HEROIN is back, swallowing up lives in Seattle and in rural areas at a rate unseen for more than a decade. Unlike the grunge-era heroin epidemic of the 1990s, there is now a low-cost antidote to overdose. The state and its county public-health partners must work to put this lifesaving tool in the hands of as many people as possible.

The number of deaths to heroin overdose in King County has doubled since 2009, to 99 last year, the highest total since 2000. Overdoses among people age 30 or younger have risen the fastest.

The University of Washington’s Caleb Banta-Green, who tracks drug trends, notes that treatment admissions for heroin are now well above the level of the late 1990s.

Heroin has a historical hold in Seattle, but just as concerning is an apparent rise in use in rural areas. First-time treatment admissions for heroin, as well as police seizures of the drug, have spiked in the I-5 corridor north of King County and in Southwestern Washington and in the coastal counties in the past decade.

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What’s driving this trend? The state wisely clamped down on access to prescription opiate drugs such as OxyContin — known as “hillbilly heroin” — when overdoses rose in the mid-2000s. The manufacturer of OxyContin altered its formula, making it harder to crush and snort. Real heroin, especially cheap black tar heroin, stepped in to grip a new generation of users.

Fortunately for this generation, the antidote called naloxone is increasingly available. Available for as low as $3 a dose, it should be in the tool kit of public-health and emergency responders. Ensuring this should be a priority of both the state Department of Health and county-level public-health agencies.

The UW’s Banta-Green rightly argues that needle-exchange sites are the best place to distribute this lifesaving antidote because about half of users have witnessed an overdose.

King County, seasoned by previous heroin epidemics, wisely distributes naloxone via needle-exchange clinics. Since March, it also has provided naloxone kits at the King County Jail in Kent to discharging inmates who self-identified as wanting the antidote, for themselves or for a loved one.

For the state, it is even more critical to ensure naloxone is readily available outside King County. Congress has made this issue more complicated, reinstating a ban on federal funding for needle exchanges in 2011. That wrongheaded policy artificially limits the number of viable sites in the very areas where they are now needed the most — particularly rural and economically distressed counties.

The state should compensate with a cogent plan to ensure needle-exchange sites are funded, and naloxone is stocked. Naloxone itself won’t kick the scourge of heroin, but it can ensure that users stay alive long enough to seek treatment and kick it themselves.

Editorial board members are editorial page editor Kate Riley, Frank A. Blethen, Ryan Blethen, Sharon Pian Chan, Lance Dickie, Jonathan Martin, Erik Smith, Thanh Tan, William K. Blethen (emeritus) and Robert C. Blethen (emeritus).