Nearly every major city across the United States has been affected by a wave of heroin abuse and overdoses in recent years, but none have responded with the radical — but proven — approach that Seattle-area officials now plan to take.
A county-level heroin task force recommended Thursday that the city and surrounding municipalities open places where addicts can inject or smoke opioids without fear of arrest and with access to clean needles and treatment.
After unveiling a 99-page report on the subject, which outlined the myriad public health benefits from similar experiments elsewhere in the world, King County Executive Dow Constantine told reporters why he decided to endorse "safe consumption" sites.
"If this is a strategy that saves lives, if there are people who are going to die if we do not do this," he said, "then regardless of the political discomfort, I think it is something we have to move forward with."
Nearly every key local official and agency is on board with the plan, including Seattle Mayor Ed Murray, who reportedly did not say precisely when or where the facilities would open, but vowed to fight the potential "blowback" at the neighborhood level.
Lindsay LaSalle, a senior staff attorney at the Drug Policy Alliance, said that while cities such as New York, Boston, San Francisco, and Baltimore have all inched in the same direction with harm reduction programs, Seattle is the first to fully commit to establishing supervised injection sites.
"It's thrilling," LaSalle said. "The support of someone like a mayor is pretty groundbreaking."
Heroin and illicit opioid use will still technically be illegal at the facilities, but police and prosecutors are willing to stop arresting people there and pressing charges. It's the same principal that led to the establishment of syringe exchanges, which are now fairly common across the US. But while some syringe swaps have what LaSalle called "an active bathroom," where users are tacitly allowed to get high, this will the first local government to sanction use.
"It's just an exercise of discretion we see law enforcement make all the time," said Patricia Sully, a member of the task force and a staff attorney at Seattle's Public Defender Association. "The public health authority has the power to operate a facility like this as a public health emergency measure."
The argument for safe spaces is that it's better for both users and the public to have addicts injecting indoors in a place where they won't die, rather than in a high-risk place like a park, alley, sidewalk, or indoors alone. In addition to providing sterile needles, staff members at safe injection sites typically carry the overdose antidote naloxone.
Just a few hours north of Seattle in Vancouver, British Columbia is Insite, North America's first and only supervised injection facility. Insite has seen its guests inject more than 3 million doses of street drugs since it opened in 2003, according to spokesperson Anna Marie D'Angelo, and it has not had a single fatal overdose. Insite also works closely with Vancouver's police, D'Angelo said.
"They'll put out resources saying 'There's a bad batch, go to Insite, don't inject alone,'" she said. "There's a partnership."
But as advocates like Sully point out, "supervised consumption sites don't exist to prevent just overdoses." Insite visitors are offered comprehensive medical care under Canada's public health system, and, beyond reducing fatal overdoses in Vancouver by nearly 10 percent, the program reversed what one researcher called "the most explosive epidemic of HIV infection that had been observed outside of sub-Saharan Africa." British Columbia now has one of Canada's lowest HIV infection rates.
Seattle is expected to place its facilities at locations where users can already access rehab programs, clean syringes, and basic health care. A recent survey of Washington syringe exchange participants found that 75 percent were interested in getting help reducing or stopping their use, but only 14 percent were enrolled in treatment. The city and nearby areas saw 132 overdose deaths last year, a slight decrease from 2014 but still way up from 49 opioid-related deaths just five years prior.
The supervised consumption sites in Seattle aren't being pitched as a panacea — the heroin task force report suggests a comprehensive approach that includes county-wide expansions of treatment and prevention programs — but the Drug Policy Alliance's LaSalle says that if the facilities prove successful, they could catch on nationwide.
The mayor of Ithaca, New York proposed opening injection facilities earlier this year, but his plan has faced resistance from some local officials and state lawmakers. Opponents claim giving addicts a place to get their fix will only lead to more drug use, but research from Vancouver's Insite has shown this fear to be largely unfounded.
"It seems like a really radical idea, but we need to help people to understand that it's an incremental step," LaSalle said. "[Users] are already going to exchanges to get clean needles, [but] they're still walking out the door and using somewhere. It makes a lot of sense both medically and politically to reduce all the nuisances around public injection. You improve public safety, and there's all these health benefits for the users themselves."
Follow Keegan Hamilton on Twitter: @keegan_hamilton