdose. So just in our immediate family, we’ve seen a lot of the devastation.

On a larger scope, I have a lot of friends who are either dead or are actually still addicted to heroin or in prison. This is an ongoing problem in our community.

[My other brother] has totally turned his life around. There are a lot of stories like this too, where people went down the wrong path but were able to get out of it and stay out of it. He went down dark path, but you would never know it looking at him. He went cold turkey. I think that he realized the path he was going down was not a good one. We’ve never talked about it, but I assume that, like many people gripped with addiction, he hit a rock bottom and he turned his life around.

“I don’t necessarily think a safe injection site will make the situation worse. My issue with the safe consumption site, in the context of Seattle, is that it can’t scale to the size of the problem.”

[My brother] is homeless. Fortunately, because he’s a veteran, he can get access to VA help. He overdosed four times last year, and every time he was saved by a person who had naloxone. He’s been on suboxone, methadone, and Vivitrol. I think the problem with him is, he’s done it for so long that his impulse control mechanism in his brain is really shot. He’s been in this constant cycle of being in treatment, getting sober, living in sober living—and then almost every single quarter, right when he gets his [benefit] check, he goes and spends it and he’s back in that cycle.

I don’t necessarily think a safe injection site will make the situation worse. My issue with the safe consumption site, in the context of Seattle, is that it can’t scale to the size of the problem. We have 23,000 opioid-addicted IV drug users in King County. On average, they inject three times a day. So you have 69,000 injections a day. The two [proposed] safe consumption sites can only supervise 500 injections combined, so we have choices. Either we can scale up and offer [274] other facilities to supervise all the injections, or we can do what saves my brother consistently and have widespread distribution of naloxone and layperson training. For the $3 million it will cost to fund these two safe consumption sites, we could literally give every single one of the 23,000 addicts 47 prescriptions of naloxone. What we should be doing is having a CPR crowdsourcing model, where we teach lay people to reverse overdoses.

“[Canada] and other countries that have these systems in place have government-run health care. They can provide access to detox and rehab on demand. We don’t have that.”

I don’t think they really ever contemplated fentanyl. It used to be that you could use black tar heroin for a long time and not risk overdosing like you see with fentanyl. What I fear most is that we’re going to die our way out of this epidemic. Fentanyl is not as prevalent here yet as it is on the east coast or up in B.C., but it’s going to make its way here. I just fear those 23,000 opioid addicts we have here are going to die and never get a chance to recover.

We have to actually look at the recovery system here in Washington State. We don’t have access to detox or rehab on demand. One of things I hear a lot of proponents talking about is how they do all these great things [at Insite in Vancouver and other safe consumption sites around the world], but [Canada] and other countries that have these systems in place have government-run health care. They can provide access to detox and rehab on demand. We don’t have that. We might have a bed available to you in nine to 12 weeks, which is a lifetime for detox. We’re also looking at months for rehab. We need to fix that structure. I think that’s a critical component.

“The compassionate side of me says we shouldn’t be [banning safe consumption sites]. The strategic side of me says, yes, we should, because we should be focusing on better solutions than safe injection. “

They do have HIV testing and hepatitis C testing. I think that’s absolutely a great point. But we also can do that with our navigation teams. I was talking to Daniel Malone from DESC and we both agree that if we have a mobile van where they can meet with opioid addicts where they reside, that would be a more strategic, cost-effective approach [to dealing with certain health problems common to opioid addicts].

The compassionate side of me says we shouldn’t be [banning safe consumption sites]. The strategic side of me says, yes, we should, because we should be focusing on better solutions than safe injection.  I recognize that a lot of people do it out of hatred towards drug-addicted people. What I always say to someone who hates an addict is: You are going to have an addict in your family. And once you do, this whole mantra of ‘They chose to stick a needle in their arm’—well, they did it under the influence of withdrawal and pain and sadness and different types of trauma.

Some people say, ‘I had to hit rock bottom. I had to be threatened with jail. I had to have these pressures.’ I think [tough love] absolutely works with some people. I think it would be silly to say that only tough love works, because there’s some very stubborn people out there. I’d probably be one of them, because I’m a bit hard-headed at times.

Honestly, I don’t think my brother will ever recover. My mother has said the same thing I’m just waiting for the call. We wish it was different. It’s been 15 years and he’s been so very lucky to survive, but we know, based on just the trajectory and frequency of his overdoses, he’s on more than borrowed time.

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