The Opioid Crisis: What Can Cleveland Learn From Seattle?

Greater Seattle's unconventional approach to helping people with addicitions could be among the most effective in the nation.

In King County, Washington, officials compare their holistic approach to helping people with addictions in greater Seattle to picking up pebbles on a beach.

“Like the pebbles, you can’t gather them all,” says Dan Satterberg, the prosecuting attorney of King County, which encompasses Seattle, “but people you help have their lives forever changed.”

That might sound tragically familiar to Clevelanders. Like officials in Seattle, Cleveland-area law enforcement and treatment organizations have been scrambling to pick up as many pebbles as they can before the ever-advancing tide of opioids rushes in and swirls them away.

According to the Cuyahoga County Medical Examiner, 647 people died from drug overdoses in 2019, fewer than at the height of the crisis in 2017, but 96 more than in 2018. About 448 people died from the powerful opioid fentanyl, while 220 died from fentanyl’s more-powerful cousin carfentanil, which is used to sedate elephants and hippos. Those numbers have some officials concerned that 2020 could bring a “fourth wave” of the opioid crisis.

King County has been locked in a similar struggle. According to statistics from 2019, there were 429 overdose deaths in the county last year, 299 involving opioids. But while progress against opioids in Cuyahoga County seems to come in fits and starts, King County has created a comprehensive drug treatment program that could be among the most effective in the nation. It’s called Law Enforcement Assisted Diversion; Satterberg and other Seattle-area leaders established it in 2011. It is a model that Cleveland can learn from.

LEAD measures its success one life at a time, says Satterberg. About 800 individuals have participated in the program, and they tell success stories of going on to get their own apartments and holding down jobs. Instead of jailing nonviolent offenders for possessing or using less than a gram of drugs, police officers have the option to divert them into the LEAD system, where they work closely with a social worker to change every aspect of their lives and get access to services such as housing and treatment programs. LEAD isn’t a quick fix, but the program appears to be working, helping many embark on a journey toward change.

The number of drug deaths over the past 10 years in Cuyahoga County is much higher than the number in King County, even though King County has almost twice as many residents. A peer-reviewed University of Washington study also suggested that LEAD could slow down the street-to-jail-to-street revolving door, a cycle many Cleveland-area individuals find themselves trapped in.

“You have to understand that drug addicts do not get that way without a host of other problems,” says Satterberg. “Homelessness, mental illness, alcoholism, poverty — these are all things that work together. So simply trying to help someone kick an opioid addiction is not enough if that person is hungry and living on the streets.”

LEAD’s holistic approach has spread rapidly around the country, with 59 localities now offering LEAD initiatives or rolling them out. That change is expensive. The Seattle project’s 2020 budget is about $9.7 million, which is funded by the city and King County. It costs about $350 per month per participant just to provide case managers. But LEAD advocates say the program is cheaper than jail, homelessness and court.

Cleveland has not adopted a LEAD framework. But leaders here can learn from it. One LEAD fan is Scott Osiecki, chief executive officer of the Alcohol, Drug Addiction and Mental Health Services Board of Cuyahoga County. He sees a lot to like. “The ADAMHS Board offers programs that provide all the services that the LEAD program does, just not in one package,” says Osiecki.

The ADAMHS Board is currently working with the county and the Greater Cleveland Congregations, among others, to develop a pre-arrest diversion center, perhaps two. They could work like LEAD in Seattle.

“Once the program is established, a police officer would take an addict [facing arrest] to a diversion center instead of arresting him,” says Osiecki. “This does not include anyone involved in a violent or sexual crime. Once there, the person can get into a detox program or receive mental health services. They will also offer further services to help him.”

Osiecki also noted that Cuyahoga County currently has four residential treatment centers with detox programs for people with drug or alcohol problems. Together, they have 338 beds available, plus another 65 beds in three facilities for short-term detox.

“We know that jail is not the right place for a person to go through detox,” Osiecki says. “They already have these diversion centers in San Antonio and Dade County [Miami] and they are working.”

A recent settlement with major drug companies also presents an opportunity to put funds behind a LEAD-like program. Some money from the $179 million settlement is already being directed to immediate treatment. About $10.5 million will go to the ADAMHS Board. St. Vincent Charity Medical Center will receive $2 million to extend addiction treatment hours in the emergency room. The Stella Maris addiction treatment center will get $5.5 million to secure an additional 32 residential beds. $3.1 million will go to train recovering individuals to work with new patients, offering counsel. “They can look the person in the eye and said, ‘I’ve been there. I can help you,’ ” says Osiecki.

But the other important element of the LEAD program — foregoing prosecution for some — could be potentially controversial in Northeast Ohio. “In effect,” New York Times columnist Nicholas Kristof wrote, “Seattle is decriminalizing the use of hard drugs.”

Something similar could spur rancor here, as seen by the response in some corners to a recent push by Cleveland City Council to decriminalize marijuana possession.

Even so, local law enforcement has made friendly gestures toward shifting away from punitive enforcement, except in so-called “drug-induced homicide” cases. Cuyahoga County Prosecutor Michael O’Malley, for instance, agrees with focusing on rehab.

“People arrested for low-level possession, meaning low-level felonies, generally don’t go to prison,” O’Malley says. “The focus is on rehabilitation, not jail. We want to get them the help they need. In fact, it’s a common misperception that our state prisons are full of people in for low-level drug offenses. That’s not true. It’s about 1%.”

The uncomfortable fact is that the flow of drugs won’t stop. Dealers keep moving to more powerful opioid analogs, mixing them with other drugs. This year’s sharp increase in deaths is blamed on dealers stretching their heroin or cocaine supply by cutting them with fentanyl and carfentanil. The additives can be deadly in even the tiniest doses. In response, the ADAMHS Board hands out free fentanyl test strips. First responders have also been equipped with lifesaving Narcan. Even with all that, the illness of addiction persists. “We don’t want people to use street drugs,” says Osiecki, “but we know it will happen.”

Cleveland’s beach is still strewn with pebbles. Learning the lessons of programs such as LEAD could mean scooping up more of them, before the tide washes them away.