Want to Improve Neighborhood Safety? Invest in Public Health



Like most other states, we in Washington spend millions of dollars prosecuting and incarcerating drug users every year. If, instead, we invested that money in treatment and public health, we would see progress in tackling the opioid addiction crisis, reducing the spread of diseases such as HIV, and in improved public safety outcomes. This is exactly what I will propose in this upcoming budget.

We aren’t the only ones looking for workable options, some have succeeded in implementing them.  Portugal for instance, is on the right track.  Quoting Nicholas Kristof from the New York Times on September 22, 2017, “Decades ago, the United States and Portugal both struggled with illicit drugs and took decisive action –in diametrically opposite directions.  The US cracked down vigorously, spending billions of dollars incarcerating drug users.  In contrast, Portugal undertook a monumental experiment: it decriminalized the use of all drugs in 2001 and unleashed a major public health campaign to tackle addiction. The result is staggering. Portugal’s drug mortality rate is about one-fiftieth the latest number for the US.”

If we want to address the addiction problem in our city, we must treat addiction like the disease we know it to be. Instead of handcuffs, I propose a warm hand-off to programs that assess the needs of specific individuals, and provide them the treatment that helps them get better.

Our King County Prosecuting Attorney Dan Satterberg agrees too.  In a letter to our Board of Public Health last January, he wrote, “I want you to know that in this drug crisis, unlike the response to crack cocaine in the 80’s and 90’s, that I believe that the criminal justice system should not take a primary role, and that instead we should follow the lead of public health professionals.”

Mr. Satterberg and professionals in our Seattle/King County Public Health and Human Services Department are right.  Our investments should be in prevention, treatment expansion and enhancements, and health and harm reduction.  We can be effective if the City and County work together to coordinate investments in multiple areas including public health clinics and the LEAD program as examples.

Why? Because when people are finally ready to kick their addiction, “Treatment on Demand” means they can receive treatment that day, instead of being added to a long wait list. Having ready access to options such as Buprenorphine (called “Bupe” by some, also known as Suboxone), a medically assisted treatment option that can block cravings for opioids, is a common-sense change.  This treatment is vital in fighting this crisis.

Last year in our budget we added money for one additional social worker at our Belltown Public Health Clinic to help operationalize our city’s first “Bupe” clinic.  Following San Francisco’s model, we encouraged those with addictions to consider Bupe as an alternative to opiates. It is working, and hundreds have come into the Belltown clinic searching for treatment.

During my Human Services and Public Health Committee in June, local experts reported on the success of the program. Within six months of opening, they engaged with over 600 people and 102 people began Bupe treatment. Read more and see the hearing here.

Additionally, last year, we funded a second mobile medical van to provide public health treatment throughout Seattle.  These two options are helping some of our City’s most marginalized community members receive health care. On the ground health care keeps people out of Harborview Medical Center, offering good treatment and avoiding expensive emergency costs.

Last year, the City and County joined forces to confront the region’s growing and increasingly lethal heroin and opioid epidemic. A task force of experts recommended a comprehensive strategy.  The final recommendations included:

Primary Prevention

  • Increase public awareness of effects of opioid use, including overdose and opioid-use disorder.
  • Promote safe storage and disposal of medications.
  • Work with schools and health-care providers to improve the screening practices and better identify opioid use.
  • Treatment Expansion and Enhancement
  • Make buprenorphine more accessible for people who have opiate-use disorders.
  • Develop treatment on demand for all types of substance-use disorders.
  • Increase treatment capacity so that it’s accessible when and where someone is ready to receive help.
  • Health and Harm Reduction
  • Continue to distribute more naloxone kits, a drug that reverses an overdose, and making training available to homelessness service providers, emergency responders, and law enforcement officers.
  • Create a three-year pilot project that will include at least two locations where adults with substance-use disorders will have access to on-site services while safely consuming opioids or other substances under the supervision of trained healthcare providers.

As Portugal’s approach, has shown, if we add more health care sites, increase access to Methadone and Buprenorphine, we will reduce overdose deaths, and offer more people healthy alternatives to opioids. We will reduce HIV and Hepatitis C infections.  All good things.Additionally, when we provide treatment for individuals we will see a reduction of property crime, used needles in our parks, alleys and sidewalks.   This is what every neighborhood wants.Seattle has come a long way in a reduction in drug-related crime prosecution. Investments in programs such as the 180 Program, King County’s diversion program designed to keep youth out of the criminal justice system and the Law Enforcement Assisted Diversion (LEAD) program, which currently operates in Belltown, Downtown, Pioneer Square, the International District, and Capitol Hill diverts low-level drug offenders into treatment and support services instead of prosecuting them. This allows people to stabilize their lives with the help of a caseworker instead of a jail guard.

Investing in these programs and expanding them throughout the City and County are a few steps that we in Seattle can take to make a healthier and safer community.

To be truly successful we must robustly fund these public health programs. Although imperfect, Portugal found success because they invested heavily in public health and harm reduction instead of prosecution and incarceration.  We can see marked success too.

In this year’s budget, I will seek city money for additional public health options and programs we know to be successful.  We are on the right track but should invest significantly more. If we are committed to funding real solutions to the challenges of addiction, the path is clear. We are ready to lead.

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