Tag: heroin task force

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.

Heroin Task Force Recommends Safe Consumption, but Do Leaders Know What It Means?


Part 1 of a two-part series on the recommendations of the Seattle/King County Heroin and Prescription Opiate Addiction Task Force. Part 2, which will focus on the task force’s emphasis on medication-assisted treatment and on whether the heroin epidemic is waning, will run tomorrow.

On Thursday, King County’s Heroin and Prescription Opiate Addiction Task Force released a long-awaited list of recommendations  to prevent opiate addiction and reduce harm for people addicted to opiates and heroin.

The headline, of course, is the group’s endorsement of two safe drug consumption sites in King County–one inside and one outside Seattle. The subhead, though, is the task force’s emphasis on “medication assisted treatment” for people addicted to heroin and other opiates, which would make it much easier for people to access maintenance opiate agonists like buprenorphine, which sells under the name suboxone, an opiate that helps reduce cravings for more harmful opiates like heroin, and methadone. (Traditional treatment generally relies on an abstinence-based approach that puts heroin users at a higher risk of relapse, particularly if they lack support systems.) The recommendations also include measures to promote prevention of opiate and heroin use such as education campaigns and drug-abuse screening in schools, and expanded distribution of naloxone, a drug that can reverse the effects of an opiate overdose, to more people, agencies, and institutions.

The proposals, which come with no price tag or timeline, prompted some bold claims on Thursday morning, when task force members gathered at Harborview Medical Center to discuss their impact in a camera-choked conference room. “I think that if we do our job effectively, we should theoretically be able to reduce opiate deaths over time by 80 percent,” said Brad Finegood, head of King County’s behavioral health and recovery division. King County public health officer Jeff Duchin emphasized that addiction is “a medical condition that is treatable and should be treated like other medical conditions,” not a moral failing. And advocates and officials heaped praise on the task force for setting prejudice and stigma aside to come up with nonjudgmental solutions for people with substance use disorders. “What is different and distinct about King County … is always being willing to be oriented toward outcomes of health and safety and following that wherever it goes,” said Lisa Daugaard, head of the Public Defender Association. “It is truly remarkable and unique.”

The political backlash to, say, allowing community clinics to prescribe drugs used mostly by heroin addicts alone could have buried that recommendation, but the task force went even further.

And, by virtually any measure, it is. Any one of these recommendations—wider access to naloxone; increasing the number of physicians and locations authorized to prescribe suboxone; creating a safe-consumption pilot site—could be seen as a radical improvement in itself, especially for a city where heroin addiction is such a visible problem. (According to one estimate, about one in five homeless people in King County suffer from substance use disorder, and the percentage among unsheltered people experiencing homelessness is likely higher). The political backlash to, say, allowing community clinics to prescribe drugs used mostly by heroin addicts alone could have buried that recommendation, but the task force went further and recommended not just wider suboxone distribution, and not just eliminating barriers to getting naloxone, and not just safe injection sites, but all of those things, and more.

It’s an impressively ambitious list of recommendations. But it will remain just that—a wish list—unless the county and its cities, including Seattle, commit firmly to funding all of the proposals on that list, not just the relatively cheap and uncontroversial ones like universal naloxone access and educational pamphlets, and dedicate resources to funding them.

Let’s start with safe consumption sites, which, as I’ve written before, go beyond the safe-injection model pioneered in North America by Insite in Vancouver, to allow supervised consumption of all drugs, including drugs that are consumed by smoking (technically, vaporizing), like meth and crack.

The political challenges facing any kind of supervised drug consumption site are already phenomenal. (In fact, I wrote a four-part series focusing on some of those challenges; part four, which looks at the likely political opposition in Seattle, is here). Opponents will argue that building facilities where law enforcement overlooks consumption of illegal drugs will make Seattle a magnet for drug users, and trash neighborhoods already overwhelmed by needles and crime. (Imagine, for a moment, a proposal to build a safe-injection site in Ballard, where a sober tent encampment proposal was nearly upended by howls of protest from residents, and whose residents turn to Nextdoor and Facebook to condemn addicts as worthless “druggers” and criminals who freely “choose” drug addiction as they rampage lawlessly through neighborhoods filled with upstanding homeowners who got where they are through hard work and willpower.)

Opening just one site could create a situation where the worst-case scenario of concentrated drug use does come true, because every drug user who wants to use the site will flock to a single spot.

Given the inevitable protests, the question will become: Which neighborhood will be the first to accept such a facility? The task force recommends just one safe consumption space as a short-term—three-year—pilot project, instead of multiple sites in the most heavily impacted neighborhoods, which many experts here recommend and which is the standard in Europe. That means putting the site in the neighborhood of least resistance—say, Capitol Hill or the University District—but it also means we won’t get a sense of what the true impact a network of safe consumption spaces would have, and could instead create a situation where the worst-case scenario of concentrated drug use does come true, because every drug user who wants to use the site will flock to a single spot. This could lead the city to declare failure prematurely, before more sites can open.

From Welcome to Murraysville.

At Thursday’s press conference, Mayor Ed Murray was quick to point out that “if you look at the heat map of where needles are distributed across Seattle, it’s not restricted to one neighborhood.” He added that his experience with homeless encampments has taught hims that when “certain neighbors tend to go sideways on us, that’s not the whole neighborhood. … Will it be easy? Will there be protests? Will there be another website to go along with Welcome to Murraysville that says I’m putting [safe consumption sites] everywhere? That’s going to happen. But I think we’re going to get there.”

If leaders  look to Insite as a model, without understanding the nuances of the term “safe consumption,” they might end up creating a site for needle users only that will do nothing for people who smoke meth and crack, or who smoke other drugs.

Murray said he plans to travel to Vancouver soon to visit Insite, the only safe-injection space in North America. (The comment was apparently inadvertent, and a Saturday press release announcing his trip to Vancouver on September 19 did not indicate whether he still planned to visit Insite.) But he won’t be getting a complete picture of what a safe-consumption site might look like here, and not just because Insite is a single facility, located in a neighborhood where most of the city’s heroin use and crime have long been concentrated.  Insite, critical as it is, isn’t a true safe-consumption site, since it only allows injection, and therefore isn’t the model for what safe-consumption advocates want to see here. (For that, you have to look to Norway, Germany, Spain, or Switzerland, along with other European countries where safe consumption is relatively commonplace.)

Harm reduction means meeting people where they’re at and reducing the harm they do to themselves while they’re in active addiction, and smoking, say, heroin instead of injecting it is one kind of harm reduction. But if leaders like Murray (and the other officials arrayed behind him at Thursday’s press conference) look to Insite as a model, without understanding the nuances of the term “safe consumption,” they might end up creating a site for needle users only that will do nothing for people who smoke meth and crack, or who smoke other drugs.

This isn’t just a theoretical concern. For example, media reports on last week’s announcement have consistently referred to CHELs as “safe-injection sites,” the assumption being that they will be for heroin users to inject heroin under supervision. And the report itself hedges on this question. “Every effort is to be made to ensure that the provision of supplies and space for consuming illicit drugs (NOT tobacco-containing products or marijuana) via smoking (more precisely sublimation, meaning without combustion of the drug itself) and nasal inhalation be incorporated into the CHEL program design,” the report says.

I asked Finegood what “every effort” means, and whether true safe consumption might end up falling victim to political compromise. After a long pause, Finegood responded: “I just don’t know.”

“There was just such an emphasis on it through the task force, to be able to provide that kind of resource and understanding—that we don’t want to move downstream inadvertently and say you can’t come here because you’re smoking,” Finegood told me. “Maybe [not emphasizing other means of consumption more] was an oversight on our part.”

If you enjoy the work I do here at The C Is for Crank, please consider becoming a sustaining supporter of the site! For just $5, $10, or $20 a month (or whatever you can give), you can help keep this site going, and help me continue to dedicate the many hours it takes to bring you stories like this one every week. This site is run entirely on contributions from readers, which pay for my time (typically no less than 20 hours a week, but often as many as 40) as well as costs like transportation, equipment, website maintenance, and other expenses associated with my reporting. Thank you for reading, and I’m truly grateful for your support.