Amid an opioid overdose crisis that’s seen hundreds of deaths in recent years, King County is planning to bring medication-assisted treatment for opioids to homeless encampments and shelters this fall.
The county last month put out a $1 million request for proposals, with bidders to be picked in September. Another $500,000 is going to a new street medicine team on wheels to meet with people living in tents and shelters starting this month.
The two-pronged approach is to ensure that people who want addiction treatment can get it, and to bring more medical care into encampments and shelters. The strategy will focus on outreach and improving people’s health — not on abstinence, and not connected to efforts to remove encampments from public sight.
How it’s received by people struggling with both homelessness and addiction — and by neighbors increasingly frustrated by visible drug use — will be a test of how well the county can implement new strategies based on recommendations from opioid experts that have been kicking around local government for years.
At a recent King County Council meeting, County Councilmember Jeanne Kohl-Welles acknowledged that the program, like other low-barrier drug-treatment or harm-reduction proposals, “may have some controversies associated with this.”
But Kohl-Welles is optimistic that this strategy will be welcomed.
“To me, it just makes sense to get people help when they have challenging situations in their lives,” Kohl-Welles said. “People want treatment to take place.”
As King County has struggled with the opioid crisis, much of the public debate around solutions has been consumed by safe injection sites, one of several recommendations released by the county’s opioid task force three years ago. Other, less-debated recommendations focused on expanding treatment to people who have trouble getting it, including people living outside.
Last year, 277 overdose deaths involved opioids — increasingly involving synthetic opioid fentanyl, and often combined with stimulants like methamphetamine. People who are experiencing homelessness make up less than a percentage point of King County’s population, but in 2018, represented an estimated 16% of its opioid-related deaths.
At the same time, King County data shows that people using its needle-exchange sites, many of whom are homeless, want treatment. In 2017, the most recent year with data available, 78% of survey respondents said they had an interest in reducing or stopping opioid use.
“I didn’t know where to go”
On a recent Thursday morning, inside a big, carpeted meeting room with sunlight streaming through the windows, Casey Saputo sat at a table surrounded by people in various stages of recovery.
A program like the one planned by King County would have made it a lot easier for Saputo to kick heroin. Last year, Saputo was living under a bridge near the light-rail line in Tukwila when he said he got a bad batch of drugs and developed chemical burns on his hands.
Saputo remembered walking around for hours in the rain, looking for a place to rest where cops wouldn’t mess with him. At that point, he wasn’t even shooting up to get high — he was just trying to avoid getting sick.
Saputo, then 26, started looking for treatment options, but said he couldn’t find anything. “I didn’t know where to go,” Saputo said. “And when I did call, I got bounced around different places.”
It took a week before Saputo found a Valley Cities program that could get him a prescription for the opioid-treatment medication Suboxone the next day. At first, Saputo thought he could just use the Suboxone — which includes buprenorphine, and both reduces a person’s urges and helps reverse the effects of opioids — when he couldn’t find heroin, but after a week on the medication, he changed his mind.
“I had decided that the Suboxone was working and I didn’t really have a craving to use heroin,” Saputo, now a facilitator for a medication-assisted treatment support group at Peer Seattle, said. “So I was like, why use it?”
King County’s soon-to-be launched street-medicine program is informed by one run by San Francisco, which started prescribing buprenorphine in 2016 and later expanded treatment into shelters and encampments. Data from San Francisco’s first-year pilot showed that 26% of people continued to receive care from the street team and 18% of people given buprenorphine prescriptions remained on the medication a year later.
“Even though there were lower rates of retention than you’d find in traditional treatment settings, because our population was so marginalized and not seeking out treatment at initial engagement, we felt overall this was successful,” said Dr. Jamie Carter, the primary author of the study.
Scott Lindsay, who served as a public safety adviser to former Seattle Mayor Ed Murray and as a member of the county opioid task force, supports the strategy.
“It’s a long path for most of the people living in the situations that we’re most concerned about outside and in the criminal justice system to make it back to some form of stability where they can modify their behavior,” Lindsay said. “We have to make sure there are realistic options available.”
However, some in King County’s recovery community are skeptical about the government’s ability to establish trust with people in encampments, and criticized the idea of offering treatment without coupling it with housing and other services.
“If you don’t establish connection and community, how do you expect that to work?” said Angel Cat, a Peer Seattle opioid recovery facilitator and trainer. “If you’re not supporting the person, then the reasons for using will still exist.”
King County’s public health officials insist that one of their primary goals is to develop trust by offering other kinds of medical care, not just addiction treatment, and that medication-assisted treatment can steady other parts of a person’s life.
To this end, the county already has a mobile medical van that can prescribe medication-assisted treatment and has disbursed more than half a million dollars in grants to local organizations to provide low-barrier access to buprenorphine. Some local service providers have also started some of the work of bringing medication to shelters and encampments on their own.
The new $1.5 million in funding will build on the county’s existing efforts and specifically target people who don’t tend to show up in clinics.
Turina James, a program assistant at the Public Defender Association and alumna of Seattle’s Law Enforcement Assisted Diversion (LEAD) program, said she thinks expanding access to medication-assisted treatment in shelters and encampments is a good idea.
But she worries that the county won’t have the capacity to treat or track everyone who wants help, especially with high turnover at tent encampments. During this year’s one-night count, an estimated 1,276 people were living in tents or unsanctioned encampments in King County, a 32% increase over 2018’s count.
“I just hope they don’t make promises they can’t keep,” James said. “People are already suffering enough.”