Does Seattle Need More Drug Laws?

[00:00:01] [SPEAKER_00]: Hey Seattle Nice listeners, Seattle politics gotcha low. Well get high with Uncle Ike's

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[00:00:53] [SPEAKER_03]: Hello and welcome to the latest edition of Seattle Nice, I'm David Hyde here as always with Erica C. Barnett of Publicola

[00:01:00] [SPEAKER_03]: Erica who I want to say like Dick Cheney is always in an undisclosed location when she's done

[00:01:06] [SPEAKER_04]: I am in an undisclosed location

[00:01:10] [SPEAKER_03]: Undisclosed and undisclosable our audience has a huge appreciation for bizarre

[00:01:15] [SPEAKER_03]: Analogies and and comparisons also with us as always

[00:01:18] [SPEAKER_03]: Political consultant Sandeep Kaushik feeling chipper

[00:01:21] [SPEAKER_03]: I know after the presidential debate almost more so after his commentary on the debate at a recent folio event

[00:01:28] [SPEAKER_01]: Right Sandeep. Yeah, that was last night. Yeah. Yeah, we had a panel on the on the debate

[00:01:33] [SPEAKER_01]: I mean short answer Harris won on points. That's it. You can find that it's folio the Athenaeum

[00:01:40] [SPEAKER_03]: Today we have a really special guest professor Caleb Banta Green

[00:01:43] [SPEAKER_03]: Who's an expert on drug use disorder and is going to help us understand the drop in drug overdose?

[00:01:51] [SPEAKER_03]: Deaths that we've been seeing here at the beginning of this year

[00:01:54] [SPEAKER_03]: We'll be asking what factors have sort of led up to that or what he thinks is going on there

[00:01:59] [SPEAKER_03]: First this week the council's Public Safety Committee voted to move a new drug law forward and it was an unanimous vote

[00:02:07] [SPEAKER_03]: I think Erica so tell us a little bit about this new soda law, you know

[00:02:12] [SPEAKER_03]: What's the council trying to do stay out of drug areas? Law is what it stands for

[00:02:18] [SPEAKER_04]: basically

[00:02:19] [SPEAKER_04]: Reinstatement of an old policy. It wasn't a law and for some reason they like to put everything in the municipal code to

[00:02:25] [SPEAKER_04]: Really serious and essentially what it does and what this policy did do for you know for decades was allow

[00:02:32] [SPEAKER_04]: judges to issue orders that say that if you are

[00:02:36] [SPEAKER_04]: convicted or now even accused of committing a

[00:02:40] [SPEAKER_04]: Drug related crime and that now includes the new drug law that made drug use and possess public possession

[00:02:46] [SPEAKER_04]: Public use a misdemeanor if you're even suspected of that and charged you can be banned from certain areas

[00:02:53] [SPEAKER_04]: That they're calling drug areas and city attorney and Davidson

[00:02:57] [SPEAKER_04]: Originally proposed one in the downtown area centered around third and Pike pine

[00:03:02] [SPEAKER_04]: But the council members from various districts decided that they all needed their own ones as well

[00:03:08] [SPEAKER_04]: And so there's now six of them. There's one on Broadway. There's one in the U district

[00:03:12] [SPEAKER_04]: there's basically all of you know, sort of chunks across all of downtown and the International District and

[00:03:19] [SPEAKER_04]: You know these things that we've talked about this before they have kind of an expansionary logic

[00:03:23] [SPEAKER_04]: So, you know, they've already gotten bigger and I'm sure they will get bigger as well because as we've seen in the past

[00:03:28] [SPEAKER_04]: What happens is that people just either, you know

[00:03:31] [SPEAKER_04]: Violate the law by being in their same areas that they like to hang out or they just go a little bit outside that

[00:03:37] [SPEAKER_04]: Area and they in the city ends up expanding it. So it's a reinstatement of that policy

[00:03:42] [SPEAKER_03]: Alright Sandeep critics

[00:03:44] [SPEAKER_03]: I think including Erica think that this is a return to some of the failed war on drug policies of the past

[00:03:50] [SPEAKER_01]: What do you have to add? What do you think? It's coming up for a final vote on Tuesday

[00:03:55] [SPEAKER_01]: I think it's gonna pass right either 8 1 or 7 2 probably and

[00:04:00] [SPEAKER_01]: I do think the expansion stuff where a number of the council members have proposed

[00:04:05] [SPEAKER_01]: Adding some of these zones in their own districts is a problem, right?

[00:04:11] [SPEAKER_01]: The previous iteration of soda laws, I think Erica is correct turned kind of farcical and you know by the end of it

[00:04:18] [SPEAKER_01]: 40% of the entire city was designated a soda area including almost all of North Seattle and that's obviously an

[00:04:27] [SPEAKER_01]: Absurd thing. I think there's real questions about whether they're gonna be able to provide the resources to actually enforce in six different zones

[00:04:34] [SPEAKER_01]: Right now as opposed to the original two that was passed that were proposed by the city attorney

[00:04:39] [SPEAKER_01]: so there's gonna be a lot of I mean, I think there's gonna be a lot of devil in the details here about implementation and

[00:04:46] [SPEAKER_01]: What actually happens here once this law passes how much how much in the way of resources is?

[00:04:53] [SPEAKER_01]: SPD and interim chief raw are gonna put into this. How are they gonna kind of coordinate?

[00:04:59] [SPEAKER_01]: Where are they going to enforce? So we're gonna have to wait and see I think there's a lot to be determined here

[00:05:05] [SPEAKER_01]: About how this all plays out

[00:05:07] [SPEAKER_01]: We'll see

[00:05:08] [SPEAKER_03]: Okay, Caleb Banta green. What questions do you have? What comments do you have about this new?

[00:05:15] [SPEAKER_03]: old public policy

[00:05:18] [SPEAKER_02]: I guess my main question is why would things be different this time since we've tried it before and we've tried

[00:05:24] [SPEAKER_02]: iterations of it and iterations of it for for decades

[00:05:27] [SPEAKER_02]: So that's I understand people's frustration and a desire to do something

[00:05:32] [SPEAKER_02]: But I think there's a real opportunity cost because we have so little time for public discourse on this topic that it gets

[00:05:38] [SPEAKER_04]: Stuck on these types of topics. So Caleb, I know that you were or I believe that you were around the last time

[00:05:46] [SPEAKER_04]: These you know, these were really being enforced which has been a while. I mean the soap and soda

[00:05:52] [SPEAKER_04]: Areas, I mean a judge could theoretically, you know impose something like this now

[00:05:57] [SPEAKER_04]: I mean they have they never got overturned so to speak but you know, it's sort of stopped around 2010

[00:06:03] [SPEAKER_04]: Do you remember what it was like back then just in terms of like?

[00:06:08] [SPEAKER_04]: being able to do

[00:06:09] [SPEAKER_04]: harm reduction outreach to

[00:06:11] [SPEAKER_04]: To focus on the street and just kind of get people able to access services

[00:06:16] [SPEAKER_04]: I know you don't do direct outreach, but anecdotally. Do you remember what it was like?

[00:06:21] [SPEAKER_02]: Well, what I'm really memory is the nine-and-a-half block strategy where there was an attempt to do this and yet it turned out

[00:06:27] [SPEAKER_02]: There was an attempt to do diversion, but most of the people they arrested weren't actually qualified for that diversion

[00:06:32] [SPEAKER_02]: So that's what I recall of that in particular

[00:06:36] [SPEAKER_02]: I think you're raising a different issue which is you know, how does this impact our ability to

[00:06:42] [SPEAKER_02]: reach people and provide the interventions that we have and I

[00:06:47] [SPEAKER_02]: Don't know the quantifiable piece of that. I mean the folks are still out there

[00:06:51] [SPEAKER_02]: They're just getting squeezed around and you're generally able to find them somewhere else

[00:06:55] [SPEAKER_02]: The challenge is is that we've really made attempts to put services where people are and

[00:07:02] [SPEAKER_02]: So, you know, I was reading in the Seattle Times about there

[00:07:05] [SPEAKER_02]: You know their ways that you know a judge can authorize a person to be in this area

[00:07:09] [SPEAKER_02]: That sounds extremely cumbersome to me. So that doesn't listen like much of a solution to the problem

[00:07:15] [SPEAKER_02]: So that's my concern is that we've actually done pretty amazing things over the last decade in terms of expanding access to health care

[00:07:23] [SPEAKER_02]: Treatment services harm reduction and such and a lot of that is putting it where people are

[00:07:28] [SPEAKER_02]: Which is also where these areas are

[00:07:32] [SPEAKER_01]: So I don't disagree with anything that's been said here and Caleb particularly the point you just made

[00:07:37] [SPEAKER_01]: I fact I was just as people know because I've said it before I'm the DSC board chair right now and

[00:07:43] [SPEAKER_01]: And I was just had we had a board meeting yesterday where Dan Malone the executive director of DSC was

[00:07:49] [SPEAKER_01]: Informing the board that he wrote a letter to the council

[00:07:53] [SPEAKER_01]: in

[00:07:54] [SPEAKER_01]: opposition to the soda law and Daniel's concern with the expansion right

[00:08:01] [SPEAKER_01]: One of the areas they've added is the area in Pioneer Square that encompasses the Morrison, right?

[00:08:08] [SPEAKER_01]: Which is where we're putting the opioid overdose recovery, you know center right the orca

[00:08:14] [SPEAKER_01]: Center and so Daniel's concerned that this stuff about exempting people or you know that are that are sort of headed to the

[00:08:21] [SPEAKER_01]: To services right and have to go into this zone is going to be cumbersome and unworkable, right?

[00:08:27] [SPEAKER_01]: I so I think that that is a legitimate and real concern that said I think there is potential

[00:08:33] [SPEAKER_01]: opportunity here to use these zones if it's done in a

[00:08:38] [SPEAKER_01]: systematic organized, you know kind of consistent way coordinated way across, you know law enforcement and

[00:08:48] [SPEAKER_04]: And and if you were here during this stuff, too

[00:08:50] [SPEAKER_04]: Yeah, and do you think this council is gonna do a better job than all the previous councils and mayor?

[00:08:57] [SPEAKER_04]: The council passes the law now that do you think that the city is going to do a more a better more

[00:09:02] [SPEAKER_01]: Coordinated job this time and if so, why I think there's potential because I think if there's buy-in my understanding

[00:09:09] [SPEAKER_01]: Is that there's buy-in from from su rar the interim chief and SVD

[00:09:14] [SPEAKER_01]: Working with the city attorney's office. There were the police have buy-in

[00:09:19] [SPEAKER_04]: That's not really a question again the question isn't like well police support

[00:09:23] [SPEAKER_04]: I mean, I guess I'm just saying what is you sort of spout this like if it's coordinated and well done

[00:09:27] [SPEAKER_04]: We've never seen it coordinated and well done and I don't see any reason

[00:09:33] [SPEAKER_04]: I think I guess I guess you have to justify that no

[00:09:37] [SPEAKER_01]: People I have talked to dating back to the 90s the origins of stuff is that

[00:09:42] [SPEAKER_01]: Some of this stuff did work well in its origins and sort of then devolved and like by 2010

[00:09:48] [SPEAKER_02]: It wasn't really working anymore. So Sunday there's coordination that does what what's the next thing?

[00:09:55] [SPEAKER_02]: I don't understand what the next thing is then what yeah

[00:09:58] [SPEAKER_01]: Well, and that's what I want to talk about one of the things I wanted to talk about today is how do we intervene?

[00:10:06] [SPEAKER_01]: it proactively in

[00:10:09] [SPEAKER_01]: Situations where people are on the streets of our city suffering serious

[00:10:16] [SPEAKER_01]: Addiction

[00:10:18] [SPEAKER_01]: Often or at least sometimes fatal, you know addictions, right?

[00:10:22] [SPEAKER_01]: We've had a huge spike in overdose deaths as as fentanyl and meth have essentially displaced heroin and cocaine is the

[00:10:28] [SPEAKER_01]: Street drugs of choice in our city

[00:10:30] [SPEAKER_01]: I think there have been some really really pernicious downstream impacts of that that

[00:10:35] [SPEAKER_01]: To my mind makes me think that we really need to rethink how we intersect

[00:10:40] [SPEAKER_01]: with those who are suffering from addiction

[00:10:43] [SPEAKER_01]: right and so

[00:10:45] [SPEAKER_01]: What I'm looking for are mechanisms of intervention

[00:10:49] [SPEAKER_01]: Where the end result Caleb to your question is actually try to get people

[00:10:54] [SPEAKER_01]: Help before they kill themselves

[00:10:56] [SPEAKER_02]: Let me just throw a little stat out there just for context, right?

[00:11:00] [SPEAKER_02]: So moving substances doesn't cure substance use disorder, right? It doesn't do that

[00:11:05] [SPEAKER_02]: treating substance use disorder is

[00:11:08] [SPEAKER_02]: Helping to manage a chronic condition. It doesn't fix it

[00:11:11] [SPEAKER_02]: Doesn't solve it and it doesn't address the social emotional context psychological ramifications of substance use

[00:11:19] [SPEAKER_02]: Those take a lot of time to unpack

[00:11:21] [SPEAKER_02]: We're fortunate when it comes to opi deuce disorder to have the medications buprenorphine and methadone

[00:11:26] [SPEAKER_02]: That can address the biological component of addiction within minutes to hours. So we're fortunate there, but then there's the process of sort of

[00:11:34] [SPEAKER_02]: recreating your life

[00:11:36] [SPEAKER_02]: And just one aspect of life is pretty striking and that's just housing and what's really striking if you look at the King County

[00:11:43] [SPEAKER_02]: Data I encourage people to look at it. It's on kingcounty.gov

[00:11:46] [SPEAKER_02]: forward slash overdose is there now I'm looking at the housing status of people who die and it is stunning in

[00:11:54] [SPEAKER_02]: 2023 50% of people were essentially in housing sort of private housing or rented housing

[00:12:01] [SPEAKER_02]: 21% were in something was subsidized or permanent supportive housing and

[00:12:05] [SPEAKER_02]: 24% of folks were unhoused

[00:12:08] [SPEAKER_02]: So coming back to the original topic like how does displacing people who are in these situations?

[00:12:16] [SPEAKER_02]: How is that fixing something right and I'm all in my work and the world that I work in is

[00:12:21] [SPEAKER_02]: You know trying to get health care substance use disorder harm reduction services to folks, but I know that's only a first step

[00:12:28] [SPEAKER_02]: It's the whole then what?

[00:12:30] [SPEAKER_02]: And so we're kind of looking for these quick facts fixes

[00:12:33] [SPEAKER_02]: We're lucky to have some kind of quick interim fixes for opioid use disorder not for methamphetamine

[00:12:39] [SPEAKER_02]: Methamphetamine which we should talk about is a whole other thing a huge intersection with folks who are on how it's a mental health issues

[00:12:44] [SPEAKER_02]: But we do have a fundamental issue of housing instability for folks that even if we did get them connected to services

[00:12:53] [SPEAKER_02]: Then what we don't have the capacity

[00:12:55] [SPEAKER_02]: We won't have it for years to address the housing status and the ability for people to recover who are on houses is

[00:13:02] [SPEAKER_04]: And I and I think too I mean, you know, you started out Caleb is saying how does how does that help?

[00:13:07] [SPEAKER_04]: I mean, I you know

[00:13:08] [SPEAKER_04]: I think that the council has explicitly said that we want to scatter people they wouldn't use those words

[00:13:13] [SPEAKER_04]: They said they wanted to disrupt the concentration of drug users and that there are you know

[00:13:18] [SPEAKER_04]: There is a different category of people from drug users

[00:13:21] [SPEAKER_04]: That is drug sellers and those people that that unique category people is preying on the victims who need to be scattered

[00:13:29] [SPEAKER_04]: and I guess you know, I

[00:13:32] [SPEAKER_04]: Don't know what the question is other than when you hear stuff like that

[00:13:35] [SPEAKER_04]: I mean, how do you react like that that scattering people is a good solution to you know

[00:13:40] [SPEAKER_04]: The disorder problem and and also that it will help people

[00:13:44] [SPEAKER_04]: I mean one councilmember and I'm

[00:13:46] [SPEAKER_04]: Forgetting which one this week was saying that this is it might have been Sarah Nelson saying that this is good

[00:13:52] [SPEAKER_04]: Because it gets them away and makes the drugs less accessible and and that will make them

[00:13:58] [SPEAKER_04]: You know sort of come to their senses and seek recovery

[00:14:01] [SPEAKER_04]: I assume you're watching all this stuff. How do you respond to all that?

[00:14:04] [SPEAKER_02]: Well, I mean I so part of this is just my anecdotal piece

[00:14:06] [SPEAKER_02]: You know, I'm a native Seattleite. I go all over the city all the time

[00:14:09] [SPEAKER_02]: I ride my bike all over the city all the time

[00:14:12] [SPEAKER_02]: There's folks who use drugs all over this city and the rare places where there aren't are often incredibly affluent areas

[00:14:20] [SPEAKER_02]: With their own sort of monitoring systems where these folks are never gonna be able to blend in or go to

[00:14:25] [SPEAKER_02]: So this whole sort of squeezing thing

[00:14:28] [SPEAKER_02]: It's it's not like it's in one or two places

[00:14:30] [SPEAKER_02]: Like where are we gonna push people? Yeah, too

[00:14:33] [SPEAKER_02]: I just don't understand where that's gonna happen and then and then what and then what when you've pushed on there?

[00:14:40] [SPEAKER_03]: Can I broaden it out? You know Caleb you're saying we need to be patient. We need more resources

[00:14:44] [SPEAKER_03]: You understand people's frustration but over the years I've interviewed a lot of folks who want folks to get help

[00:14:50] [SPEAKER_03]: They want harm reduction

[00:14:51] [SPEAKER_03]: But they also want to live in neighborhoods where their kids feel safe walking to school

[00:14:56] [SPEAKER_03]: And when they live in the CID and their kids have to walk through a block that feels really unsafe

[00:15:02] [SPEAKER_03]: That's untenable for them and they have to either move or move move move their kids from school or make some really tough decisions

[00:15:09] [SPEAKER_03]: Right, and so that's part of the community that the City Council has to serve

[00:15:13] [SPEAKER_03]: So I wonder I mean, I know it's not your area of expertise

[00:15:16] [SPEAKER_03]: But when we talk about what works

[00:15:19] [SPEAKER_03]: Why isn't an attempt to try to just simply make things better on that block?

[00:15:24] [SPEAKER_03]: Even though it's not gonna solve things long term and as you say though

[00:15:27] [SPEAKER_03]: You know those solutions are gonna take a lot of time and be really difficult

[00:15:31] [SPEAKER_03]: Why shouldn't the council want to try and address those neighbors concerns more immediately?

[00:15:37] [SPEAKER_03]: With these kinds of quick fixes that are imperfect. Why shouldn't they why shouldn't they consider that?

[00:15:42] [SPEAKER_02]: I just don't know how it isn't just kicking the can to the next block

[00:15:44] [SPEAKER_02]: I just don't understand how that isn't what happens because the people don't disappear their medical and health conditions don't disappear

[00:15:52] [SPEAKER_02]: You know, I'm doing my best to not pay for Jeff Bezos is next spaceship, right?

[00:15:58] [SPEAKER_02]: And so I'm trying to support local businesses. I try to go out to local communities

[00:16:01] [SPEAKER_02]: I try to support local businesses and local restaurants like I want our community to be thriving and I feel

[00:16:07] [SPEAKER_02]: Very much for folks who are struggling both with substance use but also the consequences of substance use

[00:16:13] [SPEAKER_02]: Like I totally get it and I get the frustration and I work in the University District like I get it

[00:16:19] [SPEAKER_02]: But I just don't see that it so it moves one block. I mean it helps those folks for a short period of time

[00:16:25] [SPEAKER_02]: I mean, I mean you could you could do that but

[00:16:29] [SPEAKER_02]: Then the next block is gonna get upset and it's gonna get moved to the next block

[00:16:32] [SPEAKER_02]: I mean so the then what is then you do it again

[00:16:35] [SPEAKER_02]: Then you do it again, then you do it again. And the challenge is is that to address this?

[00:16:39] [SPEAKER_04]: That's that expansionary logic

[00:16:41] [SPEAKER_02]: I mean the dress the issue just it's a multi-year process and it's a hard process and somebody has to be willing to own

[00:16:48] [SPEAKER_02]: That political tension that will exist and say we have a long-term strategy. It's gonna be tough

[00:16:55] [SPEAKER_02]: We're gonna do our best to help people through this period of time

[00:16:58] [SPEAKER_02]: But this is there isn't a quick fix. I mean if there was a quick fix, we would have done it by now

[00:17:05] [SPEAKER_01]: There is no quick fix but I also think there is that

[00:17:09] [SPEAKER_01]: To some extent I think there's also a logic

[00:17:14] [SPEAKER_01]: If you push sort of some of the what I think are very sound principles of harm reduction too far

[00:17:21] [SPEAKER_01]: you create a logic of

[00:17:26] [SPEAKER_01]: Sort of not just you know, essentially tolerating permitting

[00:17:32] [SPEAKER_02]: Large-scale open-air drug markets, right? I'm gonna push back. I knew that's are we tolerating harm reduction

[00:17:38] [SPEAKER_02]: Are we tolerating not housing people? Well, I mean

[00:17:41] [SPEAKER_04]: You're making you're making up a straw man that is not harm reduction

[00:17:45] [SPEAKER_04]: No one has argued for large concentrations of open-air drug markets. I mean, you will not hear me making that argument

[00:17:51] [SPEAKER_04]: I cannot imagine Caleb would make that argument. I mean nobody it's a straw man. Nobody's saying that

[00:17:55] [SPEAKER_01]: That's the entire intent of the SOTA law is to take what are right now

[00:18:00] [SPEAKER_01]: large scale open-air drug markets and to disrupt those mechanisms right from

[00:18:06] [SPEAKER_01]: Which do I think?

[00:18:07] [SPEAKER_01]: Increase levels of addiction if you allow it's the same argument we have about encampments and encampment cleanups

[00:18:13] [SPEAKER_01]: if you just allow encampments to form and grow and

[00:18:18] [SPEAKER_01]: Continue to kind of kind of morph into nodes. What's the mechanism by which they increase addiction?

[00:18:23] [SPEAKER_04]: I just again like I think you're saying things and I don't know what that means

[00:18:27] [SPEAKER_04]: I I don't I don't know any of any evidence that that's yeah, I will give you some

[00:18:31] [SPEAKER_01]: Yeah, I'll give you some evidence my own fucking lived experience, right?

[00:18:35] [SPEAKER_01]: Talking about

[00:18:37] [SPEAKER_01]: Because let's talk about

[00:18:39] [SPEAKER_04]: Let's talk about the psychology of addiction I could talk about my lived experience, too

[00:18:43] [SPEAKER_04]: I've written I mean like I've written about it a lot, but I'm asking about data

[00:18:46] [SPEAKER_04]: What is the data that large concentrated open-air drug markets when disrupted reduce?

[00:18:51] [SPEAKER_04]: Addiction in people and make people's lives better. Yeah, let me give you an example and Kayla

[00:18:56] [SPEAKER_01]: I'm curious about your take on this Ezra Klein

[00:18:59] [SPEAKER_01]: A couple of months ago on this New York Times podcast did an episode of where are we on sort of their you know

[00:19:06] [SPEAKER_01]: I think it's called like a weird weird a weird place and in drug policy, right?

[00:19:10] [SPEAKER_01]: It was a bell hour-long podcast where he talks to Keith Humphreys from Stanford

[00:19:14] [SPEAKER_01]: Who's a drug policy guy, right?

[00:19:17] [SPEAKER_01]: And I bet kill it that you disagree with Keith Humphreys

[00:19:20] [SPEAKER_01]: But I think Keith has some interesting things to say and one of the things he points out is that

[00:19:27] [SPEAKER_01]: Addicts right people who actually get into treatment

[00:19:31] [SPEAKER_01]: What you'll find is if you just say we got to sit here and wait until somebody says they're ready to get treatment

[00:19:40] [SPEAKER_01]: That's not how

[00:19:42] [SPEAKER_01]: Getting people out of addiction and into treatment actually works. There has to be some kind of pressure

[00:19:46] [SPEAKER_01]: Exterior pressure whether it's familial pressure whether it's job pressure

[00:19:51] [SPEAKER_01]: Whether it's pressure that comes out of the out of the criminal justice system that sort of

[00:19:58] [SPEAKER_01]: prompts people in the throes of addiction to take the step that moves them and this is why measure 110 failed

[00:20:05] [SPEAKER_01]: It was a joke right in Oregon where they said we're just gonna create this

[00:20:09] [SPEAKER_01]: 1-800 hotline and give people a little card and say call this number

[00:20:13] [SPEAKER_01]: Nobody called the number right even every one of those people who's addicted on the street wants to stop

[00:20:19] [SPEAKER_01]: But how do you create a

[00:20:22] [SPEAKER_01]: Set of interventions that move people towards people in the throes of addiction

[00:20:28] [SPEAKER_01]: Towards actually taking steps to for them to get the help that they need easy

[00:20:32] [SPEAKER_02]: You don't call it treatment. You know, I did my training in a methadone clinic in 1995 next to what was then the kingdom and

[00:20:41] [SPEAKER_02]: Good people good intent bad model bad dynamics

[00:20:45] [SPEAKER_02]: That the the fundamental issue is and we started asking us in 2015

[00:20:49] [SPEAKER_02]: We continue to see this in our statewide syringe services program survey. We asked people do you want to stop or reduce your opioid use?

[00:20:58] [SPEAKER_02]: 80% of people yeah, we asked them

[00:21:00] [SPEAKER_02]: Do you do you want health care at the syringe services program three quarters of people?

[00:21:05] [SPEAKER_02]: Do you want methadone or buprenorphine 70% of people have you needed health care in the last year not gotten it?

[00:21:11] [SPEAKER_02]: 60% of people why because I'm treated terribly

[00:21:15] [SPEAKER_02]: So what we call treatment is super important and it's the entire premise of where and what I'm excited about

[00:21:23] [SPEAKER_02]: Where King County is going where Washington State's going with their federal legislation

[00:21:28] [SPEAKER_02]: They can't well and Cassidy have introduced are going and that is the move out of this idea about just treatment

[00:21:33] [SPEAKER_02]: And the way that I was trained in treatment and what treatment generally looks like and with the general public think people people think

[00:21:39] [SPEAKER_02]: Treatment is which is 12-step and inpatient treatment. That's not treatment for most folks. It's not treatment

[00:21:45] [SPEAKER_02]: It might be a social support. It might be a necessary intervention

[00:21:48] [SPEAKER_02]: But it's not ultimately what moves them towards recovery in and of itself it can but for most folks

[00:21:54] [SPEAKER_02]: There's a lot more that needs to happen and the issue is particularly with opioids and stimulants

[00:22:00] [SPEAKER_02]: Which the time to getting into recovery is about three years as opposed to one year for

[00:22:06] [SPEAKER_02]: Cannabis and alcohol it's a period it's a recovery process and then that process is a lot of ongoing use

[00:22:13] [SPEAKER_02]: Which means you're going to need harm reduction services and treatment services and recovery support services all at the same time

[00:22:19] [SPEAKER_02]: So this idea that we need to force people into treatment or we need to coerce people into treatment

[00:22:25] [SPEAKER_02]: When we have 80% of people who say they want to stop or reduce their use I want to start with them

[00:22:29] [SPEAKER_02]: I want to be creating service venues where they can get whatever they want every day

[00:22:34] [SPEAKER_02]: The margin the 20% of people who don't want to stop or reduce their use if they need some additional leverage or push

[00:22:41] [SPEAKER_02]: We can consider that but that should be the last thing we do not the default of what we do

[00:22:45] [SPEAKER_02]: That shouldn't be the first thing we do which is to try to force people into treatment. You know, I have

[00:22:51] [SPEAKER_04]: You know, I'm not putting myself out there as an expert

[00:22:53] [SPEAKER_04]: But I've written a book about relapse and recovery and one of the things that kept coming up in the research

[00:22:58] [SPEAKER_04]: I was reading was not as Sunday puts it that people need an external motivation

[00:23:02] [SPEAKER_04]: Some people do you say that you know jail is a thing that got them. I know lots of people

[00:23:07] [SPEAKER_04]: I've gone to lots and lots of 12-step meetings over many years at this point

[00:23:12] [SPEAKER_04]: but you know

[00:23:13] [SPEAKER_04]: But the but the factor that really makes a difference is internal motivation to change and it's I mean, you know

[00:23:18] [SPEAKER_04]: And I don't know if that is a term of art or a scientific phrase

[00:23:21] [SPEAKER_04]: But you know it comes at different times for different people for me

[00:23:25] [SPEAKER_04]: It did not involve any particular external motivation, you know

[00:23:29] [SPEAKER_04]: I've had all those external motivations and none of them worked and believe me losing my job was a big external motivation and

[00:23:37] [SPEAKER_04]: And so I mean I do think that you know Sunday. This is the part that makes you impatient

[00:23:42] [SPEAKER_04]: I think it's what Caleb is describing is you do actually have to wait and

[00:23:46] [SPEAKER_04]: You know and relapse, you know or whatever you want to call it continue drug use whether it's alcohol or meth or fentanyl

[00:23:53] [SPEAKER_04]: Is is generally almost always part of that process?

[00:23:56] [SPEAKER_04]: And I think when we have these you know

[00:23:58] [SPEAKER_04]: Quote-unquote solutions where we're like, well just push them out of this area and that'll get them away from these evil drug dealers

[00:24:04] [SPEAKER_04]: You know who are also often addicts themselves

[00:24:08] [SPEAKER_04]: And and that'll inspire them to get better and to stop using even though they may be homeless even though they may have

[00:24:13] [SPEAKER_04]: No access to health care. I just think that's a fantasy and

[00:24:17] [SPEAKER_04]: Yeah, and so I just I well I wanted to hear what Caleb thinks about

[00:24:20] [SPEAKER_04]: You know the sort of the motivation factor of what kind of prompts people but yeah

[00:24:25] [SPEAKER_02]: You know the motivation part is important

[00:24:27] [SPEAKER_02]: There's a whole thing that we're generally trained in and counseling around addiction around motivational interviewing

[00:24:32] [SPEAKER_02]: And what's important in there are a couple of things

[00:24:34] [SPEAKER_02]: I will say is talking with a person having a space to talk about the pros and cons of their drug use and

[00:24:40] [SPEAKER_02]: One that's very important because you're acknowledging there are reasons that people use drugs and make in a space where they can actually

[00:24:46] [SPEAKER_02]: Have a logical trust and conversation with you so you can understand some of the motivations for their use

[00:24:51] [SPEAKER_02]: But also then the idea of motivational interviewing is to work with them to figure out what are their own intrinsic motivations to change

[00:24:59] [SPEAKER_02]: Is it about their appearance? Is it about their relationships?

[00:25:03] [SPEAKER_02]: Is it about their job and to really build on that and focus on that?

[00:25:07] [SPEAKER_02]: So internal motivation is super important or can there be external motivators?

[00:25:11] [SPEAKER_02]: Yes, have I heard from dozens if not hundreds of people who said, you know jail is what saved my life

[00:25:17] [SPEAKER_02]: I'm like yes, and I said but what if you'd gotten housing and health care

[00:25:21] [SPEAKER_02]: And good quality counseling like oh, yeah

[00:25:23] [SPEAKER_02]: It's just that I didn't have access to that I had access to jail

[00:25:26] [SPEAKER_02]: Which is where I got a timeout and I got some of those things and we know that

[00:25:30] [SPEAKER_02]: Jail is the most expensive place to get those services with the folks who at the least time and resources and qualifications

[00:25:35] [SPEAKER_02]: To do it. So yes, there are different aspects of motivation for sure

[00:25:40] [SPEAKER_02]: But I also think the idea that the Oregon law failed because there was an 800 number the Oregon law failed for the same

[00:25:46] [SPEAKER_02]: Reason that I talked to legislators as they were drafting the original Blake fix

[00:25:51] [SPEAKER_02]: You're building a system to nowhere you're building a diversion program. You're building their first half of a ship to nothing

[00:25:57] [SPEAKER_02]: We didn't stand up the services or create adequate services and the right mix of services

[00:26:02] [SPEAKER_02]: Not just more treatment not just more treatment beds, but the whole array of services that people need

[00:26:07] [SPEAKER_01]: So that's an implementation failure not a policy failure a couple of things about so right. I'm a former heroin addict

[00:26:15] [SPEAKER_01]: Right. I was addicted as you know, we talked about this

[00:26:17] [SPEAKER_01]: I was addicted a run for me a dozen years maybe even a little more than that

[00:26:22] [SPEAKER_01]: To varying degrees of functionality in my life

[00:26:25] [SPEAKER_01]: I think the last three years is where my of my addiction is where my life really came apart, right and

[00:26:30] [SPEAKER_01]: To the point that you know, I was probably

[00:26:34] [SPEAKER_01]: Not gonna make it that much longer, you know

[00:26:37] [SPEAKER_01]: And so my experience of that psychology, right and this is where I think some of the stuff

[00:26:44] [SPEAKER_01]: I hear from from both you and Erica. I just doesn't

[00:26:48] [SPEAKER_01]: Quite fit. I mean there's a lot of truth to it, but doesn't quite fit was that

[00:26:52] [SPEAKER_01]: Every addict in the throes of really serious opioid addiction pretty much every addict wants to stop at the same time

[00:27:00] [SPEAKER_01]: They don't want to stop right?

[00:27:02] [SPEAKER_01]: I mean was almost like I had a split

[00:27:05] [SPEAKER_01]: Like I literally had voices in my head, right and there would be a voice in my head where every time I shut up

[00:27:11] [SPEAKER_01]: That would say to me. Oh my god. My life is unraveling. I

[00:27:16] [SPEAKER_01]: Just got busted, you know, I spent a day in jail and I still haven't stopped

[00:27:21] [SPEAKER_01]: I'm not doing you know everything my relationships are falling apart. I've got abscesses

[00:27:28] [SPEAKER_01]: I'm you know all the horrible things that are happening and I gotta go get help but within

[00:27:34] [SPEAKER_01]: 30 minutes there's this other voice in my head that's there the whole time whispering to me saying no no

[00:27:41] [SPEAKER_01]: No, you just got a score man. Get a fix and get well

[00:27:45] [SPEAKER_01]: And it's that's the conversation that's going on internally in the brain. I think of every addict and

[00:27:54] [SPEAKER_01]: Ultimately that second voice is the one that won the argument every time right and the thing that actually obviously

[00:28:03] [SPEAKER_01]: finally work like I had

[00:28:06] [SPEAKER_01]: Throw away I was you know working on a fucking Princeton PhD dissertation. I had to abandon that

[00:28:12] [SPEAKER_01]: I had to move away to a entirely new city. I had to go get on the methadone

[00:28:17] [SPEAKER_01]: You know, I did a whole series of things to just completely

[00:28:22] [SPEAKER_01]: Reset my entire life and start over and it worked. Thank God right methadone saved my life

[00:28:28] [SPEAKER_01]: I'm really as I've said before I'm really happy that I'm gonna get a chance to speak at the Evergreen Treatment Services

[00:28:34] [SPEAKER_01]: lunch on September 26

[00:28:36] [SPEAKER_01]: I was a client of theirs when I first got to Seattle, right?

[00:28:38] [SPEAKER_01]: I'm about trying to get addicts help

[00:28:41] [SPEAKER_01]: But I don't think most addicts I if you had sort of given me this current Seattle situation where it's like

[00:28:48] [SPEAKER_01]: Hey, man, we're just gonna be real chill about your addiction and not push you and really

[00:28:54] [SPEAKER_02]: That's not the intervention that we're designing what would I would

[00:28:58] [SPEAKER_01]: Stop though Caleb. That's that's that's where I kind of come

[00:29:02] [SPEAKER_01]: I don't think I would have stopped without some of the pressures

[00:29:06] [SPEAKER_01]: That were put on me now a lot of it was terrible what if you had a place to go

[00:29:11] [SPEAKER_02]: What if you had a place where you could go get clean needles where someone would ask you how you're doing and actually give a shit

[00:29:17] [SPEAKER_02]: Yes, right. Yes, and I mean breaking new rules without doing and so I'm a strong supporter of a

[00:29:24] [SPEAKER_01]: Safe consumption, you know for exactly that reason I think that would have helped me earlier

[00:29:29] [SPEAKER_03]: Caleb you said

[00:29:30] [SPEAKER_03]: Cited surveys showing that 80% of people saying that they want to stop and reduce their use

[00:29:35] [SPEAKER_03]: Obviously, I mean what's on deep is kind of raising is that that doesn't necessarily mean that those people all want to get into treatment tomorrow

[00:29:44] [SPEAKER_03]: Does it I mean there's gonna be a big difference or a lot of difference within that 80%? I'm imagining so

[00:29:50] [SPEAKER_03]: You know kind of when you talk about let's let's not worry so much about the 20%

[00:29:54] [SPEAKER_03]: Maybe it's more like 40 or 60% of well, I do worry about the 20%

[00:29:58] [SPEAKER_02]: I don't want them to die right?

[00:30:00] [SPEAKER_02]: So that's why I went off I want something for every day for everybody every day

[00:30:03] [SPEAKER_02]: And that's why you need the harm reduction services next to the treatment next to the health care services so that on any given day

[00:30:10] [SPEAKER_02]: There's a reason for everybody to come in and as people's own recovery process ebbs and flows

[00:30:17] [SPEAKER_02]: There's still a reason for them to come back every day

[00:30:19] [SPEAKER_02]: You know one of the anecdotes we had out of the buprenorphine pathways product

[00:30:23] [SPEAKER_02]: Which was the first low barrier buprenorphine project opened in 2017 was a young woman who said I've been in and out of recovery

[00:30:30] [SPEAKER_02]: Many years and generally when I'm in treatment and

[00:30:35] [SPEAKER_02]: I fall off the wagon and I start using again

[00:30:38] [SPEAKER_02]: I just keep using because I know I'm gonna get kicked out of treatment

[00:30:41] [SPEAKER_02]: But I knew you weren't gonna kick me out of treatment, so I didn't keep using that's technically called the abstinence violation effect

[00:30:47] [SPEAKER_02]: And we broke it because that person knew they could keep coming back no matter what and that's what we want to build

[00:30:53] [SPEAKER_02]: We want a reason and a place for people to come back no matter what every day whatever they need and and that's our goal

[00:30:59] [SPEAKER_02]: That's a thing that we are working to build. It's what we've been doing with low barrier buprenorphine

[00:31:04] [SPEAKER_02]: It's what we're working to build with this overdose recovery care access center down at third and James

[00:31:09] [SPEAKER_02]: And it's what we're working in Washington State to do with these five health engagement hubs that have been funded and which now

[00:31:15] [SPEAKER_02]: Cantwell and Cassidy are trying to do with the federal

[00:31:18] [SPEAKER_02]: Fentanyl overdose reduction act which is a 10 state federal demonstration product of health engagement hub

[00:31:23] [SPEAKER_02]: So but that's that you know I've been doing this for whatever however you count 25 or 30 years

[00:31:29] [SPEAKER_02]: I'm putting my eggs in that basket

[00:31:30] [SPEAKER_02]: It's not gonna fix everything by any means

[00:31:34] [SPEAKER_02]: But it's the best bet and it's the it's to offer everything to everybody every day that I don't know what else to do

[00:31:39] [SPEAKER_02]: besides that

[00:31:40] [SPEAKER_03]: So the council is trying to make Seattle a city

[00:31:44] [SPEAKER_03]: Maybe it helps people but part of what they're trying to do which I think Sonny was getting at is they're trying to

[00:31:48] [SPEAKER_03]: Make it a city where it's less easy to buy and use drugs

[00:31:51] [SPEAKER_03]: Than it is today right Caleb and

[00:31:55] [SPEAKER_03]: Seattle isn't quite Amsterdam, but within the United States

[00:31:59] [SPEAKER_03]: It's it's maybe it's closer than some other places. I don't know

[00:32:03] [SPEAKER_03]: Texas or something so as a public policy goal. It's it's not gonna help people

[00:32:09] [SPEAKER_03]: They might end up moving to other states, but this is my sort of

[00:32:14] [SPEAKER_03]: Question because I think it comes from where we are

[00:32:16] [SPEAKER_03]: It's a city that wants to help people

[00:32:18] [SPEAKER_03]: But doesn't have the resources to do all the things that it wants to do right now when it comes to housing when it

[00:32:24] [SPEAKER_03]: Treatment and in some ways it wants to make it a less hospitable place for people to buy and use drugs

[00:32:29] [SPEAKER_03]: Should that not be a part of the public policy here in Seattle?

[00:32:33] [SPEAKER_03]: And and I asked that question not because I you know want to be a right winger who knows the answer to it

[00:32:38] [SPEAKER_03]: But but how do you grapple with it because I do think that's part of the question here

[00:32:43] [SPEAKER_02]: You're not gonna

[00:32:44] [SPEAKER_02]: Be the drug distribution business

[00:32:47] [SPEAKER_02]: They have all the money and none of the rules and we have all the rules and none of the money like it's just

[00:32:51] [SPEAKER_02]: A game that we will never win

[00:32:53] [SPEAKER_02]: You know we have and in the way

[00:32:56] [SPEAKER_02]: I see the equation is is if I wanted to I would not do because I'm at work on state property

[00:33:02] [SPEAKER_02]: You know I could have fentanyl delivered to me for a couple of dollars in a couple of minutes

[00:33:06] [SPEAKER_02]: Doesn't matter where I am in the city

[00:33:09] [SPEAKER_02]: You can't beat that

[00:33:11] [SPEAKER_02]: So the goal the calculus that I try to think about is you need to make

[00:33:17] [SPEAKER_02]: Method on a buprenorphine at least as easy to get as fentanyl

[00:33:22] [SPEAKER_02]: That's the calculus you know going back to Jeff Bezos. How do you undermine that market? I?

[00:33:28] [SPEAKER_02]: Think you undermine it by having a better cheaper alternative

[00:33:31] [SPEAKER_02]: That's more easily available that by the way is a medication you take once a day or once a month

[00:33:37] [SPEAKER_02]: As opposed to a powder or a pill that you inject or smoke 10 15 times a day that you have no idea

[00:33:43] [SPEAKER_02]: What it is and there's a good chance you're gonna have an overdose like we have the tools

[00:33:47] [SPEAKER_02]: We're choosing not to deploy them when it comes to services that will benefit people

[00:33:52] [SPEAKER_02]: I'm you know as a as a public health person. That's where I'm putting my effort

[00:33:57] [SPEAKER_02]: I I just you know and I worked at the White House drug czar's office in 2012 and

[00:34:04] [SPEAKER_02]: In there, I didn't go on the fifth floor

[00:34:06] [SPEAKER_02]: That was the and that was the agent orange floor for Central America

[00:34:10] [SPEAKER_02]: It didn't work I and now it's that didn't work when we were talking about growing crops in fields and

[00:34:16] [SPEAKER_02]: Now we're talking about synthetic drugs made anywhere like I just don't understand

[00:34:22] [SPEAKER_02]: I don't understand how that approach around trying to displace the drug market is gonna work

[00:34:29] [SPEAKER_02]: I just I've never seen it work

[00:34:31] [SPEAKER_01]: So Eric I talked a bit about my lived experience on this stuff and how I see the psychology of my own addiction working

[00:34:38] [SPEAKER_01]: I know you disagree with me on this some so so why don't you if you if you're will yeah

[00:34:43] [SPEAKER_04]: I think that I think that when you say that every single addict experiences this way

[00:34:47] [SPEAKER_04]: I know that you're not right because that wasn't my experience

[00:34:50] [SPEAKER_04]: My experience was I needed to get well and my drug of choice was alcohol and and it was just it was just a simple

[00:34:57] [SPEAKER_04]: You know physiological calculation on a day-to-day basis versus

[00:35:00] [SPEAKER_04]: You know how bad my life was and I know other people who think about it differently and that's why I think that these

[00:35:07] [SPEAKER_04]: The kind of one-size-fits-all solutions quote-unquote

[00:35:10] [SPEAKER_04]: That the Seattle City Council is talking about which is you know go to the 28 day 12 step treatment

[00:35:16] [SPEAKER_04]: Get out come out shiny and new never relapse or you failed

[00:35:21] [SPEAKER_04]: I think that's incredibly unrealistic. It doesn't work for most people as Caleb said and

[00:35:27] [SPEAKER_04]: You were talking about David wanting to make it, you know, maybe a little bit harder to get drugs here

[00:35:32] [SPEAKER_04]: You know, I mean I think that yes disrupting these, you know

[00:35:36] [SPEAKER_04]: 50-person markets by

[00:35:38] [SPEAKER_04]: Scattering everybody somewhere is not going to reduce, you know the market for drugs and it's not going to reduce

[00:35:43] [SPEAKER_04]: You know international drug smuggling and you know and the overall market

[00:35:47] [SPEAKER_04]: It's just not going to have any impact on that never has never will they're trying to make it less

[00:35:52] [SPEAKER_03]: Hospitable for people trying to buy and use drugs here

[00:35:55] [SPEAKER_03]: So that's that's everything from the use of drugs to to like harm reduction, right?

[00:36:00] [SPEAKER_02]: But then people with untreated substance use disorder use their drug of choice. They will get it

[00:36:05] [SPEAKER_02]: They need to get it and it will happen

[00:36:08] [SPEAKER_04]: Nature finds a way so then what and the point the point that I was that I was trying to make David was that

[00:36:14] [SPEAKER_04]: you know for me my drug of choice is alcohol and

[00:36:18] [SPEAKER_04]: an alcohol is absolutely everywhere and

[00:36:21] [SPEAKER_04]: alcohol will kill you the fuck dead because I almost died from it and

[00:36:25] [SPEAKER_04]: You know and it is not as though

[00:36:27] [SPEAKER_04]: My recovery depends upon the prohibition of alcohol from grocery stores

[00:36:32] [SPEAKER_04]: If it did, you know, and I was drinking I would find a way to get it and that's what happened during prohibition

[00:36:38] [SPEAKER_04]: And that's what's happening

[00:36:39] [SPEAKER_04]: You know with these drugs that you can overdose from and die immediately like fentanyl

[00:36:43] [SPEAKER_04]: People will get it people will seek it out. And I mean there's just nothing you can do about that

[00:36:48] [SPEAKER_04]: it's a fantasy to think that you know that that we can just make things less hospitable and

[00:36:54] [SPEAKER_04]: You know, I mean you were saying maybe in Texas. It's different. No, it's not that's the thing

[00:36:58] [SPEAKER_04]: It's not different really anywhere. It's just that here, you know in Seattle

[00:37:02] [SPEAKER_04]: We do have you know these these little hotspots that everybody freaks out about but like I'm in an undisclosed location right now

[00:37:09] [SPEAKER_04]: that has you know a shit ton of drug use everywhere and

[00:37:13] [SPEAKER_04]: You know and and a more, you know more health care infrastructure probably than Seattle and you know

[00:37:18] [SPEAKER_04]: And it doesn't it doesn't work. It doesn't work to just say well

[00:37:21] [SPEAKER_04]: We're gonna we're gonna ban it if there are ten times as much, you know

[00:37:24] [SPEAKER_04]: I don't think that you know if the market meets its need unfortunately, right? So what?

[00:37:30] [SPEAKER_01]: one quick point I wanted to make and then I want to I want to ask Caleb a

[00:37:35] [SPEAKER_01]: Question about the reduction in overdose death that we've been seeing in Seattle and what that means, right?

[00:37:41] [SPEAKER_01]: What how we should take that but I just a point

[00:37:43] [SPEAKER_01]: I want I guess the point I want to make to close this part of the conversation

[00:37:46] [SPEAKER_01]: We were just talking about measure 110 in Oregon, right? They decriminalized use of drugs in Oregon in 2020

[00:37:53] [SPEAKER_01]: Coincided with the rise of fentanyl the streets of Portland

[00:37:56] [SPEAKER_01]: Can fill with you know, it was also during the pandemic we can filled with encampments lots and lots of open-air drug use

[00:38:03] [SPEAKER_01]: There's a backlash against it. They pulled back I actually

[00:38:06] [SPEAKER_01]: think that there's some promise to the compromise that they

[00:38:10] [SPEAKER_01]: Came up with in the Oregon legislature to replace measure 110 and we're gonna have to see how it works

[00:38:15] [SPEAKER_01]: but basically what they're trying to do is create an escalating set of

[00:38:20] [SPEAKER_01]: Interventions with off-ramps right? So if you're smoking fentanyl

[00:38:25] [SPEAKER_01]: Downtown Portland cop comes up to you and basically now says look I can take you to this place that they haven't stood up yet

[00:38:32] [SPEAKER_01]: But they're supposed to stand it up called the deflection center where you can get talked to

[00:38:37] [SPEAKER_01]: You know a counselor and get connected to services and we're gonna try to get you some help or I could take you

[00:38:42] [SPEAKER_01]: To jail right and I think Caleb your point

[00:38:45] [SPEAKER_01]: I think the vast majority of addicts are gonna say I'll go over to the deflection center have that conference

[00:38:50] [SPEAKER_01]: No, maybe they're not gonna do anything beyond have that conversation

[00:38:53] [SPEAKER_01]: But the next time they get busted right there's a that choice is presented again

[00:38:58] [SPEAKER_01]: but there's a you know over time and escalating series of

[00:39:03] [SPEAKER_01]: Sort of punitive measures on the side

[00:39:05] [SPEAKER_01]: but mostly it's an attempt to kind of push people to kind of have the conversation and sort of

[00:39:11] [SPEAKER_01]: That side that that first voice in my head and get that to sort of help win out right whether it'll work or not

[00:39:17] [SPEAKER_01]: We'll see but that looks to me at least something that's kind of promising then punitive responses is our go-to and you're talking about

[00:39:24] [SPEAKER_02]: escalating punitive responses

[00:39:26] [SPEAKER_02]: And my whole point and it's just you know what I find out when I work with humans

[00:39:32] [SPEAKER_02]: And when I design interventions, and we do research the test them is

[00:39:36] [SPEAKER_02]: The more and the better the carrots the better you don't need more and more hammers

[00:39:42] [SPEAKER_02]: And if you do save the hammer for laughs

[00:39:44] [SPEAKER_02]: We have not put the effort and thought and intelligence into making delicious carrots available to everybody

[00:39:50] [SPEAKER_02]: We spent all the time retrying different shapes of the same hammer like why don't we say you know what?

[00:39:55] [SPEAKER_02]: Let's try something much more dramatic in terms of making meaningful services available to people that no one's saying that

[00:40:03] [SPEAKER_02]: Why don't we just figure out how do we keep escalating services?

[00:40:06] [SPEAKER_02]: We keep saying how do we escalate punitive responses and you know, that's what I do

[00:40:11] [SPEAKER_02]: You know, but when we do this and I'll say when we did this in 2017

[00:40:14] [SPEAKER_02]: This is very important when we opened up buprenorphine pathways and this is in our research paper

[00:40:19] [SPEAKER_02]: My favorite part of that is a not very researchy graph

[00:40:21] [SPEAKER_02]: It's the demand curve and what happened is that we just tracked who came in to talk about the services who initiated the conversation

[00:40:29] [SPEAKER_02]: Was it the staff or was that the clients by week five the clients were initiating all the conversations

[00:40:34] [SPEAKER_02]: They were asking for the services

[00:40:36] [SPEAKER_02]: They were lining up two hours early to get free drop-in access to buprenorphine and the program was full at 12 weeks

[00:40:43] [SPEAKER_02]: In other words, if you build it they will come that's my approach. It's never been tried

[00:40:49] [SPEAKER_02]: We know I was the co-chair of the state substance use recovery services advisory committee

[00:40:54] [SPEAKER_02]: I and we recommended 39 health engagement hubs in Washington State a third model of care to address the 80% treatment gap

[00:41:02] [SPEAKER_02]: They funded two

[00:41:04] [SPEAKER_02]: This year they funded three more so we shouldn't be surprised when we get a modest impact when we're making a modest move

[00:41:11] [SPEAKER_02]: That's why we want to do something bold. That's why I wanted to transform the care marketplace and that just hasn't happened yet

[00:41:18] [SPEAKER_03]: All right, let's shift gears for a minute

[00:41:20] [SPEAKER_03]: There's been a 20% drop in overdose deaths related to fentanyl in the first six months of 2024

[00:41:26] [SPEAKER_03]: So that seems positive and we're wondering why Caleb Banta green maybe can help us understand it

[00:41:33] [SPEAKER_02]: Couple of things so we're still three times higher than we were of the overdose rate just five years ago, right?

[00:41:38] [SPEAKER_02]: So we're still an extremely high rate

[00:41:40] [SPEAKER_02]: It's just gone down a little bit and this is exactly the pattern we would have predicted so far

[00:41:44] [SPEAKER_02]: We've lagged what's happened on the East Coast when it comes to the fennel by three years

[00:41:48] [SPEAKER_02]: My dear friend Brad find good would say Caleb said fennel is gonna level off pretty soon

[00:41:52] [SPEAKER_02]: That's just what we see and there are a couple of reasons for that

[00:41:56] [SPEAKER_02]: I am guessing as an informed person as an epidemiologist and health services researcher a couple of things

[00:42:02] [SPEAKER_02]: the biggest effect is a population effect and it is a

[00:42:07] [SPEAKER_02]: Scary and sad one and is that the population is dying off that the new people coming in

[00:42:13] [SPEAKER_02]: It's a smaller number of people than a number of people who are dying the new users

[00:42:17] [SPEAKER_02]: The numbers are smaller than a number who are dying

[00:42:19] [SPEAKER_02]: And so that's a population shift where the mortality rate for the people who are using fennel is probably about the same

[00:42:26] [SPEAKER_02]: But this sheer number of people using fennel has declined because they're dying at such unprecedented numbers

[00:42:31] [SPEAKER_02]: That's the same pattern we saw in the East Coast. We're doing things like widespread distribution of naloxone

[00:42:37] [SPEAKER_02]: We've done amazing work in Washington State. We've been tracking it for 10 years

[00:42:41] [SPEAKER_02]: 84% of people at certain services programs have naloxone

[00:42:44] [SPEAKER_02]: Even in that model we estimate a 4% mortality reduction due to naloxone and that's because people are using 10 to 15 times a day

[00:42:52] [SPEAKER_02]: times

[00:42:53] [SPEAKER_02]: 365 days a year. That's a lot of potential opportunities for overdose

[00:42:57] [SPEAKER_02]: You just can't have naloxone at every overdose

[00:42:59] [SPEAKER_02]: The biggest impact is method on a buprenorphine when a person's on them their mortality risk is cut by 50 60 70 percent

[00:43:07] [SPEAKER_02]: So those can have a big impact as well

[00:43:10] [SPEAKER_02]: We've been increasing access for sure

[00:43:12] [SPEAKER_02]: But I still think that of all of those different things that we're doing the biggest thing unfortunately is the population

[00:43:18] [SPEAKER_02]: dynamic of the sheer number of the thousands and thousands of people who have died and it's a pattern we saw in the East Coast

[00:43:24] [SPEAKER_02]: So I wish we could say it's due to all the amazing intervention. We've been doing

[00:43:27] [SPEAKER_02]: I'm sure that's I know that's helping but I think the strongest impact is probably this population effect in terms of

[00:43:34] [SPEAKER_04]: Interventions, you know, I and this is also true. This is not our subject today

[00:43:38] [SPEAKER_04]: It's also true of the state of prostitution zones

[00:43:41] [SPEAKER_04]: There is a lot of talk about diversion and intervention and no money for it. And you know, the budget is coming up

[00:43:47] [SPEAKER_04]: I do not predict massive investments in anything new and good on this front

[00:43:53] [SPEAKER_04]: So yeah

[00:43:54] [SPEAKER_04]: so what what kind you know in a world where that was not the case what kind of interventions would

[00:43:59] [SPEAKER_04]: Should people be advocating for and what kind of cost are we looking at?

[00:44:03] [SPEAKER_04]: Well, yeah, just just to say too we like we'd love to do a pilot program

[00:44:08] [SPEAKER_04]: But we don't like to really fund things at scale two things

[00:44:11] [SPEAKER_02]: I will say on that actually so my doctoral student who just wrapped up Adi Pal you did a really interesting analysis of safe

[00:44:17] [SPEAKER_02]: supply and what they found was that a

[00:44:21] [SPEAKER_02]: Pilot project you're not going to be able to measure the impact

[00:44:23] [SPEAKER_02]: So it's a really interesting issue

[00:44:25] [SPEAKER_02]: but you got to kind of go all in if you hope to see an impact because we typically do a pilot project and

[00:44:29] [SPEAKER_02]: It's too hard to prove the impact and we say it didn't work

[00:44:32] [SPEAKER_02]: So that that's an issue right there about the implementation scale, which is a hard political thing

[00:44:37] [SPEAKER_02]: It's like well, we'll put a little bit of money at it

[00:44:39] [SPEAKER_02]: But then when you don't you know, that's an implementation failure not a policy failure

[00:44:43] [SPEAKER_02]: So I think that's a big piece

[00:44:45] [SPEAKER_02]: I will say and I was at another meeting yesterday the King County crisis care centers are

[00:44:50] [SPEAKER_02]: Quite striking what they can potentially do to build these four crisis care centers

[00:44:55] [SPEAKER_02]: That can have drop-in 24 7 access to behavioral health and substance use services for anybody in the county

[00:45:02] [SPEAKER_02]: Wherever they live with with a whole array of services that is getting close to the scale that we need

[00:45:08] [SPEAKER_02]: And you know, the one just opened in Kirkland

[00:45:11] [SPEAKER_02]: The overdose recovery care access center, which is not neither of these are quite technically part of the crisis care center levy

[00:45:17] [SPEAKER_02]: That's going to come a little bit later. But but pieces are starting so though any no, that's a billion dollar plus levy

[00:45:23] [SPEAKER_02]: So that's a big thing the challenges this interim phase where we haven't been able to sort of scale up these interim services on it on enough

[00:45:31] [SPEAKER_02]: Scale to repeat myself. We just need more of that. So we actually are going the right direction

[00:45:37] [SPEAKER_02]: We have a lot of the pieces that are out there. We know what to do. I mean

[00:45:41] [SPEAKER_02]: King County is doing amazing things

[00:45:42] [SPEAKER_02]: I mean having a buprenorphine hotline where you can call 24 7 to get medications

[00:45:47] [SPEAKER_02]: Having paramedics who are administering their treatment medications in the field. We also have federal changes

[00:45:53] [SPEAKER_02]: They're gonna make methadone far easier to access at a higher dose without a counseling mandate like things are changing quite radically

[00:46:00] [SPEAKER_02]: We do need a lot more and it's this issue about kind of what we call this 80% treatment gap on an opioid use disorder side

[00:46:07] [SPEAKER_02]: Between those who have opioid use disorder and those who are accessing effective treatment medications

[00:46:11] [SPEAKER_02]: So we really are going the right way

[00:46:14] [SPEAKER_02]: I think that billion dollar levy gives you a sense over a nine-year time frame of what we need to be spending

[00:46:19] [SPEAKER_02]: As someone who's working to stand up a small project this orcas Center that has taken a couple of years. It's slow

[00:46:26] [SPEAKER_02]: It's slow and I will say one of the things the crisis care center is doing is they're putting out regular email blasts and

[00:46:32] [SPEAKER_02]: Communications about what we're doing so that people are aware because this information vacuum people get super frustrated

[00:46:38] [SPEAKER_02]: So it's tough, but as someone you know

[00:46:42] [SPEAKER_02]: Ten years ago. I went to a guy named Scott Lindsay if you've ever heard of him who worked for a previous mayor

[00:46:48] [SPEAKER_02]: 2015 with this idea of a low-barreled buprenorphine program and they were interested in and we did it and now

[00:46:54] [SPEAKER_02]: It's getting proposed as federal legislation, but that took ten years

[00:46:57] [SPEAKER_02]: And we still have yet to scale it up clinically as much as we need so we've done a lot

[00:47:02] [SPEAKER_02]: But it is it's painfully slow. It's painfully so for the people with substance use disorder

[00:47:06] [SPEAKER_02]: There are loved ones in our communities. I freely acknowledge that we are definitely going the right direction and we need more

[00:47:12] [SPEAKER_03]: That's it for another edition of Seattle nice. I'm David Hyde. He's Sunday Kashuk

[00:47:18] [SPEAKER_03]: She's Eric to see Barnett and he was Caleb Banta green professor killed Banta green

[00:47:22] [SPEAKER_03]: Thank you so much our editor is Quinn Waller, and thanks everybody so much for listening