Shilo Jama is not shy about his drug use. The director of the People’s Harm Reduction Alliance (PHRA), Jama, now 43, has been using drugs off and on since he was a teen. By this age, he says, he has more friends dead than alive, but despite living in a world where overdoses are not just common but routine, Jama has managed to stay alive. For this, he credits the older drug users who took him under their wings when he was a kid, teaching him how to do drugs without dying. He also credits Bob Quinn, the founding father of the People's Harm Reduction Alliance, who was something like a father figure to Jama himself.
Jama met Quinn, who died in 2012, over 20 years ago, when he was looking for a positive way to spend his time. He tried volunteering at various needle exchange programs in the city, but no one was interested in his help except Quinn. "He gave me a chance when no one else would," Jama told me. "That act saved me. It gave my life purpose."
Since then, Jama has spent his career advocating for drug users. With his work at the PHRA, he runs syringe distribution sites, including a drop-in site in the U District. Users can go there and dispose of old needles and get clean ones as well as information about mental health services and drug treatment programs. They have a nurse practitioner on site who prescribes medications like Suboxone, which helps with withdrawal symptoms. Still, this is hardly enough to stem the flood of the opioid overdoses in King County or the spread of infectious diseases like HIV and hepatitis.
"We have people coming in every day desperate to get help but we're often overwhelmed and there are times when they can't get into treatment for several days," Jama says. "We tell them to come back, but there is a good chance they are not going to."
Evidence-based options for treating opioid abuse are limited in the U.S. If, for instance, a drug user goes to the PHRA or even a hospital seeking Suboxone, they are unlikely to get it right away due to overwhelming demand. It’s even harder to get methadone, often considered the gold standard for opioid treatment. Both state and federal laws require that methadone patients show up in person to get their doses, even if the clinic is miles or hours away. And, until recently, there were strict limits on how many patients healthcare providers or clinics could serve. While these limits have been lifted in light of the nationwide opioid crisis, Evergreen Treatment Services, for instance, a nonprofit methadone provider with locations in Seattle and Renton, just doesn’t have the staff, or the money, to treat everyone in need. And this public health crisis, Jama told me, is only going to get worse until every internal medicine clinic in the city is able to provide opioid treatment on-demand.
Over the years, Jama has helped countless people who use drugs, but his efforts aren't exactly appreciated by everyone. In December, flyers featuring a photograph of his face started popping up in the University District and elsewhere in North Seattle. "HAVE YOU SEEN THIS MAN," the flyers read in all caps.
"This is Shilo Murphy," the flyer reads, "who more commonly goes by the alias of Jama. He runs a needle dispensary on 43rd Street in the University District and is a notorious figure who is partially responsible for a large increase in drug activity and deaths across Seattle." The flyer accuses Jama (who legally changed his last name from Murphy a few years ago to honor the family that raised him) of "enabling and encouraging harmful behavior that has caused many deaths."
Jama finds this allegation not just insulting but ridiculous.
"I'm not God," he told me. "I didn't create Fentanyl and I'm not a producer or seller of any drug. And I can't force people to do anything."
The flyer claims that Jama, his organization, and the U District needle distribution site are a danger to the public, but according to public health experts, harm reduction projects like Jama's do reduce overdose deaths and other public health issues. Safe injection sites, which are facing legal hurdles in Seattle and elsewhere, have been found to not just reduce overdose deaths but also reduce outdoor drug use and improve access to health care. They have not been linked to an increase in crime rates or drug use.
The flyer also says that the Seattle Police Department and the Seattle City Council are "almost powerless” to prosecute Jama and lists a phone number for the FBI's Seattle office, encouraging people to call and report him. The FBI declined to tell me if anyone has actually called to report Jama, but a spokesperson for the organization did point out that the number listed on the flyer is wrong, so he’s probably not in much danger of the FBI breaking down his door any time soon.
Jama doesn’t know who put up the flyers but he suspects it was members of Safe Seattle, an organization that, among other issues, advocates against safe injection sites. When reached for comment, David Preston, the head of Safe Seattle, said that none of the group's administrators are responsible for the flyers but that someone from the group, which has over 8,000 Facebook followers, might have put them up.
Preston also sent me an email explaining why the group objects to Jama’s work and the PHRA.
“In the first place, we take issue with this term ‘needle exchange’ because it’s misleading,” the email reads. “These things are more properly called needle dispensaries because there’s no requirement that a dirty needle be brought in for every clean needle that’s distributed.” This, to Preston, is a problem because he thinks it leads to dirty needles being left in the streets.
Jama disputes this, saying that PHRA collects more syringes than it gives away. Requiring a dirty needle in exchange for a clean needle also “punishes low-income people who don’t have access to syringes,” Jama says. “If you have two people and only one needle to exchange, it makes them more likely to share.”
The research on this backs him up. According to Robert Heimer, the director of the Emerging Infections Program at Yale School of Public Health, “Distribution approaches to syringe exchanges have a larger impact on reducing syringe sharing and unsafe injection practices than one-for-one exchanges, and do not result in increased unsafe discard of syringes. This is the policy that works best.”
Preston and Jama both agree that using clean needles is better, but Preston also takes issue with the fact that PHRA “doesn’t actively encourage people to get off drugs.” But to Jama, that’s not the point of the project. If people want to get off drugs, he is happy to help them, but PHRA isn’t rehab. The point is to reduce the harm that drug use can and does cause.
While Jama wasn't exactly thrilled to see his face on flyers around the city, he's also used to be demonized. Soon after they appeared, he says a woman followed him down the street, yelling that he’s a criminal. And this, he says, is exactly the problem with how Safe Seattle and others treat people who use drugs. Demonizing drug users causes them to hide their drug use, which, in turn, increases the likelihood of overdoses and death. But after 20 years working in this business, Jama refuses to feel shame about who he is. This, along with a healthy dose of both luck and privilege, he says, is what has saved him when so many others have died.
"No longer being ashamed about who I am is hands down one of the biggest factors," he says. "I believe in myself and know that I'm worthy. This is something I try to spread to everyone because if you think you deserve to die, you are more likely to.” The goal of the People’s Harm Reduction Alliance, Jama says, isn’t to encourage people to use drugs but to help people who are already using them make better choices. “The question is whether or not we will allow our citizens to die or to get the help they need,” Jama says. And regardless of what people say or think about him, he’s going to keep doing this work.