Safe Injection Sites and the Opioid Crisis

Claiming the lives of 142 Americans every day by drug overdose, the opioid crisis has been called a “Killer Drug Epidemic” and each level of government is reacting. This blog post gives a brief overview of the steps that federal, state, and local governments have taken so far to address this crisis.

Federal Government

The federal government has formed an Opioid Fraud and Abuse Detection Unit and a Commission on Combating Drug Addiction and the Opioid Crisis, the latter of which urged in its July 2017 preliminary report that the crisis be declared a national emergency. On October 26, 2017, President Trump declared the opioid crisis a nationwide public health emergency. While the declaration did not request new funding, it did provide for expanded access to telemedicine services to help those in rural areas, allow DSHS to hire specialists to address the issue, and provide for worker grants for those displaced from work because of the opioid crisis. 

State Government

At the Washington State level, Governor Inslee issued an executive order to combat the opioid crisis, and the state has developed an Interagency Opioid Working Plan, a comprehensive strategy to combat the crisis. Washington State Attorney General Bob Ferguson, in partnership with the Washington State Patrol and the Washington Association of Prosecuting Attorneys, convened a two-day summit in June on Reducing the Supply of Illegal Opioids in Washington. The State Attorney General’s Office also filed a lawsuit against pharmaceutical company Purdue Pharma, maker of OxyContin, alleging “a massive deceptive marketing campaign and convincing doctors and the public that their drugs are effective for treating chronic pain and have a low risk of addiction, contrary to overwhelming evidence.”  

For its part, the 2017 Legislature passed ESHB 1427, which directs various Washington medical boards and commissions to “adopt rules establishing requirements for prescribing opioid drugs.” As further detailed by the Washington State Department of Health:

In developing these new rules, the statute requires consideration of Washington’s Agency Medical Directors’ Group (AMDG) Interagency Guideline on Prescribing Opioids for Pain, and the Centers for Disease Control (CDC) Guideline for Prescribing Opioids for Chronic Pain. Additionally, the new statute requires local health officers to have access to the Washington Prescription Monitoring Program (PMP) to provide patient follow-up and care coordination following an overdose event.

Local Government

So, what is happening with regard to the opioid crisis at the local government level in Washington State?

Everett has taken some bold steps by partnering with the Police Assisted Addiction and Recovery Initiative (PAARI) to connect people with drug treatment programs and provide other resources for fighting opioid addiction. Everett has also filed a civil lawsuit against Purdue Pharma for allowing Oxycontin to be funneled through the black market, causing Everett’s opioid crisis.

Tacoma has filed a lawsuit against three of the biggest manufacturers of prescription opioids in the U.S., claiming the companies provided "false and misleading information to doctors and patients about the safety and efficacy of prescription opioids." Seattle has similarly filed suit against opioid makers for deceptive marketing. 

At the county level, many counties (including King and Clark) provide a needle exchange and safe disposal programs, and Pierce County declared itself to be in a State of Opioid Crisis.

Currently, much of the attention with regard to the opioid crisis at the local government level is focused around safe injection sites in King County. The idea of safe injections sites emerged from the Heroin and Prescription Opiate Addiction Task Force (convened by King County Executive Dow Constantine and former Seattle Mayor Ed Murray in 2016). Asked to confront the heroin and opioid crisis with immediate action, the task force issued a number of recommendations in its Final Report. One of those recommendations was to establish two safe injection sites, referred to as “Community Health Engagement Locations” (CHEL), in King County: one in Seattle and one outside of Seattle, “reflecting the geographic distribution of drug use in other King County areas.” The CHEL sites would provide supervised consumption of illicit drugs for adults with substance abuse disorders in addition to a number of other services:

• Hygienic space and sterile supplies
• Overdose treatment and prevention
• Rapid linkage to medication-assisted treatment, detox services and outpatient/inpatient treatment services
• Direct provision or linkage to basic medical treatment, wraparound social services and case management
• Syringe exchange services
• Sexual health resources and supplies
• Health education
• Peer support
• Post-consumption observation plan

According to the report, “the primary purpose of these sites is to engage individuals experiencing opioid use disorder using multiple strategies to reduce harm and promote health, including, but not limited to, overdose prevention through promoting safe consumption of substances and treatment of overdose.”

The King County Board of Health passed a resolution endorsing this final report and called on cities to implement the report’s recommendations. The King County Council amended its appropriation ordinance to only allocate funding to those cities whose governing bodies choose to allow a CHEL to locate in their cities. In response, many King County cities passed or are considering passing resolutions banning these CHEL sites from locating in their cities, finding them to be detrimental to the public health, safety, and welfare of city residents and contrary to state and federal law (see, for example, Auburn, Bellevue, Federal Way, Kent, Renton).

Adding to this complicated landscape has been the effort to put Initiative 27 on the ballot for the February 2018 special election. If approved by King County voters, this initiative would ban safe injection sites across King county. In August, there was a lawsuit filed against it. In mid-October, King County Superior Court Judge Veronica Alicea-Galvan struck the initiative, declaring it an unlawful infringement on the power of the King County Board of Health. Supporters of Initiative 27 plan to appeal the court’s ruling. 

Final Thoughts

Dealing with the opioid crisis is an unprecedented challenge and all levels of government are trying to address the opioid crisis with various tools. Time will tell which of the tools will be the most effective.

Questions? Comments?

If you have questions about the opioid crisis or other local government issues, please use our Ask MRSC form or call us at (206) 625-1300 or (800) 933-6772. If you have comments about this blog post or other topics you would like us to write about, please email me.