Pubdate: Sun, 25 Aug 2019
Source: New York Times (NY)
Copyright: 2019 The New York Times Company
Author: Nicholas Kristof


SEATTLE - On gritty streets where heroin, fentanyl and meth stride
like Death Eaters, where for decades both drugs and the war on drugs
have wrecked lives, the city of Seattle is pioneering a bold approach
to narcotics that should be a model for America.

Anyone caught here with a small amount of drugs - even heroin - isn't
typically prosecuted. Instead, that person is steered toward social
services to get help.

This model is becoming the consensus preference among public health
experts in the U.S. and abroad. Still, it shocks many Americans to see
no criminal penalty for using drugs illegally, so it takes courage and
vision to adopt this approach: a partial retreat in the war on drugs
coupled with a stepped-up campaign against addiction.

The war on drugs has been one of America's most grievous mistakes,
resulting in as many citizens with arrest records as with college
diplomas. At last count, an American was arrested for drug possession
every 25 seconds, yet the mass incarceration this leads to has not
turned the tide on narcotics.

The number of opioid users has surged, and more Americans now die each
year from overdoses than perished in the Vietnam, Afghan and Iraq wars
combined. And that doesn't account for the way drug addiction has
ripped apart families and stunted children's futures. More than two
million children in America live with a parent suffering from an
illicit-drug dependency.

So Seattle is undertaking what feels like the beginning of a historic
course correction, with other cities discussing how to follow. This
could be far more consequential than the legalization of pot: By some
estimates, nearly half of Americans have a family member or close
friend enmeshed in addiction, and if the experiment in Seattle
succeeds, we'll have a chance to rescue America from our own failed

In effect, Seattle is decriminalizing the use of hard drugs. It is
relying less on the criminal justice toolbox to deal with hard drugs
and more on the public health toolbox.

Decriminalization is unfolding here in part because of Dan Satterberg,
the prosecuting attorney for King County, which includes Seattle. It's
also arguably underway because of what happened to his little sister,
Shelley Kay Satterberg.

At the age of 14, Shelley ran away from home because her parents
wouldn't let her go to a concert on a school night. It was a rebellion
that proved devastating. She was away for several months, was
gang-raped by two men, was introduced to hard drugs and began to
self-medicate with those drugs to deal with the trauma of rape.

As Dan Satterberg rose through the ranks of prosecutors, Shelley
Satterberg wrestled with addiction. She was never arrested or jailed
(middle-class drug users often avoid police attention, which focuses
on marginalized people who use or sell in public).

Dan told me that he was angry at Shelley - angry that she had made
terrible choices, angry that she had hurt their parents. But over time
he also concluded that his own approach of prosecuting drug users
accomplished little, except that it isolated them from the family and
friends who offered the best support system to escape addiction.

In 2015, Dan took Shelley to Navos, a nonprofit that provides mental
health and addiction services, and she was able to stop using street
drugs and gradually put her life back in order. Dan saw that treatment
made a huge difference in Shelley's life and became a believer.

Yet it wasn't enough. Shelley died of a urinary tract infection last
year at age 51, a consequence of previous drug and alcohol abuse.

"It gave me some insight about what works better than jail," Dan
Satterberg told me. "What Shelley needed was not a jail cell and not a
judge wagging a finger at her, but she needed some support."

Seattle's first crucial step came in 2011 when Satterberg and others
started a program called LEAD, short for Law Enforcement Assisted
Diversion. The idea is that instead of simply arresting drug users for
narcotics or prostitution, police officers watch for those who are
nonviolent and want help, and divert them to social service programs
and intensive case management.

Almost immediately, this was a huge success. A 2017 peer-reviewed
study found that drug users assigned to LEAD were 58 percent less
likely to be rearrested, compared with a control group. Participants
were also almost twice as likely to have housing as they had been
before entering LEAD, and 46 percent more likely to be employed or
getting job training.

LEAD isn't cheap - it costs about $350 per month per participant to
provide case managers. But it is cheaper than jail, courts and costs
associated with homelessness. As a result, this approach has spread
rapidly around the country, with 59 localities now offering LEAD
initiatives or rolling them out.

Chian Jennings, 45, who had struggled with drugs for years, living in
the streets and financing her habit by selling sex and by stealing,
was smoking crack when a policeman stopped her.

"It was probably the best thing that happened to me," Jennings told
me. "It saved my life." Instead of locking her up, the police officer
handed her over to social workers at LEAD.

Through LEAD, Jennings got medical care, clothing and housing. She
also gained confidence in herself, people who cared for her and the
idea that life could get better. "They're some of the most caring
people I've ever met," she said of the counselors. "Whether you come
in high or not, they always treat you with respect." Now, she said, "I
work to make them proud of me."

Jennings remains a work in progress. She says she still sometimes uses
cocaine, but less over time, and she adds that she's no longer
stealing. If she had been held in jail, she said, "it would have
pissed me off, and I would have gotten high when I got out. I'd still
be homeless, stealing for food and drug money."

Prison, she says, just makes people more miserable and more dependent
on drugs when they are released. "This bit about 'I learned my lesson'
- - no, it doesn't work that way," she said. "People are hurting inside.
That's why they're using in the first place."

The war on drugs began in 1971 out of a legitimate alarm about
narcotics both in the United States and among U.S. troops in Vietnam.
But the "war" approach locked up enormous numbers of people and
devastated the family structure. Drug laws discriminated against
African-Americans (possession of crack cocaine, disproportionately
used by blacks, drew far harsher sentences than possession of the same
quantity of powdered cocaine, more likely to be used by whites).

Yet locking up endless waves of users has had little deterrent effect,
and overdose deaths have surged. The White House has estimated that
the economic cost of the opioid crisis in the United States exceeds
$500 billion a year, equivalent to about $4,000 per household. And
that doesn't even include cocaine, meth and other drug use.

While the U.S. doubled down on the criminal justice approach to drugs,
Portugal took the opposite avenue, decriminalizing possession of all
drugs in 2001. It was a gamble, but it succeeded. As I've reported,
Portugal's overdose deaths plunged. The upshot is that drug mortality
rates in the United States are now about 50 times higher than in Portugal.

Increasingly there is global recognition that drugs are better
addressed as a health challenge than as a law enforcement issue. "To
criminalize people who use drugs is ineffective and harmful," argues
the Global Commission on Drug Policy, a panel of former presidents and
other prominent figures from around the world who have explored these

It would be difficult to think of a policy that has failed more
definitively than America's war on drugs, sending even small-time
users to prison for years. This policy has cost the economy trillions,
ruined tens of millions of lives, ruptured the family structure,
exacerbated racial inequities - yet we still have a fatal overdose
every seven minutes in the United States.

"Legislative and law enforcement solutions to drug problems in the
U.S. have consistently caused more harm than they have solved," noted
Alex Kral, an epidemiologist with RTI International, a think tank.
Countless studies have shown, he said, that public health approaches
work better.

That's the context in which Seattle took another crucial step last 
September: Satterberg announced then that he would no longer prosecute 
cases involving possession of less than one gram of drugs, even cocaine 
and heroin (one gram is more than a simple user would normally have at 
any one time). In practice, that means that dealers still get arrested, 
but not ordinary users.

"Seattle is leading on this," said Daliah Heller of Vital Strategies,
a New York group that examines how to reduce overdose deaths. "It's
extremely significant."

But don't expect miracles. Overcoming addiction is a slog, and no
approach has eradicated drug abuse. Maybe that shouldn't surprise us.
We've been wrestling with alcoholism for thousands of years, and we
still haven't solved that, either. Even now, more Americans die each
year from alcohol (88,000) than from drug overdoses (68,000).

It's too early to have reliable data from the decriminalization
experiment, but outside the courthouse in downtown Seattle where
Satterberg has his offices, drug users continue to be homeless and
feed their habits. At the same time, some police officers feel
undermined and robbed of authority.

"You've got a guy shooting heroin on the street, and the cop is
supposed to say, 'You O.K.?'" grumbled one law enforcement officer in
Seattle. (In fact, an officer would typically confiscate the heroin,
admonish the user and move on.) Some residents worry that when the
city ignores its own laws on the books and tolerates people openly
abusing narcotics, it takes a step toward incivility that will
eventually result in chaos and crime. There's also a legitimate
argument that the threat of prison is sometimes necessary to motivate
users to participate in treatment programs.

Businesses are resentful of homeless drug users discarding needles on
sidewalks and using bushes as toilets. A television documentary
released this spring, "Seattle Is Dying," captured the frustration of
residents; some would prefer to see the police cart drug users off to
jail to get them out of the way.

"It isn't as easy as I thought to create a sensible drug policy,"
Satterberg admitted to me. But he remains confident that his path, if
not easy, will work better than simply throwing people in jail.

As I see it, the problem is that while Seattle has done an outstanding
job halting the war on drugs, it hasn't done well in financing the war
on addiction. It closed the law enforcement toolbox without fully
opening the public health toolbox.

Local officials found that in a world of competing budget silos, money
saved from jails can't easily be reallocated to treatment. This is so
even though researchers repeatedly find that drug treatment pays for
itself by saving huge amounts of taxpayer money, not to mention lives.
One study found that substance abuse treatment in California paid for
itself seven times over in reduced crime and other savings.

We need a greater focus on services - mental health, housing,
counseling, medication-assisted treatment and more. It should be a
scandal that less than 20 percent of Americans with substance abuse
disorders get treatment.

We should also try other evidence-based public health interventions to
reduce the drug epidemic. Let's have safe injection sites, so that an
overdose won't turn fatal, as well as testing for fentanyl, so that
users can understand what's in the drugs they buy. Let's distribute
naloxone widely, as Baltimore has done, to counteract opioid overdoses.

We might also experiment (as Canada has) with providing safe heroin to
longtime users who can't break their addictions, for use under medical
supervision. It's impossible to help people defeat addictions if
they're dead.

Local jurisdictions like Seattle are leading partly because the
federal government isn't. President Trump has boasted that his
administration is making "tremendous progress" against opioids, but
after more than two years, he still hasn't even gotten around to
appointing an administrator of the Drug Enforcement

As a country, we also must tackle root causes, which means ensuring
that every kid graduates from high school and that job training and
apprenticeships usher disadvantaged young people into decent jobs. The
most important kind of drug policy is preventive: It's about providing
a future that isn't so depressing that people numb themselves with
opioids or meth.

Perhaps I sound too bleak. Nothing is easy, but Johnny Bousquet is a
living example of how a patient public health approach can save lives
and leave everyone better off.

Bousquet, 42, was born with drugs in his system into a dysfunctional
household. His mom, who had been raped by her father and her brother,
self-medicated with heroin, and Johnny himself began selling crack at
13 to buy money for food. At 19 he found his mom dead of a heroin
overdose. Soon afterward, his stepbrother who was also his best friend
was murdered while trying to rescue his sister from being pimped by a
gang; then the sister died of an overdose.

In short, Bousquet experienced more trauma by young adulthood than an
entire suburb of more privileged children. Yet he's a talented
musician and made a good living for a time producing records and
corporate jingles, while marrying and having two children. Then life
took a rough turn, his wife left him and took the children, he
self-medicated, and he ended up homeless on the streets and stealing
and selling drugs to get by.

In 2014 he sold $40 worth of crack to an undercover police officer and
was referred to LEAD and a young counselor, Mikel Kowalcyk, who
herself had a long history of abusing drugs. Kowalcyk had overcome her
addiction and gone to college, and she and Bousquet quickly formed a
symbiotic relationship.

"Part of what keeps me clean is Johnny, and people like Johnny,"
Kowalcyk told me. "Because they let me give back."

Bousquet repeatedly relapsed, but Kowalcyk never gave up on him, and
he gradually stayed sober for longer periods. Now he has been
drug-free since Feb. 14, 2018, and he has a home and a job. If it
hadn't been for LEAD, he figures he would be dead of an overdose,
would have killed himself or might have killed someone else.

Now, he says, he goes to a 7-Eleven that he used to shoplift from -
and he buys from the cashier. "I'm nothing special," he told me, "but
it's a big deal compared to being homeless last year and sleeping
outside with needles in my arm."

Day by day, Bousquet is making progress, a reminder that treating drug
users as humans with an illness is a more effective strategy than the
almost 50-year policy of imprisoning them as "junkies."

"I just paid my rent again yesterday," he said, beaming. "I'm not in
your car stealing your stereo. I'm paying damn taxes now."
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MAP posted-by: Matt