Tag: suboxone

Morning Crank: A New Line of Business

1. When Mayor Ed Murray announced his $275 million homelessness ballot measure last week, he noted several times that the measure included “5,000 new treatment slots” for homeless people struggling with addiction, accounting for about $20 million over the five-year life of the levy. If the image that pops into your mind is beds in a residential treatment facility like the Betty Ford Center, think again: The treatment in the levy proposal consists primarily of programs that expand access to buprenorphine, also known as Suboxone—a prescription opioid that reduces cravings in people who are addicted to heroin and other opioids—and “housing with intensive outpatient substance use disorder treatment,” also focused on expanding buprenorphine distribution.

Suboxone is a drug that allows people who are severely addicted to heroin or other opiates to stabilize on a less-harmful opioid drug under the supervision of a medical professional, without having to go to a clinic to receive medication every day, as methadone patients do. Increasingly, health departments and addiction experts are recommending long-term buprenorphine use for people with severe addictions, because it reduces cravings for street drugs like heroin that can lead to overdoses and dangerous lifestyle choices. (Suboxone itself has been shown to be addictive). However, no prescription alone can address the many factors that lead a person to start abusing drugs in the first place, such as trauma, abuse, depression, mental illness, and despair. And buprenorphine doesn’t address addictions to non-opiate substances at all, including alcohol addiction, which kills about 88,000 people each year (compared to about 33,000 deaths from opioid abuse) and is endemic among people experiencing homelessness.

Curious about the precise breakdown of those 5,000 “treatment slots,” I asked the levy campaign for more detailed information. Here’s the breakdown they provided. Of the 5,000 slots over five years, 3,600 would consist of expanded access to buprenorphine, through new clinics, transportation to and from buprenorphine providers, and a new access point for people seeking treatment to find a provider in their area. That accounts for about $1.6 million of the approximately $4 million in new annual spending.

Another $540,000 a year would subsidize rent for about 300 formerly homeless people in “Oxford-style” sober housing—self-managed houses where people with substance use disorders live together in a sober, supportive environment. It’s unclear at this point what measures the city would take to monitor the quality of the sober housing it subsidizes, but Kaushik says the city will take steps to ensure the providers are legitimate.

The remainder—about $2 million—would pay for two programs: A low-barrier, residential inpatient treatment center serving 16 people a year, and an intensive outpatient program, with case management, serving about 300 formerly homeless people who would receive housing subsidies from the city. (The treatment would not be located in or tied to the housing itself).

When I asked about the relatively small amount of money for treatment in his levy proposal last week, Murray pointed out that treatment was “a new line of business” for the city and is typically funded by King County. Given that millions of people seeking treatment are likely to lose health care coverage under Trump’s health care “reform,” the city might need to get used to being in the treatment business.

2. Another question that nagged me about the mayor’s levy proposal had to do with the “landlord liaison” program that will be funded through the levy. I wondered if the city still needed a program to match landlords with tenants just coming out of homelessness, given that the city now has a law banning housing discrimination based on a tenant’s source of income.  (A tenant paying with one of the short-term rent vouchers funded by the levy, for example, could not be turned away because he had a voucher). City council member Sally Bagshaw, perhaps the most vocal elected proponent of the program, told me the landlord liaison program would go much further than helping renters get access to housing; it would also provide landlords with a financial “backstop” by promising to pay for any damages tenants cause, to provide case management, and to respond quickly to emergencies or landlord concerns.

“Let’s say we put Bob in [a unit], and we know Bob has some bipolar issues. If he’s stabilized, he’s fine’ if he goes off his meds, he’s not,” Bagshaw says. “Let’s pretend, for the sake of argument, that Bob does trash the place. We will have an insurance pool and we will say to the landlord, when Bob leaves, if he has trashed the place, if he puts his hand through a wall or puts a stick of dynamite down the toilet, we will come in and pay to fix the place back up.” Bagshaw says the goal of the program would be to identify 1,000 units around the city whose landlords would agree to participate in the program.

 

Murray Unveils $275 Million Levy Proposal for Homeless Housing, Shelter, and Treatment

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At a news conference in the common room of a Downtown Emergency Service Center-run permanent supportive housing facility this afternoon, Mayor Ed Murray released details of his five-year, $275-million proposal to address homelessness, which includes short- and long-term housing vouchers, new funding for 24-hour shelters, expanded medication treatment for opioid addiction, and permanent housing for people who need intensive services. What the proposal doesn’t include is funding for transitional housing, traditional overnight shelters, or a broad expansion of inpatient treatment for people whose addictions can’t be treated by medication.

Acknowledging that the $55 million annual commercial and residential property tax levy would represent an additional burden for Seattle taxpayers, Murray said he had hoped the federal government would pick up some of the tab for addressing what is also a national emergency. “When I announced the [homelessness] state of emergency, when we announced [the homelessness response plan] Pathways Home, I emphasized … that we could not do it alone; we needed the federal government,” Murray said. “In my State of the City address, I basically conceded a point that many of you in the media have challenged me on: that federal help is not coming.” In fact, Murray said, “we will probably see less money than we see today.”

The briefing came just one day after the city removed the few remaining stragglers from the SoDo homeless encampment known as the Field, to which the city itself directed people five months ago when it cleared the vast encampment under I-5 called the Jungle. Earlier this week, residents of the camp and their supporters showed up to the 2pm city council meeting to ask the council to delay the sweep, arguing that the city had failed to respond to repeated requests for things like sawdust, additional port-a-potties, fire extinguishers, and trash pickup, making the squalor at the camp inevitable. The city argued that the camp was not just unsanitary but unsafe, citing the arrest last week of a camp resident for rape and sex trafficking of teenage girls.

Murray’s proposal emphasizes getting people indoors through “rapid rehousing” in the form of temporary rental subsidies for housing on the private market; the mayor’s proposal would divide those subsidies into “short-term, medium-term, and long-term vouchers,” Murray said today. (The proposals are based on a set of recommendations called Pathways Home, which in turn is based on a report by Columbus, Ohio consultant Barb Poppe, and another firm called Focus Strategies). Short-term vouchers could provide rental assistance for as little as three months, while medium-term vouchers could last 18 months or longer, and long-term vouchers would effectively be permanent.

A slightly more detailed breakdown of the measure provided by the city reveals that the vast majority of the housing vouchers it would pay for would be either short- or medium-term, meaning that when they run out, formerly homeless renters will need to make enough money to pay for a market-rate apartment. (Currently, the median rent for a one-bedroom apartment in Seattle is just under $2000). About 4,250 of the 5,100 “housing exits” the proposal aims to accomplish over five years take the form of short- or medium-term housing vouchers; another 475 people would receive long-term vouchers, and 373 would be moved into permanent supportive housing.  The proposal also aims to prevent 1,750 people from becoming homeless through diversion programs, and to provide subsidies for 1,500 people to move into clean-and-sober Oxford Houses over the next five years.

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Other than the subsidies for Oxford housing, the mayor’s proposal includes no new funding for transitional housing, temporary housing that’s somewhere between a shelter and a private apartment. It does include 200 new beds at 24-hour, low-barrier shelters, which would replace some funding for traditional overnight-only shelters in the city’s 2018 budget, according to details provided by the city.

Although rapid rehousing hasn’t been implemented on the scale Murray is proposing in a city with a comparably unaffordable rental market (in the cities most commonly cited as rapid-rehousing success stories, Salt Lake City and Houston, a one-bedroom apartment costs about half what a comparable unit rents for in Seattle), council human services committee chair Sally Bagshaw said it was time to stop asking questions and start taking action. “We can debate, we can continue to study, or we can do what our experts have recommended to us,” Bagshaw said. “Do we just keep studying it, or do we invest big in what we know works?”

The proposal also includes a $10 million “housing innovation fund”—unallocated dollars that will go toward finding new housing models and building types that might be cheaper and faster to bring online than conventional low-income housing. Murray’s housing policy advisor Leslie Brinson Price said today that the fund is meant to “spur new thinking and provide a way to pilot projects” that the city might not try otherwise, like modular construction and cohousing.

Substance abuse treatment makes up a relatively small portion of the proposed levy, about $20 million of the $275 million total. That treatment consists primarily of programs that expand access to buprenorphine, brand name Suboxone, a replacement opiate that reduces cravings in people who are addicted to heroin and other opioids, and “housing with intensive outpatient substance use disorder treatment,” which Price said would also focus on buprenorphine distribution.

The measure would add 16 new inpatient treatment beds as part of a pilot project based on Philadelphia’s Journey of Hope project, which offers long-term residential treatment for chronically homeless individuals. The proposal does not appear to explicitly include treatment for alcohol addiction, which is also extremely pre homeless people as as addiction to heroin and other opiates, or other drugs with more complicated courses of treatment than taking a daily dose of Suboxone.

Asked about the relatively small emphasis on treatment—a subject that comes up often in discussions about homelessness—Murray said, “Remember, addiction treatment is not a city function, it is a county function. … We are getting into new lines of business that I hoped we wouldn’t get into, but again, if you look at the restricted nature of the county’s funding and the fact that they constantly find themselves cutting budgets, that’s why we’re getting into buying some services from them.”

sally-bagshaw

As I noted earlier this week, by gathering enough signatures to take his measure directly the ballot, Murray is effectively bypassing the city council, which tends to tinker with (and often reduce) mayoral spending proposals. Asked why he chose this tactic over the more traditional course of sending the ballot measure to the council for approval, Murray said, “I thought it was important for this to come from the community, for signatures to be gathered through a grassroots effort, rather than the usual model of doing things where the council puts it on the ballot. .. It gives people the chance to think about whether they want to sign that measure and whether they want to vote for that measure.” Then, smiling slightly, Murray added, “I mean, I’m a former legislator. [Legislators] always change the executive’s budget.”

Assuming supporters gather the requisite 20,000 valid signatures, the measure will be on the August 1 ballot—alongside Ed Murray, who is running for reelection.

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