Under the Needle Against Safe Injection Sites for Drug Users? A Self-Guided Walking Tour Through the Injection Sites We Already Have Just Might Change Your Mind!

Robert Ullman

Attention, moralizing pearl-clutchers:

Do you think allowing a safe consumption site for drug users will only "enable" people who use illegal drugs? Do you, like KIRO radio host Jason Rantz, think safe consumption sites represent "coddling behavior"? Do you agree with Magnolia resident Cindy Pierce, who thinks anyone using a safe consumption site should be required to get treatment? Do you fear, as seemingly every online commenter does, that this will only increase drug use and crime?

You're kidding yourselves.

If the idea of providing hard-drug users a place to shoot up sounds radical, consider this: We're already doing it. "We have consumption spaces now," Kris Nyrop, who works with a law enforcement diversion program for drug users, said last month. "It's called the library. It's called the bathroom at McD's. It's called the bathroom at Cal Anderson Park. The issue is where do we want those consumption spaces to be?"

Now, amid a national heroin epidemic, drug-user advocates and some city council members hope to bring safe consumption sites to Seattle. The mayor of Ithaca, New York, is proposing the same idea. Whichever is successful would be the first city in the United States to offer a safe consumption site. (Seattle advocates use the word "consumption" instead of "injection" in hopes of accommodating people who smoke instead of inject illegal drugs. That's more than semantics. It's an effort to account for racial disparities between injection and non-injection drug users.)

Vancouver, British Columbia, is already doing this. Every day, somewhere between 800 and 1,200 people walk into a sparse, open room, sit down in a cubicle facing a large mirror, and inject illegal drugs like heroin. About 20 to 30 times a month, someone in one of those booths overdoses. Not once has one of those overdoses ended in death.

At Insite, North America's only government-sanctioned safe injection site, nurses are on hand to care for drug users and administer help if they overdose. Clients can go into a nearby room to relax after they inject—and if they're interested, they can learn about drug-treatment opportunities.

In the area around Insite, a neighborhood historically known for heavy drug use, overdose deaths are down and crime has not increased. The model is based on a simple idea, according to its founder, Liz Evans: "Just because people are using drugs doesn't mean they need to die."

Advocates in Seattle want to see safe consumption sites all over the city. Some Seattleites—maybe you—will panic. You won't just be ignoring the success of Insite, but ignoring Seattle's current reality as well. Because Nyrop is right: Seattle already has scores of injection sites—lots of them, all over the city, all of them unsafe.

To help people think clearly about the issue of safe-injection/consumption sites, we put together a self-guided walking tour of the dangerous injection/consumption sites we already have. You'll be covering a lot of ground—the problem is citywide. Welcome to the Seattle you're ignoring. HEIDI GROOVER

CENTRAL LIBRARY, PIKE PLACE MARKET

Your tour kicks off in downtown Seattle, where the public toilet unobstructed by a keypad is a rapidly disappearing amenity. But in the center of city, you can find at least two wide-open restrooms: at the Central Library and Pike Place Market.

"People are consuming at the moment in completely unregulated and unsanctioned [spaces]," says Kris Nyrop, the national support director for LEAD, the widely lauded diversion program that offers drug users in Belltown access to services instead of jail time. Nyrop says libraries, the Pike Place Market bathrooms, City Hall Park, the parking garage at Second and Pike, and below the viaduct are common consumption spaces. (A spokesperson for Seattle Public Library says they found needles only a "handful" of times at their branches across the city last year. The head of Pike Place Market downplayed the issue but provided no numbers.) Using in downtown spaces is "problematic for [users], for their vulnerability to law enforcement, and for the people who run the places they're doing it in," Nyrop says.

So where should they put the safer alternative? Where to locate was obvious when Insite, Vancouver's safe injection site, opened. More than a third of the city's injection drug users live in the Downtown Eastside neighborhood, according to Insite, so that's where it's located.

"You need to focus your efforts where people are and not make it hard for people to get to," Insite founder Liz Evans told the Seattle City Council last month, "because they won't go eight blocks. It's too far for a lot of people."

Seattle doesn't have such a clear path. Drug use is spread across the city, according to advocates and service providers, so reaching users where they're already using will be harder. Sally Bagshaw, the city council member who represents downtown and Belltown, is leading the push for consumption sites. She won't commit to locations she supports, but says they should be across the city and county.

"We know opioids are being used not just in downtown Seattle but in every city and every economic strata," Bagshaw says. "Having spaces people can go and be safe rather than suggesting that if you live in Bellevue you have to come to Seattle [will] increase the chances of people being safe and healthy." HEIDI GROOVER

DOWNTOWN

Now stroll a few blocks north. Here, on the edge of Belltown, in a fetid alleyway splitting off from Stewart Street between Second and Third Avenues, needle caps and pieces of syringes litter the pavement. Tourists, office workers, and shoppers crowd the nearby sidewalk.

Hans, the gruff maintenance supervisor at the Josephinum apartments, comes out here for cigarette breaks. "They go into all these cubbies and do their business," Hans says, pointing down the alleyway at ledges, doorways, and alcoves. He sees people injecting on a near-daily basis. Last week, one guy "cut himself right there and injected," he says. "That's HIV blood, stay away!" the man warned him. While we stand there talking, several people walk slowly through the alleyway. One heads down and goes behind a dumpster to defecate.

As a member of the cleanup crew for the Downtown Seattle Association (DSA), Jan roams the streets and cleans up the needles left behind by drug users. Jan overcame addiction himself not long ago. He finds needles in doorways and alleyways, and even on sidewalks. "People are getting pretty bold these days," he says. He finds most of them in Belltown, the Convention Center area, and the waterfront.

The DSA keeps track of how many needles its cleanup crews find in the downtown area: The association collected 599 in March, 352 in February, and 442 in January. Between 2014 and 2015, the number of needles they found more than tripled as the heroin crisis escalated.

Another popular injection site: under Interstate 5 on James Street, around the corner from City Hall and Seattle Police Department headquarters. There were a dozen dirty syringes on the sidewalk on the day I visited. Dozens more lay behind a fence blocking off the area under the overpass, along with books, cans of food, bottles, clothes, and hygiene products. On a pole, the city has posted a notice of eviction for homeless people who've left two tents in the area. The city has been criticized in recent months for stepping up these evictions, effectively chasing homeless people from one location to another.

Both Hans and Jan think safe consumption sites are a good idea—certainly worth trying—in order to get people who are using drugs off the streets. Hans cautions that it should be paired with an employment program. "If it was linked with a job," he says, "that would shut a shitload of this down."

Even the DSA—one of the city's most influential political players—seems to support the idea of safe consumption sites: "It is clear that this is an epidemic nationally and that the ways we dealt with this issue are no longer working," the DSA said in a statement. "We see firsthand the impact this is having and support new and innovative harm reduction methods for the individual and for the community. This is about saving lives and creating safer streets for all." ANSEL HERZ

THE JUNGLE ENCAMPMENTS

Ever been to the Jungle? No???

In the aftermath of a shooting that left two people dead in the Jungle—the notorious three-mile stretch of homeless encampments under I-5—city officials staged an assessment of the area and confirmed what everyone already knew: The area and the people who lived there had been neglected for a long time. Officials found needle caps and used needles, human waste in the absence of clean water and bathrooms, as well as residents with mental health and/or addiction issues.

There are places like the Jungle—though maybe not quite as severe—all over the city. The hidden nature of these semipublic spots works in two ways. First, it allows drug users to take drugs without being hassled by the police, and second, it further isolates people who need and want help from any help they might be able to get.

There's a reason why people are drawn to places like the Jungle, or in Turina James's case, under a bridge near Victor Steinbrueck Park and Pike Place Market. James, a former heroin user and a member of Voices of Community Activists and Leaders (VOCAL), lived there for two weeks before the rodents and safety concerns drove her away. She's been to the Jungle, too. "The spaces under the bridges and under the ramps and things like that—it's not as likely to have police show up in that area," James says. "The police ran everybody out of [downtown and Capitol Hill], so for now they set up camps under the bridges and they call that home."

James got hooked on heroin after experiencing a trauma. She's clean now, but only because after getting in trouble with the law, she was sent through LEAD, the Seattle Police Department's low-level drug and prostitution diversion program. It worked for her because she wanted help, but the SPD can't arrest everyone into treatment, she says.

James says building safe consumption sites would be a great place to establish trust between service providers and drug users—and would allow drug users to find treatment resources, if they choose. "Is it going to take it all away? No," James says. "But I think it'll do a lot better than pushing them from one state or one area of the city to another, or forcing them to go to jail and do something they don't want to do." SYDNEY BROWNSTONE

Robert Ullman

CAL ANDERSON PARK

Cal Anderson Park is gorgeous in the summer, as everyone knows. It's also widely known as a site for drug use—particularly the bathrooms. Since January, the city's park crews have found 26 needles scattered around the park, the majority coming from the bathrooms, says Seattle Parks and Recreation spokesperson Christina Hirsch. The bathrooms are often (though not always) dirty—with just one stall, a rudimentary sink, and no soap. And this is nothing new. "People are shooting up heroin on the sidewalk and in the park's new bathrooms," The Stranger reported in 2003.

Last summer, Seattle Fire Department medics saved a 24-year-old woman's life with naloxone as she was suffering from an overdose. Another man at the park, suffering from a heroin overdose, died on the scene when medics arrived.

These days, social workers walk a beat around the park, as KUOW recently reported, offering social services to people they encounter. But they can reach only so many people day in and day out, and the bathrooms in the park are still perceived as a no-go spot for people who aren't shooting up.

"I've seen syringes," said Albert Soul, a skateboarder who uses the park every other day. "It's pretty disgusting sometimes... You can't be mad at 'em, because they're sick people."

Perhaps the fastest way to get people to stop shooting up in the bathrooms—to make it safer for them and everyone who uses the park—is to open a nearby safe consumption site. Council Member Kshama Sawant, who represents Capitol Hill, has said she supports opening safe consumption sites in Seattle. One self-identified former addict, Ray, recently told the city council: "People who are prone to use drugs will use them regardless." He went on to say he'd asked dozens of people who are currently using drugs whether they would actually go to safe consumption sites—instead of alleys or public bathrooms.

"They were all for it," Ray told the council. ANSEL HERZ

HARBORVIEW MEDICAL CENTER

You can jump on the new First Hill Streetcar on Broadway near Cal Anderson Park and get off at Terrace Street plaza, two short blocks away from Harborview Medical Center.

According to Dr. Richard Ries, associate director of the University of Washington's Addiction Psychiatry Residency Program and director of Outpatient Psychiatry, Dual Disorder Programs, and the Chemical Dependency Project at Harborview Medical Center, there are about five outcomes for someone who shoots heroin at an unsafe injection site. The first outcome is that you're fine—that is, if you bring your own needles, clean them with bleach, and aren't too loaded to make safe choices. The second could be that you do everything right in terms of clean needles, but the drug happens to be twice as strong as what you're used to and you overdose. "If they're lucky, somebody has a naloxone kit and they get revived," Ries says. Outcome three: If you've stopped breathing, maybe someone calls an ambulance to take you to Harborview, where you're given more naloxone. "Then, depending on whether they've come to fully or not, they probably decide they want to leave," Ries says, "and they leave and they go out and probably find more heroin before they go into withdrawal again."

The fourth outcome from an unsafe injection site can occur when you're "loaded not just on heroin, but maybe some meth on board, and you're impulsive," Ries says. A person says you can borrow one of their needles and promises it's clean, but they're not telling the truth. You risk contracting hepatitis C or HIV. The fifth: You don't get HIV or hepatitis C, Ries says, but you get another bacterial infection that leaves you with some terrible abscess and a fever. "And then you end up in the ER, you get admitted to the IC, they drain the abscess, and you're on antibiotics for days or weeks."

Ries has been treating substance abuse for more than 40 years. And just like doctors see other patients with chronic medical conditions—hypertension, diabetes, rheumatoid arthritis—cycle through the hospital when they screw up or have flare-ups, he sees patients with addiction in similar patterns. Ries thinks having safe consumption sites is "just fine as an engagement place," but he also warns that there's also a dearth of funding for addiction treatment. "There's never enough addiction treatment available for the number of people who need it," he says. SYDNEY BROWNSTONE

AURORA CORRIDOR

According to Elizabeth Dahl, for many Seattleites, Aurora Avenue—the next stop on your walking tour of Seattle's unsafe injection sites—is synonymous with shame. (It's a long walk from Harborview, so you'll probably have to jump on a bus.) The street, which also serves as SR 99, is lined with cheap motels. These places serve as home to sex workers and drug users. Dahl is the executive director of Aurora Commons, an organization working to create community among the people living along Aurora.

The organization, which provides a place for everyone from homeless people to sex workers to rest and cook food, regularly sees people dealing with drug addiction.

"We have had a lot of relationships with people over the years who have died because of using dirty needles. It's just senseless. It's insane that people are punished for using a substance that they use to cope with the trauma they've been subject to in their life," says Dahl.

In a previous interview, city council member Debora Juarez told The Stranger that she wants to open a safe consumption site on Aurora Avenue. However, according to Dahl, opening such a site is a controversial topic in the community and has caused a "big stink" among business owners in the area. Despite this, Dahl and the Aurora Commons still fiercely support a safe consumption site in the neighborhood.

"The closest needle-exchange site is miles away. When you don't have an income, even paying to get on the bus [is too much], it can take someone all day long to get to the University District from our neighborhood. There's nowhere for them to have access to clean needles," she said.

Although her organization does not currently have a needle-exchange program, Dahl said Aurora Commons works with other groups like the People's Harm Reduction Alliance (PHRA), which runs a clean needle distribution program and works to reduce the stigma surrounding drug users.

According to PHRA's executive director, Shilo Murphy, the organization delivers about 300,000 syringes to the Aurora Corridor annually and is looking into opening a safe consumption site in the neighborhood. ANA SOFIA KNAUF

NORTH SEATTLE PARKS

Mineral Springs Park is about 15 blocks north of Aurora Commons. The four-acre park is home to walking trails, a free disc golf course, odd dome-shaped marble sculptures by artist Stacy Levy, and a lot of discarded injection needles.

"It is safe to say that in almost all larger North Seattle parks, the number of needles found by our crews and reported by residents and neighbors has been dramatically on the rise. We're noticing the phenomenon, and we're alarmed from the public safety aspect of it," said Seattle Parks and Recreation communications manager David Takami.

This has pushed the department to be "extra vigilant" with cleanups, he said.

In 2015, cleanup crews in North Seattle picked up 197 needles total. In just the first three months of 2016, crews have already disposed of 225 used needles, Takami wrote in an e-mail.

Because of the 14 percent increase, this has encouraged organizations like the North Precinct Advisory Council to lead workshops for community members to teach them how to safely dispose of used needles.

The parks department is not involved in these community classes. Although parks officials are concerned about the city's heroin boom, according to Takami, the department must first prioritize the safety of park-goers and staff members tasked with cleaning up the discarded needles. ANA SOFIA KNAUF

THORNDYKE AVENUE

Last stop: the corner of Thorndyke Avenue West and 20th Avenue in Interbay. Here's what I saw the day I stopped by: an overgrown strip of land next to a rail yard. The ground is dotted with takeout containers, two Four Loko cans, a Ben & Jerry's container, and two hypodermic needles poked into the dirt. Eight orange caps without needles are strewn nearby. A bright-green reusable grocery bag contains three more needles, a few pieces of gauze, and a metal coat hanger.

If you went to a community meeting in Magnolia in January, here's how you would have heard this area described by Harley Lever, a fed-up Interbay resident with a thick Boston accent: "If you fall along Thorndyke and 20th Ave, you've got a really good chance of falling onto a pile of needles."

In the months since then, Lever has become a face of the angry neighborhood movement arguing the city isn't doing enough to rid neighborhoods north of the ship canal of drug users and homeless people. Lever says he supports safe consumption sites—yes, even in his neighborhood—but he qualifies it with calls for the city and state to spend more on drug-treatment services.

Cindy Pierce, a Magnolia resident who held up a mason jar of hypodermic needles at that meeting in January, has even more conditions. She wants a limit on the number of times a drug user could visit the safe consumption site without seeking treatment or a requirement that they "sweep the sidewalk" near the site. Pierce says safe consumption sites and the city's tent encampments and RV "safe lots" require "no responsibility for the individual. I think it's very much like raising a child. A child doesn't want to do something—well, what do you do?"

With law enforcement offering tacit approval of safe consumption spaces, neighborhood advocates—and their demeaning views of drug users—will be the single biggest hurdle to opening the sites in Seattle. HEIDI GROOVER

Q&A with Shilo Murphy, Executive Director of the People’s Harm Reduction Alliance

Your organization, which is based in the U-District, already has plans to open up a safe consumption center. How is that going to work?

We're looking for a landlord, essentially, which is the last step. We're in talks with several landlords. We could open as early as a month and as late as several months. But by summer's end, we'll have a consumption room or a drug user health center in Seattle. We've had 25 years of harm reduction services for drug users in this town. If we look the way we do now in 25 years, we will have completely failed our people.

Who will use your clinics?

People who are homeless, people who don't have access to anywhere else, people who are working drug users who may be working nearby and don't have time to go home.

Where would it be?

Capitol Hill, U-District, downtown—we're looking in multiple locations and to do multiple site openings. [Seattle doesn't] have a centralized drug area, and the small areas that people [go to] are ever-moving. Let's be clear: Even if we had 50 sites, it's not like police are going to stop enforcing drug laws. So groups [of users] are going to move around for various reasons. So we're going to have to have the ability to move with them.

What would your ideal location look like?

It will be something that has multiple stalls for smoking and injecting. We'll have a quiet room for people who have used opiates so they can kind of relax and we can monitor them to make sure that they [won't] overdose. We're linking [the facility] to HIV and hepatitis C testing along with detox and treatment facilities. We think of it as essentially a health center.

Why are safe consumption sites so important?

What we've forgotten in all of this is that the people in front of you are your friends and your family. We're going to change [things] by loving them and taking care of them and not abandoning them. One of the messages our organization says is "We love you just the way you are and we're proud of you just the way you are. We want you to be the best damn drug user you can be." ANA SOFIA KNAUF

Q&A with Caleb Banta-Green, Senior Researcher at the Alcohol and Drug Abuse Institute at University of Washington

What are some of the patterns you've picked up on in drug use and abuse in recent years?

Heroin is increasing, and heroin and meth together are increasing. We still see a lot of meth use. What we've seen in the last couple of years is a substantial increase of use of meth by injection, and a real increase of meth and heroin together. We've also seen an increase in meth deaths overall, and most of those deaths are meth and heroin together.

What do you think about the prospect of safe consumption sites?

Safe consumption facilities are fine in the context of good, comprehensive, community-based drug-user services. That's my opinion. I'm a public-health guy. I like Insite in Vancouver. It's kind of a one-stop shop. It's kind of the front door. You can come in and use and be safe, and I want to acknowledge that. It's fine to keep somebody safe while they're using. I think there are other benefits in terms of treatment and housing and having access to that as well.

What would you say to people who might be resistant to the idea of safe consumption sites?

I think it's a reasonable concern to not have bloody needles around, and I think there's good evidence that safe consumption has decreased public discards [of used needles]. I think people are interested in safe consumption because there is public consumption.

I'm concerned that there will be an acceptance of supervised injection facilities (SIFs) to hide the problem. And while it will meet that goal, I hope that we can be doing it not out of shame but out of respect for drug users. I hope it can start a conversation about drug use—and that a person is not an addict but a person can be addicted.

What might that conversation about drug use look like?

The vast majority of out of control users don't want to be out of control, and they don't want to be using. It's not because they're stupid, it's not because they're bad—it's because their brain chemistry has changed. What looks irrational is completely rational biologically.

Particularly for opiates, we have really, really good treatment options that keep people alive. It's important for people to understand that. You want a drug treatment clinic in your community, because otherwise you just have drug users in your community. Eighty-seven percent of injectors want a SIF, but they want it to be pretty close. They're not going to travel a long time for their drugs. [SIFs] are not going to become a draw. There's a reason we have 400 Starbucks in Seattle, and it's the same thing for a SIF. SYDNEY BROWNSTONE

Q&A with Sergeant Sean Whitcomb, Spokesperson for the Seattle Police Department

Yes. Two years ago, my older brother passed away from a heroin injection. An overdose. He was 44. It was incredibly hard. I found out about it while I was up working in Oso during the landslide. We were close all our lives. As we both grew into adulthood, he struggled with addiction. It was hard to watch. My brother didn’t have much of a criminal history. He’d been to treatment. We didn’t know he was using heroin. I suspected it. But I also worked in drug court. I worked with people who struggled with addiction. I saw hundreds of people like my brother.

And based on what I experienced, which was eye-opening, people need to make choices about their lives. You can direct them, you can prod them, you can plead, you can coerce. But they have to choose. You can’t make the choice for them.

I couldn’t choose sobriety for my brother. So the best thing you can do in the meantime is make sure you’ve got sound policies around the issue and make sure it’s a compassionate approach. It’s a deeply personal reminder of how vicious and unforgiving and awful the heroin epidemic is. Police see that all the time. Firefighters see it. The public sees it. It’s not something that gets talked about.

Under Chief Kathleen O’Toole’s leadership, we’re finally able to say that SPD bike officers are going to be able to deploy naloxone, commonly known as Narcan, to people in need who have overdosed. It’s a relatively inexpensive drug that police can use during an overdose to save someone’s life. It’s a big commitment, but it’s time. It absolutely would have saved [my brother’s] life. He died in a restroom in North Seattle.

What else should people know?

The Good Samaritan law grants people immunity when they’re reporting an overdose to 911. People still think they’re going to get in trouble, but it couldn’t be further from the truth. In a state of overdose, seconds count. You have to get the person help right away. It has to get into the collective psyche that you need to call for help. It’s very risky to inject. We’ve said it before: If you’re going to inject, at least do it with someone else in case something goes wrong, so they can call and ask for help.

What’s the department’s position on safe consumption sites?

We’re going to defer to the mayor’s office and Public Health on that. ANSEL HERZ

Q&A with Anonymous Starbucks Barista

Is disposing of used injection needles something that all Starbucks baristas have to deal with?

I would say it's dependent upon location. Some locations throughout downtown don't see a lot of illegal activity, but certain locations do—First and Pike, 23rd and Jackson, the stores in the Pioneer Square neighborhood.

Does this make you feel unsafe at work?

Yeah, absolutely. As someone who serves food, you don't want to have to think about what is and is not safe in [your] store to touch. There's a real sense of if I go to pull the trash out of my bathroom and I have the bag too close to my body, will I get pricked by a used needle? Will it make me sick?

Are Starbucks workers trained on how to safely dispose of needles?

We have safety training that tells us, "As you're pulling your trash bags out, make sure that you hold them only by the top. Don't depress the trash. Don't hold the trash bag against your body." Every store stocks a sharps kit [kept in the back] for proper disposal. Some stores never use it, some stores use it every week. If there's anything significantly dangerous, we can call in a hazmat cleaning team to deal with it. If there are needles, it's kind of up to us to dispose of them appropriately.

What has been the hardest thing for you to deal with in terms of cleaning up after people who use your store's bathrooms to inject drugs? A specific day—help me paint a picture.

The very first day I started in a store in Pioneer Square, I walk in and one of the restrooms was closed. I was like, "Oh, are you waiting on the plumber?" And [my coworker] told me: "No, someone almost died in there yesterday. The fire department had to take the door off." [On another] day I found unwrapped, used razor blades and a needle in the toilet. That was the day that I thought, "Dear God, please get me out of here."

How has your store dealt with people who use drugs and leave behind injection needles in the bathroom?

It doesn't matter if they're a customer; it doesn't matter if they're spending money. I don't care. Everybody deserves to be able to use the restroom and have some dignity. If they would just use it properly, we wouldn't have an issue. ANA SOFIA KNAUF