In February 2015 the Indiana State Health Department announced an outbreak of dozens of cases of HIV infection in southeastern part of the State resulting from needle-sharing among prescription drug users. It was not particularly newsworthy, except it happened in white rural Indiana as opposed to urban neighborhoods with large Black and Latino populations, causing a shockwave that appears to finally be making drug policy reform an acceptable policy choice to the mainstream.
Among other cities, Seattle and King County are working on becoming the first U.S. city to open a safe consumption (injection) facility in the near future, and I have attended many meetings in which community members, public health officials, social workers, activists, and others discussed how to establish and operate such facilities, as well as what other preventative and treatment options should be pursued. I was initially concerned about some of the random comments made by community members and elected officials who did not seem to know much about the issue, but in the end I feel that the task force came up with a fairly decent proposal (considering the political climate) for the city and county to consider.
Referred to by various names including “drug consumption room,” “medically supervised injecting center,” or “supervised injection facility,” safe consumption sites are “professionally supervised healthcare facilities where drug users can use drugs in safer and more hygienic conditions,” according to a paper by Dagmar Hedrich, Thomas Kerr and Françoise Dubois-Arber. Enforcement of anti-drug laws are often suspended at and around the facility in order for drug users to enter and use the facility without the fear of prosecution. At this point, InSite in Vancouver, Canada which opened in 2003 is the only existing facility in North America, even though multiple cities in the U.S. including Seattle are considering starting one.
One of the key decisions made during the early stages of Seattle’s effort to establish a safe consumption facility was the adaption of the “equity and social justice charge” which guided the process. The document states:
The King County Heroin and Opiate Addiction Task Force will apply an Equity and Social Justice (ESJ) lens to all of its work. We acknowledge that the “War on Drugs” has disproportionately adversely impacted some communities of color, and it is important that supportive interventions now not inadvertently replicate that pattern. Interventions to address the King County heroin and opiate problem will or could affect the health and safety of diverse communities, directly and indirectly (through re- allocation of resources). Measures recommended by the Task Force to enhance the health and well-being of heroin and opiate users or to prevent heroin and opiate addiction must be intentionally planned to ensure that they serve marginalized individuals and communities. At the same time, the response to heroin and opiate use must not exacerbate inequities in the care and response provided among users of various drugs.
All recommendations by the Taskforce will be reviewed using a racial impact statement framework. The Task Force will not seek to advance recommendations that can be expected to widen racial or ethnic disparities in health, healthcare, other services and support, income, or justice system involvement. Whenever possible, these concerns should lead to broadening the recommendations of the Task Force, rather than leaving behind interventions that are predicted to enhance the health and well-being of heroin and opiate users.
One of the reasons the task force used the phrase “safe consumption facility” throughout its discussions (although political compromises resulted in it being rebranded as the “Community Health Engagement Locations” or CHEL in the final recommendation) was precisely because the group did not wish to further the disparities between communities using different types of drugs by offering legal and medical relief to people using drugs in one way without doing the same for those using them in a different way (smoking).
Speaking of political compromises, it was interesting to observe how the task force ended up recommending the establishment of “at least two CHEL sites,” one of which shall be in Seattle and another outside. Some task force members commented that the downtown Seattle business association would not tolerate establishment of the safe consumption site if they felt singled out, while officials from nearby cities of Renton, Auburn, and others fought to push the second facility on each other, fearing that the safe consumption facility would bring drug users to their cities (which is ridiculous: people will not travel to Auburn just to use drugs at the safe consumption facility unless they already live in the area). In the end, police officers representing Renton and Auburn Police Departments both opposed to the recommendation to establish safe consumption facilities, but the rest of the task force adapted it.
Even with the political compromises, I feel that recommendations that includes prevention, treatment (including changes to State regulations that are making access to medication-assisted treatments such as methadone and buprenorphine programs unavailable to many who need it), greater distribution of naloxone, as well as the safe consumption facility are positive steps toward protecting the health and dignity of our neighbors.
But before Seattle celebrates itself upon becoming the one of the first cities if not the very first city to establish a safe consumption facility (or CHEL or whatever) and brags about its progressive tendencies, as it did when they legalized same-sex marriage or marijuana use, or when they enacted an ordinance to raise the minimum wage to $15 an hour over several years, I want to push forward with a couple of proposals to further protect the individual and collective health.
First proposal: Provide a public option. Here, I am not talking about heath insurance policies, which is an entirely different matter altogether. I am calling for the City of Seattle and King County to sell drugs to users directly at the safe consumption facility to remove third party suppliers and ensure the quality and safety of drugs consumed at the facility. In my proposal, consumers can purchase drugs that they consume at the facility, and would not be allowed to bring them outside. This will certainly increase the likelihood that consumers will use the facility–perhaps they might even travel to Auburn if this was available. Users will know exactly what they are putting in their bodies because the City can eliminate any contamination of drugs it sells, and it will make it easier to monitor their health while they us them.
Second proposal: Start a safe prostitution facility. The City of Seattle has been at the forefront of the nationwide effort to shut down Backpage, a website that many sex workers (and yes some traffickers) use to advertise their services, which has led to the recent raid on the site. But shutting down Backpage only pushes sex workers as well as potential sex trafficking victims further underground, perhaps onto offshore websites using encrypted and decentralized payment methods like Bitcoin that are harder to subpoena or investigate even when they needed to be investigated for human rights abuses. Safe prostitution facilities would provide client background check, physical safety, social workers on site, as well as safe and clean environment for sex workers.
In both proposals, it would be essential that the City does not receive fees and revenues exceeding what it costs to offer these products or services, lest the City would itself become financially entangled as a drug dealer or a pimp. The City should certainly promote the services to increase its use among people who already engage in drug use or prostitution, but the system should be designed to minimize the financial incentive for the City to overreach this aim, perhaps by requiring that any profit would go toward lowering the fees for the next year.
These proposals may not be satisfactory to people who demand full decriminalization of drug use and prostitution (and I support that as well), but I feel that they are what is possible under the existing laws under the same rationale that make safe consumption sites possible in Seattle. Some versions of these policies are already practiced in some parts of Europe, such as the prescription of heroin to those diagnosed with substance use disorders or the establishment of government-funded facilities for sex workers to operate at, and if any city in the U.S. could do it, it would be Seattle.