After a stalled push to set up a site where residents can safely use drugs in Seattle, advocates and some City Council members want to move forward with a new approach in 2021 budget talks.

This time, there would be no new, brick-and-mortar supervised consumption “site,” also known as a safe-injection site or Community Health Engagement Location, where drug users could smoke or inject with sterile tools, medical supervision and overdose-reversing medication on hand. Instead, drug users could access the same supervision and amenities at existing social service and health care locations where they already seek other services.

The new proposal still faces many of the same potential legal and public sentiment obstacles that have plagued the project for the last three years. However, it could overcome a financial one.

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A regional opioid task force recommended in 2016 that Seattle and King County establish two supervised consumption sites with the goal of preventing overdoses and bettering health outcomes for drug users. King County Executive Dow Constantine and former Seattle Mayor Ed Murray endorsed the recommendation the following year.

Since then, plans to open those sites have been tempered by cities banning the locations, a challenge from a ballot initiative that was blocked by a court ruling, threats of federal litigation and questions about what it would take to fully fund a location.

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Enthusiasm from supporters has persevered.

Advocates are pitching the new proposal as something that could be more cost-effective and take place in locations that already see the impacts of public drug use. A group of advocates, health care providers and social service workers that grew out of the 2016 task force also repeated the call for supervised consumption spaces in a larger list of recommendations published this year.

The newest plan, proposed by advocates in a Sept. 22 committee meeting and briefly discussed in a budget session last week, would transfer the $1.4 million the city already set aside for a supervised consumption site in previous years to the city’s Human Services Department, which would then work with Public Health – Seattle & King County to contract with nonprofits to provide the service at their locations.

“If you have loved ones who are in the throes of addiction, you want them to get better. You want them to have the support and the resources to fight their addictions, but what you’re most afraid of is if they’re going to die,” said Councilmember Lisa Herbold, who proposed the budget action.

Jesse Rawlins, public policy manager at the Public Defender Association and a leading advocate for the proposal, suggested that the new approach would be cheaper and reduce harm to people already using drugs at these locations.

“Unsafe consumption already happens at social service and health care locations across the city,” Rawlins said. “This funding can decrease the negative impact of unsafe or unsupervised consumption happening already.”

Kelsey Nyland, a spokesperson for Mayor Jenny Durkan, said the mayor supported increased access to drug treatment and services but offered a cautious response to the new proposal.

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Supervised consumption and treatment could be a way to accomplish recommendations put forward by the 2016 task force, Nyland said, “and the mayor is interested in learning more about how this proposal could work.”

Durkan, Nyland added, “would also look to legal counsel regarding the risks of any such proposal.”

Councilmember Alex Pedersen, who represents neighborhoods in Northeast Seattle, said he still had concerns about the proposal and believed “dollars should be invested in more treatment instead.”

Advocates point to data from other cities that show the sites could alleviate symptoms of a problem Seattle increasingly faces.

A supervised consumption site that has been operating in Vancouver, B.C., since 2003 was estimated in one study to have prevented between 1.9 and 11.7 deaths annually over a period of four years; researchers in another peer-reviewed study in medical journal The Lancet found overdose death rates in the surrounding area decreased by 35% after the site opened. Another review of the first 18 months of a supervised injection site in Sydney, Australia, found that the site had likely reduced overdose deaths.

Several other countries have opened similar sites throughout Western Europe, and Canada has since opened more sites throughout the country. However, a provincial government task force assessing impacts to surrounding neighborhoods in Alberta, Canada, found evidence of increased emergency calls outside some sites, as well as an increased number of deaths in surrounding areas. Those numbers included alcohol poisoning, though — the report did not look at opioid deaths alone.

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A letter published in the New England Journal of Medicine this past summer showed five years of findings from an unsanctioned supervised consumption site at an undisclosed location in the U.S. with thousands of injections and 33 overdoses, but no deaths.

Overdose deaths in King County have risen significantly over the last decade. In more recent years, much of that increase has been driven by overdose deaths for people using both opioids and stimulants. The number of people who have died with both opioids and stimulants in their systems has increased sharply, from 83 in 2016 to 172 in 2019. And local research has shown that it’s more difficult for people with opioid use disorders to stay in treatment if they also use stimulants like methamphetamine.

Still, critics have thrown up barriers. Bellevue, Kent, Renton, Federal Way and Auburn, King County’s largest cities outside Seattle, have banned the placement of a supervised consumption site within their borders. A ballot initiative attempted to give voters the option to ban public funding for the sites, though it was struck down by the Washington Supreme Court in 2018.

Last year, concerns about the cost of the project and federal litigation further dampened the prospects of a local site.

City Human Services Interim Director Jason Johnson told City Council that there wasn’t enough money to fund and operate a supervised consumption site in Seattle. He said operations would cost $2.5 million annually, on top of the capital needed to set up a site.

Johnson also said that the city was concerned about potential legal threats from the federal Department of Justice.

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Brian Moran, U.S. Attorney for Western Washington has said in the past he wouldn’t allow the city to open a supervised consumption site, in keeping with the Trump administration’s stance.

“I won’t comment on pending Seattle City Council legislation or hypothetical scenarios,” Moran said in a recent statement to The Seattle Times.

But he suggested that the city could face civil lawsuits, as well as criminal charges. Moran did not specify what its criminal liability would entail.

Lawyers for the city and county, however, have stood by the idea, even going as far as intervening in recent litigation outside the state.

This summer, both City Attorney Pete Holmes and King County Prosecuting Attorney Dan Satterberg signed an amicus brief in a federal appeals case supporting a lower court’s decision not to criminalize a Philadelphia organization that planned to open its own supervised consumption site.

The brief’s signees argued “that Philadelphia and other American communities should be able to gain the proven benefits of an (overdose prevention site) to save lives, improve public health, and enhance community trust and public safety.”

A global health crisis and “an intensified distrust of law enforcement,” the brief continued, “make it all the more apparent.”