Tag: supervised consumption

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.

Republicans Show Up, Business Community Sits Out, Hearing on Supervised Consumption Sites

King County Superior Court Judge Veronica Alicea-Galván gave no obvious indication this morning which way she plans to rule on a lawsuit challenging I-27, an initiative that would ban supervised drug consumption sites countywide, but afterward, the attorney representing safe-consumption opponents seemed perturbed. “As the plaintiff’s attorney [Knoll Lowney] pointed out, they only have to succeed on one of their claims; we have to succeed on multiple claims.” Stokesbury was referring to the fact that initiative opponents are claiming I-27 violates five different rules that govern local initiatives, including a rule that says that urgent public health decisions must be made administratively (that is, by a non-legislative body like the King County Board of Health), not legislatively, and that the King County Charter itself prohibits voters from undoing budget decisions by referendum. (I covered some of the other legal arguments on Twitter). Alicea-Galván plans to rule on the lawsuit by the end of the day Monday, and both sides have said they will appeal if they lose.

Earlier this year, the King County Council voted to prohibit funding for safe consumption sites except in cities that explicitly approve them; since then, Bellevue, Federal Way, Auburn, and other cities have passed legislation banning the sites wihtin their boundaries. After the hearing, I asked Stokesbury why, if cities have the right to ban sites already, I-27 proponents want the right to prohibit cities like Seattle from allowing them. “We live in a regional area,” Stokesbary said. “Some folks might live in a city but work in a different city. I don’t know if we want to go back to an era where cities aren’t connected.” Stokesbary also suggested that allowing supervised heroin consumption, in particular (safe consumption sites would cover all drugs, but opponents refer to them as “safe injection sites”) would make it “harder to dissuade people from using heroin,” in the same way, he said, that legalizing marijuana has made marijuana use more common.

Without going too deep down that rabbit hole, I noticed something … odd about the safe-consumption opponents who packed the courtroom today and spilled into an overflow room down the hallway. No, not their maroon scarves, or the baseball caps they were required to remove in the courtroom, nor even their tendency to guffaw and cough loudly when they disagreed with a point as if they’d never been inside a courtroom.

What was weird was that there were so many of them—far more than the handful of familiar faces who reliably turn out to midday hearings about supervised consumption sites. There was, it turns out, a reason for that: The state Republican Party—headed by Susan Hutchison, who remains one of Trump’s most stalwart local supporters—sent out an email to its members urging them to show up in King County Court today, and to “wear baseball caps to be identified as pro-I-27.” (Whoops.)

“Polls show that citizens overwhelmingly reject heroin injection sites as a danger to society,” the email alert says. “Unlike the city of Seattle, we want compassionate solutions to TREAT the opioid addiction epidemic.” 

The other thing about the crowd that jumped out at me this morning was who wasn’t there: Representatives from business groups in Seattle, which have effectively sat out the whole debate over supervised consumption sites. That’s notable—and represents a significant shift from just a few years ago. Groups like the Downtown Seattle Association and the  Chamber of Commerce, which were initially skeptical of another harm-reduction program called Law Enforcement Assisted Diversion, came around to that program when it became clear that throwing drug users in jail wasn’t solving the problem of downtown drug use and disorder. Supervised consumption sites, radical as they may seem now, will serve a similar purpose: Meeting drug users where they are and offering them alternatives instead of locking them up and pretending that will fix the problem.

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 funded entirely by contributions from readers, which pay for the substantial time I put into reporting and writing for this blog and on social media, as well as costs like transportation, equipment, travel costs, website maintenance, and other expenses associated with my reporting. Thank you for reading, and I’m truly grateful for your support.

Morning Crank: Mayor Gonzalez?

1. City council president Bruce Harrell took the oath of office as Seattle’s emergency mayor yesterday (OK, real mayor, but only for another two and a half months max), promising to announce by today whether he will continue to serve as mayor until voters elect a successor to former mayor Ed Murray, who resigned this week after a fifth man accused him of sexual assault. .

The stakes for Harrell are high, although perhaps not as high as you might think: Although serving as mayor until the election results are certified at the end of November would require Harrell to give up his council seat, rumors have swirled since his most recent election in 2015 that this term, Harrell’s third, would be his last. Harrell ran for mayor and lost in the primary in 2013, so remaining as mayor would give Harrell a short-lived opportunity to serve in the position he lost to Murray four years ago.

If Harrell does stay on as mayor, Lorena Gonzalez would be next in the (informal) line of succession for council president. If he decides to return to the council, the council would choose another council member to serve as mayor. While Tim Burgess is an obvious choice—he’s stepping down this year, to be replaced in January by either Jon Grant or Teresa Mosqueda—the fact that Burgess chairs the council’s budget committee inserts a political wrinkle into the decision. If Burgess becomes mayor, the chairmanship of the budget committee would pass to council freshman Lisa Herbold—a member of the council’s left flank who might be more inclined than the centrist Burgess to tinker with Murray’s budget to reflect more left-leaning priorities (like, say, reducing the emphasis on rapid rehousing in the Human Services Department’s budget).

So who does that leave? Gonzalez, who was the first council member to call on Murray to resign, appears to be the next in line. She’s running for reelection this year, and assuming she wins, would be able to go right back to being a council member when the results are certified in November

Harrell has said he will make his decision before 5:00 this afternoon.

2. The Seattle Ethics and Elections Commission dismissed a complaint by one of the losing candidates in the August primary election against Seattle City Council Position 9 incumbent Lorena Gonzalez. That complaint alleged that Gonzalez had deliberately misled the commission about how many open debates she had participated in before the primary and demanded that the commission fine her and force her to  return all the money she has received from voters in the form of “democracy vouchers.”

“If the Commission terminates the candidate’s participation in the Program, it will invalidate the choice of the more than 2,100 residents to date who have assigned their vouchers to Councilmember González,” commission director Wayne Barnett wrote in his recommendation to the commission. “The Program exists to empower residents to participate in elections in ways they have not been involved in the past. The Commission should be cautious about exercising the ‘nuclear option’ in a way that disserves one of the primary goals of the Program.”

Although the commission ruled against Gonzalez’ erstwhile opponent, Barnett’s recommendation letter raises interesting questions about the breadth of the initiative that instituted public financing of local elections, and could have implications for what campaign forums look like in the future.

The democracy voucher program requires any council candidate seeking voucher funding to participate in at least three forums at each stage of the election (primary and general) to which all candidates have been invited to participate. The complaint argued that because the losing candidate was not invited to some of the forums Gonzalez listed as qualifying events (including a “women of color” forum), she should have to return all her vouchers. This interpretation could require candidates to figure out who was invited to every potentially qualifying event they attend. Or it could mean that every single candidate must be invited to every debate, regardless of whether they are viable. In the mayor’s race, Barnett points out, that would have meant that every debate could have included all 21 people who filed for the position, including “Nazi shitheads” screamer Alex Tsimerman—a prospect that would have rendered the debates more or less useless for people hoping to learn anything about any of the six candidates who were actually viable.

3. Some people just can’t take a joke. And some people just can’t get a joke—even when you explain it to them. Case in point: Last week, I ran an item about a going-away gift from the mayor’s staff to longtime City Hall staffer (and Murray chief of staff) Mike Fong—a giant fake check for $3.5 million made out to the “Michael Fong Community Health Engagement Location.” (CHEL is bureaucratic code for supervised drug consumption sites.) As I wrote at the time, “The joke, concocted by Murray’s comms director Benton Strong, is a little obscure.”

Too obscure, apparently, for Neighborhood Safety Alliance member Jennifer Aspelund, who filed a records request on Friday, September 8 seeking “any monies allocated for Michael Fong community health engagement location center and any discussion of such center.”

The city’s response? “This location center does not exist; therefore, the Mayor’s office or any other departments do not have any responsive records.”

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 funded entirely by contributions from readers, which pay for the substantial time I put into reporting and writing for this blog and on social media, as well as costs like transportation, phone bills, electronics, website maintenance, and other expenses associated with my reporting. Thank you for reading, and I’m truly grateful for your support.

Brad Finegood, King County Opiate Task Force Member: Safe Consumption Sites Will Save People Like My Brother

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

Last week, the King County Elections Department confirmed that initiative supporters had collected enough signatures to qualify for the February 2018 ballot; a last-minute effort backed by Republican King County Council member Kathy Lambert to put the measure on the ballot in November was unsuccessful.

With safe consumption very much in the news this week, I thought it would be a good time to hear from some advocates on both sides of the safe consumption issue. First up: Brad Finegood, a drug policy expert at King County with a mouthful of a title: Assistant Division Director, King County Dept. of Community and Human Services, Behavioral Health and Recovery Division. As deputy director of the recovery division, Finegood was a member of the King County Heroin and Prescription Opiate Addiction Task Force, which released a set of recommendations for addressing the opiate addiction epidemic last year. Those recommendations included promoting safe storage and disposal of prescription medications; wider access to treatment for opiate addiction, including medication-assisted treatment with drugs like suboxone and comprehensive treatment on demand; and wider distribution of naloxone, the overdose-reversal drug.

But by far the most controversial recommendation the task force made was that the county open two supervised drug consumption sites, where users could consume their drug of choice—heroin, meth, cocaine, whatever—under medical supervision. The intent, the task force wrote in its report, was to reduce drug-related health risks and overdose deaths; provide access to treatment and basic health care, reducing drug users’ use of emergency services; and “improve public safety and the community environment by reducing public drug use and discarding of drug using equipment.” Many communities didn’t buy the task force’s logic for recommending the sites (which have been common in many European countries for decades) and have passed city-level laws banning them; in February, King County voters will have their say on Initiative 27, which would prevent the county from opening a supervised consumption site anywhere, including in Seattle, where some communities especially hard hit by the heroin epidemic, such as Capitol Hill, have been open to the proposal.

As a King County employee, Finegood can take no official position on I-27, and we didn’t discuss the initiative explicitly during our conversation. But his longtime support for supervised consumption is no secret. For Finegood, the issue is more than political—it’s personal. A longtime drug counselor who worked extensively in the criminal justice system, he lost his own brother several years ago to a heroin overdose, and believes that a supervised consumption site could save the lives of people like his brother—both by preventing and reversing overdoses, and by reducing the stigma and shame that keeps drug users from reaching out for help. I talked to him at his downtown Seattle office last month.

Here’s Finegood:

Image result for brad finegoodMy brother and I were three years apart and we were always really close growing up. We grew up in a lower-to-middle-class neighborhood with two very hardworking parents and we both had really good educations. We both went to college together at Michigan State. I saw him every single day. But I never knew there was an opiate issue. That was really hidden to me and my family.  I would say, looking back, that there were probably some telltale signs. I’d go over to his house at noon, one o’clock, and knock on the door and he wouldn’t be awake. But I always figured, he was in college, he went out late, it was summertime and he didn’t have school or work.

Then he got married and went off into the working field, and there was a lot that I didn’t know, that was hidden. Some telltale signs of drug use would be marks on people’s arms or track marks or baggy eyes, and I never really saw any of that, so there was no reason to be concerned. A lot of stuff was obvious in retrospect. His wife wanted to gain some space from some of the people that he was involved with, so they moved to the East Coast to get away. Then they ended up getting a divorce and he came back to town and ended up connecting with a person who also had opiate use disorder but also hadn’t used in a long time. So when they connected, they started sharing stories, and saying, ‘Wouldn’t it be fun if we could get high together?’ She was in a different city, but they would rendezvous and go see music and get high.

That happened a couple of times. Then they got together and went on a three-day party binge for New Year’s, and he didn’t wake up on New Year’s Day.

“He cared a lot about his family, and didn’t want to let us down. There’s so much stigma that goes along with having opiate use disorder.”

We didn’t even know there was an opiate problem. And then he passes away and we meet this girl who he had been friends with, and she tells us some stories about what happened. His ex-wife then started telling me stories about past seven years of his life, when I had seen or talked to him every single day, and we started to piece together all these pieces.

It was just utter sadness and a ton of guilt—the guilt of being that close to my brother and not knowing. I was working in a clinic that served people with opiate issues, and I didn’t even know my brother was using under my nose. I think a lot of that was not wanting to let people down. He cared a lot about his family, and didn’t want to let us down. There’s so much stigma that goes along with having opiate use disorder. There was a picture that had been taken maybe two or three months before he died where he just had these raccoon eyes, and I thought, ‘Oh, that makes sense now.’ There was a lot of family system disbelief and denial that that couldn’t happen to us—’not in our family.’

One of my first jobs coming out of college was as a substance abuse counselor. I wanted to be able to help people, but I used to look at it from a criminal justice standpoint. I thought of the criminal justice system as a primary intervention for people, because I thought, people can get arrested and their drug issue could be brought up. I used to say that my brother’s biggest problem was that that he never got arrested. I had worked with so many people in the criminal justice system, and I saw that it could sometimes have a positive effect on people, if they were treated in a therapeutic environment.

You take folks who are struggling with [addiction] issues, and you put them in a confined area with other folks who are struggling with the same issues, and you don’t provide any therapeutic interventions around—then there can be some negative consequences.

I realized some of the unintentional harm that incarceration can cause people when I was working with somebody who had alcohol use disorder. He drank and got a probation violation, so the judge was going to send him back to jail for the weekend. And so I was like, ‘Hey, buddy, let’s make this an intentional experience. It’s lousy that you have to go back to jail for the weekend, but let’s get something good out of this, and you’ll come back next week and we’ll talk about it.’ So he came back the next week, and I was like, ‘So how was it? Did you learn something? And he goes, ‘Yeah—I learned how to make meth!’

That moment has stuck with me, because you realize that even the most well-intentioned intervention might have negative consequences. You take folks who are struggling with [addiction] issues, and you put them in a confined area with other folks who are struggling with the same issues, and you don’t provide any therapeutic interventions around—then there can be some negative consequences.

I was sort of raised [professionally] in the drug court world. Drug court was really the first idea that said there could be a therapeutic approach to working with people that have behavioral health issues. It’s harm reduction compared to sending someone to jail for a long period of time, but on the spectrum of harm reduction it’s not full harm reduction. That concept has evolved very much over the past 15 years to understanding that we have to be able to treat substance use disorder with a public health approach. Our partners in the criminal justice system will be the first ones to tell you, at least most of them, that criminalizing people with substance use disorder has been really unsuccessful.

“In my almost 20 years of working in this field, nobody that I’ve ever met who has opiate use disorder likes having opiate use disorder. They almost always know the risk, but they use anyway.”

The evidence [about safe consumption sites] tells the story, and the evidence is that people do not die when using those facilities. The evidence also says that when people have access to a caring environment,  they’re more likely to be able to move along the path [toward recovery]. When you provide an environment for people to feel safe, where they can come to without stigma, without prejudice, and they know that they can use on site and not die, then they’re going to continue to use that resource.

In my almost 20 years of working in this field, nobody that I’ve ever met who has opiate use disorder likes having opiate use disorder. People with substance use, especially opiate use, disorder use despite the risk of possibly overdosing. They almost always know the risk, but they use anyway. It’s a neurochemical brain disease. My brother is proof of the fact that you can be clean and sober for quite a period of time and that lure to come back is mighty difficult to fight. If you are consistently waiting for people to hit rock bottom, they’re gonna be dead.

“I think that stigma against people who have drug problems is really prejudice and discrimination against people who have drug problems.”

I think that without a doubt my brother would have benefited [from a safe consumption site.] Do I know if he would have used it? No. But do I know that there are people out there who need it and are willing to use it. Our survey from the needle exchange tells us that a significant number of people who use needle exchange services —the vast majority—would use it. And if they are willing to use it, then that means they will not be using it primarily outdoor, often by themselves, in a vulnerable situation. I know very little of the intricacies of my brother’s use, but if there was ever a time when he could have used it to make himself less vulnerable, I would have hoped he would have used it. Does it mean that my brother would be alive right now? No. But one of the things that I can say is that I believe that my brother had a lot of shame associated with his disease, and I believe that shame was because of how we as a society look at people with substance abuse disorder. I used to say, I wish my brother would have become involved with the criminal justice system. Now I wish my brother wouldn’t have felt shame. I think shame killed my brother. I think shame of having a heroin problem and having a drug problem killed my brother, because it kept him from ever wanting to ask for help. It kept him from ever admitting that he had a problem. And it kept him only trusting people that had the same problem. I think that stigma against people who have drug problems is really prejudice and discrimination against people who have drug problems.

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 funded entirely by contributions from readers, which pay for the substantial time I put into reporting and writing for this blog and on social media, as well as costs like transportation, phone bills, electronics, website maintenance, and other expenses associated with my reporting. Thank you for reading, and I’m truly grateful for your support.