The magazine of the UW School of Public Health

Download full issue PDF. Spring/Summer 2017
Volume 34, Number 1

Inside this issue


Gateway to Support: A Harm Reduction Approach to Opioid Use and Addiction

Dan Otter, a graduate student at the UW School of Public Health, worked with the King County Heroin and Prescription Opioid Addiction Task Force to make recommendations for implementing two supervised consumption sites in King County, Washington.

By Laura J. Haas

Dan Otter, a graduate student at the UW School of Public Health, worked with the King County Heroin and Prescription Opioid Addiction Task Force to make recommendations for implementing two supervised consumption sites in King County, Washington.

As in many communities across the nation, the spike in addiction and fatal overdoses from heroin and prescription opioids has reached crisis levels in King County, Washington. In 2015, 211 individuals died from heroin and prescription opioid overdose in King County alone.

To combat the epidemic, local officials endorsed recommendations made by the King County Heroin and Prescription Opioid Addiction Task Force, which included the implementation of two supervised consumption sites. Dan Otter, a graduate student in the UW School of Public Health worked with the Task Force to help inform these recommendations. He researched best practices of supervised consumption sites in cities abroad for his capstone project. While these sites would be the first to be established in the US, some cities abroad have been implementing harm reduction strategies through supervised consumption sites for over 30 years.

Harm reduction recognizes that people do and will use drugs. The pragmatic public health response is to limit the harms associated with drug use. This includes services like needle exchanges, medication assisted treatment, and Narcan distribution. Supervised consumption sites offer people who would otherwise engage in high-risk behaviors, such as injecting outdoors, a safer alternative.

“Prevention and treatment are only part of the answer; we also need harm reduction interventions,” said Otter. The reality is that there’s a population of drug users who are not ready or able to seek treatment. Behavior change is a process. “Supervised consumption sites can reduce drug-related harms to individuals and the community. They also serve as a gateway to support services for our most vulnerable and marginalized community members.”

Factors such as homelessness, mental health issues, unemployment, trauma, and violence can not only be the impetus for drug use and addiction, but can also cause people to become disconnected from mainstream social and health services. Furthermore, stigma and lack of trust in the health care system can create additional barriers for those seeking help.

For his capstone project, Otter evaluated the harm reduction principles of supervised consumption sites operating in cities abroad. Otter used a stipend from the Northwest Public Health Training Center, housed at the Northwest Center for Public Health Practice, to write up his field research findings once he returned to Seattle.

Safe Consumption Sites

Safe consumption sites in Amsterdam (left) and Frankfurt (right).

While abroad, Otter visited ten sites in six different European cities, and identified the best practices that could be applied to the King County sites. He observed daily operations and interviewed staff and managers on the successes and challenges of these sites.

Otter learned that sites are typically staffed by both social workers and nurses. While some sites had staff trained only in CPR, others had the ability to administer Narcan, a lifesaving drug that reverses the effects of an opiate overdose. “Overdose response protocols varied depending on the site’s needs and local context. Regardless of protocol, nobody has ever died in one of these facilities. Most of the time people just need oxygen. But you need someone there who is able to intervene,” said Otter.

One of the more surprising approaches Otter discovered is that promoting the smoking of drugs rather than injecting them is a widely practiced harm reduction intervention. “While providing a hygienic space for injecting is critical, it is also important to provide a space for smoking, as injecting drugs puts you at greater risk for infectious disease and overdose,” said Otter.

But perhaps the biggest takeaway for Otter was that consumption sites offer support where none often exists. “In addition to promoting survival and health, these sites have the potential to engage people, build relationships, connect them with needed services, and most importantly create a sense of community and acceptance. These site are as much a social service as they are a health service,” said Otter.

This key finding was one of the driving factors behind the Task Force using the term Community Health Engagement Locations, rather than supervised consumption sites. The research evidence that Otter gathered ultimately supported the policies and program implementation of the two King County sites. He also wrote an online FAQ for the locations.

Working as a research consultant for the Task Force was a unique hands-on learning experience for Otter. “Visiting consumption sites and participating on the Task Force allowed me to build connections with some of the leading voices in the public health and harm reduction fields. It’s rewarding to know that my work as a student has helped Washington State pave the way on evidence-based harm reduction interventions.”