Tag: harm reduction

Drugs, human services, King County, Uncategorized

County’s Midyear Budget Sparks Controversy Over Harm Reduction, Human Service Contracts, and Lobbyists

1. After PubliCola reported on a King County Council supplemental budget amendment that would have prohibited spending county funds on safer smoking supplies for drug users, the proposal’s sponsor, Councilmember Rod Dembowski, decided to withdraw the amendment and replace it with one that simply requests more information on the program. It was a significant victory for harm reduction proponents, who pointed to data showing that the program provided access to services, including treatment, to tens of thousands of drug users last year.

The supplemental budget, usually a low-key affair, sparked a number of controversies  this time around.

During a work session before this week’s county council meeting, Dembowski said that in response to “feedback,” his amendment would “modify that language away from a strict cutoff to asking for some more information about the program. You know, how many supplies are being distributed? What is the cost? Who are they going to? What studies are out there? What assessments are out there? Give us some more information, and come back in a few months to let us know about the program.”

As we reported last week, the county spends a small amount—about $14,000 so far this year—on safe smoking supplies, plus some staff time for county employees who distribute pipes and foil at the county’s syringe exchange and to nonprofit groups that run their own syringe exchange programs.

Those programs had fallen largely into disuse as most drug users switched from injecting to smoking; the result was a sharp reduction in the number of people who accessed other county services that are a primary function of the program, such as case management, basic health care and STI testing, and referrals to treatment. Opponents of harm reduction have caricatured and demonized safer smoking programs in the Trump era, claiming that they “enable” drug users and encourage drug use.

2. The supplemental budget, adopted yesterday, also included a modified version of an amendment Dembowski proposed earlier this month that will add another layer of process to every new Best Starts for Kids contract. (Best Starts has been under fire for months after an audit and followup investigation found potential misuse of funds, and possible outright fraud, by some “high-risk” organizations that received contracts during and after the pandemic.)

The amendment adopted Tuesday will require the county’s Department of Community and Human Services to send a “notification letter” to the county council certifying that every new contractor has met a series of requirements— guaranteeing, for instance, that each individual contractor has sound financial systems and “qualified personnel” to administer the contract. Previously, the amendment would have also required such a letter for every contract amendment, which opponents said would have turned routine changes into lengthy administrative nightmares.

The amendment, like Dembowski’s original proposal, also requires contractors to attest that neither they, nor any person in a position to administer contracts, has ever lost a county contract because of misconduct or misuse of funds. But it provides a new out that wasn’t included in the original proposal: If the contractor has taken “all reasonable steps” to recover misused funds and can show that “adequate corrective action has been implemented,” the county can still contract with them.

Dembowski characterized every element of the amendment as “not unusual” or something that “shouldn’t be a challenge.” But critics of his amendment argued in public comment that it still creates more process without providing meaningful oversight, since the council is made up of elected officials, not contracting or financial experts.

Dembowski’s amendment doesn’t include a minimum contract size or explain how small organizations that may be new to government contracting are supposed to prove they already have financial controls and systems in place that will meet the new requirements.

3. Also Tuesday, the county council voted to retain the county’s current federal lobbying firm, Washington2 Advocates, for at least a year while also paying a new lobbying firm, Manatt, Phelps, & Phillips. The contract with Washington2 will be with the legislative branch, while the contract with Manatt will be with the county executive.

Tensions flared over the contract decision after King County Executive Girmay Zahilay hired Manatt through a request for proposals process without telling the council what they were doing, effectively canceling out a one-year option to retain Washington2 Advocates, run by longtime county lobbyist (and personal friend of some councilmembers) Jeff Bjornstad.

During Dow Constantine’s time as executive, the council and executive jointly approved the lobbying contract. So it was a surprise to some on the council when they learned that Zahilay had run a new bidding process and picked a new contractor. (After we published this post, the executive’s office reached out to let us know that the council’s government relations staff was aware of the RFP. “We communicated to all Councilmembers our desire to coordinate with them on this RFP before it went live in April,” the spokesperson said.)

“The renewal came up sort of abruptly—we weren’t notified until there was already an RFP put out by the executive branch to search for another contractor,” Councilmember Claudia Balducci told PubliCola Tuesday. “For a very long time, we hired a lobbyist and worked together across the branches very closely … so this was a little jarring.” It “didn’t help,” Balducci continued, that Zahilay “deleted the council from the RFP” itself, effectively cutting them out of the lobbying contract altogether. “We were told that wasn’t the intent, but this all happened very quickly.”

Zahilay’s office disputes this, saying the council is still “a receiver of the consultant’s services” and saying the contract has always been just with the executive branch.

Councilmember Teresa Mosqueda told PubliCola that the fact that Bjornstad didn’t apply in the executive’s competitive process was “a sign that he wasn’t interested in competing.” Mosqueda argued that the executive had the right to issue a lobbying contract, arguing at a Monday council pre-briefing that the decision “should not be about individual relationships that people have had with a contractor over X number of years. …  This is about how the county can best be represented in these immense times.”

Doubling up on lobbyists for a year will cost the county about $200,000.

Asked about the dustup with the council, a spokesperson for Zahilay said, “we are rebidding and refreshing all federal and state lobbyist contracts. As a new administration, we believe this is good practice.”

Addiction, Drugs, King County

County Councilmember Dembowski Wants to Defund Successful Harm Reduction Program
Source: ADAI, University of Washington

By Erica C. Barnett

Earlier this month, King County Council budget chair Rod Dembowski quietly slipped an amendment into a nearly 400-page supplemental budget proposal that would prohibit the county from spending any money buying or distributing safer smoking supplies, such as pipes and foil, to drug users.

The county’s public health department only runs one needle exchange, where drug users can also access services and treatment medication, but the county distributes supplies to nonprofits that provide similar services, making the potential impact far more significant than the small amount—around $14,000— the county has spent so far this year on pipes and smoking supplies.

King County Public Health (KCPH) estimates that staff distribute safer smoking supplies at the downtown needle exchange for 15 to 20 hours a week, “translating to an estimated $83,000 annually for staff time,” according to KCPH spokeswoman Sharon Bogan. “During these interactions, staff are also connecting individuals with tools to prevent overdose, offering connections to treatment, and addressing client needs,” Bogan said.

King County hands out some of these supplies at its own needle exchange, downtown, and also distributes them to other organizations, including the Hepatitis Education Project and the People’s Harm Reducation Alliance.

Dembowski did not respond to several requests for an interview.

Opponents of harm-reduction approaches, such needle exchanges and the distribution of overdose reversal drugs, argue that making drug use safer merely “enables” drug users to stay addicted. The Trump administration has aggressively rejected harm reduction in favor of punitive approaches, including in recent policy guidance for federal shelter and housing funds.

King County, however, has long embraced harm reduction, which reduces the spread of infectious diseases like HIV and attracts drug users who would not otherwise come in contact with health care and treatment providers. The downtown needle exchange, for example, provides treatment referrals and “warm hand-offs” to the Pathways treatment clinic located in the same location; refers people to detox and medication-assisted treatment; provides case management and connections to housing, food and shelter; and hands out the overdose reversal drug Narcan, among other services.

“Distributing pipes and foil allows Public Health to build trust among people who use drugs. By building this trust, we can reduce preventable deaths, interrupt the spread of infectious diseases, and serve as a bridge to treatment and recovery,” Public Health’s Bogan said. “Discontinuing pipe and foil distribution means that we will lose our connections to people in our community who use smoking supplies and do not inject and who rely on our services.”

Source: ADAI, University of Washington

Caleb Banta-Green, a research professor at the University of Washington’s Addictions, Drugs, & Alcohol Institute (ADAI). said he “was saddened and surprised to see King County do something that appears to be following in the footsteps of the federal government’s really ill-informed approach.” When politicians actually visit harm reduction programs in person, he said, they often change their minds, “because it’s not just giving things to people. It is health promoting and it is literally about engagement and helping people.”

A survey ADAI conducted last year found that in 2025, opiate and meth users overwhelmingly switched from injecting drugs to smoking them, a change (compared to ADAI’s 2015 survey) that corresponded with a dramatic reduction in people showing up at sites that provided clean needles.

In King County, the reduction in injection drug consumption led to a reduction from 25,000 annual visits, or “encounters,” with the public needle exchange program to a low of 12,000 in 2022. After the county began handing out pipes and foil, that number rebounded, from 20,000 in 2023 to 60,000 in 2025, according to the county’s public health department.

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“There has been a dramatic shift in a decade from heroin to fentanyl, and from injecting to smokin—that is how people are consuming substances, and if we want to keep providing public health services for people who consume substances, we have to be adapting to that,” Banta-Green said.

Smoking from dirty or broken pipes, or using cheap, thin foil as a smoking surface, both pose their own safety risks, such as facial wounds and burns—making it a good idea for drug users to replace pipes and only use thick, high-quality foil. But coming in for safer supplies has another benefit, ADAI’s research found: It keeps people from injecting drugs, which is much riskier and can lead to abscesses, infections, and collapsed veins.

At needle exchange sites that didn’t offer smoking supplies, participants were far more likely to have injected drugs (70 percent) than at sites that offered smoking supplies (35 percent), according to the survey. At those same sites, 83 percent of participants said they would “like to get free, clean pipes or foils to smoke opioids, cocaine, or meth,” and 75 percent of the people who injected drugs but were interested safer smoking supplies said they would “inject less often”  if smoking supplies were available.

“All of the evidence points to the same thing, which is when you make smoking supplies available, people will inject less, and if you take smoking supplies away, people will start injecting more,” Banta-Green said.

The county council is scheduled to vote on the full supplemental budget next Tuesday.

Addiction, Drugs, homelessness, Mayor Harrell

Downtown Recovery Center Will Give Drug Users New Options After an Overdose

By Erica C. Barnett

The Downtown Emergency Service Center will open Seattle’s first post-overdose recovery center at its headquarters at the historica Morrison Hotel building in Pioneer Square next year. The Overdose Response and Care Access (ORCA) Center, part of a larger new behavioral health clinic, will be a dedicated space for drug users to stabilize, rest, and access voluntary treatment, including long-acting medication, after experiencing a nonfatal overdose.

Currently, when emergency workers revive someone experiencing an overdose in downtown Seattle, their options are basically: Transport the person to Harborview Medical Center or let them go. Those who walk away from an overdose typically seek out more drugs to counteract the effect of overdose reversal drugs like Narcan, which can send users into a state of painful, intense withdrawal.

The ORCA Center offers a third option for emergency workers to take people immediately after an overdose—”breaking the cycle of repeated overdoses” as Mayor Bruce Harrell put it Thursday, “by stopping painful withdrawal symptoms [so] people [can] find a pathway to recovery and support.” Admission to the ORCA Center will be voluntary, as going to the hospital after an overdose is today.

Thursday’s announcement took place in the second-floor area that will house the recovery center, which looks out on Third Avenue through large, semicircular windows. For decades, this floor housed a large, crowded shelter, along with day rooms and a clinic (and, at one time, an enclosed indoor smoking area). Today, the space is a hollowed-out construction zone, with two rows of metal lockers the only visual reminder of the building’s former purpose. Rooms that once held dozens of metal bunk beds are stripped to the studs, with cords hanging from the ceiling, and the floors have been stripped to their bare plywood bases.

PubliCola first reported on DESC’s plans last summer, after Harrell announced he would use $7 million in unspent federal funds to “provide care and treatment services for substance use disorders” in Seattle. DESC will receive $5.65 million of that total to help build out the new $12 million facility, which will also be funded through state and county grants and private donations. The remaining $1.35 million will go to Evergreen Treatment Services, which is building out a new campus on Airport Way.

Recent floods forced ETS to reimagine the facility, which will now include a “fire station-style” building to house its mobile units, which provide methadone treatment to hundreds of clients in downtown Seattle. ETS will also receive another $1 million from the city to add another unit to its mobile-clinic fleet, which ETS director Steve Woolworth described as another important part of the continuum of care for people with opioid use disorder.

Methadone is a highly effective treatment, but federal law requires patients to travel to a physical clinic to get doses until they “earn” take-home doses—a hurdle to recovery that’s even more daunting for people who lack a stable place to live. “Expecting folks who are living unsheltered… to come to a fixed location can’t be the only strategy we’re investing in to address community health,” Woolworth said. “And so what you’ll see from us will be a much more adaptive, flexible and mobile approach to taking medication out to where people are.”

The new recovery center won’t be a shelter, although it will have places for people to sleep. Legislation that established new licenses for 23-hour crisis clinics in 2023 stipulated that these clinics are supposed to offer “recliner chairs,” rather than beds, which is one way these clinics are distinct from hospitals or shelters. But, Malone noted, “true stability” will require places for people to live on a more permanent basis. Continue reading “Downtown Recovery Center Will Give Drug Users New Options After an Overdose” →

City Council, Drugs, homelessness, Mayor Harrell, Taxes

Council Debates Harm Reduction, RV Storage and Jumpstart Tax as Annual Budget Deliberations Begin
Mayor Bruce Harrell’s proposed budget turns an estimated $212 million funding shortfall in 2026 into a $247 million shortfall, according to a city council staff analysis.

By Erica C. Barnett

Seattle City Councilmember Sara Nelson raised objections to funding several small harm-reduction programs using funds from the state’s settlements with opioid makers and distributors on Thursday, saying that the funds might better be spent on “treatment” rather than drug user health programs at the Hepatitis Education Project (HEP), Evergreen Treatment Services, and the People’s Harm Reduction Alliance.

These programs, which total less than $500,000, were originally funded using money the council set aside for a safe consumption site; in the face of strong political opposition to that idea, including from former mayor Jenny Durkan, the city worked with advocates to come up with alternatives that would still fulfill the original mission of harm reduction and health care without requiring a physical site.

Nelson, who has advocated for the city to fund traditional, abstinence-based inpatient treatment, said she wanted to know “what is the harm that is being reduced by the use of this money, and how do we measure the the performance of that investment? Because I know people know that I prefer that our scarce dollars should be used for treatment.” Although the three groups received funding from King County through a competitive Request for Proposals process, Nelson said they should go through another one, since the funding source is new.

According to City Attorney Ann Davison’s office, any lot for storing RVs that were previously used as residences has to be directly adjacent to a noncongregate shelter site—a requirement that has had the effect of virtually prohibiting such a lot. Davison said RVs could be allowed in this situation for up to 90 days, with extensions on a “case-by-case basis if the resident is working in good faith towards permanent housing”—a significantly more paternalistic approach than the previously approved proposal.

Both council president Debora Juarez and Councilmember Lisa Herbold seemed exasperated by Nelson’s objections. Juarez said it was already the city’s policy to fund both conventional treatment and harm reduction, while Herbold noted that the King County Board of Health, which includes Herbold and Councilmember Teresa Mosqueda, just unanimously approved a resolution supporting harm reduction as one use for the opioid settlement funds.

The council, Herbold pointed out, just approved spending $5 million in block grant funds for a new low-barrier opioid treatment facility, along with $2 million for a post-overdose recovery site, on Tuesday.

Another odd detail that emerged on Tuesday: Although the city allocated $1 million a year last year for people who had been living in RVs to store their vehicles for up to a year while they transitioned to living in shelter or permanent housing, the money has not been spent. The reason? According to City Attorney Ann Davison’s office, any lot for storing RVs that were previously used as residences has to be directly adjacent to a noncongregate shelter site—a requirement that has had the effect of virtually prohibiting such a lot.

The reason for allowing people to hang on to their old vehicles, at least for a while, while they transition into shelter is obvious. Many people are reluctant to move from the relative safety and privacy of their own RV into a shelter bed or tiny house, and don’t go into shelter as a result. If people can keep their RVs as a backup option, they’re much more likely to say yes to offers of shelter.

In a memo, an advisor to the city’s Human Services Department told the KCRHA that Davison’s office had determined that RV storage is “not identified as a permitted princip[al] use in the Seattle Land Use Code and is prohibited” everywhere in the city. RVs, the city attorney’s office said, could be allowed as an “accessory use” to a tiny house village for up to 90 days, but only if each resident who owned an RV started meeting with a case manager within 90 days to move toward permanent housing; extensions allowing people to store their vehicles longer “could be granted on a case-by-case basis if the resident is working in good faith towards permanent housing.”

This significantly more paternalistic version of the original proposal will require a provider willing and able to meet the city’s new conditions and restrictions. KCRHA put out an initial “letter of intent” seeking providers that are interested in opening an RV storage lot and a tiny house village next to each other on Wednesday.

On Thursday, Councilmember Lisa Herbold called the city attorney’s interpretation a “pretty significant misunderstanding” of the reason people want to store their RVs while they stay in a shelter. “The idea is is that this is a lot—much like a tow lot—where people voluntarily allow their vehicles to be towed into a fenced-in area,” Herbold said. “There are tow lots all over the city and they don’t all have to be next to housing for formerly homeless people.”

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The council is just starting its annual budget deliberation process. At a high level, the council will be debating how best to prepare for a “structural” general-fund budget deficit that’s now estimated at $212 million in 2025, an improvement from earlier predictions. Harrell’s budget plan would increase that structural deficit by adding $51 million in new expenditures, of which almost $28 million are ongoing annual costs.

Although the general fund is actually projected to do better in 2024 than anticipated, a lot of one-time funds that created new programs during COVID are set to expire, and the new council, which will likely have at least five new members, will have to come up with new revenues and, most likely, cuts.

Given that reality, it’s likely the council will scrutinize Harrell’s decision to add 110 new city employees next year, most of them permanent positions that create ongoing new funding obligations for the city. Overall, Harrell’s 2024 budget adds $51 million to the 2024 budget the council and Mayor Bruce Harrell “endorsed” last year) and increases the estimated deficit in 2025 to $247 million. Of the 110 positions, 40 are funded through the general fund—the part of the budget that pays for most of the city’s operations—and another 16.5 come from Jumpstart.

Jumpstart revenues are now expected to come in about $21 million below previous predictions; the tax is based on payroll expenses for the highest-paid employees at the city’s very largest companies, which makes it susceptible to swings when big tech companies cut jobs or move offices elsewhere.

The mayor’s proposal would extend an exemption from the tax for highly paid employees of nonprofit hospitals who make between $150,000 and $400,000. If this exemption was allowed to expire as scheduled, the city would take in an additional $5 million. Most of the private hospitals in Washington state are nonprofits and are exempt from many other taxes.

Harrell’s budget transfers $27 million from the Jumpstart tax fund to the general fund, an ongoing practice that the council has approved every year for the past several years to keep COVID-era programs going. Much of that includes new spending beyond what the council approved last year in the “endorsed” 2024 budget.

For example, the mayor’s budget would use revenues from the Jumpstart tax—which are supposed to be dedicated to affordable housing, small businesses, equitable development, and Green New Deal investments—to pay for higher human service worker pay, relocation costs for a tiny house village that needs to move off Sound Transit property; and subsidies for child care workers.

Nelson noted that she was the only councilmember to vote against raising human service workers’ pay, because she thinks the goal of eventually raising human service workers’ wages by 37 percent—the increase a University of Washington study concluded they would need to get to parity with similarly skilled workers—is unrealistic.

“The taxpayers are paying for a lot,” she said, citing several voter-approved human services levies.

“Regardless of what jurisdiction, it is—city, county, state, federal—it’s all taxpayer money,” Councilmember Lisa Herbold responded, and noted that other local jurisdictions, like King County, are also contributing to higher wages for human services workers, who often make so little that they qualify for social service programs themselves.

Harrell’s budget does not continue funding for a one-time 4 percent pay increase, plus an ongoing 3.6 percent increase, for homeless service workers, which the city had hoped the KCRHA would figure out a way to fund long term. Paying for these pay increases would cost the city an additional $1.9 million a year.

Councilmember Alex Pedersen, who represents the University District, suggested that it would potentially harm the people living at the tiny house village to “quibbl[e] about the pots of money”—a position that runs counter to his frequent calls for audits and “accountability” for programs he believes may be wasting money.

The mayor’s proposal also includes $1 million a year in new funding to evaluate the effectiveness of the Jumpstart tax, which would include two new permanent employees and unspecified additional expenses. It would also extend an exemption from the tax for highly paid employees of nonprofit hospitals who make between $150,000 and $400,000. If this exemption was allowed to expire as scheduled, the city would take in an additional $5 million. Most of the private hospitals in Washington state, including Virginia Mason, Providence/Swedish, and Pacific Medical Centers, are organized as nonprofits and are exempt from many other taxes.

Given how often the council has had to agree to exemptions from the spending plan since Jumpstart went into effect in 2021, a council staff memo asks semi-rhetorically, “is it time to consider expanding the areas of spending the JS Fund can be used for on a permanent basis?” Jumpstart architect Teresa Mosqueda may object to changing the spending plan, as she has in the past, but she’s likely to be replaced by a new, appointed council member next year, assuming she wins election to the King County Council.

City Council, Crime, Drugs, Guest Contributor

Moving Beyond Possession and Public Use: Let’s Be the City That Makes Real Progress on the Drug Crisis
City Councilmembers Alex Pedersen and Sara Nelson; City Attorney Ann Davison

By Lisa Daugaard

Seattle can continue to lead the country toward a productive approach to substance use and related problems. This is true no matter what happens when the City Council votes next week on a proposed ordinance, sponsored by Councilmembers Sara Nelson and Alex Pedersen and supported by City Attorney Ann Davison, creating gross misdemeanors under the Seattle Municipal Code for drug possession and public drug use.

If the ordinance is defeated, its proponents are still correct that we need far more urgency in responding to the drug crisis playing out throughout the city. If it passes, its opponents are still correct that the answer to drug-related problems does not generally lie in jailing and prosecuting people for substance use. Whatever happens next week, the work before us is the same: Take the field-leading models our community has devised to foster recovery for people who are most marginalized and exposed to the legal system, and secure the resources needed for those models to have their full impact.

When responding to problematic drug use, we cannot be satisfied with engagement for its own sake. As necessary as overdose prevention and reversal and preventing disease transmission are, they are not sufficient. We have to tackle how people are living, not just prevent deaths.

As a community, we have long known and broadly agreed on what can work well to respond to individuals who use substances in a problematic way: engagement without judgment; pre-booking diversion and pre-arrest referrals to intensive case management; well-designed low barrier interim and permanent housing options for those who are living unsheltered, as well as long-term case management for people whose use is related to complex trauma and lack of other support systems.

These approaches have been branded under names such as LEAD, Housing First, JustCARE, and harm reduction, but they all share elements of evidence-based, well-researched, trauma-informed care strategies and behavior change theory. Indeed, experts in our midst have quietly been teaching other communities how to implement these approaches, nationally and internationally, for more than a decade.

Seattle led the nation in reducing arrests, jail bookings, and prosecutions for drug possession long before the 2021 Washington Supreme Court Blake decision. The fact that there is an ordinance authorizing arrest, jail and prosecution for an offense does not dictate that it be used in a stupid, counter-productive, and evidence-defying way

What we have never done is bring these approaches to scale. Despite a unanimous City Council resolution in 2019 committing Seattle to make LEAD diversion resources available in all appropriate cases, current funding limits require turning down the majority of appropriate referrals. Nor have we complemented this approach with the housing and income supports many people need to make real breakthroughs. CoLEAD and the JustCARE model, funded by temporary COVID relief dollars, began to fill that gap over the last few years, but their future is uncertain as federal relief funding recedes.

It is absolutely true that, all other things being equal, court cases and criminal charges tend to impede recovery, for complex reasons including stigma, collateral consequences, the challenge of making it to court, and the difficulty of making even well-intentioned lawyers into trauma-informed practitioners. Jail and the inherent trauma it represents, including lack of physical autonomy for people who have often been physically abused, almost always impedes recovery. These should not be the primary strategy or the first resort in our response to problematic drug use. Those objecting to the new proposed ordinance are right to raise these issues.

Yet Seattle led the nation in reducing arrests, jail bookings, and prosecutions for drug possession long before the 2021 Washington Supreme Court Blake decision. The fact that there is an ordinance authorizing arrest, jail and prosecution for an offense does not dictate that it be used in a stupid, counter-productive, and evidence-defying way. We made enormous progress as a community, and developed a consensus approach to these issues, while there was still a valid felony drug possession law in place across the state that was fully available to local officers. Police and prosecutor discretion—and the support of city and county public officials and law enforcement leaders—meant that, while the authority to jail and prosecute existed, it was rarely used.

Mayor Bruce Harrell, who has prioritized action on conditions downtown and in the Chinatown/International District, oversees the Seattle Police Department, and has gone out of his way to make clear that he has no intention of arresting, jail or referring drug users for prosecution. And the authors of the new proposed ordinance making drug possession and public use a local crime were not even proposing criminalizing simple drug possession in Seattle until Governor Jay Inslee pressured the legislature to pass a law creating these crimes statewide. It’s regrettable that lawmakers removed the option of local choice, which would have resulted in de facto legalization of possession and private use in Seattle and King County. But it’s worth recalling that, before Inslee’s choice drove us down this road, Davison, Nelson, and Pedersen, to their credit, were championing only a very narrow role for the legal system.

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We can use best practices with or without the proposed law. In six months, for example, it will be far more important whether the multi-partner Third Avenue Project is still going on—and the 400-plus people who use drugs, live unsheltered, and are having a problematic impact in the Third Avenue corridor received supportive housing and intensive case management— than whether there is formal jurisdiction for the City Attorney to prosecute these two, of many, offenses that people who use substances often commit.

Drug possession and public use are now gross misdemeanors across the state—including in Seattle. Nothing local officials can do now can formally decriminalize either. It’s evident that some local leaders feel that taking an enforcement role completely off the table sends a message that serious drug issues are unimportant or low priority, and it’s also evident that other local officials cannot stomach any steps that formally invoke the prospect of criminal system consequences for what are fundamentally health and wellness issues.

It’s important to recognize that defeating the ordinance would not in itself represent a progressive approach to drug issues. Let’s fight hardest for what will matter most: whether we actually mobilize the community-based care approach that most people in Seattle support, go and get our people, demand the housing and income support that people need to recover, and provide the wrap-around care without which there is nearly zero chance for stabilization and healing. As it stands, regardless of whether this ordinance passes, we aren’t close to scaling the plan we need—even though we know exactly what it is.

Lisa Daugaard is the Co-Executive Director for Purpose Dignity Action (PDA) (formerly the Public Defender Association), a longtime drug policy reform organization that provides project management for local LEAD diversion initiatives, technical support for other jurisdictions implementing pre-booking diversion models, and partners on the JustCARE and Third Avenue Project initiatives.

Addiction, City Council, Drugs, King County

Council Member Wants to Know: Why Isn’t Harm Reduction Abstinence-Based?

By Erica C. Barnett

City Councilmember Sara Nelson, a vocal advocate for abstinence-based treatment for addiction, argued publicly yesterday with advocates for harm reduction over their approach, which emphasizes keeping people who use drugs alive and helping them address underlying conditions, such as homelessness and health care issues, without judgment or pressure to quit using drugs. Why, Nelson wanted to know, were these organizations focused on reducing harm from drug user rather than “encouraging” them to understand that total abstinence should be their goal?

“What [is] Public Health… doing to move beyond the harm reduction phase and how much money, if any, do you spend on agencies or for treatment that is geared toward abstinence?” Nelson asked. “And as a corollary of that, I guess the more basic question is, does Public Health agree that it has a responsibility to change behavior beyond meeting people where they’re at? Do you feel as thought’s important to help people change their use patterns in ways that they can go into abstinence-based recovery?”

Nelson’s (rhetorical?) questions came during a presentation by three longtime service providers—REACH, the People’s Harm Reduction Alliance, and the Hepatitis Education Project, along with King County Public Health—about how they have used funding from a small grant aimed specifically at reducing harm related to drug use. For years, the city council has also allocated funds for this purpose but the mayor’s office has refused to spend it.

“We’ve got ‘meeting people where they’re at’ covered, I think, when we’re looking at the treatment services that are provided right now,” Nelson said.

The county, strategic advisor and drug policy specialist Brad Finegood assured Nelson, spends “hundreds of millions of dollars” on abstinence-only services; the point of also funding harm reduction, he said, is to “keep people alive” and give them entry points for services amid an overdose epidemic that claimed more than 700 lives in King County last year. Those services, the direct service providers explained, include handing out the overdose prevention drug naloxone, connecting people to health care, offering medication-assisted treatment, and handing out supplies for safer use, including pipes for smoking drugs rather than injecting them.

Nelson (like many local right-wing commentators) zeroed in on safe smoking supplies, suggesting that providers should measure their success by tracking how many people who take pipes end up in treatment.

“I know it can be controversial,” Hepatitis Education Project program director Amber Tejada responded, but “one of the keys that I see is we want to facilitate the autonomy of people that use drugs. There are folks that don’t want to stop using drugs. There are folks for whom abstinence is not how they measure success in life. … Our mission, what we have been able to do really successfully with this program, is to show that people can use drugs safely, and we can help folks get access to resources if that is something they are interested in.”

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Last week, Nelson joined her colleague Alex Pedersen and City Attorney Ann Davison to propose new legislation that would enable the city attorney, rather than the King County Prosecutor, to begin prosecuting people for simple drug possession and public drug use. In 2018, King County Prosecutor Dan Satterburg stopped pursuing charges against people for possession of small amounts of drugs while expanding programs like LEAD that work to provide case management and service connections to people who use drugs.

The legislation, if adopted, would represent a profound change to the city’s approach to drug use and a return to war-on-drugs policies that the region has largely abandoned in favor of more compassionate and evidence-based approaches.

Last year, Nelson inserted language into the 2023-2024 budget to fund “facilities” for abstinence-based residential or intensive outpatient treatment using the city’s portion of a state settlement with opioid manufacturers. However, the language of Nelson’s statement of legislative intent leaves wiggle room for other evidence-based types of treatment, such as medication-assisted treatment or contingency management, as a presentation from council central staff at yesterday’s meeting also made clear.

Yesterday, Nelson expressed her frustration that the “private provider community,” which has “more availability for people who have insurance or can pay out-of-pocket,” has not been directly involved in the group that will make recommendations on what kind of treatment to fund with the money she proposed setting aside.

The point of her budget amendment, Nelson said, was “to establish a pilot program that would allow the city to directly contract with treatment facilities, private or public, in order to [help] people who are at the phase of really wanting to go into rehab, get into rehab, especially if they don’t have medication” as an option, as opioid users do.

“We’ve got ‘meeting people where they’re at’ covered, I think, when we’re looking at the treatment services that are provided right now,” Nelson said.