To Seattle by way of Vienna
About five or six years ago I got excited about the idea of a trip to Seattle. We were at a café in Vienna, after a meeting of the UN Commission on Narcotic Drugs, and our American colleagues told us (me and my colleagues from EHRN) about an experimental study on decriminalization that had just started in Seattle. The premise was simple: police shifts in the city were randomly split into green and red. During a green shift, police would offer the detainees social assistance or treatment support. During a red shift, police would arrest them and transfer the case to court, as always. Presumably, state police actively supported this scheme, and maybe even had initiated it. We spent the whole evening talking about this project. What struck me the most was not just the fact that this was happening in the USA, a country that uses very repressive drug policy approaches (indeed, now we are getting used to hearing about marijuana being legalized in one state after another, but that was a few years ago), but also the scientific and somewhat medically rigorous approach to the study; this was a randomized drug policy study. What was inspiring was that if the project were successful it would have given us irrefutable arguments that alternatives to incarceration are more effective (and I have never doubted that social assistance and treatment work better and cost less than prison).
The project was called LEAD. Later I learned what was behind the abbreviation: Law Enforcement Assisted Diversion. Having demonstrated its effectiveness in Seattle, the LEAD approach began spreading in the USA. By 2017, seven US cities have introduced LEAD and five more are preparing to launch the program. By 2017, we at the EHRN have been convinced that the European Approach to diversion as an alternative to arrest is not systemic. It is controversial, understudied and not described in detail (this is not just my opinion; these are conclusions of an EMCDDA report which is highly recommended if you have not read it).
So, a few weeks ago together with a group of state and NGO representatives from Estonian and Lithuanian, we went to the US to see for ourselves how the program works.
When geography, harm reduction, and drug policy meet
To understand why this program was born in Seattle and why LEAD is what it is, you need to know a few things about Seattle. First, its geographical location: the city is on the West coast of the USA, in its northernmost part, close to the Canadian border. Summers are usually like this summer in Lithuania – it rains almost daily and the air temperature is 20 C on average. However, winters are mild; the temperature rarely drops down to zero. These relatively warm winters help explain how hundreds of homeless people survive on the streets of Seattle – and these are the homeless people whose problems LEAD was initially designed to address. 80% of people regularly detained by police for drugs or street sex work live on the streets. This is the first thing you should know to understand how LEAD works.
Second, it is the attitude towards harm reduction. Needle exchange started in Seattle in 1989. By the way, Washington (the state where Seattle is located) was the second state in the US to develop needle exchange programs. Compared to Canada’s Vancouver, which is only about 230 km away, there is room for improvement in Seattle; it still does not have safe injection rooms. But all the other elements seem to be in place: the needle exchange programs provide naloxone after five minutes of training, and the methadone program has about 3,000 people, which is quite a lot for a city with a population of less than 700,000. It should be mentioned that substitution therapy programs, including the one in Seattle, look more like prisons than health facilities (and for that they regularly receive criticism from the activists), but this does not surprise us. At least stable program participants receive take-home methadone. Seattle also has a same-day buprenorphine distribution pilot program right at the needle exchange site. This is some context for you.
Finally, it would be unfair not to mention that Seattle has legalized marijuana. There are coffee-shops, as it should be done. But this does not mean that in order to start LEAD they had to convince the authorities to legalize marijuana first. In Seattle, these were parallel processes, and marijuana was legalized in 2012.
How did all start?
Let’s imagine we are in 2011. Harm reduction is working, the authorities are discussing marijuana legalization, and police arrest homeless drug users on a daily basis. First-time detention with drugs (in any quantity “more than zero”) results in a minimum one-year sentence. Second detention is two years; third detention is four years, and so on. As we know, prison is not a cure for crime, and most of those who are sent to prison for drugs once will get their second and third sentence. As a result, 26% of the prison populations are doing time for drugs. At some point Seattle ran out of prison space, and the authorities had to decide whether to spend 120 million on a new prison or to do something from the perspective of spending taxpayer money more adequately. It has to be understood that a number of municipal officials in Seattle are elected. For example, a prosecutor is elected by way of a direct vote. The same people that walk the streets day after day and see the same open drug scene that their government spends lots of money to fight.
That was how the decision to launch LEAD was made; initially they decided to run a four-year program with the first two years being a pilot, as we discussed in Vienna; in the third year, the pilot was evaluated; in the fourth year, the decision was either to wrap it up or to make it a permanent program. Which was done because an independent evaluation conducted by the University of Washington showed that LEAD was effective as it resulted in a 58% reduction in repeat arrests and was less costly than arrest and imprisonment.
It works even without decriminalization
The technology is rather simple and, importantly, it works well given the already existing drug laws. That is, it does not require decriminalizing “hard drugs”, and the use and possession of those drugs is still prohibited in Seattle. If in the course of a police operation officers see a person that conforms to the LEAD criteria, they get in touch with a case manager. The LEAD criteria include the possession of up to 3 grams of drugs and absence of prior violent crime history. The case manager comes and meets the potential program participant, explains LEAD and finds out how to find the person (since these are homeless people, finding them can be challenging). One of the two staff at the prosecutor’s office that oversees the LEAD program receives this information. The next contact between the social worker and the program participant has to take place within 30 days. During that contact, a detailed form is filled out and based on the person’s request a case management plan is compiled. If the contact does not take place within 30 days the prosecutor submits the case to court. Are exceptions possible and can the prosecutor wait longer than 30 days? Yes, that is possible but they try not to let it get that far. The case managers, prosecutors, and police are working in collaboration.
Next comes the turn of the case manager. Each client has a unique primary request; some want to start by looking for a place to live, others want to get into drug treatment, and others want a job. The former being the least realistic option if the person does not have a place to live and there is significant instability because of drug use. But the case manager won’t try to talk the person out of looking for a job as an initial step, but will help to take that route. Upon realizing the impossibility of a stable job when other problems have not been addressed, the client will be better motivated to deal with their health and social problems. Of course, someone may be able to find a job first.
Many LEAD program participants have never worked. Many of them have never received treatment: neither substitution therapy nor rehabilitation. Many have a second diagnosis, which is an associated mental disorder. One may argue about the primary link in this chain: whether it is long-term dependency left untreated, mental disorders, unemployment or homelessness; however, many LEAD participants would not be successful if they did not receive support with finding a place to live. Often the LEAD case manager’s job starts with helping restore papers; this is necessary to obtain health insurance and unemployment subsidy (30% of which is co-payment for housing). LEAD works in partnership with housing programs; some of them know and want to work with drug dependent persons and people with mental disorders. But LEAD is also about taking a client to a substitution therapy clinic, finding them a place in a rehab center, accompanying them to a dentist. Monthly meetings between case managers and prosecutors and police are needed for assessing the progress for each case and ensure that the main goal of the program is being met: reducing recidivism and improving safety on the city streets.
LEAD clients need support and it is likely that they will need to be supported for a long time. This is why LEAD does not have a maximum term for working with clients; they can stay in the program for as long as they need to improve their lives. But the municipal authorities are convinced that support is better than punishment. Better for everyone, better for the city.
In June, EHRN together with Public Defender Organization, USA have organized a 3-days study tour to Seattle, WA for the delegation of NGO representatives and government officials from Lithuania and Estonia to examine drug policy practices based on health and social priorities, and learn about the implementation of the Law Enforcement Assisted Diversion (LEAD) program aimed to prevent recidivism of criminal behavior of people who use drugs and reduce social costs of drug use.
EHRN thanks the Open Society Foundations and the LEAD Support Bureau for the opportunity to visit Seattle.
Detailed information about LEAD can be found here: https://www.leadbureau.org/resources