City Drug Strategy Could Lead the Nation

Santa Fe considers a municipal drug strategy based on harm reduction, treatment, and prevention

For over a year, Santa Fe's Municipal Drug Strategy Task Force has been busy collecting information to help the city come up with a new vision for tackling a legacy of high drug abuse and overdose rates.

Policies that criminalize drug use have failed to curb the intergenerational harms experienced by communities and families in the grip of addiction. So instead of perpetuating a failing system, the task force is crafting a plan for the city with policy recommendations founded on evidence-based principles of harm reduction and prevention.

Santa Fe is only the second city in the United States to consider adopting this kind of municipal drug strategy, but similar strategies have been implemented in cities across Europe in recent decades with tremendous success.

"I think it's really important that we recognize that local government has a role when it comes to drug and alcohol use. We don't have to wait for the state, we don't have to wait for the federal government for these resources and ideas to trickle down," Emily Kaltenbach, the task force chair, tells SFR by phone.

Kaltenbach is also the state director of the Drug Policy Alliance and has worked on municipal strategies at both a national and local level.

At a City Council meeting Wednesday, she presented the task force's plan in progress and explained the nuts and bolts of a municipal drug strategy to city officials for the first time. Andres Mercado, the Mobile Integrated Health Officer at the Santa Fe Fire Department, gave councilors insight into a drug and alcohol plight that is worse here than most places, which is part of why the city desperately needs to try new strategies.

Santa Fe County's levels of youth binge drinking, drug overdose death, heroin use among 9th to 12th graders, and opioid overdose-related ER visits are all higher than the state rate and much higher than the country.

Mercado estimated that around 35 to 40% of 911 calls to which the Fire Department responds are related to alcohol and drugs. The department administers naloxone to a person showing signs of overdose once every other day, on average. When he takes the distribution of naloxone to community members into account, Mercado estimates that at least one overdose a day occurs in the county, where the Office of the Medical Investigator recorded 98 deaths from that cause in 2018.

"Alcohol and drugs are a daily cause of 911 calls, injuries and suffering, so I applaud the work of the Municipal Drug Task Force and the leadership of the governing body," he said. "From the Fire Department perspective, I think it is an area that is full of opportunity for us to accomplish our mission."

City councilors expressed support for the continued work of the task force and concern about the numbers highlighted by Mercado.

The Santa Fe Municipal Drug Task Force was convened under former mayor Javier Gonzales in 2017 and enjoys support from the current mayoral administration under Alan Webber.  It is comprised of individuals from public arenas that deal first-hand with the impacts of drugs and alcohol, including healthcare providers, law enforcement, a public defender, and family members of those with addiction.

In addition to collecting data and evidence-based research on what's working in other cities and countries, the task force held community conversations with individuals whose lives have been most directly impacted and other stakeholders to find out how to create an approach that is uniquely tailored to Santa Fe.

These conversations addressed areas of prevention, treatment, harm reduction and emergency response and public safety, and for the most part the responses documented in a task force report carried the same refrain: The city needs to move away from criminalization to more community-based solutions, and to address the root causes of problematic drug and alcohol abuse.

According to the findings, Santa Fe needs more treatment options and opportunities for community interventions and more, better education about the harm reduction and treatment options that already exist. These include  naloxone distribution, needle exchange services and programs such as LEAD (Law Enforcement Assisted Diversion), which allows law enforcement to divert low level, non-violent offenders with substance abuse problems into behavioral health and other community services as an alternative to incarceration.

In 2014, Santa Fe became the second city in the country to pilot a LEAD program. While early evaluation results show that LEAD has successfully reduced recidivism rates, overdose rates, and court costs for individuals engaged in the program in Santa Fe, its impact remains relatively small with only 179 diversions recorded since 2014.

According to the task force report, many law enforcement officers polled continue to see their role as preventing crime through more punitive measures. This is in contrast to 90% of registers voters polled who agreed that the city should shift resources from arrest and imprisonment to treatment and rehabilitation.

The Santa Fe Fire Department has also taken a stab at alternative intervention services with MIHO (Mobile Integrated Health Office), a program launched in 2016 in response to 2014 survey results indicating that the most frequent users of emergency medical services –– about 3% of 911 callers –– sucked up at least 18% of the city's EMS resources each year. MIHO sends paramedics on home visits to frequent 911 callers with chronic medical and behavioral healthcare problems to connect patients to healthcare services that could help avert future calls.

Such efforts are making a dent in the city's drug and alcohol crisis, but they are still the exception rather than the norm, Mercado says.

Final recommendations from the task force are due by the end of the year. The list could include everything from affordable housing to improved jail treatment and re-entry programs. One of the most controversial treatment options on the table is injectable opioid treatment centers where users could come to inject small doses of opiates in supervised conditions. So far, Ithaca, New York, is one of several cities exploring supervised injection, but no official sites exist yet in the US. Such services have proven to be a successful part of harm reduction programs in cities in Europe and Canada. As the New York Times recently reported, fatal overdoses in Vancouver dropped 35% in the community surrounding its main injection site in the two years after it opened in 2003 and fell 9% citywide.

All in all, Kaltenbach says the task force is looking into every possible option to find what will work in Santa Fe. Prioritizing recommendations into short, middle and long term strategies is next.

A previous version of this story misidentified Ithaca, New York, as the only city to pilot supervised injection. Ithaca is one of several US cities exploring this option but has not yet initiated the program.

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