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In Seattle, the struggle against drugs

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The 1994 suicide of grunge icon Kurt Cobain in the midst of his struggle with heroin addiction was a hint of things to come for Seattle. By the late 1990s, heroin-related deaths in the city hit one of the highest levels in the country, soaring despite the $40 billion spent nationwide each year to combat illicit drugs.

Beginnning in 1994, heroin-related deaths per 100,000 people in Seattle nearly doubled, hitting a total of 144 in 1998. The number of heroin addicts in the city rose to between 15,000 and 20,000. Set against a backdrop of pristine mountains, lakes and ocean, Seattle earned the dubious distinction of heroin capital of the United States.

Since then, Seattle and surrounding King County have pushed ahead with several new initiatives to cope with the heroin fallout, including programs that could become models for the nation.

The first order of business was to expand access to methadone treatment. The synthetic drug, taken daily, is a tried-and-true way for many addicts to quell their cravings for heroin, providing them with a fighting chance to get their lives back on track.

Despite its track record — it’s been around for at least 20 years — methadone remains controversial and is still illegal in some states. In Washington State, some counties prohibit methadone treatment clinics, and even where it is permitted, treatment is limited to 350 patients per clinic.

What Seattle’s Evergreen Treatment Center did was extend its geographical reach to outlying areas by offering services through a mobile methadone van, just the third of its kind in the country. Moving to scheduled locations around the city, the mobile unit provides methadone treatment to 175 people each day.

Not only is the van approach economical, it also avoids some of the inevitable neighborhood resistance involved in setting up a new bricks-and-mortar drug clinic.

Another pioneering effort, this one taking place at Harborview Medical Center in Seattle, moves stabilized heroin addicts, usually people who have been on methadone for years, out of drug treatment programs and into traditional health care settings.

For Frank, a long-time recovering addict, the Harborview program dramatically improves his chances for continued success, and a normal life. He now has no need to visit the drug treatment center, where he would encounter unstable addicts who are just getting started. He also gets medical attention for all his health concerns.

And unlike new methadone users, who must take their daily dose of methadone under supervision, Frank needs only to come in once a month to pick up his medicine and take it at home. It helps him put the dark days of addiction far behind him — the disintegration of his family, the loss of his job and the jail time. A long-time government employee, Frank has been on methadone for 15 years, has a new family, and new ambitions. “The program allows me to spend more time with my family and my job, and pursue some new challenges,” he says. “Taking methadone has become like brushing my teeth.”

The Harborview program is a triumph on two levels. It helps remove the stigma of heroin addiction that has kept it separate from treatment of other chronic health problems, and moves people out of treatment slots at centers like Evergreen, where others desperately need the space.

War weary
Seattle’s experience is emblematic of what has been going on around the country. The long-time war on drugs has failed. Though prison populations have soared — to more than 500,000 incarcerated just on drug offenses — the drug problem has only changed but not disappeared. Not only have old drugs like heroin resurfaced — now purer and cheaper than ever — but new and lethal drugs such methamphetamines have proliferated.

And the effort to end a cocaine epidemic starting in the 1980s has resulted in fewer users in certain social classes, but just as much cocaine consumed, in total, by hard-core users.

Seattle’s innovations emerge as a part of a national patchwork of programs aimed to make a dent in a growing drug epidemic, many of them getting away from the punitive style of the last decade.

“The future of drug policy reform over the next few years will be at the state and local levels, where people are searching for pragmatic solutions to local drug problems,” says Ethan Nadelman, executive director of the Lindesmith Center-Drug Policy Foundation. “The White House and the new Congress should stay tuned.”

Here is a look at what some states and cities are doing:

Drug courts: Since Janet Reno pioneered the notion as a prosecutor in Florida in the early 1990s, some 600 similar courts have mushroomed around the country. Drug court judges can impose substance abuse programs as an alternative to prison. If the addict doesn’t stay with the program, the threat of jail time remains.

Reassessment of drug laws: With overcrowding in jails, New York State, famous for its draconian 1973 Rockefeller Law, which included a mandatory 15-year minimum sentence for possession of relatively small amounts of drugs, is looking at shorter prison terms for nonviolent drug offenses and allowing judges to divert drug offenders to treatment.

Voters weigh in: In November, California voters overwhelmingly passed an initiative that allocates $120 million per year for a wide range of drug treatment options, including job and literacy training and family counseling and is expected to divert as many as 24,000 nonviolent offenders and 12,000 parole violators to drug treatment instead of jail.

Harm-reduction: Some communities are looking for ways to minimize the fallout caused by drug addiction. Seattle, for instance, is expanding its needle exchange programs to prevent the spread of disease among heroin addicts, after witnessing an HIV epidemic erupt in Vancouver, Canada, just to the north, in the late 1990s.

While new ideas to fight drugs abound, most are dwarfed by the magnitude of the problem, and will be until they receive massive federal and state funding. In Seattle, for instance, even with the expanded methadone treatment, the waiting list for the program is at least 600 names long.

At the moment, drug policy appears to be in limbo. While President Bush has made positive noises about drug treatment, he has not yet appointed a drug czar who would spell out policy. Secretary of State Colin Powell has pledged commitment to the $1.3 billion military funding package to stop Colombian drug production. And new Attorney General John Ashcroft has opposed leniency for drug offenders and programs such as needle exchanges.

It remains to be seen whether these divergent views can be forged into a fresh, coherent policy, and importantly, whether programs that address drug abuse will get the funding they need to be something more than a bandage on a gaping wound.