Seattle’s drug crisis has become a full-blown public health catastrophe. In 2024, more than a thousand people died from drug overdoses in King County. The Seattle Fire Department reports responding to more than 100 overdose calls every week. Open-air drug sales and use are a common sight throughout the city.

Most fatal overdoses in Seattle involve fentanyl. In 2023, there were 1,087 fentanyl-related deaths compared to 34 heroin-related deaths. A synthetic opioid that is easier and cheaper to produce than heroin, fentanyl produces a high that is very intense, but very short-lived. This drives addicts to use the drug up to 20 times a day, creating concentrations of near-constant public drug activity in some areas of the city.

Fentanyl is one of the hardest drugs to stop using. It is up to 100 times more potent than heroin, making it highly addictive. Withdrawal symptoms are extremely uncomfortable and begin just hours after last using the drug. Yet access to effective substance use treatment in Seattle has remained out of reach for many people suffering from addiction to fentanyl and other street drugs.

Unhoused people are at particular risk of substance abuse disorder. Research has shown that lack of permanent housing is both a result and a cause of substance use disorder. Substance use disorder can cause people to lose their jobs, leading them to then lose their housing. In addition, unhoused people often use drugs and alcohol as coping mechanisms to help them escape reality. Seeking treatment while unhoused is extremely difficult. Many unhoused people may not have the resources or support network necessary to work towards long-term recovery. Finding food and shelter becomes a top priority for people on the street, leaving little time, energy, or motivation to seek treatment.

For economically disadvantaged and unhoused people who do seek treatment, Medicaid-funded treatment facilities have long been the only option as private rehab access in Seattle has remained out of reach. However, Medicaid-funded facilities are typically understaffed, underfunded, and cannot offer timely access to treatment. Three-month waiting lists are not uncommon. Staffing shortages and lack of funding mean that these facilities can’t offer a comprehensive range of treatment services. And federal funds only pay for a certain number of days of treatment, meaning that patients may be forced to leave treatment before they’re ready and, for the unhoused, before they’ve secured a safe place to live. A safe, stable living situation has been shown to support long-term recovery.

For Seattle’s unhoused and disadvantaged, delays in care can often mean denial of care. The importance of timely access to care cannot be overstated. Admitting the need for help with a substance use disorder is a decision that often takes weeks or even months to make. Research has shown that people are often in active crisis when they finally choose to seek treatment. So, when someone makes the decision to seek treatment, being able to gain admission immediately is critical to their recovery. Being placed on a waiting list for a Seattle addiction treatment creates a barrier that some people cannot overcome. They may take a waiting period as a sign that sobriety isn’t for them. Or they may give up on the idea of treatment entirely and continue to drink or use drugs. Studies show that people who have to wait a long time for treatment not only return to using alcohol and/or drugs, but also become increasingly involved with the criminal justice system.

To help remove barriers to treatment for unhoused and economically disadvantaged people, the City of Seattle has recently introduced a pilot program that helps fund private addiction treatment for people who couldn’t otherwise afford it. People who are considered good candidates for successful treatment are referred by organizations involved in direct outreach with the unhoused, including Purpose Dignity Action, We Heart Seattle, and REACH. Currently, program participants are people who have engaged in ongoing case management. This has allowed caseworkers to refer people struggling with addiction to treatment as soon as they’ve made the decision to do so. Once a patient has completed treatment, the city of Seattle is billed directly for services. As the program is in its infancy, a standard for success hasn’t yet been established.

The program is the brainchild of City Council President Sara Nelson. Nelson herself went through treatment for alcohol use disorder at Lakeside-Milam Recovery Centers in Seattle. The experience convinced her that all people suffering from substance use disorders deserve a chance at recovery. In 2022, she introduced the idea for a program in which the city would pay for treatment at private recovery centers. Although Nelson didn’t achieve her initial funding goal of $2 million, the City of Seattle agreed to allocate $300,000 towards the program.

This program is one of the many ways that Seattle has tried to address the flood of fentanyl and other street drugs that has disrupted life for many in the city. Past and ongoing efforts to address Seattle’s drug crisis include:

• prioritizing enforcement of laws prohibiting the distribution and sale of narcotics
• creating an overdose response program with the first responders of Seattle Fire Department
• instituting an incentive program that rewards people suffering from substance use disorder for abstaining from use and engaging in treatment services
• working with public health partners to expand access to post-overdose medical care
• controlling access to certain public areas to discourage open-air sales and use
• identifying and focusing resources on certain geographic areas considered to be “hot spots” for crime and drug use
• creation of drug court programs that seek to address the underlying causes of addiction

This pilot program is different in that it addresses providing timely access to treatment on an individual level and is focused on helping people achieve lasting recovery. Addiction is a complex problem that cannot be solved by one single institution or industry. By bringing together the resources and capabilities of the public and private sectors to create treatment solutions such as this pilot program, we’re able to leverage the expertise and experience of private rehabilitation facilities for the good of the entire community.

Lakeside-Milam is the only private substance use treatment facility that has been willing to partner with the city to expand access to Seattle addiction treatment. After satisfying the city’s requirements for participation, Lakeside-Milam helped roll this program out to those who need it most. So far, we’ve accepted 10 people into treatment with the hope that we will soon be able to help hundreds and even thousands more.

Lakeside-Milam is involved in many facets of addiction care in Seattle and Washington state. We train medical professionals in addiction care. We help develop policies and programs for drug-free workplaces. We work with the justice system on court-supervised treatment programs. Most importantly, we are committed to providing compassionate, effective treatment for people suffering from substance use disorders. We do this because we believe that everyone is deserving of the best substance use disorder care available. We’re committed to expanding access to addiction care so that we can be there for our patients when they need us most. We have chosen to be in the business of helping people to heal their lives from the destruction of the disease of addiction because we believe that our work not only restores individuals, but communities.