There is a vending machine in the foyer of Peer Seattle, the Capitol Hill-based counseling and social services provider.
It does not offer soda or snacks, and it does not cost money.
Rather, it is stocked with 300 packages of fentanyl test strips, 75 boxes of naloxone nasal spray and 72 boxes of intramuscular naloxone syringes.
The supplies, meant to detect the presence of or reverse the effects of deadly opioids, are free and available to anyone who walks by. Just scan a QR code, and the machine dispenses its potentially lifesaving wares. You don’t even have to talk to anybody.
In the midst of an overdose crisis killing nearly four people a day in King County, the vending machine is emblematic of the county’s push to make drug interventions and treatment widely available.
Last year, more than 10,000 people in King County used Medicaid to access drugs like buprenorphine and methadone, medications that treat opioid use disorder by reducing the craving for more drugs. King County’s Department of Community and Human Services has 11 locations throughout the county that offer walk-in access to buprenorphine. Appointments for medication-assisted treatment are available at dozens of providers around the county.
“People do recover. I think it’s really important to know that people do recover,” said Brad Finegood, who leads the opioid and overdose response for Public Health — Seattle & King County.
But the road to recovery is often long, bumpy and filled with setbacks. For many in King County, affordable, effective treatment remains out of reach. So the county strives to provide a spectrum of options, from things that can help keep people alive while they’re still using until they’re ready and able to seek further care.
“I can’t help folks if they’re dead,” Finegood said. “The county’s role is to help foster a continuum of care and services that in the community will serve anybody, no matter where they’re at.”
The county has mostly opted to treat the overdose crisis as a public health issue, not a criminal one, focusing arrests and prosecution on drug dealers, rather than individual drug users. The county prosecutor’s office has charged only two cases of simple drug possession in the last two years, according to a Seattle City Council staff report, due largely to receiving few referrals from local police.
Last year, 1,000 people in King County died of overdoses. Halfway into 2023, the pace has only quickened, with 647 deaths to date.
Most of the deaths are attributable to fentanyl, the high-powered synthetic drug that has replaced heroin — which previously replaced prescription painkillers — as the region’s and the nation’s illicit opioid of choice. Fentanyl was present in more than 70% of the county’s deadly overdoses last year.
It’s been nearly a year since the Metropolitan King County Council declared fentanyl a public health crisis. Since then, the county has launched advertising campaigns meant to both warn of fentanyl’s dangers and reduce the stigma of addiction and seeking help. It has also expanded the distribution of test strips and naloxone. And it has approved more than $1.25 billion to build five crisis care centers that provide walk-in services for people dealing with behavioral health crises, including addiction.
What it hasn’t done is stem the flow of overdoses.
“It’s a battle that, unfortunately, we’re not winning,” County Councilmember Reagan Dunn said. “We’re going to lose nearly four people each day to overdose. It could be homeless folks; it could be upper-middle-class folks at private schools; it could be anybody.”
Measuring the success or failure of local prevention efforts “can be a challenge” as overdose deaths rise across the country, said Sharon Bogan, a Public Health — Seattle & King County spokesperson. The department looks at the number of people connected to treatment such as buprenorphine.
But the first of the newly funded crisis care centers isn’t expected to open until 2026 at the earliest.
So public health is just as focused on harm reduction strategies that try to make drug use safer and less deadly as a first step of treatment.
“Ultimately, this is a national crisis, with a surge of imported and very inexpensive fentanyl across the United States, leaving cities and counties across the country to grapple with similar issues,” Bogan wrote in an email. “Without the interventions we’ve done to date, overdose deaths in our community would be unquestionably worse.”
In 2022, the county distributed more than 13,000 naloxone kits, which reverse an overdose in progress with an injection or nasal spray. Naloxone is effective more than 90% of the time when used on someone who is overdosing, according to a 2013 study. The county’s two-year budget, passed last fall, allocates $650,000 for buying and distributing naloxone.
“I feel like a lot of people want this stuff, but it’s not always easy to understand what the situation is at pharmacies or how to get it for free,” said Diana Beare, who volunteers at Peer Seattle once a week, working the front desk.
A state order in 2019 gave anyone the power to get naloxone from a pharmacy without a prescription, however, the drug is still hard to access because of cost and insurance issues, according to a Seattle Times report. King County will mail it to any resident’s house for free and distributes it from places like Peer Seattle’s vending machine.
Last week, Charles Webster was walking with a friend near Seattle Central College in Capitol Hill when someone called out for help.
Webster raced over, beating paramedics to the scene. Someone was in the midst of an overdose. Webster took out the naloxone nasal spray that he always carries with him and, with his thumb and two fingers, sprayed the drug into the person’s nose.
“It was us that were able to bring him back,” Webster said. He’d previously picked up the naloxone from the Peer Seattle vending machine. Webster goes once a week, picking up extra naloxone and test strips to give to friends or just to people on the street.
“I get all my friends to come in every time I walk past here,” Webster said. “I’m like ‘Let’s go get it, let’s go get it.'”
The county has also distributed more than 100,000 fentanyl test strip kits, which allow drug users to scrape off a tiny bit of pill, powder or rock, mix it with water and use a simple test strip to determine if the drug is laced with potent, deadly fentanyl.
The county sends test strips to hospitals, colleges and universities, municipal courthouses, homelessness service providers, community groups and service organizations like Peer Seattle for distribution. The county will also mail test strips for free to anyone in King County, although it can take up to six weeks for delivery.
The recently passed legislative package that raised the penalty for drug possession to a gross misdemeanor also clarified that drug test kits are legal. That law went into effect July 1. The change is uncontroversial — an earlier, narrower bill to legalize test kits passed the state House 96-0.
A county website, lacedandlethal.com, warns of the unpredictable, haphazard and deadly ways fentanyl is manufactured. It’s mixed into pills and powders, and the amount of the drug in each dose can be totally random. It urges people to never use drugs alone and to carry naloxone.
“Two salt-sized grains of fentanyl can be enough to cause an adult to overdose,” the website states.
It also directs people to a national hotline, 800-484-3731, where a crisis line operator will stay on the phone while the caller uses drugs and notify emergency services if the caller stops responding.
At Peer Seattle, there’s a steady demand for the test strips and naloxone available in the vending machine, said Christopher Archiopoli, the organization’s director. A handful of people a day generally use it, and Public Health — Seattle & King County, which installed the machine, refills it once or twice a month, Archiopoli said.
Why not just hand out naloxone from the front desk? The goal is to reduce as many barriers as possible that could potentially keep people from getting the materials.
“When I was actively using, the last thing I wanted to do was talk to anybody or acknowledge like, ‘Hey, I’m using drugs. I would like something to help me with that,'” said Archiopoli, who was an intravenous crystal meth user for five years. “So, if you don’t have to talk to anybody, that’s even better.”
Archiopoli credits the harm reduction model with saving his life. He’s been in recovery since 2016, after repeatedly seeking help over the years. Twelve-step programs didn’t work for him. It wasn’t until he found a peer-counseling-focused treatment that he was able to stop using.
“We don’t force anyone into anything,” he said. “Mandatory treatment doesn’t work; forced incarceration doesn’t work; none of those things work.”
Correction: This story was corrected on July 2, 2023, to reflect a new law exempting test strips from restrictions related to drug paraphernalia.
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