1. Activists seeking to prohibit supervised drug consumption sites in King County will have to wait until next February at the earliest to see their initiative, I-27, on the ballot, a staffer for King County Council chair Joe McDermott confirms. The safe consumption site opponents, who are calling themselves “Impaction,” say they turned in 70,000 signatures last Monday, far more than the 47,000 valid signatures required to put the measure on the ballot.
However, the county elections office has to count and validate all those signatures before the county council can consider the ballot measure. Monday was the last regular county council meeting at which the council could have put the measure on the ballot, which pushes the initiative to the next election, in February. Opponents have cried foul, claiming that the council is deliberately pushing back the election until after the first site has already opened, but they’d have a more compelling case if they hadn’t waited until the last possible week to turn in their ballots—a week, it’s worth noting, when King County Elections is already kind of occupied running a primary election. (In any case, they can probably relax. Given the way the county council has already dragged its heels over funding, much less siting, a safe consumption facility, I’m not making any bets that one will be open within the next six months.)
Last year, the 27-member King County Heroin and Opiate Addiction Task Force unanimously recommended that the county open two supervised consumption sites, one in Seattle and one somewhere else in the county, as a three-year pilot program. Safe consumption sites allow drug users to consume illegal drugs, either by injection or Europe for decades, also provide basic medical care (for example, wound care and HIV tests), access to housing and other services that help street drug users begin to rebuild their lives; peer support; and access to detox and treatment.
Opponents of the sites say they enable users and contribute to street disorder in neighborhoods. At Insite, a safe injection site in Vancouver, B.C., more than 60 peer-reviewed studies have concluded that Insite has increased the number of people seeking treatment without increasing crime.
2. An election already without precedent in Seattle history may yet turn out to be the most expensive in the city’s history. By this point in 2013, now-Mayor Ed Murray had raised “only” $389,839; his successor in the “establishment candidate” role, former US Attorney Jenny Durkan, had, as of yesterday afternoon, more than eclipsed Murray with contributions totaling $491,107, plus another $127,100 from the business-backed People for Jenny Durkan PAC. (Mike McGinn, the incumbent in 2013, had raised a relatively paltry $285,912).
In the race for City Council Position 8, the “establishment” candidate, Fremont Brewing owner and former Richard Conlin aide Sara Nelson has raised $144,910—$100,000 less than her 2015 “establishment” stand-in, Tim Burgess, had raised by the same date that year. However, Burgess was a longtime incumbent, not a first-time candidate; and Nelson is getting her own assist from a business-backed PAC, People for Sara Nelson, which has raised $65,000 to spend on her behalf. Jon Grant, who ran in 2015, has reported contributions of $176,822 —dwarfing his total at this point in 2015, $40,013, and eclipsing his total in that campaign, in which he raised just $75,635 in all.
All the mayoral candidates enter tomorrow night’s primary with negative or near-zero balances in their accounts, except one: Nikkita Oliver, who has a balance of $53,165. That looks to me like the sign of someone who expects to make it through the primary tomorrow night.
3. And just to put my own prediction on the record (with the usual caveat that I’m eternally, embarrassingly bad at this): Durkan/Oliver.
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Insite founder Liz Evans and Portland Hotel Society manager Coco Culbertson at the Rainier Hotel in Vancouver
Yesterday, I gave a brief account of my recent trip with state Sen. Mark Miloscia and city council member Lisa Herbold to Vancouver, B.C., where we visited Insite, North America’s only supervised injection site for illegal drugs, a zero-eviction women’s housing project eviscerated by government budget cuts, and a prescription heroin clinic. After the trip, I sat down with Miloscia, who is running for state auditor, to talk about his impressions of the trip and his own views about the role of government in responding to addiction.
Miloscia, a Republican, has said publicly that he plans to introduce legislation preempting King County from moving forward with two supervised drug-consumption sites recommended by a county task force on opiate addiction. A former B-52 pilot with, as he puts it, “18 nukes on my wing,” Miloscia says he had a religious awakening during his time in the service and became a pacifist; his political views also did a 180, and he became a vocal opponent not only of abortion rights and the death penalty, but of drug decriminalization, which he previously supported.
The C Is for Crank [ECB]: Did anything you saw in Vancouver surprise you?
MM: A few things surprised me. One is the passion and compassion of Liz [Evans, the founder of Insite] and the people there. Two, I think in the big scheme of things, we’re not that far apart. She gets the failures of the system absolutely, and I’m the same way. She said she’s a disrupter, and so am I, because we both recognize the evils and the shortfalls of the current system. It’s not working. That’s why I got into government, why I ran for office–because the human services and criminal justice side is a complete failure, and we don’t want to fix it, and people die. It’s mind-boggling to me.
The first question out of the first reporter [at KING 5, which did a brief story about the visit] was, ‘What struck you there?’ And I said, ‘That street.’ [East Hastings Street, where Insite is located, has long been Ground Zero for the drug trade in Vancouver]. I never saw that many drug addicts on one street. I grew up in New York City, but that was horrible. I saw that need, our brothers and sisters dying on the street. And then you have that clean, very well-maintained facility, government-run, and it’s like, we’re contributing to that. We’re not helping them. They’re already on death’s doorstep. They’re dying right there, and we should be helping them five years before they get to that point.
ECB: But Insite does save lives. The data, which Liz and the other Insite staff cited to you, prove that it saves lives that would have been lost to overdoses, HIV, or wound infections.
MM: You’re absolutely right. Maybe they are. But I talked to Liz about this and Liz admitted that it’s just a little patchwork process in the entire homeless heroin addiction system, which is completely broken. It’s like, stupid government! What are they doing? Do something! They have all the money, all the authority, and they’re blowing it.
“The entire way our planet operates is about telling people what to do. Criminal justice, societal pressure—everything is about telling people what to do. Now, when they have an addiction, when the drug takes over their life, that’s when they need that more than ever before.”
And she said that she hated the government getting involved, because it’s gold-plated and ineffective and the compassion goes away when bureaucrats are running it. And ultimately it doesn’t work. I believe there’s got to be accountability and prevention, because once they get into that… What’d she say, it’s going to cost $30,000, $24,000 a year? I can’t remember what figure she gave but it was an insane act of money. We’ve got, what, 50,000, 40,000 addicts in King County? Do the math.
ECB: But they’re already costing us money. The highest number I heard for any service while we were in Vancouver was around $25,000 for someone to use the prescription heroin program, and the director pointed out that that was still much cheaper than jail, which can cost as much as $150,000 a year.
MM: And that’s why I’m a big believer in any sort of diversion program at all. You need to be able to identify people as being a danger to self or a danger to others, and once you do that, you can force people into treatment.
ECB: Liz told you that there’s no evidence to suggest that forcing people into treatment works—it just gets them off the street for a few days or weeks, at huge expense, just like jail. What do you say to that?
MM: That is a crock. The entire way our planet operates is about telling people what to do. Criminal justice, societal pressure—everything is about telling people what to do. Now, when they have an addiction, when the drug takes over their life, that’s when they need that more than ever before, and the question is getting them into a treatment that works. And to be honest, it’s almost a lifetime of treatment they need, because 30 days is the worst type of treatment. You might as well not even try. You might as well get them into detox and then kick them out onto the street. And that’s what we’re not fixing.
ECB: If 30 days of treatment isn’t enough, and that costs tens of thousands of dollars already, how are you going to pay for more intensive treatment for more people?
MM: You’ve got to focus on prevention. That’s the only way you rightsize the problem. Do an analysis of why people are turning to drugs. If you want to solve the problem rather than just maintain it, slow the growth. To solve any problem, it’s all about preventing the causes. That’s where it’s cheaper. That’s where you get results. And that’s, to be honest, where the bulk of the money needs to be spent. We’re triaging now. If we do everything in a system-wide manner, yes, there’s a way I see her program working–if it’s just a temporary stair-step program to get people into treatment. I try not to get visibly angry over the destigmatization of drugs and ‘It’s all about choice’–but that’s the wrong approach. It’s hard for people to choose to get out of their addiction. It’s carrots and sticks, for all of history–that’s how you motivate people. If you have no stick, you’ll never get a person to the point [of entering treatment] unless they hit literally rock bottom and are at death’s doorstep.
ECB: But if every addict decided they wanted to get into treatment tomorrow, we’d be thousands of beds short. And we don’t currently have the capacity to put every heroin addict on Suboxone or methadone. Are you in favor of funding treatment on demand?
MM: What I believe is when people want treatment now, you get them treatment now. So yes, that’s where you probably get your most success. If I was going to put money into triage, absolutely, get that right now. But do the math. We’re going to need $5 billion. And that’s why we’ve got to do prevention and stop it.
“I try not to get visibly angry over the destigmatization of drugs and ‘It’s all about choice’–but that’s the wrong approach. It’s hard for people to choose to get out of their addiction.”
ECB: Will you concede that you’re never going to stop from using drugs and doing dumb stuff through prevention, though? You can conceivably reduce it, but it’s going to be above zero, because people are going to continue to use drugs. What do you do with the people who are going to still use drugs and end up getting addicted?
MM: I’m going to slightly disagree with your assumption, because at the end of the day, this whole discussion we’re having is a distraction from, what is our plan to cut heroin drug use down from 50,000 down to a manageable 1,000? [It needs to be] done right, with a huge cultural stigmatization–this is controversial when I say it–and going after the root causes.
“I firmly believe that just like with homelessness, literally half the money we’re spending is spent on ineffective programs, wasteful programs, and we don’t get results because we don’t measure that.”
I started having that conversation with Liz, I said, ‘Why do people start using drugs?’ And she said, ‘Pain, broken relationships.’ That’s just another name for religion, family, community: Those networks that keep people sane and that stabilize people before it reaches the state of, you’re living in the Jungle with your heroin buddies and part of a gang. When you‘re part of a strong community like that, it’s really hard to move there. The societal, community, family, pressure prevents you from going there. The bottom line is that’s what it takes for people to get out of their addiction. You’ve got to develop that support structure around them.
A nurse at the Crosstown Clinic in Vancouver, where addicts come several times daily to inject prescription heroin.
ECB: You’ve said you don’t want a safe injection or consumption site in King County. Why do you want to interfere with local control by passing legislation making Seattle’s desire to experiment with that model impossible?
MM: Part of the reason is, if you look at where Canada’s going, with medicinal heroin, they’re still not getting rid of the root causes. They’ve still got a heroin epidemic going on, so they’re not solving the root problem. So while in the short term, I believe it slowed the deaths–instead of it taking you five years to die on the streets, it’s now taking you ten years–at the same time, it’s not solving the underlying root causes that ultimately lead to addiction.
ECB: Have you read the heroin task force report?
MM: Yeah, ten times already.
ECB: It seems to me that they’re trying to do exactly what you’re saying you want.
MM: There’s a lot of good things in there. But we know how task forces are done, and there’s really nothing in there that I haven’t seen before. It’s all the same stuff. And anybody who’s been involved in this knows that the problems haven’t changed from the 80s. It’s the same problems. The solution is the same thing. But government never does it. Government screws up the implementation every single time. But they get to spin that report and say, ‘Oh, we’re doing something.’ But does the system, the boots on the ground, really change?
ECB: The task force is only recommending safe consumption sites for two years, as a pilot project. Why not let them try and see what happens?
MM: OK, so let’s think. We’re going to take this radical change. If we scale it up, we’re going to need to do 80 sites in King County alone. Then we’ll do medicinal heroin and we’re going to continue down that path.
ECB: But nobody’s talking about doing that here.
MM: They’re doing it in Canada! It’s the next step. It doesn’t work unless you go to the next step. That’s why everybody wants to put it in that little silo: ‘Oh, this is all we’re doing.’ But no, no–if we want to change the system, we have to have real reform. How does this scale up and look systemwide? And then when you look at that you go, ‘All our resources are going into this, it doesn’t work, per se, and we’re ignoring the key factor of prevention.’
ECB: What do you think does work?
MM: Show me the numbers. No one talks about efficiencies or effectiveness. I firmly believe that just like with homelessness, literally half the money we’re spending is spent on ineffective programs, wasteful programs, and we don’t get results because we don’t measure that. But that’s the data I want. I want to know that, ‘Okay, Mark, if you do this program systemwide, it’ll save “X” lives.’
ECB: But the only way to get data on harm reduction is to do harm reduction.
MM: Oh, true, right. But what I’d like to see is, let’s fix the $1 billion we’re spending right now, which we know at least half a billion of it are wasteful, are ineffective, are not getting results. Let’s design a plan to focus on prevention, versus, let’s get distracted and put us on the path to, frankly, legalization and decriminalization.
ECB: What do you think of the LEAD program, which diverts people committing drug crimes out of the jail system?
MM: Oh, it’s fantastic.
ECB: But that involves not arresting people.
MM: As long as they get them in a treatment plan, I’m fine. Do harm reduction and treatment, I’m fine. But there’s got to be no choice. It can’t be, ‘Well, I’m going to do this for ten years.’ It’s like Housing First. I’m for Housing First, but after 30 days, pick a time, you’ve got to get with the program. Come up to me with programs that get them from Point A to Point B. Show me the data. I know behavior modification and I know this: Human behavior has been the same for as long as we’ve been on this planet. Carrots and sticks.
ECB: Do you have an opinion on long-term buprenorphine treatment?
MM: I want to see an efficient, effective, ethical program that works, that gets results. So I’m not opposed to it, but it’s a different focus from just giving you free government help and, we’re just waiting for a light bulb to magically turn on, versus being in a program where you’re monitored with ankle [bracelets], diversion programs, all that stuff. I want to be part of that solution. I think that’s the way to go, with that public stigma. And people don’t like doing this, but you have to scare the kids and scare the adults.
ECB: I grew up in the age of Just Say No and it didn’t work. Neither did DARE. Both of those programs were geared toward trying to scare kids.
MM: Of course it didn’t work. Those are government-run programs. When the program doesn’t work, you know that within 45 days of the program starting and you change the program. But that doesn’t stop you from trying to find a program that scares people and stigmatizes them. Look at Korea. Look at Japan. There’s all kinds of cultures where it does work. But it takes thought. It’s all about culture and attitudes, so people don’t turn to drugs. There’s a whole science about why people turn to drugs or do self-destructive behaviors, and it brings us back to the family and religion discussion, or the values discussion, or the culture discussion. That’s the heart and soul of how people decide to avoid listening to the little devil on their shoulder versus the angel on their shoulder. That’s just human nature. We all struggle. All of us deal with the choices that we make.
ECB: Was your mind changed by anything that you saw or heard in Vancouver?
MM: Like I said, Liz completely shocked me. She gets the problem and the gets the solution and she admits that her thing isn’t solving the problem. She’s trying to break up the system. But the practice per se of clinics–I think, no. My opinion didn’t change at all. I still think it’s a distraction from us working on the really tough issue.
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The weekend before last, I took a second trip up to Vancouver, B.C. to visit Insite, North America’s only safe-injection site and, as such, the likely model for two proposed safe consumption sites (which will include space for people who smoke meth, heroin, crack, and other drugs as well as injection stations) in King County. (The sites are among many recommendations that came out of the county’s heroin and opiate addiction task force.) I visited Insite previously over the summer, when program manager Darwin Fisher gave me a tour of the facility and the Downtown Eastside neighborhood that surrounds it. That time, Insite was open for business, and a steady stream of clients filed through; each told the staffer at the desk her code name and what drugs she was bringing in, and settled into one of 13 mirrored booths that line one wall of the tidy facility. I watched as drug users fresh off the streets searched for veins in their feet, did their makeup, washed their hands for what might’ve been the first time in days.
This time, I wasn’t alone, and I wasn’t visiting during business hours. Instead, I was playing third wheel to an unlikely pair of elected officials—uberliberal Seattle city council member Lisa Herbold, and conservative Republican state Senator (and candidate for state auditor) Mark Miloscia. Herbold, a supporter of safe consumption sites, invited Miloscia along in hopes of getting him to see the ways that Insite has benefited the surrounding neighborhood, and to view harm reduction through a more sympathetic lens. Miloscia has said he plans to propose legislation that would bar all cities from authorizing safe consumption sites—a sort of companion bill to his proposal to prevent Seattle from relaxing its policy on encampment sweeps.
Over the course of a long morning and part of the afternoon, Miloscia, Herbold, and I toured Insite, wandered around the Downtown Eastside, talked harm reduction over lunch with City of Vancouver urban health planner Chris Van Veen and Insite founder Liz Evans, and toured a clinic that prescribes heroin to addicts who don’t respond to methadone or suboxone, two common drugs prescribed as part of treatment for heroin addiction. We also visited the Rainier Hotel, a zero-eviction apartment building for women that used to be a thriving, successful drug treatment center; in 2013, thanks to what Evans calls the government’s “culture of bureaucracy,” it lost public funds for its addiction programs and is now single-room occupancy housing.
Fisher, Evans, and Coco Culbertson, a manager at the Portland Hotel Society, the nonprofit that runs Insite, walked a very curious (and at times visibly distressed) Miloscia through the admission process (more on that here), and explained the benefits of the services Insite provides. “Coming in here from the street, where you’re going to get water wherever you can find it”—that is, from a puddle in an alley— “it’s like going from the third world to the first world in a sense, because of that running water,” Fisher said. Deaths from HIV, overdose, and soft-tissue injury infections have declined dramatically in the surrounding neighborhood and in Vancouver as a whole, and detox admissions have increased (to 400 a year, according to Fisher), because Insite builds trust with its clients and doesn’t judge them, Fisher explained. Later, Evans would say that harm reduction programs like Insite have had an unanticipated side effect: Because people are no longer dying so young, “we’re treating chronic conditions in a population that’s aging ten years more than they would have 20 years ago. That’s incredible. We’re seeing chronic health conditions win a population that used to just die.”
Miloscia, who stared, aghast, at the drug users displaying goods for sale, shooting up, and chilling out on the sidewalks around Insite as Evans explained how programs like Insite and the Rainier Hotel save money, peppered the Canadians with questions: How do you know this is working? (They have data and studies that say it is). Why not just focus on prevention? (Prevention is just one pillar; you need to deal with people after they get addicted as well). And: “When do we say, enough is enough, and you have to rejoin society?”
That question was really at the heart of Miloscia’s objections to the Canadian experiment: Why coddle people who will continue to stay addicted, according to Evans, an average of 14 years, instead of just shaming them for their bad behavior, pushing them toward their own “rock bottom,” and if all else fails, forcing them into treatment? This is a fundamental difference in philosophy between those who advocate for harm reduction and those who believe in prevention and punishment. Evans and the other advocates argued that not only does forcing people into treatment not work, blaming and shaming only pushes people further into the shadows—and further away from help. “We would like to believe that forced treatment works, but it does not,” Evans said over lunch. “If we make people feel their life matters… their outcomes are going to be way better than if we push them further away.
“We have been so ingrained with this belief that telling people that what they’re doing is wrong and bad works, but it doesn’t work. In 25 years, I have never seen a drug user stop using because we told them they were wrong and bad.”
Miloscia is a firm believer in stigmatizing drug use and forcing people into treatment. He thinks it works. But what Miloscia really believes in, he says, is prevention—”scaring” parents and kids, in his words, into never picking up a drug in the first place. Tomorrow, I’ll have a post-Vancouver Q&A with Miloscia in which the conservative senator talks about what he learned from Vancouver, what he thinks of King County’s current approach to addiction, and whether anything he saw changed his mind.
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This is the second part in a series about safe drug consumption spaces. Part 1, which focuses on the Insite safe-injection site in Vancouver, B.C., is here.
The need for safer spaces for people to consume drugs in Vancouver, as in Seattle, is undeniable. Insite manager Darwin Fisher, who walked me around the Downtown Eastside neighborhood during my recent trip to Vancouver, estimates that there are about 5,000 active intravenous drug users in the city, and a huge percentage of them live in the few blocks surrounding the Insite building. As we emerge from Insite onto the street, Fisher is bombarded with comments and requests—why is the community garden fenced-off so no one can get in? Can I have a cigarette? When can I talk about getting my Insite privileges back?—from clients and others hanging out in the area.
Fisher says it’s actually that sense of community—his awareness that, as fucked-up and dysfunctional the Downtown Eastside might be, people know each other and have each others’ backs—that keeps him in the area, more than two decades after he landed here as a wide-eyed kid from Saskatoon in the early ’90s. “There’s this incredibly moving thing about people knowing each other,” he says. “You work down here for a while and you get to know some of the people… There’s almost an old-fashioned idea of, ‘Hey, neighbor!’ Not to sugar-coat that or anything, but that’s really important.
“The demonization of this community, and of other communities like the tent city [in Victoria, B.C.], is why I think it’s really important to do recognize them as a community.”
Most people (though certainly not all) would agree that saving drug users from dying is a positive thing. But overdose reversals aside, do safe-injection sites work? That is, do they improve life for more people than doing nothing?
That’s a tough question, because the answers depend on what we consider “improvement.” For many North Americans, an addicted person isn’t “better” until they’ve achieved total abstinence—usually through a process that involves “hitting rock bottom,” often expedited by the “tough love” of neglect rather than the “coddling” of harm reduction. Once a person hits rock bottom, in this narrative, they can finally have a moment of clarity, followed by an epiphany which leads to a new commitment to living a clean and sober life. Since abstaining from drugs is so obviously what’s best for a former user, relapse becomes a personal failure. If you don’t stay clean, it’s because you didn’t want it enough—or you didn’t hit your “real” bottom yet.
This narrative is obviously problematic, not least of which because the ultimate “rock bottom” is death. (And as any addict will tell you, every bottom is really a trap floor concealing another bottom.) Besides, Fisher says that if you went around talking to the people we saw on our stroll around the Downtown Eastside of Vancouver, “they’d say, ‘Where’s rock bottom? I’m there.’ … And maybe I have a moment where I feel like, OK, I’m ready to wrestle this demon and start making better choices, and maybe I go to detox, and maybe, for a variety of reasons, it doesn’t take. What does it feel like then? You feel not like any systems have failed you—you feel like, once again, I am a failure. And if we think that addiction stems from anguish, from pain, from feelings of rejection and failure, what would I want to do when I felt that way? I think I would like to numb it.”
From a public-health perspective, Insite works. More than two dozen peer-reviewed studies have concluded that Insite prevents 35 new cases of HIV each year (saving more than $6 million), has decreased the fatal overdose rate in its immediate vicinity by 35 percent, has led to dramatic decreases in risky needle use and disposal practices, and has led to 30 percent more people seeking detox services, in many cases the first step on the road to recovery. (Insite offers detox in its Onsite facility upstairs from the injection site, and helps users get into long-term treatment programs).
Matt Curtis of the harm-reduction group VOCAL-NY, the forerunner to Seattle-based VOCAL-WA, told me recently that “offering people care and love and respect and dignity is a very different experience than what you’re kind of told day in and day out [as a drug user], which is that that you’re a mindless zombie with no personal agency, a criminal, a threat to society and children—that you’re so bad you might be contagious.”
When cities adopt a different approach, acknowledging that people “fail” at abstinence all the time and that drug users aren’t bad or weak or morally inferior, people’s lives generally start to improve whether they stop using or not. Whether or not a person decides they want to stop using is their business, but in the meantime, harm reduction programs like Insite provide access to services like housing, detox, mental-health counseling, and treatment, some of which drug users may need to have just to get stable before they can start dealing with their substance use. And then, when that happens, they need treatment to actually be available.
“I think it’s important that supervised consumption spaces are not discussed in a vacuum,” Patricia Sully, the coordinator for the harm-reduction group VOCAL-WA, says. “These are not the tree that grew up to heaven and fixed all the problems; this is one tiny thing that really needs to operate in a continuum and spectrum of care. … Drug treatment itself might not be the only thing people need. Many people need connections to mental health services. Many people need connections to housing. And we know that all of those things really make a huge impact on someone’s quality of life.”
Curtis says that in his experience, “people come into harm reduction programs after hearing for years that they’re nothing but junkies or crackheads, that it’s their own failures that have kept them addicted, and a lot of times, they immediately start using less.” Unfortunately, Curtis told me, many people see harm reduction as merely “‘Meet people where they’re at.’ That’s not the motto. The motto is, ‘Meet people where they’re at and don’t leave them there.’”
The rest of this series on safe consumption spaces will focus on what a safe consumption space might look like in Seattle, and why advocates are arguing for a space consumption space for all drugs, not just heroin.
