Alex Fryer, of the Seattle Times, had an excellent piece about how divided people in Seattle are in their approach to Seattle’s growing drug addiction problem, now exacerbated by fentanyl flooding the market.
Fryer begins with what he calls the ruling orthodoxy on the issue, which is, “Meeting people where they are at.” He describes it as follows:
“In the region’s battle against substance abuse, this mantra is sacrosanct public policy. It dictates that those seeking to help others don’t judge or cajole. It’s about building trust so that incremental steps can be made toward guiding someone to a safer, better life. The approach dovetails with what’s called ‘harm reduction’ — lowering the personal and societal costs of potentially dangerous behaviors. Example: needle exchanges to prevent HIV transmission between intravenous drug users.” Another example, a city-funded program to hand out pipes to those who smoke fentanyl.
While this is the prevailing orthodoxy here and politicians are reluctant to challenge it, Fryer cited questions raised by City Council member, Sarah Nelson, herself a recovering alcoholic. Nelson wanted to know what evidence there is to indicate that such harm-reduction strategies are effective in preventing or reducing the number of overdoses on the streets of Seattle.
Nelson, salmon-like, is swimming against the current. As are the staff of the organization “We Heart Seattle,” which has no qualms about going all out to help people get into treatment for drug addiction. Fryer recounts the story of their efforts to get one man into treatment, which it turns out is a lot harder than it ought to be.
In response to Nelson’s questions an advocate of “meeting people where they are at,” Amber Tejada of the Hepatitis Education Project explained to Nelson, “There are folks who don’t want to stop using drugs. There are folks for whom abstinence is not something by which they measure success in life . . . Ultimately,” added Tejada, “bodily autonomy is key.”
I’m not entirely sure what Tejada’s reference to “bodily autonomy” means, but coupled with the rest of her statement it would seem that she is saying, some people are drug addicts because they want to be, and that is maybe not anyone else’s business.
The difficulty with these assertions of individual choice and autonomy is that they overlook something important: our choices do impact others. What’s more, they have an effect on our whole community.
I’ve been away from Seattle for a time this summer. On returning, one of the things that is noticeable is how bad actors enact a big toll on the rest of us. Here are some examples of things I noticed after my being gone for a couple months:
I went to the local Bartells in search of a 9-volt battery to replace the one that was chirping in our fire alarm. There a lot of shelves are at best half-full. Why? I asked. Is it still supply-chain problems? No, said the clerk. It’s shop-lifting. People come in with bags and scoop the shelves.
Meanwhile, all the 9-volt batteries, along with lots of other stuff, are now under lock-and-key. To get one battery, meant tracking down the employee with the key. Then another employee had to extract some sort of plastic locking device from the battery packaging, which I imagine ends up in a land-fill.
Just down the street, a repairman is at work putting glass back in a door that has been shattered (again) at the branch office of a local bank. Seeing businesses with doors and windows covered in plywood is a regular thing in our Ballard neighborhood.
One more: When I went to drop off mail at the drive-by mailbox at the Post Office, it was no longer possible to roll down your window and drop the mail into a slot with an opening that is maybe 3″ x 15″ and then continue driving. The whole apparatus had been changed, I guess so that no one could stick their hand down the drop-off opening and get people’s mail, or checks in their mail. Now, you have to get out of your car to find the very tiny slot in which to place mail, which means idling the engine longer.
And back at the 10-unit building where I live, we are on our third garage door and maybe as many of the call boxes at the front door. All in response to break-ins and property destruction.
While some of this may be unrelated to drug addiction, my guess is that a lot of it is a spill-over from that. The larger point is that drug addiction doesn’t just affect the person experiencing addiction. It has terrible consequences for children and families, big implications for the health care system, and impacts on the entire social and business fabric of a community.
To return to Alex Fryer’s description of how widely divided we are between two approaches to drug addiction here in Seattle, does it really have to be one or the other? Are “meeting people where they are at,” and “finding ways to encourage and support people in getting treatment,” truly an either/or? Can’t we do both? Can’t we ask what will incentivize people to seek treatment? And dis-incentivize drug use and addiction?
And can we be honest that even if there are some folks “for whom abstinence is not something by which they measure success in life,” it isn’t true that their choices impact their lives and welfare alone.
Thank you Anthony for bringing more light to this article. As Alex said, there is not a monopoly on compassion. All approaches can be effective. We need more outreach workers on the ground in mass. Anyone can help another person if you take some time to learn and navigate the hundreds if not thousands of various resources providers in king county. We need a stronger focus on uniting people with family and / or faith and sober communities to stabilize after detox and psychiatric care is provided. I’d love to meet you. Andrea- We Heart Seattle
Meeting people where they are and keeping people where they are are two different things. We claim to be doing the former, but we’re actually doing the latter. Radicalized activists have had the electeds by the cajones perpetuates the status quo. No uniform enforcement of laws exacerbates the issue. Apartments for all addicts flies in the face of shelter first and earned autonomy. Replace progressive theories with fact-based policies and programs. Consider Switzerland’s successful four pillars approach: Prevention, Therapy, Harm Reduction and Enforcement. Make sure the harm reduction protects society, instead of coddling troublemakers.
“Harm reduction” is a failed concept that has produced no significant benefits to either the addict or the community. It is popular because it is non-confrontational. Seattleites don’t like confrontation. It only enables further destructive behavior without providing any real incentive to change. It is also popular among the professional outreach community because it insures job security. A person who is addicted to fentanyl is in no condition to make any positive decisions. He has the judgement of an alligator.
“Can’t we ask what will incentivize people to seek treatment? And dis-incentivize drug use and addiction?”
In May of this year, SB 5536 requires the establishment of Health Engagement Hubs as defined in RCW 71.24.112. These are supposed to be places where addicts can go in and get what treatments they may need, including buprenorphine or methadone, without spending hours in interviews or signing up for a program. That has a lot of potential to keep people alive and in a condition where they can potentially make some progress with their issues.
The “harm reduction” philosophy has suffered a lot from redefinition recently. Originally, living clean needles to drug addicts had a very defined purpose: curbing the spread of HIV (and later hepatitis) through shared needles. Especially back in an age when fatal overdoses were far less common, HIV was a death sentence, and there were fewer effective treatments for stopping the spread of HIV, it was clear that it was saving lives both among the drug-user community and broader in the population — a “lesser of two evils” approach. Today the “harm reduction” label is applied much more broadly to a set of tactics that are often ill-defined and lack any clear metrics as to whether they are achieving their intended goals.
The “meet them where they are” approach for drug addiction started with a simple, well-documented observation: the success rate for drug treatment programs among people who are forced into the program (rather than signing up voluntarily) is abysmally low. In short: unless you want to be in a drug treatment program, it isn’t going to work to put you in one. Arresting people and forcing them into drug treatment is ineffective, despite wishful thinking to the contrary. So social service providers have tried to build trust and a “non-judging” approach that will create an opportunity for people, if and when they reach a moment that they are willing to enter a drug treatment program, to ask for help from someone they trust. It’s important to place this in the right context: most of the chronically homeless people suffering from drug addiction have been repeatedly burned by “the system” and absolutely do not trust anyone working for or representing the government. So getting someone into drug treatment requires both a sincere desire on their part and building a level of trust with someone they can ask for help to get into such a treatment program.
Unfortunately, as you point out, in some cases (but not all!) and for some social service providers this has evolved into an approach that seems to imply that being addicted to drugs is OK. In part, this is just them trying to build trust and be non-judgmental. Also it’s a recognition of the circumstances under which the individuals became addicted to drugs: for some it was opioid prescriptions for chronic pain; for others it was addiction to Adderall or other prescribed stimulants. Among the homeless population with drug issues, the data shows clearly that for many of them homelessness came first and then they developed the drug addiction as a coping mechanism for the trauma of being homeless (though the media and right-wing pundits like to reverse that order when they tell the story). There are chronically homeless people who are addicted to opioids to dull the trauma and pain of life on the street; there are others who use stimulants like meth constantly in order to stay awake to protect themselves and their property; to sleep is to put yourself in danger. It’s understandable how a social service worker dealing with people in these situations every day, who doesn’t have a shelter or housing spot to offer to move someone into, can decide not to push hard on the drug addiction issue. That doesn’t mean being addicted to drugs is ok, or that it’s a “bodily autonomy” issue. It’s not OK. But in many cases it’s not immediately addressable.
The four pillars: prevention, treatment, harm reduction (in the real 360 degree sense) and enforcement of the law pretty much fix everything as can be seen in Switzerland. Making excuses or assumptions about why people take drugs or the path to their addiction is infantalization, imo. The addicts I’ve helped wish Seattle used the 4 pillars instead of treating addiction with only a bleeding heart approach.
I think Kate Martin’s post is very important. I hope the leaders of this city and social service providers will pay serious attention to the ‘four pillars’ approach. A ‘one size fits all’ approach does not, with evidence to demonstrate that. It’s a waste of resources of many types, as well as people’s lives, to insist on one approach only. It’s also arrogant and not helpful, as well as discouraging, because the issues persist. The failure, because I think it is a failure, to consider more than one approach, to listen to others, to work together, to evaluate outcomes as much as possible and to consider people who live on the streets or who use drugs as people, is well-demonstrated. Facing our collective failure is essential. I dearly hope we do so.
Meanwhile, the enablers in Seattle are helping at least 4 people die of overdoses every damn day. Pretty soon, we’ll not have to provide nearly as much so-called “supportive housing” (where junkies can continue their ways). This is what too many people call “the compassionate approach”. Frankly, they are going to be “Meeting people where they are at” in the morgue. If there’s any upside to this scenario, it’s that processing the dead is much cheaper than housing the addicted.
It’s hard to ignore that before and during the wave of shoplifting these retail stores were trying to make a greater profit FOR THE SHAREHOLDERS by having a ridiculously low number of employees to help the CUSTOMERS, who are the source of income, rather than the beneficiaries of income. The same situation is true for Lowe’s and countless businesses that think they can run a business as a self help experience. Shoplifting is a form of self help when employees can be numbered on one hand and less. I have no sympathy for those gaining wealth with no consideration for the experience of those who provide the wealth.
As simple as this sounds, every single person living on the streets and taking drugs is someone’s daughter, son, brother, sister, father or mother. Someone is “out there” wondering where they are, how come they don’t get help, and how come they don’t come home for holidays. To have an attitude of “well, let people use drugs and don’t interfere” is also saying to the people who love and care about the addict that that persons life does not matter. It is, IMO, assisted in suicide.
Totally.