Advocates are trying a new approach to create safe consumption spaces for drug users in Seattle — and this time, they are optimistic it might work.
The City Council’s 2021 budget includes $1.12 million that could go toward organizations, such as health clinics, hospitals or needle exchanges, that already serve drug users and allow them to provide safe consumption services to those who need them.
The Council has allocated virtually the same amount in the budget each year since 2018 to create a brick-and-mortar safe consumption site. This year, Councilmember Lisa Herbold proposed a budget action moving the money into the Human Services Department, for organizations to contract with Seattle & King County Public Health and receive grants to provide safe consumption services.
It is up to Mayor Jenny Durkan to use the money and contract with Public Health for these services. While Durkan publicly supported safe consumption spaces during her 2017 mayorial campaign, she has not spent the money in the past, fearing a legal challenge from the Trump administration. Herbold and advocates are hopeful things could change when President-elect Joe Biden holds the office.
Jesse Rawlins, public policy manager for the Public Defenders Association, lost a best friend and lover to a drug overdose some 12 years ago. “It was a really tragic situation,” he said. Rawlins is a member of the Yes to Safe Consumption Spaces coalition that formed in 2016.
Safe consumption spaces are intended as a component of public and harm reduction, to meet drug users where they are and prevent overdose deaths, as well as the transmission of diseases like Hepatitis B and C and HIV. They are similar in this way to needle-exchange programs.
Only one sanctioned safe consumption space exists in North America: the Insite facility in Vancouver, Canada — but many exist in western Europe. Seattle is one of several U.S. cities with a movement advocating for them, including San Francisco, Boston and New York.
In 2016, in response to a crisis in addiction and overdoses from heroin and prescription painkillers, Seattle and King County convened the Heroin and Prescription Opiate Addiction Task Force, which released a report recommending a pilot program of two safe consumption sites: one in Seattle and one outside Seattle, to address the pattern of drug use in the county.
In 2017, the King County Board of Health passed a resolution endorsing safe consumption sites.
Overdose deaths continue to rise each year in King County, including a sharp spike in spring this year. People who inject drugs, particularly those experiencing homelessness, remain especially vulnerable to outbreaks of HIV.
“I really believe that you can’t even think about getting people into treatment if you’re worried about them dying,” City Councilmember Lisa Herbold said. “I just think that’s so fundamental. To the people who are saying, ‘Oh, we should focus on treatment,’ well, you can’t focus on treatment when you don’t have services to make sure that people are not suffering OD deaths.”
One such person was Councilmember Alex Pedersen, the only councilmember to vote against Herbold’s budget action this month; he said it was not sufficiently focused on treatment, The Stranger reported.
A 2006 study of over 1,000 people who inject drugs in Vancouver found that after opening a safe consumption site, referrals to treatment increased by 30% in a year.
Rawlins noted that there’s a stark disparity in overdose deaths, with 14% of such deaths in 2019 in King County people experiencing homelessness, who make up less than 1% of the county population.
According to Herbold and Rawlins, it was more financially feasible to fund organizations who could provide safe consumption services than to build new brick-and-mortar sites.
Rawlins noted that unlike in Vancouver, where “outdoor problematic drug consumption” is concentrated mostly in one neighborhood, Seattle’s drug use is dispersed throughout the city and county. “So it doesn’t really make as much sense for just one brick-and-mortar space,” though he isn’t opposed to that approach in principle.
A recent public health evaluation published in the International Journal of Drug Policy in May 2019 used a mathematical model to estimate that a safe consumption space pilot in Seattle would prevent 167 overdoses per year, including six overdose deaths, 45 hospitalizations, 90 emergency department visits and 92 emergency medical service deployments. It comes out to a savings cost of $5 million, which is more than it would cost to set it up.
However, safe consumption proposals consistently draw alarm. After the Heroin and Prescription Opiate Addiction Task Force of King County and Seattle released its recommendation for a safe consumption site, several cities in the county preemptively banned safe consumption sites in their jurisdictions.
Herbold toured the Insite facility in 2017 with former state Sen. Mark Miloscia, a Republican, hoping to change his mind about safe consumption sites. Herbold was unsuccessful.
People sometimes visit the site in Vancouver and get alarmed, without understanding the context, Herbold said. “They look at the neighborhood around Insite, and their immediate reaction is ‘Oh, is this what we could expect if we were to bring safe consumption services to our neighborhood?’”
Insite has widespread support in Vancouver, including from the police department, and people agree it has improved the situation in the Downtown Eastside neighborhood, Herbold said — even though the area remains troubled by a high concentration of poverty and drug use. In her invesigative reports on the Insite facility, local journalist Erica C. Barnett notes that there is no comparable neighborhood in Seattle.
Rawlins believes the lack of safe consumption spaces can be more impactful on neighborhoods and public places, when people have nowhere to use drugs. “No one wants people using drugs outside in a problematic way,” he said. “The reality, though, is that we don’t have safe places for [people] to use substances — and people are currently using substances — and so we need to make safer places for people to use.”
In 2019, U.S. Attorney Brian Moran, who represents Western Washington, told City Attorney Pete Holmes that he would not allow Seattle to set up safe consumption sites, and Durkan and Holmes said they took the threat seriously, My Northwest reported.
However, a federal judge in Philadelphia later ruled that a safe consumption site does not violate federal law because its purpose is not to facilitate drug use.
As Biden takes office, perhaps a federal crackdown is less likely.
The resolution from the County Board of Health endorsing safe consumption sites strengthened the legal grounds for them, according to Mark Cooke, the policy director for the ACLU of Washington’s Campaign for Smart Justice, who believes local jurisdictions have latitude to regulate public health and public safety.
In response to the new safe consumption spaces proposal, Durkan has provided statements to the media that are broadly supportive but noncommittal. In a statement provided to king 5, her office said: “Mayor Durkan supports expanded access to drug treatment and increased services for people experiencing substance use disorders. Access to treatment and services was a critical aspect of the study and recommendations put forward by the Heroin and Opiate Addiction Task Force and has been important in harm reduction models that have been piloted internationally. Supervised consumption services and treatment offered in partnership with Public Health – Seattle & King County could be a way to accomplish those recommendations and the Mayor is interested in learning more about how this proposal could work. She would also look to legal counsel regarding the risks of any such proposal.”
Read more in the Dec. 16-22, 2020 issue.