I wouldn't be surprised if a problem is that Seattle and Portland lack treatment capacity, because that's the big problem just north of the border in Vancouver,

I wouldn't be surprised if a problem is that Seattle and Portland lack treatment capacity, because that's the big problem just north of the border in Vancouver, which also has a big problem with toxic drugs use. Having safe drug use sites and replacing the illicit supply of toxic drugs with a safer known, prescribed source does a good job of preventing overdoses and preventing mass deaths, but beyond this there needs to be path ways to treatment. Where some places have failed and come under criticism is that while they've done the necessary step of implementing some harm prevention policy to keep people alive until they can access treatment, there hasn't been the follow through in creating treatment options. A major cause of the inability to create treatment options is that it's expensive and there's a severe shortage of doctors and nurses in general. Can't create treatment options if there's no one to work them.