Seeking positives in current times can feel futile. But for drug policy reformers, there are a few. San Francisco and King counties, in California and Washington respectively, are both engaging in a radical form of harm reduction—at least by US standards.
Like many other parts of the country, the two jurisdictions are using hotels to provide temporary housing for homeless people who have either tested positive for COVID-19, or who suspect infection. But the two counties have also announced that they are providing a select few of these quarantined patients with alcohol, tobacco or marijuana. It is, in other words, a limited and rudimentary form of safe supply.
The pandemic has spurred a number of changes to US policies related to drug use, addiction and treatment. These include allowances from the Substance Abuse and Mental Health Services Administration (SAMHSA) for the widespread dispensing of 14- and 28-day methadone take-home doses, and from the Drug Enforcement Agency (DEA) for buprenorphine to be initiated by telehealth.
Though these changes have been welcomed by harm reduction and treatment advocates, many have criticized the fact that it took an unrelated pandemic—one which threatened the general public, not just people who use drugs—to provoke these humane, common-sense steps.
In San Francisco, donations have been funding the efforts, which include supplying quarantine guests with alcohol if they meet criteria for alcohol use disorder.
For people who are dependent, “safe supply” means providing regulated doses of the relevant substance, thereby allowing people to use more safely, regulate their use, and focus their energies on something other than procuring drugs. But the notion that, rather than criminalizing drug use and tying drug users to unpredictable illicit markets (or even expensive legal ones), the government should grant access to regulated, safer products, remains hotly contested in this country.
States that have legalized marijuana have taken one step in this direction. But overall, momentum has been slow and laborious, and plagued by media sensationalism and controversy at every turn. So even in light of the other pandemic-driven changes, the news from California and Washington is surprising.
In San Francisco, private donations have been funding the efforts, which include supplying guests who are in hotel quarantine or isolation with prescribed doses of alcohol if they meet criteria for alcohol use disorder, as well as tobacco for people dependent on nicotine. County employees working at the hotel are also facilitating deliveries of medical marijuana for patients with prescriptions, in addition to deliveries of other essential medications like methadone or buprenorphine.
Similar efforts have been reported in Shoreline, a city that shares King County with Seattle. King County Department of Community and Health Services Director Leo Flor self-financed the initial purchase of beer and nicotine products (it is currently unclear which products, and whether, for example, they included vapes), according to a spokesperson who spoke with Kiro 7 News.
Although Shoreline and neighboring Lake City have been subject to gentrification efforts similar to those infamously overtaking Seattle, there remain severely impoverished pockets of the North King County area, with high rates of drug dependence. For many who lack stable housing, entering quarantine without access to those substances might be unappealing (creating a disincentive to isolate) or outright dangerous.
In particular, alcohol creates a physical dependency which, when suddenly discontinued, produces sometimes-fatal withdrawal symptoms. These symptoms include insomnia, anxiety, stomach upset, and heart palpitations in milder manifestations; in more severe cases, withdrawal can cause seizures, hallucinations, serious cardiac disruptions and death. Benzodiazepines are commonly administered to patients who require hospitalization for alcohol withdrawal, but there is medical precedent for treating alcohol dependence with ethanol infusions—or, alcohol itself.
Jenna Lane is a behavioral health communications specialist with the San Francisco Department of Public Health. She told Filter that for people in quarantine (for suspected COVID-19 cases) or isolation (for confirmed cases) at the hotel “who would get tremors or other really unpleasant but mild alcohol withdrawal symptoms,” on-site providers prescribe “the minimum amount [of alcohol] necessary to prevent withdrawal … It is stored in a locked cabinet and administered in prescribed amounts with meals.”
Predictably, these efforts have received media backlash.
Lane could not provide a firm, up-to-date number of people who had benefited from this intervention, but reported it as being “in the low dozens,” adding, “that includes both alcohol and tobacco” provisions.
She also added that, “if someone is going to experience anything more than mild withdrawal symptoms, then isolation and quarantine is not the right setting for them; they might need to go to the hospital.”
Predictably, these efforts have received media backlash. A blog post on MyNorthWest.com opened with this snarky (and inaccurate) complaint: “Your tax dollars at work! As hundreds of thousands of people are newly unemployed in our region, you should know that your dwindling family budget is buying beer and cigarettes for patients at the Shoreline COVID-19 quarantine site.” Both King County and San Francisco have publicly denied using government funds to finance these efforts to-date.
Kiro 7 News quoted North King County community member Carolyn Nelson as commenting, “I didn’t like the idea, I don’t care who’s paying for it … It just seems like a bad situation, although I don’t want them running around loose either.”
Nelson’s dehumanizing commentary—which, even in the best light, depicts homeless people as selfish and savage, incapable of stopping themselves from ruthlessly spreading coronavirus—is indicative of a prevailing attitude that denies certain classes of people who use drugs the comfort and safety enjoyed by those who can afford to consume the same chemicals in their private residences.
“A harm reduction approach … includes the continuum, from supporting abstinence and recovery to helping people who continue to use to reduce their harms. There are decades of literature supporting this approach,” said Grant Colfax, director of the San Francisco Department of Public Health, in response to a question at a May 6 press conference that accused the department of “blurring the line between harm reduction and enabling.”
A Program That Failed to Take These Steps
The result of not utilizing harm reduction during this crisis is demonstrated in Peoria, Illinois, where Chris Schaffner, program director of the JOLT Harm Reduction Foundation, reported that he has struggled to land referrals into his city’s homelessness quarantine effort, which is also in a local hotel. He said that only three people are being housed in the 150-room hotel.
“We’ve got small airplane bottles of alcohol we were helping them smuggle in.”
“The people we have had referred there that went there said it felt … like a jail, Schaffner told Filter. He said the medical organization that is helping to facilitate the quarantine offers buprenorphine services for people with opioid use disorders who wish to engage in pharmacotherapy, and also provides nicotine replacement therapies. But there is a ban on alcohol, cigarettes and illicit drugs.
“Several people we had referred there lived with chronic alcohol use disorders,” he continued. “We were worried about withdrawal, so … we’ve got small airplane bottles of alcohol we were helping them smuggle in.”
He also described an intake process that included the temporary surrendering of clothes and belongings, for the purported reason of preventing bed bugs. Beyond the ethical concerns surrounding such a potentially humiliating procedure, that raises the question of how people were able to smuggle in the bottles, and whether some had to resort to more demeaning and invasive means of hiding them—despite being old enough to legally purchase and consume alcohol.
“It was not trauma-informed; that was not even considered.”
“I get we are in a moment of survival mode with everything going on, but [the intake and quarantine process] was not trauma-informed; that was not even considered,” said Schaffner.
“Unfortunately, resources to meet the need of an absolutely trauma-informed program were not available,” Kate Green, executive director of the Heart of Illinois Homeless Continuum of Care, one of the organizations involved in designing and implementing the hotel quarantine project, told Filter by email.
She added that they were updating the program as needed, writing that “the guidance from the health authorities at the beginning of the program was to require 100 percent isolation to an individual’s room in order to protect both themselves and others. However, an accommodation was made to allow scheduled time for individuals to go outside to get fresh air, etc.” She also confirmed that only three people are currently utilizing the hotel service.
In San Francisco, by contrast, people in quarantine or isolation at the hotel have access to a spectrum of support, including mental health counseling and addiction treatment options. “In fact, some of our providers … are liking this chance to invite more conversation with folks about any patterns of use that they may wish to change, and the feedback I’m hearing anecdotally is they feel like they may be able to engage more people in care,” Lane said.
At the press conference, Colfax stated, “Right now, with regard to supporting people who are at risk, or who need to be in quarantine or isolation because they’re COVID-positive, our focus needs to be on supporting them and meeting them where they are so that they can be cared for in the most appropriate way, in a way that’s good for them and for our community.”
Photo via NeedPix.com/Public Domain