Smack down

Seattle's heroin treatment program may soon get the boot from downtown.

EVEN A PLEASANT, sunny morning in downtown Seattle can't wipe away the fatigue and anxiety etched into the faces of the dozens of people gathered on a littered sidewalk, not more than three blocks from the bustling crowds outside Westlake Center.

Here, at Second and Pike, intravenous drug users are lining up to exchange their used syringes for clean ones at a county-funded site. Two storefronts over, in the same building, a large group of haggard-looking men and women crowd into a sparsely decorated room to socialize, watch videos, and receive referrals for medical services and temporary housing.

In this musty, humid space Patricia Hastings, a counselor for the nonprofit organization Street Outreach Services (SOS), spends her days tending to the needs of Seattle's heroin addicts.

Hastings, a 52-year-old woman with a warm, enveloping smile, kicked her 25-year-long habit just slightly over three years ago. She held onto a good job, a marriage, and raised two children while she and her husband maintained their heroin habits in a comfortable home in Seattle. "You wouldn't have found me walking around on these streets," she says, pointing toward the shabby downtown block. Eventually, Hastings found herself walking out on her husband, penniless and homeless. She ended up kicking her habit in a cheap hotel room, cold turkey, and later began the process of rebuilding her life.

As Hastings knows full well, heroin use is hardly new to Seattle. But over the last few years, she says, the problem has "gotten much worse." From 1990 to 1999, opiate overdose deaths increased in King County by 134 percent, according to a July report from the Centers for Disease Control and Prevention. Last year, King County reported 110 deaths from unintentional heroin overdoses, following a record-setting 140 in 1998.

Yet even as the problem is worsening, the agency where Hastings endeavors to make a dent in the local heroin epidemic may soon be forced out of its location. The Seattle Housing Authority, at the behest of the Mayor's Office, is taking steps to condemn the building where both the downtown county-funded needle exchange site and Street Outreach Services are located.

Deputy Mayor Tom Byers explains that the move toward condemnation was a measure of last resort, after building owner Richard Nimmer responded too slowly to the city's request to sell or remodel the six-floor structure. City government has been approached by the Market Foundation and Plymouth Housing with a plan to turn the building on the northwest corner of Second and Pike into a mixed-use building with ground-floor retail, a senior center, and new housing for low-income senior citizens.

The fact that the building is dark and unoccupied above the first floor contributes to an uninhabited feeling on that block, Byers says. "This is an attempt to bring more life [to the area] and to help find some low-income housing that's severely needed for the elderly . . . as well as strengthening the fabric of that key corridor between the [Pike Place] Market and the rest of the retail core."

But the very reason why the city wants to condemn the building is the same reason why the agency insists that it needs to be headquartered at Second and Pike. This has always been the heart of drug trade in this town, says Kris Nyrop, executive director of Street Outreach Services.

Nyrop admits that a fixed-up building might improve the appearance and environment of the block on which SOS is housed. "But the problem [of poverty and crime] is not building-specific—it's a problem in the neighborhood."

To Nyrop, the move to condemn the building is a "classic" example of Seattle-style liberalism: "'Yeah, we support it, but can't you do it somewhere else?'"

THE IRONY IS that the building condemnation threatens to disrupt a treatment program that has been unusually enlightened and effective in targeting heroin addicts. Innovative strategies and a pioneering approach on the part of local government and nonprofit agencies, such as SOS, are, in fact, making a difference in keeping HIV- infection rates low among addicts and moving users into treatment.

The early decision to support regional needle exchange programs—aided by a 1992 state Supreme Court decision legalizing them—signified King County's willingness to assume a pioneering role in what's called the "harm reduction" approach to substance abuse.

Harm reduction recognizes that many people are either unwilling or unable to abstain from drug-taking and other high-risk behaviors. Instead of castigating an addict, harm reduction looks to meet a person where they are and help them reduce the harm they do to themselves and others. Providing clean needles to prevent HIV is an important example. The Seattle-King County Health Department, which operates five needle exchange sites, including the one at Second and Pike, has already exchanged nearly 10 million needles since 1989 and expects to exchange 2 million more this year. Street Outreach Services also exchanges needles at its two sites on Capitol Hill and in the U District, at an average of 80,000 syringes a month.

Taken together, these programs are widely believed to be the reason why HIV-infection rates among injection-drug users in King County—who number between 12,000 and 15,000—have hovered between 2 percent and 4 percent over the past seven years, while other major cities, including Miami and New York, are still grappling with infection rates of 40 percent to 60 percent.

Federal funds still cannot be used for needle exchange programs because of the federal government's dogged insistence—in the face of innumerable national and international studies with research findings to the contrary—that such programs encourage people to take drugs.

"We're trying to link our exchange to aggressive outreach and treatment," says Dr. Alonzo Plough, director of the Seattle-King County Health Department. "Every time someone comes in to exchange needles, we give them information [about addiction and recovery], and there are counseling rooms available. Whenever they're ready, we're ready.

"At some point, 30 percent of them come in and say, 'This is the day. I don't want to live like this anymore.' And then, we're ready with a program that will provide [a voucher] and a slot in a methadone maintenance program."

Seattle/King County's "voucher" program allows addicts without medical insurance or adequate funds to get placed in a methadone program. (Methadone is a synthetic substitute for heroin and enables some addicts to stay off heroin and regain a functional life.) Without vouchers, methadone treatment costs $10 per day, or $3,650 per year, according to Dr. Plough. Fewer than half of the 2,100 treatment slots currently available in King County are supported by public funds, he says. "The remaining slots are self-pay."

But methadone demand still far outstrips supply. Over 600 people sit on the King County methadone treatment waiting list. Most are expected to have to wait at least a year.

While these users wait their turn, homeless addicts can increasingly be seen shooting up in Seattle's downtown alleys and in darkened doorways within a few feet of upscale dining establishments and concert venues. Because of the city's net loss of affordable housing in downtown and Belltown, low-income drug users are more visible than ever before, says Nyrop. These addicts, he adds, are at greater risk of overdosing because they take less precautions in injecting drugs, for fear of getting caught by police.

Last December, King County took the noteworthy step of convening a task force, with the participation of former heroin addicts, to work on such issues as improving 911 dispatching protocol so that addicts who recognize an overdose situation will be more likely to call for help without fearing arrest from the police officers who usually accompany the medic dispatches to OD situations.

King County's mobile methadone maintenance clinic, an RV-style van that makes stops around town, has been another unique strategy, bringing methadone closer to where recovering addicts actually live and work. And in February, Seattle also became the first city in the nation to dispense methadone from a hospital pharmacy, after Harborview Medical Center secured permanent waivers of stringent federal methadone regulations.

"SEATTLE/KING COUNTYis fortunate in having a health department that's acutely aware of the [heroin] problem and in having employees dedicated to working with users in a progressive and humane way," says Nyrop. He stresses that 36 other counties in Washington and eight other states in the country have no methadone treatment programs. "In that way, we're in better shape than many places."

Ron Jackson, executive director of Evergreen Treatment Services, agrees. "There's not a lot of political capital in advocating for the health and well-being of heroin addicts," he says. "They're not folks [who] vote or have a constituency, so it's a blessing when those in political power will say that we need to step up and do something about [this situation]."

But will all that goodwill be enough to save the existing services at Second and Pike?

"We value the work that they're doing," insists Deputy Mayor Tom Byers. "None of this is intended to get in the way of those programs which have proven from a public health standpoint to be very useful." Byers adds that the city plans to assist with short- or long-term relocation for both programs as a part of the lengthy, drawn-out condemnation process.

If the city is willing to help SOS relocate somewhere else in downtown Seattle, Nyrop says the move will simply amount to a temporary inconvenience. But relocation outside of the downtown area would seriously hamper the agency's outreach efforts, according to Nyrop. "The homeless and poor clients that SOS serves are not very geographically mobile, and that's why it's important that we're in this area."

"There are still a lot of possibilities to be worked out," says the Health Department's Dr. Plough. "So it's still a matter of watching and waiting. We have emphasized [to the city] the importance of maintaining a presence in that part of downtown."

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