Auditor: City Needs to Implement Smarter Strategies to Reduce Overdoses and Drug-Related Crime

The report recommends activating sidewalks, harm reduction, and other evidence-based approaches.

By Erica C. Barnett

The City Auditor's Office released a report on Tuesday calling for an "place-based problem-solving approach" to addressing overdoses and drug-related crime, basing its recommendations on local and national research as well as a case study focused on two blocks of Third Avenue between Blanchard and Virginia Streets, where there were 11 fatal overdoses, ten of them in or outside of the three permanent supportive housing buildings in the area.

This section of Third, according to the audit report, had the fourth-highest concentration of overdoses and "crime incidents" in the city; the top ten spots on this list are all in or around downtown, encompassing much of Third Avenue along with hot spots just outside downtown, including 12th and Jackson in the International District, around Harborview hospital on First Hill, and in the area around Pike and Broadway on Capitol Hill.

A "place-based" approach to overdoses and street crimes, according to the report, would include making the areas where drug use and illegal street vendors concentrate more appealing to people using the streets for other purposes— essentially dispersing drug activity and improving overall street safety by activating the sidewalks. For instance, the report identifies opening up sight lines in areas that are currently blocked by construction scaffolding and low-growing shrubs, opening up storefronts that are currently vacant to increase “natural guardianship,” and making other changes that are specific to conditions at specific locations, such as eliminating back-in angled parking on Blanchard Street. 

City Council Public Safety Committee chair Bob Kettle put out a statement in response to the audit, saying it showed the need for "additional meaningful action that includes a coordinated effort to address permissive factors at the intersection of public safety and public health." However, few of the recommendations explicitly involve police or a crackdown on the "permissive environment" Kettle often cites as a reason for crime. (The report does recommend that that Seattle police start investigating fatal overdoses, and says King County transit police should "increase patrol checks of bus stops and shelters" and enforce the Metro code of conduct.)

Instead, the audit points to the community-based project Rainier Beach: A Beautiful Safe Place for Youth, which used a framework developed by the Substance Abuse and Mental Health Services Administration’s (SAMHSA) to identify non-arrest interventions to address youth crime and victimization in Rainier Beach. Although the project wasn't connected to an immediate reduction in crime, a followup report found that it "significantly improved community members’ perceptions of serious crime and the police in the short and medium term" and suggested that "even communities with entrenched crime problems can leverage this capacity to reduce crime in the longer term."

The report also emphasized the need for "evidence-based" approaches to drug use, including medications like naltrexone and methadone that help people reduce or eliminate their opiate use, "wraparound human services," recovery housing, and harm reduction for people who continue using drugs.

Although Councilmember Sara Nelson, in a letter responding to the audit, wrote that the rise in fatal overdoses "reveal[s] the limitations of relying on our current harm reduction approach to address a drug that is so cheap, ubiquitous, and deadly," the report actually endorses harm reduction strategies like needle exchanges and naloxone distribution, and calls harm reduction "an essential component of overdose prevention framework."

The report does note that housing is not a panacea for preventing overdoses, which happen indoors as well as on the street. In 2023, 279 people in subsidized, permanent supportive, or abstinence-based recovery housing died from overdoses in Seattle. "Although housing is essential for addressing homelessness, new research suggests that housing alone does not sufficiently address overdose risk," the report notes

Nelson, a proponent of abstinence-only treatment, said this finding shows that the city should consider "modifying our current low-barrier, housing first model for city-funded affordable housing projects."

However, the research the auditor's report cites did not call for erecting barriers to housing or adopting a "treatment first" model that requires people to get sober before they "qualify" for housing and stay sober if they want to keep it—quite the opposite.

In fact, the author of the forthcoming study has written that existing research suggests the need for both low-barrier housing and "co-location of safe consumption sites, on-site provision of harm-reduction supplies, and expansion of peer workers" at permanent supportive housing sites. The study itself aims to confirm that it's possible to implement "gold-standard" strategies like harm reduction in permanent supportive housing, not test whether these strategies are worth pursuing.

 The study involves implementing three evidence-based strategies—overdose response, harm reduction, and support for substance use disorder treatment—in 20 existing permanent supportive housing buildings in New York.