When she awoke from 10 hours of unconsciousness, Ashley Hempelmann managed one slurred sentence: “Let’s do some more.” She and her boyfriend had bought heroin earlier that day, gone back to their apartment, and shot up. “This feels great,” she thought, right before collapsing on the bed where her boyfriend monitored her shallow breathing and watched her skin turn blue.
Addiction for Hempelmann began during her last year at Cornish College of the Arts, in 2010, when she added Fentanyl, a smokable synthetic opioid, to her reckless lifestyle of booze and cocaine. The next several years were a blur. She shot up in secluded spots around Magnolia Park or inside cars parked on Capitol Hill. Or in the bathroom at Nordstrom. “I’d just waltz in, shoot up, and toss the bloody needles in the trash.” She also got fired from a couple of entry-level jobs, once for falling asleep at her receptionist gig at a law firm in the Columbia Tower, and for stealing at another.
There were useless stints in rehab too. Her well-off parents paid for expensive treatment, like a detox facility with horses in Arizona. When her parents couldn’t keep writing the $30,000 checks she turned to cheaper, and then, free facilities. All the treatments had two things in common, though.
They were all abstinence based. And they never worked.
In fact, she first learned to shoot up at one of the pricey rehabs. “Ten minutes outside of treatment,” she remembers, “and we’re in the car shooting dope. That’s how fucked up it is,” she says. “It’s insanity.”
A brief respite came about a year ago when Hempelmann got sober for several months while living at a free Belltown treatment center. Being out and on her own in the real world again, however, undid the treatment. “I’d actually been wanting to relapse the whole time I was there,” she admits. “It was all about abstinence and controlling you. How do you learn when you’re in a bubble? And then you come out…of course you’re going to be like a kid in a candy shop.”
Hempelmann’s repeated failures to beat heroin now inform a landmark experiment to address opioid addiction. In September, heeding a drug reform concept known as harm reduction, which prioritizes the immediate safety of users over stern mandates for abstinence, a local government task force made two key policy recommendations. First, increase access to restricted prescription opioid addiction medication like Buprenorphine (also known as Bupe), which dulls the desire for opioids. Second, and more radical, open a clinic in the Seattle area where addicts can get high.
The city council has signaled it wants to make this happen: Human services chair, Sally Bagshaw, who’s queueing up preliminary money to study a site in the budget for 2017, told me she wants “a safe injection/Bupe site soon. This is a breakthrough.”
That may be true, but it will be difficult to find a neighborhood in King County willing to house a site. As city council member Tim Burgess, who supports the idea, fretted at a briefing, “What do you say to people who say it’s going to create a problem…wherever these safe injection use sites are? We’re already starting to hear comments.” State senator Mark Miloscia, who represents part of King County, has also been critical: “Drug injection sites will only destigmatize and enable heroin users and dealers, which will only increase use and deaths.”
Those fears don’t jibe with what’s happening in Vancouver, BC, where Insite, a legal injection center, has existed since 2003. Crime has not increased in the surrounding neighborhood. Public drug use, moreover, has declined dramatically, along with a 35 percent reduction in overdoses in the area around the clinic versus a 9 percent decrease citywide. Insite has also brought down health costs systemwide, preventing 35 HIV cases a year and saving $6 million. And according to a study by the Canadian Medical Association, taking heroin use off the streets and into regulated sites benefits neighborhoods. “There were significant decreases,” a summary of the study stated, “in numbers of publicly discarded syringes, injection-related litter…and people injecting in the area.”
Heroin, of course, is illegal under federal law. But Seattle has led on radical drug policy before. Rather than seeing pot use, for example, as a serious crime, progressive leaders got behind recreational marijuana legalization after Seattle voters made pot arrests the lowest priority, paving the way for legalization statewide. Likewise local policy makers looking at the data now believe allowing addicts to use heroin is the best approach to saving them from heroin.
Task force member and University of Washington researcher Caleb Banta Green laid out this seemingly counterintuitive vision to the city council in early October. The first step? Understanding how bad the heroin problem has become.
Nearly seven million needles were exchanged at local exchange programs last year, compared to only about two million in 2000. Meanwhile, deaths from heroin overdoses have tripled in King County in the last five years. Other numbers point to possible solutions: Two-thirds of addicts say they want to kick heroin. And medically assisted treatment compared to counseling alone decreases heroin deaths by 50 percent.
Banta Green also notes that restricting access to medication like Buprenorphine (doctors have limits on how much they can prescribe) makes it more likely that addicts stay on the streets. In the “circuitous, crazy, destructive path” of an addict’s day, he told the council, “it’s the easier choice to…go find something to steal…go find a place to buy drugs, and go find a place to use drugs…than it is for them to go get a medication that costs $12.” (Unlike a high-dosage opioid like methadone, Bupe can be prescribed for home use, making it a more flexible option.)
“It’s important to take seriously not only prevention and treatment but also the place in between: a drug user’s health,” says Patricia Sully, a Public Defense Association attorney and coordinator for Voices of Community Activists and Leaders, or VOCAL—a group of active and recovering drug users helping to put a human face on reform.
The professionals on site at safe consumption clinics also guide people to recovery. A 2007 survey showed a 30 percent increase among Insite clients seeking treatment to get clean.
Those sites—regulated settings staffed by health professionals with well-lit booths plus rooms to ride out the high in safety—represent the exact opposite of shooting up out on the streets, which Hempelmann, now 31, describes as a minefield; iffy lighting and dirty needles. Terrified of being arrested, users rush and “maybe miss the vein and get abscesses,” she says. “And what do you do with the needles? You just toss them, which is gross and a public safety risk for everyone.”
On a gray, windy afternoon in late August, Ashley Hempelmann—with fashionably dyed blue hair—was in Westlake Park, fastening white helium balloons to hundreds of pairs of donated shoes. VOCAL was observing International Drug Overdose Awareness day by sending 320 pairs of shoes skyward in a vigil to honor the 320 locals who died from overdoses during the year. Hempelmann had taken an active role in the group a few months earlier, helping, for example, set up mock, popup drug-consumption sites around the city; people could step into a tent, see what safe sites looked like, and watch video footage from Vancouver’s Insite.
Safe consumption sites “take [addiction] seriously,” Hempelmann told me later. “You’re not just pushing people back into the shadows. It’s shifting from punishment of a ‘bad person’ to a public health issue—a medical condition just like anything else we have services for.”
Hempelmann is clean herself now. After relapsing last March when she left the abstinence-treatment program in Belltown, Hempelmann called her mom and admitted she was sneaking out of a Capitol Hill group house for recovering addicts and using again. Her mom invited her to move back home with the caveat that she go to Harborview, where a doctor administered Buprenorphine, stalling her craving to get high. She’s been sober and on the medication ever since. “It’s amazing,” she says. “It’s like my cancer treatment. It keeps me alive.”
At the Westlake vigil, a woman around Hempelmann’s mother’s age added a pair of shoes to the pile of donated ones. The pair had belonged to her own child, who had died of an overdose. “Her daughter was probably around Ashley’s age,” Sully, the Public Defense Association attorney, remembers thinking, standing at the vigil and looking at Hempelmann. “That could have been Ashley.” Instead, Ashley took the stage that evening.
There is a way, she told the crowd, to prevent more deaths.