Law and Justice / Human Services Committee - Regular Meeting

Good morning, everyone. Thank you for being here. Thank you for joining us. Today is Tuesday, August 25th. It's 11 a.m. We're meeting in the Jackson boardroom and also remotely. Welcome to the Snohomish County Health and Community Services Committee. So we're going to do things a little bit differently with this hearing. We have one hour. We're starting late. We have 57 minutes and we have a long what's probably going to be a lengthy panel discussion. So we're going to limit our public comment portion to just 15 minutes, and we're going to reduce the amount of time per commenter to two minutes. So if you all are here to provide public comment, just know that those are the restrictions we're going to be running with because we do want to make sure we have time for the panel and then the questions from council members. So first thing we will do is read a public comment script. We'll be taking public comment, beginning in person and then remotely. If you're in Zoom, you'll click the hand icon to raise your hand, and if you're calling by phone, star nine to raise hand, and when you're called upon, press star six to unmute. Each speaker will have two minutes to speak, and please start your comment with your name and your city of residence. So first we will open up public comment. So do we have anyone in person who's here to provide public comment? I see at least one. If so, you can just go on, head up to the podium, and start with your name and your city of residence. Welcome.

We go around to parks and public places in Seattle, Washington, picking up trash and invariably needles and foil that is found throughout public spaces, playgrounds. It's found hidden under leaves everywhere. We do our due diligence to clean that up safely. It is in a lot of places. It's in a lot of spaces that children are and public are at. And I just know that it's a really big problem in Seattle. And it's places you wouldn't imagine finding it. So that's all. Just want to make sure that it does not continue to spread.

Thank you for your public comment. I do realize I just skipped our roll call as well. I'm sure our clerks are like, what are you doing? I was trying to speed through this thing. So why don't we do roll real quick, and then we'll jump back to the public comment.

Committee Chair Meade.

Here.

Vice Chair Lowe.

Present.

Committee Member Neering.

Here.

Committee Member Dung. Here. Committee Member Peterson.

Here.

Chair, there are five members present.

Great, thank you. All right, back into our public comment. Do we have anyone else who'd like to provide public comment today? All right, seeing none, I'll turn to our clerk, see if we have anyone online.

No hands are raised.

No one online, so we will close our public comment. And we are going to first speak to the ordinance. We'll have our analysts speak to the ordinance, see if council members have questions, and then we'll bring the panel up. So, Cynthia.

For the record, Cynthia Foley, council staff. This ordinance was presented to this committee in May. The proposed ordinance prohibits the expenditure of county funds for purchasing syringes and smoking equipment for illegal drug use. The proposed code bans expenditure of all locally collected revenues, grants, and pass-through funding for these purposes. Under the terms of the legislation, the county may contract with organizations that run syringe service programs but cannot provide funding for the syringes used by these programs. The request is to move ordinance 26-017 to the GLS agenda to set time and date for a public hearing.

Thank you, Cynthia. Do you have any questions or initial comments from council members?

I had a question.

Council member Dunn?

Are we currently providing funding for this?

No, we're not currently expending funds on any of the items in the ordinance.

Thank you.

All right. Thank you. Other questions from council members or comments? Okay, so I propose to council instead of us moving forward with an action on moving the item to set time and date or anything like that, maybe we do the discussion first, the panel, and then we decide. Are there any objections from council members on that? Okay, so that's what we'll do. So we'll just pause on this and we'll bring up our panel so we can have our panel discussion. I'm going to let you all introduce yourselves first, but I'll just read a script while we have people coming up here. So welcome to the panel for Ordinance 26-017. When the ordinance was first introduced, several of our council members expressed interest in hearing community members and partner feedback on the proposal. So I want to thank all of our panelists for coming being willing to speak, provide your perspective, and then answer some questions from the council members. Now that you all are up here, maybe we go down the line, and you can introduce yourselves, and then I will propose both of the questions, and you can decide if you want to address both of the questions in your comments first, or if we want to do the first question, and then the second question's going to be up to you. Why don't we introduce ourselves first? Welcome.

How's that?

Art Dahl in Battlefield Diction. Thank you. Yeah, you'll have to turn the mics on. You'll see the green light when they're...

David Hayes drug task force commander Andrea Suarez we heart Seattle Shannon go for sound pathways James Lewis health officer for the less knowledge County Health Department Eric Falez executive director of Snohomish County recovery coalition

Great. So thank you all for being here. We do have the two questions that we sent you all ahead of time as well, but I'll read them here for the benefit of the public and the council members. So our first question was, what are individual and public health impacts of distributing the syringe and smoking equipment? The second question is, is the distribution of syringe and smoking equipment an effective use of public resources? So we can start down at the beginning, and you can choose to address both of the questions if you want and talk about Your perspective on this and then eventually we'll get to council members questions as well, which will be unscripted.

Okay, let me start. Yep, thank you. Well, I like to take the perspective of loved ones. So for me, I work with families. And if a family had come to me and their loved one was in their basement doing drugs, and I were to say to that family, do they have clean foil? Do they have all the stuff that they need to continue to use and do it safely? I think the family would call me crazy. So we run an organization that really works hard to stop drug use. And when you say that's your loved one, how many people would want their son or daughter being given tools to smoke drugs with. Even if it doesn't enable, even if it doesn't, whatever it does on the positive side, what is the symbolic nature of going, here, when we have an illegal act and we're saying, here's some tools to do that illegal act and hurt yourself, symbolism is everything there. It's saying it's permitted, it's allowed. And for me, I think we have to go the other direction and say that this stuff isn't permitted and isn't allowed And even if it was, and for sure, meaning taxpayer dollars shouldn't, you know, that same family in that house, I say, do they have enough foil? Hey, go get your brother some foil and make sure he's okay and watch him with Narcan. And that wouldn't be the mode to get someone off drugs. That would be the mode to allow them to continue to do drugs. And that would be what we were saying. So for me, it's just a pretty... As a physical trainer in a gym going out and handing out donuts so that he can meet those people that he later wants to train, I think that that would be a crazy thing for that physical trainer to do. I just don't want to be part of killing anybody. So I would never want to know that the foil that I handed somebody was led to their death and aided in their death. I don't want to be part of that. I don't want to be part of giving someone, my son or anyone, if my son is on our streets and he's holding foil, and smoking it, please, all of you, knock it out of his hands. Don't give him more. Tackle him, and please stop him from smoking that drug that could kill him. Do not give him foil to do it, or do not give him a meth pipe that could make him go permanently insane and have mental issues for the rest of his life. Just please don't be part of my son's destruction. So I'd say, if that was your loved one, Would you really, after you've had to remove them from your house and you can't see them because, you know, it's hard because they won't stop using drugs in your home. And so you've done this tough thing and you've said, please, I can't have you here and I can't be part of your destruction. So I got to have you go away and I love you so much, but you got to go. And then somebody comes up and says, does he have all the tools to keep getting high? I think that that's something that as your loved one, you wouldn't want anyone doing that for them. So if it's people you love, I think you'd want them. you know, not given the tools, but maybe even arrested and helped and brought into treatment. So that's just the perspective we take. I don't get into the epidemiology of it or any of that stuff. I just get into the symbolism of it and what it looks like. And when we have a gross misdemeanor or a misdemeanor and we say, hey, do you have all the tools to commit that misdemeanor? What are we saying as a government? So thank you.

Thank you. So I was going to address the two questions separately if I could. So, first of all, thank you, Councilman Nearing, for bringing this forward, and thank you to everybody for being here today. I think that this is a really important conversation for us to have of how the county or the government at large addresses drug use and all of the related issues in our communities. But as a law enforcement officer, public health is not my area of expertise, but I can speak my observations and what I hear from my colleagues in the field. Drug trends regionally reflect that fentanyl meth and cocaine are the most common in that order of in that order of prevalence Smoke in the drug either using glass device or tin foil is are the most prevalent manners I also understand that the use of syringes are not nearly as common as they once were but my colleagues are telling me that syringes are most common more commonly used now for meth instead of the opioids or fentanyl that they had been in the past and You know, today you're going to hear some testimony from some colleagues down the aisle here, local experts about the pros and cons of this proposal, and they each make valid and valuable points regarding the public and individual benefits. But there's also a legitimate policy concern that making drug consumption safer by providing syringes and smoking devices is facilitating the continued abuse of these drugs. These competing arguments are not mutually exclusive. I've had the pleasure of developing strong working relationships with virtually everybody that you see here on this panel. And those partnerships have broadened my perspective regarding harm reduction and the value of connecting people with critical services that law enforcement simply can't provide. If council moves forward with restricting the county funds or pass through funding for the distribution of needles, I believe that we need alternative policies and programming in place to ensure that the people Suffering substance use disorder continue to have access to the broader services and I'd like to be part of that conversation Thank you Thank you for inviting us from King County to testify today.

My name again is Andrea Suarez with we heart Seattle We've been picking up hundreds of thousands of needles and caps and pieces of foil tourniquet cookers glass pipes the copper tools, all these different pieces of equipment in our parks by the hundreds of thousands of pieces. And when we talk about public safety for all, this is where the missing link really is, is that this equipment to use illegal drugs, which you can be arrested, as Art said, as a gross misdemeanor, and effectively enabling illegal behavior, ends up in our parks, in our school grounds, on our picnic tables. stuck on the bottom of our shoes. In fact, it's so bad in King County, we're now handing out flyers on how to reverse the overdose of a dog. So when we think about the symbolism, I second that with Art Dolan, that kind of just morally ask yourself, should we be handing people tools to use lethal, illegal narcotics that are the number one cause of death between the ages of 18 and 45 in our nation. And we're tired of losing our loved ones and living in a culture where we've normalized drug use. Around Halloween time, you can get your needles in a pumpkin. At Valentine's, your glass pipe is in a Valentine now in King County. They're calling the kit party kits or the works which now include pipes and paraphernalia to do drugs in your butt and That is wrong that we're allowing this distribution to be handed out with no information on how to properly collect it safely or where to get treatment. And so it really just don't be like King County. This should not be funded in any way, shape or form. As a professional litter picker, I can tell you that we pick up about one needle now per 1000 pieces of foil. So syringes really are not so much of the concern we see in the playgrounds anymore. And then you just have to ask yourself, what do cookers and tourniquets and foil and pipes due to reduce the harm of a drug user. And second to that, where does it end? Should we start giving out shot glasses for alcoholics to share a shot? Do we start handing out marijuana kits to people to share a joint? When does it end? We need to have a culture where we make it really hard to get high and easier to get clean. So for that, do not fund this distribution of this harmful paraphernalia And thank you for allowing myself and my volunteer to testify today. Thank you.

Thank you. Chair, can we remind our panelists to please rely on evidence-based or peer-reviewed information that's shared today?

Evidence of what? So we've asked them to all be here to share their perspective from their work in the communities. From my perspective, that hasn't been violated here.

Appreciate hearing professional and lived experience, but if we can If there's statements that are made if they can be Backed up by evidence. So especially if you have broad statements to make you can share the error site any information Providing the literature afterwards would be appreciated I think we should let the panelists speak and if council members have questions after that might be a good time to follow it All right other comments from council members

Go ahead. Thank you.

Again, I'm Shannon Goforth, and I'm the Executive Director of Sound Pathways. I oversee the Harm Reduction Center and the Health Engagement Hub. I have to be scripted or I will go off. James is going to go over some of the scientific, so I've led that up to him. But I want to talk a little bit about what we do. Our Harm Reduction Center provides participants with an access to a wide range of supplies and services designed to reduce the risk of disease, overdose, infection, and other health complications. Participants can obtain syringes, safer smoking devices, as well as naloxone hygiene kits, wound care supplies, testing strips, and drug checking services. These resources give individuals practical tools to reduce the immediate health risks associated with substance use. The Harm Reduction Center serves as an entry point to healthcare and other services. Through our partnership with Conquer Clinics, participants can meet with a medical provider for wound care, prescriptions, evaluation of other medical needs, opioid replacement therapy, mental health, and substance use treatment. Participants can also be tested and treated for Hep C in one visit. Our Health Engagement Hub is designed as a no-barrier program. Participants are not turned away because they lack insurance or cannot afford care. By meeting people where they're at and providing services, we have the opportunity to identify health concerns earlier, connect people with treatment, and build relationships that can lead to long-term engagement in healthcare. Sound Pathways has a mobile medical van that can be deployed throughout Snohomish County to areas where the need is greatest. This allows us to bring healthcare and harm reduction services directly into communities. Participants can meet with a peer navigator who helps connect them with resources throughout the community, and walk alongside participants to help them navigate the systems necessary to access those resources. Sound Pathways also has a foundational community supports program on site. Participants can meet with a case manager to work to address chronic homelessness and to help and maintain permanent housing. Our parent child assistance program works with women who self-disclose using substances during pregnancy and provides them with a dedicated case manager for three years. We believe that harm reduction must include accountability and responsibility to the community. When our outreach team responds to designated locations, participants are expected to take responsibility for helping clean up the area before receiving additional supplies. Our outreach team regularly responds to known encampment locations for cleanups. We have developed relationships with community partners, local businesses, and residents who contact us when cleanup assistance is needed. The HRC's designated disposal site We actively encourage participants to return used syringes. Safe disposal is an important component of our program and helps reduce the risk of accidental needle sticks and discarded syringes in public spaces, part two. Yes, given how individuals enter and engage with our program, it is an entry point to care. These resources bring individuals through our doors who may otherwise remain disconnected from traditional systems. This approach also provides a public cost benefit by intervening earlier. preventing infectious diseases and serious health complications, mortality rates, and reducing avoidable emergency room and hospital utilization. Councilmember Nearing stated in the May 6th Herald article, if we are to make meaningful progress on the complex and interconnected issues of homelessness, substance use, and mental health, we must chart a path forward with balance, balance is compassion, and with accountability. That is exactly what the Harm Reduction Center and Health Engagement Hub are doing. We meet people where they are with compassion, but we don't stop at providing supplies. We use that engagement to create pathways to healthcare, treatment, safer behaviors, and greater stability. Harm reduction is the doorway, not the destination. I want to end with two of the many stories that encompass how our program has affected those we work with. We recently moved our two buildings into one location. During the move, the movers had a naloxone distribution box outside. A man on the street stopped and asked the movers

and we could get some. And the man on the street told the movers how much he loved our agency and appreciated everything we did for him. And the mover asked him if he was clean, and the man said no, but if he ever decided to get clean, he knows exactly where to go. We were conducting interviews to show the importance of the health engagement hub in the community, and a female participant told me that she started coming to the Harm Reduction Center because she was a drug user, and her drug dealer made her come in to get supplies. She felt like that was all she was worth. She told me that by working with the staff, she found out that she was a human being. Today, she is sober and continues to work with the medical team. Before you pass judgment on the population we work with or the programs we offer, I invite you to come to visit our site and go on outreach with my team. We are making a difference by offering harm reduction supplies because as long as there's a breath in their lungs, there is hope.

Thank you.

James Lewis, I'm the Health Officer for the Health Department here. And I want to couch this in a few things from a lived experience perspective, and then I'm going to get to scientific information about the evaluation of potential interventions. Because I 100 percent agree, we want to make treatment easier for people to enter into. That should be the primary goal, is the health and safety of our community. And so, the question is then, how do we accomplish that in as efficient and effective way as possible? And so couch that, I'm an infectious disease doctor and I trained in University of North Carolina in Chapel Hill. And I've seen countless drug users throughout my career for various infectious disease. But one of the most devastating is infectious endocarditis, which is an infection of bacteria on the heart valve. And I've worked with multiple drug users who have had to have multiple open heart surgeries to replace heart valves. after using IV drugs. Now, it has been mentioned that it is true that syringe use is a much less common form, but I want to use this to illustrate the point that creating barriers to drug use has not been shown to be an effective way to stop people from doing drugs. People are going to find a way to continue to use drugs regardless of the barriers you put in front of them. And if having multiple open heart surgeries to the point where now the cardiac surgeons say we can't give you any more heart valve replacements because there's not enough tissue left in the heart to put in a new heart valve isn't the most effective barrier you've ever heard of and it's still not working, then I don't know what is. I would also like to couch it in the fact that, again, it was already asked at the beginning of this, but this is not something that the county is doing right now, the health department is funding right now. And there is no intention in the imminent future for us to do so. So this ordinance would not actually change anything about the way we're approaching this problem today. And so I'm going to present to you some scientific evidence. And I'll be the first to admit, when I started my career in medicine, I thought that harm reduction was counterintuitive. would potentially lead to harm in many of the ways that have been described. But the beauty of science is if you approach a problem with an open mind, you often find that counterintuitive solutions are effective. And that is, in fact, what has been found with regard to harm reduction and syringe service programs. So regarding the first question on health impacts, syringe service programs are supported by nearly three decades, 30 years of research. And a recent 2023 Veterans Affairs-led systematic review, as also mentioned in CDC guidance, finds syringe service programs reduce HIV transmission, lower risky injection behavior that can lead to things like what I mentioned, infective endocarditis, and likely reduce the spread of hepatitis C. There is direct randomized control, which has been touted recently as the gold standard of science, that syringe service programs are also significantly more effective at distributing naloxone to those who need it most to reverse overdoses when they do occur. People who use these programs have been shown to be five times more likely to enter drug treatment than those who don't, and three times more likely to stop injecting altogether at some point in their life compared to those who don't. Multiple reviews have found no evidence that these programs increase drug use or neighborhood crime. And this support for this was reaffirmed by a very recent study this year as a cross-sectional study out of San Francisco, which also found that not only reaffirmed the findings that I just went through, but also found that engagement and criminal legal system involvement to try and redirect people and provide treatment or prevent people from using by imprisoning them was less associated with reduced drug use than syringe service programs. Safer smoking supply distribution, which has been brought up, admittedly is an area of growing evidence, and there is not as strong evidence to support it as there are syringe service programs, which may be the bigger question right now, given that syringe use is on the decline. But safer smoking distribution has shown the start of similar benefits, although the data is not as strong. It is likely to reduce the disease transmission from shared equipment. One example of this is we have an outbreak in Washington, Oregon, also California and Alaska, of a clonal bacteria called Haemophilus influenzae B, which used to cause fatal meningitis infections in children. We now thankfully have a vaccine for this, but this is mostly impacting people who use drugs as well as those who are unhoused. And we're seeing more invasive infections there. And there is a hypothesis that has not been shown yet that perhaps this is spreading because it is a clonal variant. So it's being passed from person to person within the community that that is potentially being spread by inhalational drug use equipment because of the shared saliva between those pipes. And then it also reduces cuts and burns and wounds from unsafe makeshift tools and appears to help some people shift from higher risk injection to lower risk smoking. It also reaches people who wouldn't otherwise connect with the health or treatment service as Shannon so eloquently describes. That was for question one. For question two on cost effectiveness, this is a shorter answer because the data is clear. The return on investment for syringe access programs is very well documented. National models estimate that a $10 million investment in syringe access averts roughly 194 HIV infections per year, a return of over $7 for every $1 spent. And a specific example is Philadelphia's policy expansion is estimated to have produced around syringe service programs is estimated to have produced over $243 million in one year public savings. A sterile syringe costs pennies and the lifetime cost of treating one HIV infection exceeds $380,000 and that's a conservative estimate. So at this time, once again, this proposed ordinance would not have any impact on public health practice or county practice with regard to syringe service programs and harm reduction. The health department and the county do not currently fund syringes or smoking equipment at harm reduction center, which the health department currently contracts with as part of a federal grant. However, if this ordinance is passed, it could prevent in the future the county from accepting federal grant funding to address substance use or communicable diseases such as HIV in the future if the funding opportunity includes provisions requiring or incentivizing syringe service programs or smoking equipment distribution. The proposed ordinance could also limit the health department's ability to address future disease outbreaks or upticks in drug use and overdose fatalities. By limiting the use of cost-effective tools to address disease outbreaks or overdose, the county might be inadvertently adding to overall health care costs, and there would be significant cost implications for emergency care as well as those who use Medicaid. If of interest, I'm happy to provide a list of research articles supporting these services and everything that I've stated today for the record. And of interest, this research is strongly supported by local experts at the world-renowned Addictions, Drug, and Alcohol Institute at the University of Washington, who are closely with the local community of people who use drugs and local harm reduction centers. I urge you to weigh this evidence carefully as you consider this ordinance, and I can submit the references to the clerks if desired.

Thank you. Thank you very much. You have not already submitted those? Okay, that would be great. Thank you.

My one recommendation is never go after the doctor. I don't know why I chose this spot. It was very poorly decided. I wanted to start by acknowledging my own lived experience accessing harm reduction services that I have over 20 years of lived and working experience in behavioral health field that I've spent the last decade living and working in Snohomish County to improve their systems of recovery. Question on the face implies a simplicity in harm reduction that does not exist in Snohomish County. I've spent time at the harm reduction center. I've shadowed their work, and I can tell you they're doing more than distributing syringes and safe smoking supplies. This is a tool to affect change and reduce the harm associated with substance use. Like all tools, the efficacy depends on adherence to best practices and the effectiveness of those who use it. We talk about public health often stressing the physical. I can tell you from firsthand experience that I still experience lingering physical effects from my years of opioid abuse. Greater still are the spiritual and psychological effects that allowed those disorders to proliferate in isolation and shame. My colleagues will point out the reduction in communicable diseases and the increased interaction with the hardest to serve populations, which increases the likelihood of change. Those outcomes should be maintained and celebrated. These services are just one of many tools that initiate and guide people through the stages of change. It's rooted in treating people like human beings with complex needs. The offer is not enabling or encouraging people's substance use. The offer is to treat a person they need to be willing to engage. They need to show up to receive services. And without those services, people will struggle in isolation. People will remain sicker than they need to be And that is what the impact will be by denying access.

Are we all doing question two? We had a couple do. I think pretty much everyone addressed question two as well, if you wanted to jump into that. All right. Fair enough.

Again, the word distribution sticks with me. I want to point out the fact that I could have syringes and smoking supplies delivered to my home by Amazon next day for less than $20. That's what I think of distribution, cold and mechanical movement of items. Regarding public resources, as a Snohomish County taxpayer, I would be curious to know what public resources are currently being used to support the practice and what direct costs are associated with it. I would never knowingly support a reduction in behavioral health in Snohomish County, and I feel a more valid debate would be the best use of funds to treat the behavioral health needs of Snohomish County residents. At the Snohomish County Recovery Coalition, we believe in all paths to recovery and using a yes and approach to address complex behavioral health needs. We push back against binary arguments and favor pragmatic approaches that create conditions for recovery. It's hard to examine a specific practice in isolation from the ecosystem and determine whether it is effective use of public resources. I was initially introduced to opioids in the late 90s. Struggled with substance use until the early 2010s, and have been working in the field from the late 2010s till now. I have an intimate understanding of the opioid crisis. We see waves and changes, often caught flat-footed and baffled by the new trends. The only constant is change. Given that fact, creating policy that prevents or limits our response when we don't know what comes next is rather confusing. It is not a question of if this form of harm reduction is a good use of resources, but rather what conditions might make it a good use of resources and where on the scale those conditions currently fall and are projected to fall. Why would we limit how we respond to a crisis that is far from resolved? Thank you.

All right, thank you for that. So I know that you all probably have other things you wanted to say as we went through the whole panel, but first I want to give council members a chance to ask our questions of you, and then we can get into more open dialogue. So do we have any other questions initially from council members?

Council member, yes? Council member Nair? Yeah, thank you. I appreciate it. First of all, thank you all for taking the time to be here. I know this is a sensitive conversation. Each of you, I have no doubt in my mind, care very much about everybody who's struggling with this issue as well as I imagine everybody in the audience. Everybody wants to see people get helped and ultimately get healthy. And so just appreciate all the work that's being done in this space and you taking the time to share some of your thoughts with us. My question, sort of in the interim between when this ordinance was introduced and today's hearing, I've had a lot of conversations. And one of the things I've noticed about many of the conversations is that syringes in particular often are maybe categorized differently from other types of paraphernalia. And so maybe a two-part question. The first is, is there agreement, and maybe there's not, but is there agreement that aside from syringes, Maybe the others, you know, spoons, pipes, foil, should be categorized differently and maybe regulated differently. And then the second part of the question, when it comes to syringes in particular, I know when I have visited syringe exchange programs in the past, and granted this was years ago, and so things may have changed, but some of them are purported to be, you know, you bring a syringe, a dirty syringe, and then you take a clean one with you, and it's a one-for-one, and that was kind of one of the big selling points of it. What I witnessed on multiple occasions was, you know, bring one in or bring none in and take several out. There was not really a limit. It was kind of a free-for-all. And granted, that may have changed, and maybe that was a one-off deal, but that's a question I have as well, is that is there a change in perspective if it's limited to a one-in, one-out program versus one-in, several-out? So I guess kind of two questions, one on the syringe side and then other on the other types of paraphernalia for anybody who'd be interested in addressing that. Go ahead, Dart, and then Shannon.

I definitely see a different category between needle exchange and harm reduction and the benefits of that compared to the other things that we're talking about. I've always, you know, I think one of the things that we miss is that there's, you know, when we're going to help people, and like I said, I represent families, and one of the questions the family is asking me is how do we help them get sober? That's the question. And if you're a mother and you're at home and your son is on the streets and you're waiting for a phone call, You call me, and I'm going to go do whatever. And the idea that barriers don't stop people from, what does? What stops people from using drugs? I've seen 3,000 people that I've personally gotten sober. I get this notion that people say, just do it all you want, and then magically, some point, someone's just going to come to the conclusion that they don't want to do drugs anymore. That's not how it works. I got 17 people in my current program right now, another 50 living in my houses. All of them were intervened on by something. There was a barrier that stopped them from using drugs, whether that was a psychological barrier, whether that was a physical barrier, or it was a consequential barrier. But everyone will tell you the consequences that led to their stopping of using drugs. So there's a nuance to it that we don't discuss. That if I'm going to have a young woman that's out prostituting and using drugs, I want to make damn sure she has clean needles and that she's safe. Because maybe there's not something that's going to stop her from using drugs today. And our only hope is that that girl hits a psychological or an emotional bottom. She probably won't hit a consequential bottom because she's going to be able to continue her habit. If we're talking about getting people sober, if it's your son or it's your daughter, and you're doing everything you can to get someone sober, would you want that? Would you want someone to walk up and go, oh, here's your meth pipe. Here's your foil. I don't think any parent would want that of their loved one. And these are loved ones on the streets. So the question is, how do we get these people sober? If you say you helped an addict and they are smoking fentanyl on Monday and you help them for a week and they're smoking fentanyl on next Monday, how did you help? They are still one breath away from death. So for us at our organization, families are coming in desperate need and they're asking our government to please help us. And our government in King County is doing the exact opposite. And we haven't seen this. We're not seeing problems. Families aren't coming to us and saying, my kid has endocarditis. Families aren't coming to us and saying, you know, this is happening unhealthy-wise. They're saying they're smoking fentanyl. And so for us, it's about how do you get someone sober? And interventions work. They work all the time. When someone stops using drugs, there's always a barrier to using drugs. That's a ridiculous thing to say. Name a person that was just going along in their drug use. They're in a penthouse in Vegas partying, and all of a sudden they just go, I'm done, and walk out of the penthouse. That's not how it works, okay? Barriers, whatever you say, whether it's a financial barrier and they've lost everything, in our state, we have taken away all barriers. You're right. Not only have we taken the barriers away, we're saying, hey, you don't have enough foil. You don't have enough pipes. You got to keep going, man. Let's get that shit to you. There's a difference. I can build a relationship with someone without giving them tools to kill themselves. I could go talk to someone. I'd rather you give them a sandwich.

Just to reel you back to the question, I appreciate what you're saying, but the syringe thing. Different. You do see a difference.

I see an absolute difference because there's a nuance to it. Because harm reduction has a nuance. Is this person on the verge of actually changing and can we do something today? Or are they desperate? Are they in need? Are they wanting help right now? And if that person's different from somebody that's going to use drugs, then we know no matter what. So harm reduction used to be a last resort. Okay, well, if they're going to use, they're going to use. Let's reduce harm. Okay, I get that. But we're using it as a first resort and maybe even an only resort to say, we don't know. They're going to use no matter what. That's a poor stance to take when your loved one is using or someone that you love is using drugs to just say, well, they're going to do it anyway. So let's just, what kind of stance is that to take? They're going to do it anyways? That's not true. That can't be true. Or the work that I've done in getting over 3,000 people sober just didn't matter. And, you know, I hear it all the time, and I've been doing this for 15 years after 17 years of active addiction, and somehow I get discounted or something sometimes because evidence-based. Evidence of what? Methadone is evidence-based. Come show me somebody actually, like, really prospering on it. Show me. Evidence of what? Evidence of somebody that's not using fentanyl anymore because they're using that? Okay. I get that. But we take people to independence, and we actually believe in these folks. And to say that we all have the same compassion, I understand that. But if it's your son or daughter, go ahead and give me a call, because I'm going to do anything to get them off those drugs today. And we're going to put up some barriers, and we're going to make damn sure that they get sober. And we're going to fight for them, because that's the only way for us to help. Thank you. Thank you.

Shannon, I want to put you in.

So for at our services, we are technically one for one. But if somebody comes in with nothing, we're going to make sure that they leave with something. So, yes, so that's our philosophy is one for one. But we're not going to leave them with nothing. As for whether or not they're all the same, I mean, in our eyes, harm reduction is harm reduction. So whether it be a syringe or foil or, you know, a smoking device, I mean, It's the same for us. If somebody comes in looking for a harm reduction tool, they're all the same across the board for us. Now, whether the law determines that to be, I mean, that's the law. So I don't know if that answers your question or not.

I think so. Maybe just to clarify. So you don't believe it should be limited to bring one in, take one out?

No, we do. But if somebody comes in with nothing, we're not going to tell them they can. So if they come in and they have one syringe, you know, they come in packs of 10, you know, we would give them 10. So if, you know, they come in a little bag. So if they come in with nothing, we're going to give them something. If they come in with a whole container, we give them that much back. Okay.

Yeah, I think that answers the question.

They don't come in with a dirty pipe or, you know, a broken pipe. That's just not how that works. You know, same with the foil and stuff like that. We do limit our amount of smoking devices that we give. You know, we don't just hand them, you know, a pack of smoking devices. You know, so those are limited to how many we give out total a week. So when they're gone, they're gone. So if somebody comes in and we've given out the amount that we've had that week, then they're gone. So we limit the amount that we provide each week. And so those are limited. And it's like one per person. And if that person has had that week, then they don't get a secondary one. So we do have an amount that we do give out for those. Hopefully that answers that.

Thank you. Dr. Yeah, I have a few comments. So, I think, to answer your question directly, yes, I think there is a difference, mostly in the evidence base, right? We have way more experience and way more studies looking at syringe service programs and syringe exchange. Clearly effective. Smoke that's transitioned from predominance to injection, particularly for opioids, but for things like meth and other things, to a smoking predominance, which isn't true everywhere yet, by the way. Like, in Philadelphia, still syringe or injection drug use is still more common than smoking. It varies geographically, but it's relatively new from a perspective of harm reduction evidence and study. And so I think my initial reaction when I heard it was like, I don't know that I would want to distribute smoking supplies, right? And I'm only just now recently starting to come around as more evidence is being shown. And actually, one of the biggest things that has convinced me is this outbreak of invasive drugs. Haemophilus influenzae B, which we are experiencing currently, has been going on for the last three years because that clearly you can transmit that via saliva. That would be on a pipe. The other thing that's convincing me is just wounds related to reuse of old foil and reuse of broken pipes. We know that that is one of the major medical costs associated with caring for people who use drugs. That ends up going through our ERs primarily or through street medicine teams. And if we can reduce the amount of wounds that people have, that will have a substantial medical impact. The other thing I would say around syringe disposal in Snohomish County in particular, which is another policy issue that is related but a little bit different, is they provide a safe way to actually dispose of syringes, which Snohomish County is particularly deficient in, because in most counties you're allowed to dispose of syringes like diabetes syringes, for instance, in a rigid plastic container like a like a Tide container, liquid detergent container. We're not allowed to do that here in Snohomish. So people have to find a designated place to actually dispose of those, which results in more litter, syringe litter. Now, the transition to smoking, I think, has reduced some of that. But that is another issue. Then as far as, you know, I just want to address the concern about, you know, effectiveness of interventions. I have no doubt that you have helped thousands of people. The question is one of efficiency. How can we be more efficient in connecting people to care? I mean, I don't know about you. I don't have direct evidence for this necessarily, other than it's been shown to be five times more effective at getting people into treatment for syringe service programs, but I have rarely been convinced to change my mind about something. And that's really what has to happen. Someone with addiction has to make up their mind and decide that they want to quit. Now, whether that's from feedback from this organization or whether it's feedback from a syringe service program or harm reduction center, that's what has to happen. And there's been studies surveying the people who use drugs in our region by the Alcohol and Drug Addiction Institute And they clearly show that the vast majority of people who use drugs within the last year have been interested in quitting and have tried and either failed or couldn't get into treatment or got into treatment and then relapsed. And finally, I would say what is, you know, with the question of methadone and buprenorphine treatment, I think the question is one of longevity, right? What's the relapse rate? So I think before we can compare what the care that syringe service programs and harm reduction centers are able to get people into versus this man's organization. Sorry, I didn't catch it. What's the relapse rate there? And so I think that's what we would need to compare head to head in order to say which is more effective. And I'm not aware that that data exists.

And on the, does the, do you or the health department have an opinion on the needles, whether it should be one for one or one for several?

Ideally, it should be one for one, but I, you know, I certainly, if someone has syringes that they're bringing in or they want syringes, I would say the risk of, you know, or the chance to reduce the potential risk of one transmission of hepatitis C or HIV is well worth it to give someone a syringe, even if they didn't have one to trade in.

Andrea? Hi. My organization, again, as we hurt Seattle, and we provide a facts on the ground point of view, having picked up over two million pounds of trash and hundreds of thousands of pieces of drug paraphernalia, so I just kind of wanted to square up that, where we're getting our evidence from. And while I'm not getting it from a classroom, I would ask, what is the cost of one of those 650,000 needles that the city of Seattle reported picking up in 2025, got in the hands of a little baby. What's the cost for that child versus the cost of say treating somebody with HIV? So I don't think we have all of the information when we talk about the overall comprehensive evidence of harm reduction and what these pieces of foil and needles do to and cost our communities to collect and dispose over and over and over again. We also have these like mailbox size collection boxes for people as if they have the faculty to use, nod out, and then turn their needle in. On paper that sounds great, but in reality what we see on the ground are hundreds of thousands of needles under the leaves, in the sidewalks, you know, under that. So to answer the question specifically, should needles be treated separately than the rest of the paraphernalia, yes. But in practicality, those needles still end up on our ground. And if we're going to talk about overall cost to stop the spread of disease for the now very few people that are actually using needles, for the case that there might have somebody who needs to be cured of HIV, that those hundreds of thousands and millions of dollars are spent collecting the garbage, the needles, shutting down parks, and treating people who are otherwise getting poked by those needles simply by playing on a merry-go-round. So I just wanted to weigh in on that.

Thank you. Dr. Lewis?

I just need to respond. I totally agree. I don't want anybody to get stuck with needles.

Just real quick, I'm going to let you respond.

Sorry.

I just want a reminder. Nobody was particularly offensive in any of this yet, but I didn't read the script. Make sure we're addressing the council and the comments rather than each other. Yes. So it doesn't become chaotic.

Yes. So just to make clear so that the council understands, there's never been a single reported HIV transmission from a community discarded needle. It is extremely low risk for HIV based on the viability in the environment to be transmitted in that way. So that risk is extremely low. And syringe service programs provide an avenue to actually more effectively dispose of those rather than throwing them away. So if we had more syringe service programs, we would almost certainly, and this is part of the evidence that I'll submit, see less discarded syringes in the community.

Great. Thank you. Council Member Peterson? Yes. Thanks, Chair Mead. One, again, yes, very much appreciate the work that you're all doing in this space, whether we agree on methods. I do want to say when I went to Sound Pathways a couple of years ago, I Still distinctly remember, I'm almost positive her name was Crystal. She came in with a coffee can full of needles and said, these aren't all mine. I just needed to clean up the place where I have to live right now. And that was really impactful. So I think that there is. And the access that your staff gave to her to possible sobriety, I think, was amazing. But one of my concerns with this, and I know this is not in this ordinance, but I have heard this language spoken here in the region as well as nationally when it comes to kind of an anti-harm reduction posture is that they also include things like test strips, naloxone distribution. I actually have a cousin who does naloxone distribution in the state of Indiana and they have to limit the number of naloxone shots that they can give to an individual because of state laws in Indiana. So I have a real concern that this is a path to even creating more barriers to things that are probably even more evidence based. Maybe not. I mean needle exchange. Yes. But things like naloxone things like fentanyl test strips. So I don't know if I really have a question here other than if you've heard that kind of same Rhetoric either here in the region coming out of King County or coming out of kind of this Well, maybe I'll call it a movement of kind of anti harm reduction. So I don't know if anybody is Familiar with with some of that but that's a real concern as we travel down possibly this path Shannon I have not heard but that would be a speculation that I would have as well.

I That would be my fear that if this ordinance was put in place that this is just a stepping stone for future ordinances to be put into place that would provide more barriers for us to do the work that we're doing. Just to put into perspective that we distribute probably 1,200 doses of naloxone a month. We have distribution boxes all throughout Snohomish County. that we fill up. We have injectable and nasal. We get reports of probably 60 a month reversals by our participants alone that are probably not noted in Snohomish County Health Department because they're personal. So yeah, that would be a fear of mine that our hands are going to be tied even more so as things move on. And I could go on and on. I've already told you about all the services that we provide. That could be limited for accessing additional services if that happened.

Great.

I just want to just note we have six minutes left in the committee hearing But go ahead and then I don't know if we have another council member question or not, but then we'll be I'll be quick I this is a topic with their health officers across the state of Washington that comes up regularly and there's ordinances of a similar type being proposed Or discussed at multiple counties and I agree. I think this is something that's a Political movement to some degree that that I do see getting worse I would also point out the the Lewis County situation if you're not aware of that They proposed us an ordinance that was much more broad sweeping them what we're seeing he proposed today And they ultimately ended up having to repeal it which was very costly for that County Okay, thank you.

Okay Did you have a response, Andrea? Your mic is on.

Oh, sorry. Since it's on, I will just say I don't know anybody that fentanyl addicts don't test their fentanyl for fentanyl. It's 100% fentanyl, so I don't know. Test strips is a concern of mine whatsoever.

Okay, thank you. So five minutes left. Do we have maybe one more question that we can go to? I'm looking at you, Council Member, just because you haven't asked a question yet. Okay. Any questions from council members? Last burning question, Council Member Peterson.

And we can continue this discussion offline, but Dave, and thanks again for being here. A few months ago, we had, I think it was you and Sound Pathways and one of the recovery agencies, and you talked a little bit about kind of the three legs of a stool of going after kind of this drug crisis. You're in your office and focus mostly on the higher level dealers, but what it meant to have access for kind of the street-level users to have these other... Do you remember that when we talked about that, do you have anything to add to that? Because I thought that was really telling testimony, and that's why I wanted to make sure that you were here today as well.

Well, I think my only response specifically to that, and I appreciate you asking, is that, you know, when I talk about my three-legged stool, it's just really all about balance and public policy and public funding, right? If we continue to ignore one part of that stool, we're going to continue to fall down. You know, a lot of folks talk about the failed war on drugs. And quite frankly, I got to call BS on that. It's not failed. It's continuing. And it's just how we address it. The war on drugs, I think, is perceived to have been failed because it was one-legged, focused on law enforcement. Now, fast forward to today, and the legislature and other government bodies have pulled the rug out from under law enforcement and taken us out of the equation in many respects and focused on harm reduction treatment and recovery issues, which are all critical matters. But if you continue to ignore the supply reduction side of the equation, there's no other barriers. We've talked a lot about barriers today, and they are all very valid. But if we're not doing anything to address that supply side, we're going to continue to fall down as well. So that's how I have tried to address it. I've developed relationships with Shannon and other folks in health and human services, and we talk about what it's going to take to work together to deal with these issues and to support each other's messaging, public policies, and funding. So I don't know, Councilwoman Pitt, member Peterson if you're looking for more about that, but that is my perspective. You know, right now drug task forces across the state are at a breaking point of failing because of the lack of public funding. Um, we, we, we've lost it from the state level and from the federal level and, and you know, even my operations, no homeless regional, we're hurting and you're going to hear more about that from me in the future about why. but you know funding the drug task force at the at the expense of any other operation in the county I think would be short-sighted I think that we need to come at this from a collective collaborative viewpoint okay I think that's probably a decent place to end it we got about a minute left I just want to say thank you to all of you for all of your time and to the public for showing up and being available as well and the testimony that we had

I think we have contact information for all of you, and I think we have more questions and more conversation to be had than the hour that we had allotted. But I appreciate you all being here and being open and sharing your perspective and answering all of our questions and taking your time out on a Tuesday afternoon. So thank you all for being here. That brings us to the end of our hearing today, and council will be in recess.

We have an action item.

Oh, that's right. Thank you, Council Member Dunst. So our panel is done. You can all be excused if you'd like. But we do have an action item. And the action item was the ordinance itself. and the proposal at first, at least on the agenda, was to move it to set time and date on September 2nd. Council Member Neering had a perspective to keep it in committee, I think, or did you want to speak to what you'd like to see with this?

Yeah, I think it makes sense to, I don't know, whether we want to look at additional information or what's come out of the discussion to keep it in committee and then take action at a later time. I don't know that I'm at a place where I think it's ready to go on the 2nd, so I would like it to remain in committee for...

Okay, I see head nodding, council member Dunn.

No objection, that sounds good.

No objection from council members, okay. So then we will just hang on to this in committee and have no action on it for today. So that does bring us to the end of our agenda for today's meeting. We will be in recess until, I believe, 1 p.m., our 1 p.m. committee. Thank you.