Shilo Jama, an activist and former drug addict, is used to being sworn at, spat at, and even threatened with death. As the head of what’s thought to be the US’s largest needle exchange, which has handed out 34 million syringes in the last 27 years, he has never shied away from controversy.

In the past, he has pushed legal boundaries by handing out crack and meth pipes and the opioid antidote naloxone. Now he’s embroiled in a bitter dispute over safe-use sites, where addicted people can take drugs openly with nurses on hand in case of overdose – and he has an unlikely ally: a Methodist pastor.

Q&A Why is there an opioid crisis in America? Show Almost 100 people are dying every day across America from opioid overdoses – more than car crashes and shootings combined. The majority of these fatalities reveal widespread addiction to powerful prescription painkillers. The crisis unfolded in the mid-90s when the US pharmaceutical industry began marketing legal narcotics, particularly OxyContin, to treat everyday pain. This slow-release opioid was vigorously promoted to doctors and, amid lax regulation and slick sales tactics, people were assured it was safe. But the drug was akin to luxury morphine, doled out like super aspirin, and highly addictive. What resulted was a commercial triumph and a public health tragedy. Belated efforts to rein in distribution fueled a resurgence of heroin and the emergence of a deadly, black market version of the synthetic opioid fentanyl. The crisis is so deep because it affects all races, regions and incomes

In response to the opioid abuse crisis, King County, which encompasses Seattle, has approved two such sites. Similar places operate in nine other countries, including Canada, Denmark and France. When they open, they will be the first legal facilities of their kind in the US.

But the decision has infuriated many in Seattle, who argue that they will encourage drug use and increase crime and public disorder, while not doing enough to get people into treatment. Nearly 70,000 people signed a petition calling for a public vote in an attempt to stop the sites. That move was overruled by a judge last month but an appeal is planned.

Shilo Jama. Photograph: Patrick Kehoe for the Guardian

In the meantime, Jama, 42, who is a member of the county opioid addiction taskforce that recommended the sites, is fed up with waiting for them to open. Last year there were 332 deaths from drugs in King County, with two-thirds of those opioid-related overdoses.



Jama, executive director of the not-for-profit People’s Harm Reduction Alliance (PHRA) needle-swap programme, which operates out of a Methodist church in Seattle’s University District, said: “While we wait, people are going to die. I think every day of the folks who are dying needlessly while bigoted cowards yell and scream about hatred.”

Rumours have swirled that the organisation is planning an illegal site at the church, which also houses a childcare centre, a young adult shelter and meal programs.

Jama said he would only start one at the church if the county health department gave the green light.

“My opinion hasn’t changed. We want [safe-use sites] as part of the solution because people are dying. By any means necessary.”

Jama has the backing of the University Temple United Methodist church pastor, the Rev Pat Simpson, and the church’s board of trustees.

Simpson said: “We stand beside them. The PHRA has been with us in this building a long time. We’ve had time to learn that they are trustworthy, highly committed to their work and expanding services to meet unmet needs. For example, they started giving out Narcan [naloxone] before it was strictly officially permitted in order to equip people to reverse overdoses.”

Jama believes there should be several places for taking drugs safely across the city.

“A million-dollar facility is not a good idea. It’s too big, too much money. You just need a room in an existing facility where people can pop in and use. They need to be the price of a nurse and the paraphernalia. Super, super simple.”

Officials from Seattle-King County public health department said in a statement: “The independent safe consumption site proposed by the PHRA in Seattle’s University District is not part of our efforts. If the PHRA does establish a site, we will not have enforcement authority, except in the event that this particular facility becomes a threat to public health.”

Jama and Simpson’s stance is not popular in some quarters, and both have received some negative reaction.

But Simpson said the idea for a safe-consumption site had broad backing among her congregation. Their support of a harm reduction approach, focusing on safe use rather than abstinence, is a philosophical shift given that Methodism was a major organisation in the temperance movement that led to prohibition.

The Rev Pat Simpson. Photograph: Patrick Kehoe for the Guardian

Simpson said: “When you look at the list of participants in the taskforce that recommended this and see the law enforcement representation there, the medical community, several layers of government, we’re part of a broad coalition that believes it’s the right thing to do.

“This is not some wildcat renegade effort. It’s well planned and it’s being done by knowledgeable people based on this long experience elsewhere. That’s why we have the confidence to do this and intend to brave the storm of whatever the opposition might be.”

She added: “We’re a congregation of people who appreciate science and are willing to look at the evidence and not just rely on gut reactions or public prejudice.”

Jama, who believes drugs should be legalised, says much of the opposition comes from fear and ignorance of nimbys (adherents to a “not in my backyard” view). “They have met a drug user or have had a drug user in their life that they have negative feelings about and they hypothesise that all drug users are like that. We are not a homogenised group of people.

“They have been very vile in their treatment of us. When I was on the streets, passersby called me disgusting and gross and spitted at me. I see them as no different to these people who are blinded by their own rage and hate.”

Seattle-born Jama, who spent time in foster care as a child, spoke of his own drug experiences. He tried magic mushrooms on a camping trip aged 13, began taking LSD in high school, and eventually ended up homeless with a heroin habit. He suffered a lot of trauma, he said, and felt a lot of anger.

The turning point came when his best friend died from an overdose in the mid-1990s. He volunteered at the needle exchange and found his vocation.

He also founded a drug users’ union, the Urban Survivors’ Union, which lobbies for alternative drug laws. He met his wife, a mental health worker whom he describes as “one of the best things in my life”, when she was helping out at the exchange.

Jama calls the 60 to 90 daily visitors to the exchange “my family”. They were all invited to his mermaid and unicorn-themed wedding reception, held in the alley next to Simpson’s church.

The PHRA now operates in eight locations, in Washington and Oregon. It has five employees and 250 volunteers, of which 51% have to be drug users.

“So many people come into the exchange with smiles – this is the only service that treats them with respect and dignity,” he said. “I say, ‘I love you just the way you are and I’m proud of you just the way you are,’ and some people look at me like I’m a crazy person, and other people give me big hugs.”

Jama still uses illegal drugs occasionally. Holding up his takeaway coffee cup, he points out that most people use some stimulant – whether caffeine, alcohol or illegal drugs.

He’s keen to stress that he is lobbying for the other proposals contained in the taskforce recommendations, as well as the safe consumption sites.

“We need to focus on mental health services and treatment on demand for folks who are in chaotic use. There is chaotic drug use and there is stable drug use. We want to keep people on stable drug use.”

Whether a safe-use room at the church will be part of that mission remains to be seen.