King County Executive Dow Constantine and Seattle Mayor Ed Murray are officially endorsing a tactic for curbing opiate use that’s so uncharted in this country that it may well draw the eyes of the new president.
That is the creation of so-called safe consumption sites — government-funded facilities where people can use heroin, cocaine or any other intoxicant without the fear of arrest.
On Friday, they also endorsed, along with the consumption sites, seven other recommendations on dealing with the opiate crisis that won approval a week ago from the King County Board of Public Health.
Although safe-consumption facilities have been used across the globe — including in Vancouver, British Columbia — King County would be the first host to host one in the United States. While this was certainly a high-profile issue when the county’s opiate task force unveiled its recommendations in September, there is now the new Trump administration. And, following the likely confirmation of Sen. Jeff Sessions as attorney general on Tuesday, the Justice Department will be led led by an '80s-era drug warrior, which means the region will wait for a federal reaction with the same bated breath as when the state legalized marijuana in 2012.
The stamp of approval from Murray and Constantine, delivered in a sterile conference room at Harborview Medical Center, could be forecast months ago. Although neither leader had explicitly endorsed the recommendations, both had spoken at great length about allegiance to data and what other countries consider best practices — rhetoric used by proponents of these consumption sites and largely dismissed by their skeptics. In Seattle, Vancouver’s facility is the most commonly drawn parallel, and for strong reason: As Andrew Lewis noted in a Crosscut op-ed favoring the sites, while the Canadian city saw 159 overdose deaths, its injection site Insite had none.
On Friday, Constantine and Murray could not have been more clear. “We do what works,” said Constantine. “We don’t want to do the things that are easy … we want to do the things that will solve the problem.” The sites, he continued, are an extension of the harm reduction model King County long ago adopted, “where we meet people where they are and try to get them on a path to recovery.”
Murray took care to frame the response as a public health necessity. The Seattle Fire Department over the past two years, he said, has responded to more overdose calls than cardiac arrests. “The crisis has grown beyond anything we’ve seen before,” he said.
The hope, said county Health Officer Dr. Jeff Duchin, is to have two pilot sites running within a year. One will be in Seattle and the other somewhere in the county.
Members of the task force — an impressive cross-section of doctors, advocates, social workers, government officials, former and current drug users and law enforcement — were quick to point out that, while the consumption sites, labeled Community Health Engagement Locations, would garner the most press, the other recommendations were at least as important. “CHELs are the more sexy,” said Shilo Murphy of the Peoples Harm Reduction Alliance, which facilitates needle exchanges, “but we don’t want to lose sight of those other things.”
Those include expanded prevention efforts, like better education and more safe storage options for prescription opiates. Additionally, the recommendations call on investing $100,000 more a year for expanded distribution of naloxone, a drug that can reverse the effects of an overdose, as well as more than a $1.5 million over the next three years to expand programs providing buprenorphine, a prescription drug that kills cravings.
Members have emphasized that their priorities are the efforts to prevent opiate use in the first place and to offer readily available help to those hoping to quit. Dr. Caleb Banta-Green, the principal research scientist at the University of Washington’s Alcohol and Drug Abuse Institute, frames the current state of affairs in stark terms: “Right now it is an easier choice to wake up somewhere, be in withdrawal, feel like I’m going to die, go steal something, go sell that something, go find some heroin, go use some heroin, go recover from that heroin and repeat three hours later, three times a day — than getting the life-saving drug Suboxone [which includes buprenorphine].”
But the challenge has always been, how does a community overcome the stigma of drug use enough to effectively connect people to those resources? This is where the consumption sites fit in. Banta-Green and other health professionals emphasized Friday that most of the people they work with do not, in fact, want to be using heroin. By setting up the sites and staffing them with easy-to-access resources and advice, the other pieces of prevention and treatment would therefore be made more simple.
In taking this step, however, Seattle and King County are sticking their necks out. State Sen. Mark Miloscia, R-Federal Way, has already introduced a bill that would forbid municipalities from hosting safe consumption sites, arguing that they have not been proven.
And while the proponents of the sites argued repeatedly that the data should convince any skeptics, the next attorney general is known for hardline statements, including that “good people don’t smoke marijuana.”
Heroin use is a crime and, as City Attorney Pete Holmes told Crosscut recently, the locations of these sites will be public. On Friday, King County Sheriff John Urquhart restated a pledge to not arrest people using the sites, and said he's not really worried about federal Drug Enforcement Administration agents picking up people there. But he took a wait-and-see attitude towards Sessions.
The hope, said Dr. Jim Walsh of Swedish Medical Center, is that safe consumption will follow the same path as needle exchanges in the United States. "When needle exchange started in the '80s, the Reagan administration was not supportive of such effort," he said. "In fact they were profoundly against it. They thought it was encouraging drug use and they did everything they could to stop it. And communities found a way."
Walsh added that he doesn't necessarily expect a ready federal welcome for the effort, but he expressed hope that something can be worked out. "We may have to find a way: a work-through, a work-around," he said. "This is a life-and-death effort and if we’re committed to it, we’ll see it work."
