December 10, 2015

Seattle may get nation’s first safe injection site

Supervised injection site INSITE Vancouver

Shilo Murphy, drug user and harm reduction advocate, is poised to open facilities where people can inject illegal drugs in the presence of medical staff.

The first supervised injection site in the United States will open within six to 18 months in Seattle, Shilo Murphy said.

His nonprofit, the Seattle-based People’s Harm Reduction Alliance, doesn’t receive any government funding, which allows it to experiment with controversial programs that tax-funded syringe exchanges aren’t as free to pursue.

For example, for five years, the alliance has been giving Seattle drug users glass stems for smoking crack, and as of February, it has been handing out about 25 to 30 meth pipes each week. It’s illegal to give away drug paraphernalia under Washington state law.

Additionally, active drug users make up at least 51 percent of the staff and volunteers operating the nonprofit’s programs, which extend into five counties across Washington and Oregon, including Multnomah.

Murphy, executive director of the alliance, uses heroin, and his attitude toward his own drug use has drawn criticism from other advocates in the harm reduction community.

If his nonprofit and Seattle’s local drug users union are successful in establishing the nation’s first safe injection site, it will likely be held under a microscope, serving as a model of whether such an approach to drug abuse will work as well in the U.S. as it has in Europe, Australia and Canada.

In October, Seattle Weekly first reported a safe injection site could be on the horizon after Murphy told a crowd at Seattle’s Town Hall cultural center it was time to “get on the bandwagon, or get the fuck out of the way.”

It also reported that the Public Defender Association had joined the effort and that every member of the incoming Seattle City Council said they either supported or were open to safe drug sites. Even Seattle Mayor Ed Murray told the weekly he’d consider the option.

Seattle recently saw a 58 percent spike in heroin-related deaths – 156 in 2014, up from 99 the previous year, according to a report by University of Washington Alcohol and Drug Abuse Institute.

While deaths from heroin overdose in Multnomah County happened at nearly the same per-capita rate as in King County in 2014, unlike their counterparts to the north, politicians in the Rose City haven’t demonstrated that safe injection sites are an option they’d be willing to consider.

Multnomah County officials recently turned down a request from Street Roots to include a recommendation for a safe-injection-site feasibility study in its 2014 Domicile Unknown report. This report, which tracks the deaths of people experiencing homelessness who died outside of medical facilities, found heroin was a primary or contributing cause of death in 14 people who died on the streets. That was out of a total of 56 deaths from heroin overdose in Multnomah County last year.

Safe injection sites are indoor spaces where drug users can inject drugs safely under the supervision of trained medical professionals rather than injecting while hidden from view in places such as behind a dumpster or locked inside a public bathroom. In those scenarios, users may overdose and die because people can neither see nor get to them in time to administer an overdose-reversing drug.

When users are able to inject at a facility where staff can quickly reverse an overdose, it drastically reduces deaths among intravenous drug users, according to numerous peer-reviewed studies. These sites are also shown to cut down on public injection, and addicts who use them are more likely to enter into drug treatment.

A recent Multnomah County report on opiate trends found nearly 40 percent of the 632 ambulances responding to opiate overdoses last year, including heroin and pills, were dispatched to public areas and roadways. An additional 4 percent were dispatched to bars and restaurants.

To save lives and take injection off the streets, Murphy said, the time has come to open safe injection sites across the Seattle area. If organizers decide to open the facilities as a direct extension of the People’s Harm Reduction Alliance, he said, the first site will likely open next year. If the committee decides a separate nonprofit should be created to oversee the facility, then it will likely open closer to mid-2017.
Street Roots gave Murphy a call to find out how he plans to pull this off and to learn more about his approaches to harm reduction.

Emily Green: What role will active drug users play in the operation of the site?

Shilo Murphy: Our bylaws state that 51 percent of the board, 51 percent of the staff, 51 percent of volunteers have to be active participants of the program (active drug users) – and the official definition is “served by us, or could be served by us.” So active participants will realistically have a controlling share of the site.

E.G.: Will there be doctors or nurses on site?

S.M.: Yes, I think it will be medical personnel to handle medical emergencies and medical assistants, along with active participants of the program to assist people in what they are trying to consume.

E.G.: Do you know how large the facility will be?

S.M.: I don’t think the U.S. should invest in an Insite-like model. (Insite is a safe injection facility operating in Vancouver, B.C., since 2003. It’s located in an area with a concentrated population of heroin users.)

This is why: Insite was responding to a specific problem in Vancouver, and Vancouver had, for lack of a better term, a European-style red light district. And yes, there are users that live all across Vancouver, but the strategy they use at Insite is a very expensive model and can work for that concentrated area.

You’re in Portland, for example. What if we put a safe injection facility in downtown Portland? Well, drug users in downtown Portland will probably use it – maybe 85 percent of drug users may use it – who are homeless and using outside. But if you live in Southeast Portland, are you really going to use it? Probably not. You’re probably not going to get on a bus and go the far distance just to do it. That’s why it needs to be multiple places. So it needs to have a mobile part of it, or a place that can easily move, like a trailer, or have 10 sites simultaneously open. Because that’s the problem with the American drug war; we don’t really have a centralized drug area. People can talk about outdoor drug markets, but those are in multiple places. It’s a complicated problem, and this is definitely a solution to this complicated problem, but it needs to be maneuverable.

E.G.: Do you see these sites also serving as a pathway to treatment services for people who express an interest in quitting?

S.M.: Yes. The way we divide up drug use is: There is stable drug use and chaotic drug use. A stable drug user has much more control over their own lives and much more ability to moderate their own drug use. Stable drug users kind of stop using drugs or lower their drug use or increase their drug use all the time. And then there is chaotic drug use, and chaotic drug use is like drug use that has become unmanageable, like your life is focused on consuming this drug, and there are usually, not always, but usually a combination of problems: homelessness, mental illness, abuse, trauma, all mixed into this chaotic use. So for chaotic drug users, it’s really important to give them really clear access to treatment facilities and detox facilities and also therapy facilities and mental health facilities. Our hope is that we will be an access point for lots of people for lots of different reasons, and treatment is going to be one of those options and always be offered and be there. But to be perfectly honest, too, Portland – Oregon is in a similar place as Washington. Funding is not necessarily going too well for detox facilities and treatment facilities. There’s been a big shakeup since the Affordable Care Act. It made it so a lot of folks have insurance, which means a lot of the more private places are now a lot more accessible to low-income folks, and the low-income folks are engaged in those services, making those services a longer waiting list. And so along with being a big referral to those services, it would also be an advocate for more of them.

E.G.: Are the King County Prosecuting Attorney’s Office and Seattle Police Department supportive of opening a safe drug use facility?

S.M.: That’s a question you should probably ask them. We’ve been in some talks with them, but we’re at the beginning of those conversations.

Street Roots did ask, and both were reluctant to comment. A spokesperson from the King County Prosecuting Attorney’s Office said it’s too early in the process to say where it will stand, and the Police Department didn’t respond with an answer before press time.

E.G.: Are you at all concerned the police might target people using the site, to try to bust them for possession or anything like that?

S.M.: No, because we have 25 years of history in Seattle, working with the Police Department and prosecuting attorneys, and they understand that people have to use; have the ability and need the ability to use a direct service. The Police Department, and I don’t want to speak on their behalf, but they want people to get services just as much as everyone else, and to be perfectly honest, the police have been the most supportive of this idea – of ending pubic intoxication and ending public drug use. They don’t want it because that’s where a lot of the complaints come from.

E.G.: Is there anything standing in the way of getting this site open, or do you think it will happen pretty seamlessly?

S.M.: I don’t think there’s anything standing in the way, really. Fighting has always been “not in my back yard” folks, but a lot of communities have contacted us and said, “We want it in our area,” and other communities have contacted us and said, “We don’t know about in our area,” and there’s lots of different people in the same community that said, “I want it” (or) “I don’t want it.” And so we’ll figure out the best site for it.

What I think we’ve missed in this conversation about drug use is all the stigma that goes along with it, and all the lack of love. We get a lot of folks that keep hearing from people that they’re bad and they’re horrible and they should stop, but they don’t stop to tell them, “We love you just the way you are.”

People make better choices when they’re loved, and people make better choices when compassion has been given to them. We want people to be loved and cared for, and there are lots of folks that come into our program who burst into tears because we’re the first person in years that told them they were loved. For me, it’s like, fuck politics, this is what people need, and this is what people deserve, and our mantra is: If not us, who? And if not now, when?

E.G.: Why now?

S.M.: Because I’m tired of my friends and the people I love dying of overdose. I’m tired of my friends being so panicked in a dumpster, getting hepatitis C, getting bacterial infections, doing damage to their body, unnecessary – and tired of people telling people they should stop, but then closing down detox facilities. I’m tired of the shame and brutality we give to some of the most wonderful, caring human beings that I’ve ever had the opportunity to know. And so I think people need to understand that people are dying, and people are suffering, and we spend trillions of dollars on a war designed to make them suffer. I think it’s time for people to stand up and say, “No, not now, not here.”

E.G.: Have you already secured funding?

S.M.: We are an organization that never secures funding until something is open. We do first and ask questions later.

E.G.: It seems a lot of progress toward safe injection sites is made when there are actual, active drug users lobbying for them, many times in the form of a drug users union. How has the union played a role in your current efforts?

S.M.: The Urban Survivors Union (a national drug users union founded in Seattle by Murphy) is what actually brought it to the People’s Harm Reduction Alliance to work on. And they have been in constant communication, and we have worked on it together. There’s lots of our membership saying, “The dumpster is not a safe place.” We’ve been working on this a long time. Portland and Seattle – Vancouver is right next to us; it’s had a safe injection facility for 10 years that’s been incredibly successful.

E.G.: Can you explain how distributing meth pipes is a form of harm reduction?

S.M.: Our participants kept coming up and saying, “Hey, I want you to know, I’m just picking up needles because I don’t have access to a pipe.” And we thought about that and we said, “That seems really dumb.” I mean dumb in the sense that if you want to use something that is safer to use but are using something more dangerous because you don’t have access to it, then why don’t we just give you the access to it. And so we started talking to folks, and we did a little survey. The majority of folks said if that service was offered, they would engage in it and inject less. So then we offered it. We are doing a survey right now, actually, to see how successful it is, but I can tell you our program is wildly successful – so the longer answer to that is: We want to keep people smoking for as long as possible. If you’re going to smoke, stay smoking, and less chance to inject. We (also) offer it to folks who want to transition back (from injecting to smoking). Because with smoking, there is a minuscule possibility of hepatitis C, and there’s no HIV and no abscess risk.

E.G.: No syringe exchanges here in Portland offer meth pipes. I did see that you have a branch of your nonprofit here. Do you plan to bring your meth pipe distribution to Portland through that project?

S.M.: The way we operate our programs is drug users in each area decide the services. So Portland drug users have been talking about it, whether or not they want that service, and they just haven’t come to an exact decision, so it’s possible.

E.G.: I noticed your syringe exchanges don’t require a one-to-one trade. (Portland area exchanges run by Multnomah County and Outside In practice the one-to-one-trade model, where users must trade dirty needles for clean ones. However, they do provide kits with syringes to those who don’t have needles to exchange.) Can you explain why you don’t use this model?

S.M.: Essentially it’s best practices. It’s a standard of syringe exchanges nationally, and all of the data has shown that unlimited access is the best means to stop hepatitis C and HIV, and so we just go with the best practices. I understand that the public health department has to follow the politics more than science, but we just follow the science on it.

E.G.: Do you accept dirty needles?

S.M.: All of our sites collect dirty needles, and to be perfectly honest, we kind of gauge by volume, and we’ve always gotten back vastly more than we’ve ever given out.

The Portland People’s Outreach Project* is a People’s Harm Reduction Alliance site. We helped start it, but it’s really the amazing folks on the ground in Portland that made this project become successful with a physical site and an under-the-bridge (bike) delivery service. It’s kind of like we’ve always met this new school of thought with the old school of thought – that uses science-based philosophies and data along with old-style outreach so we can get services to the people that need them, because the person living under the bridge isn’t necessarily going to go to the syringe exchange.

We’re looking into the idea of People’s Harm Reduction Alliance opening up a science-based treatment facility in Portland.

We bring data and science. We also bring love and compassion, because we don’t focus on numbers and statistics when it comes to our people; we focus on individuals and how to improve individual health. And the other is we are run by the people who use our service. So if there’s, for example, heroin mixed in with fentanyl that hits the streets and people are dying of overdose, we can move faster to respond to that than other organizations that aren’t peer run. I can tell you of many times that we will see something happen that we will respond to, and then three months later a government official will send us information or an email about the thing that we’ve already responded to.

E.G.: You are an active drug user yourself. I saw you were quoted as once saying, “Heroin saved my life.” Can you explain that statement?

S.M.: I was one of those typical lost teenagers and living on the streets and had thoughts of chaos, and drugs really opened my mind and expanded the way I think. I got to meet and engage people because of it, and had to deal with lots of different cultures, ideas. Me and my parents were very liberal minded, and I got to engage with some much more conservative folks, for example. I include LSD and hallucinogenics in that; it really has made my life better. That doesn’t necessarily mean it makes everyone’s life better.

E.G.: You’ve been criticized by other harm reduction advocates for taking this stance on drugs. Do you think you’re setting the right example for your clients?

S.M.: Yes, I think we give people hope, and I’ve always said, you must reach for the stars. Your dreams are never big enough; you must go for all – otherwise, you will always fall short. Do you think we could have gotten to the moon if we didn’t reach for it? Do you think we could have done the five-minute mile if we hadn’t strived for that? Everyone will tell you it cannot be done, and your heart will tell you that it must be done. And so people say we can’t, we’ll never get to a time where drug users are respected, but I was told as a child that gay marriage would never happen – and it happened. They said marijuana would never be legalized; it’s, in both of our states, legal. So if you don’t reach for the stars and you don’t dream, we’ve already lost.

E.G.: Are you still an active heroin user?

S.M.: Yeah. I use drugs whenever I want to use drugs. To be perfectly honest, I’ve been so overworked lately, I’ve used much less drugs. The biggest barrier I have to my drug use is the fact that I do so much work for drug users.

*The Portland People’s Outreach Project, established in the fall of 2014, offers clean syringes by bike delivery to heavy-drug-use areas in downtown Portland on Friday evenings and out of the Anarres Infoshop in North Portland on Saturdays. Call 503-765-PPOP (7767) for delivery locations.


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