The King County Council took a step back in time last week, defying science by voting to bar County funding for safe consumption programs except in cities that specifically vote to approve such facilities.
In taking that vote, the County Council majority was following a well-worn playbook written by North Carolina’s legendary reactionary senator, Jesse Helms, in 1988. In the summer/fall of that year, two sets of events were playing out in both Washington State and D.C. The two stories, one honorable and one shameful, were in response to the HIV/AIDS epidemic.
One story took place in Tacoma, where the late Dave Purchase decided that it was immoral to sit on the sidelines and do nothing while scores of individuals contracted HIV through the use of shared syringes. Protesting and lobbying weren’t enough to prevent the further spread of HIV among people who inject drugs. Dave notified the Tacoma Health Department and the Police Department that he was going to start a syringe exchange. And so, using his own money, card table, and folding chair, Dave went out and began exchanging used syringes for sterile ones. This was in August 1988. Within months, Seattle, San Francisco, Portland and a variety of jurisdictions followed Tacoma’s lead, opening sanctioned, above ground syringe exchanges. All of these jurisdictions, however, had to use their own funding and operate without federal support because of Senator Helms’ defiant stand against science and health in the nation’s capitol.
Congress was working on drafting the Health Omnibus Programs Extension (HOPE) Act of 1988. This act was the first legislation at the federal level that appropriated funding for HIV prevention. Unfortunately, ideology and moralism overrode behavioral science and sound public health. At around the same time that Dave Purchase decided it was time for action, Senator Helms attached a rider to the bill that would have prohibited any use of federal funds for condoms, bleach (distributed to people who inject drugs so they could sterilize syringes), and needle exchange. Led by Ted Kennedy, Senators acted to protect funding for bleach and condoms, but the ban on syringes passed.
Between 1988 and 2016, that ban remained in place in place every year but one. But in 2015, a funny thing happened: white folks in Appalachia and other heartland places started dying in droves from heroin overdoses. That year also saw a devastating HIV and hepatitis C outbreak in Scott County, Indiana, a state that prohibited syringe exchange entirely. As white people died, GOP orthodoxy of the Helms variety crumbled, and after almost 30 years of mimicking ostriches when it came to sound public health, even hardheads like Mitch McConnell pulled their heads out their asses and voted to allow federal funding for syringe access. But, make no mistake: that legacy resulted in tens of thousands of entirely preventable HIV and hepatitis C infections and hundreds of millions of excess health care spending.
What the hell does this have to do with King County in 2017?
Last week, the King County Council pulled a page from the Jesse Helms playbook and used a funding stratagem to effectively kill a proven public health intervention based on solid science and backed up by hundreds of peer reviewed evaluations. It is important to note that Councilmembers Rod Dembowski, Larry Gosset, and Jeanne Kohl-Welles argued passionately but unsuccessfully against this.
Concerned by the skyrocketing rates of fatal opioid overdoses locally, last year Seattle Mayor Ed Murray and King County Executive Dow Constantine convened a task force charged with recommending concrete actions to try and save lives. After several months, that task force released a suite of recommendations, which they stressed all needed implementation to truly have an impact. Their report called for prevention, treatment, and opening safe consumption sites: Places where people can come in and use their own drugs under supervision and where there can be an immediate intervention if something goes wrong.
In more than 30 years and millions upon millions of injections, there has never been a fatal overdose in a safe consumption site and sterile facilities and injection equipment virtually eliminates the risk of onsite HIV and hepatitis C transmission. The sites more than pay for themselves in reduced public health and public safety costs. They get drug users off the streets and into supervised locations. In many cities, local police, business owners, and community groups are strong supporters.
Dozens of cities around the world have recognized that safe consumption sites are a logical extension of syringe exchange—acknowledging it makes no sense to provide sterile injection materials and then tell people they need to leave and go inject in a public bathroom, parking garage, or alley. There are now more than 100 such sites globally and Canada is set to open over 20 in the next year or so. After suffering through the dark years of Prime Minister Stephen Harper (Canada’s George Bush), the government of Justin Trudeau is moving rapidly to rectify inaction.
So how did the King County Council decide to deal with the task force recommendations?
While making all sorts of mouth noises about their concern for public health, they stuck a rider into the 2018 county budget prohibiting any General Fund dollars from being used to fund safe consumption sites. They also stipulated that the County’s Mental Illness and Drug Dependency (MIDD) tax dollars can only be used if the jurisdiction slated to host a safe consumption location votes to authorize use of those funds—a local version of a “states’ rights” approach on civil rights that Senator Helms would surely approve of. In effect, the County Council just killed any chance of sites opening outside of Seattle while not actually voting against them. This is shameful. This is not how to do public health and it replicates the absolutely failed approach that this state has adopted towards drug treatment (allowing localities to veto the siting of methadone clinics).
Numerous jurisdictions around the US are considering opening safe consumption sites as a way of addressing HIV, hepatitis C, fatal overdose, and the public safety issues presented by outdoor and public drug use. Seattle—King County could serve as a national model, much as Tacoma did back in 1988. There is time to undo this damage, but the Council needs to hear loudly and unequivocally that King County won’t look back to 1988.
Kris Nyop is LEAD (Law Enforcement Assisted Diversion) National Support Director, for the Public Defender Association.