Seattle's epic plan to fight heroin starts with a simple nose spray.
On Wednesday, April 27, Officer Drew Fowler rode his bike over Pike Street's rainbow-colored crosswalk and started pedaling back up toward the precinct.
Fowler is a tall, broad-shouldered man. Every day, he rides around Seattle's Capitol Hill neighborhood on his bicycle, as part of the Seattle Police Department.
On this particular day, it was the middle of the afternoon. Fowler and his partner, Officer Chris Myers, were ready to finish up their shifts and head in.
But as they started pedaling up Pike Street, something caught Fowler's eye. On the other side of the street were three men, sheltered in the covered stoop of a dusty, abandoned music store. They were all sitting down, but something didn't seem right with one of them.
All illustrations by Kitty Curran.
"There's no good way to explain why we were alerted," said Officer Fowler. "It was just that instinctual. The way he was laying, it was very unnatural."
In fact, the man was lying on his side, back twisted, legs splayed out on the sidewalk.
Fowler and Myers stopped, still balanced on their bikes on the other side of the street, and called out to the men: Is he OK?
The officers had to shout over the noise of traffic. The man's friends seemed out of it, but one of them vaguely waved his hand, as if to say come here, come here.
Fowler and Myers rode across and stepped into the doorway. The man wasn't just lying down. He was unconscious. Foam had settled around his mouth and he wasn't breathing. Fowler recognized the signs. The man appeared to have overdosed on some sort of opioid. If something wasn't done, he was probably going to die.
Opioid abuse is not unique to Seattle.
"Our nation is in the midst of an unprecedented opioid epidemic," starts a fact sheet from the U.S. Department of Health and Human Services.
It's estimated that about 2.5 million Americans are addicted to either heroin or prescription opioids. Overdoses have more than quadrupled since 1999. In King County alone, 229 people died of opiate overdoses last year.
King County is where Seattle is located, and county officials are determined to bring that number to zero — which is where Officers Myers and Fowler come in.
As Fowler leaned over the man, Officer Myers darted to his bag and pulled out a small syringe.
The precinct had given the syringes to all of Seattle's bike officers not even a month earlier, as part of a pilot program with the University of Washington and The Marah Project. The syringe was full of naloxone, a powerful medicine that can essentially hit the undo button on an opiate overdose. Opioids kill by latching on to the part of a person's brain that controls breathing, and naloxone fixes that.
Myers screwed on a plastic applicator tip and shoved the syringe up the unconscious man's nose. He pushed the plunger once, sending a spray of the medicine up into the man's sinuses where it would be absorbed straight into the bloodstream. He switched to the other nostril and pushed the plunger again.
Then, Myers and Fowler waited.
Naloxone isn't a new drug, but giving it to cops is a new idea.
Hospitals and medics have used naloxone to save lives since the 1960s, but for a long time, that was pretty much the only place you could get it.
Starting in 2001, however, states started making it easier for people everywhere to get a hold of it, and soon enough, police departments were interested. In 2010, the Quincy Police Department in Massachusetts became the country's first police department to equip all of its officers with naloxone.
Cops don't have the advanced training or equipment that medics do, but they do have one big advantage: speed. Cops patrol neighborhoods. Firefighters and medics don't. This means cops can get to a call quicker. They can also keep an eye out for public overdoses, like Fowler and Myers did. Medics still follow up, of course, but by equipping cops, cities can get someone help much sooner.
And seconds count when someone isn't breathing.
Within 30 seconds, Fowler and Myers' man started breathing again.
Deep within his brain, the naloxone went to work. Nerve signals started to flow again. Breathing signs reappeared. Color started to slowly return to the man's face. Within two minutes, he had opened his eyes. Within five minutes, he was sitting up and talking.
"It would be overly dramatic to say 'coming back from the dead,'" said Fowler. But the comparison is not without precedent. Either way, it's a "pretty impressive thing to watch over the span of 10 minutes," said Fowler.
Medics arrived to give the man a more thorough once-over. One shot is often enough, though sometimes patients need an extra dose or additional care. This man didn't. Within about 10 minutes of Fowler and Myers' first inkling that something was wrong, the man had completely recovered.
Saving lives is important, but if we want to defeat this epidemic, we'll need to address the root causes of it as well.
Much of the recent rise in opioid addiction has been fueled not by heroin, but by the rising availability of prescription painkillers. Prescription opioids used to be prescribed very narrowly and kind of as a last resort, but since 1999, the number of prescriptions has increased four-fold.
This is a problem because opioids can be incredibly addictive. Even people using them for legitimate pain relief — such as after a surgery — can end up addicted. In fact, the majority of people who end up using heroin turn to it because of a pre-existing addiction to prescription drugs.
There are also problems with how we treat addiction and the laws surrounding addiction as well. That can be frustrating to some people and officers, who may see naloxone as enabling an addiction or as just a stopgap solution.
Luckily, King County has been thinking about these problems too.
Washington is one of many states that has Good Samaritan laws, which provide some legal immunity to people who report an overdose. But they're not just dealing with this from a legal viewpoint. Seattle already diverts many low-level drug offenses away from prison and into community-based services or drug court.
"This is a social issue; it needs a social solution," said Seattle Police Department Sergeant Sean Whitcomb.
They've even put together an opioid addiction task force.
The mayors of Seattle, Auburn, and Renton commissioned the task force in March 2016 and have already put together a suite of recommendations. The naloxone program was actually one of their recommendations.
King County also wants to do things like institute prescription drug take-backs, remove barriers to anti-addiction therapies, and combine drug treatments with mental health and other care services. They want to set up safe-injection sites — an idea that's attracted a lot of controversy but has been working in Europe since 1988. The task force is also well aware that current War on Drugs policies have disproportionately hit communities of color and that it's important that they not replicate those mistakes.
Taken together, these recommendations would stop overdoses, get users help, and prevent new addictions in the first place.
Back at the doorway, Fowler and Myers' man was eventually able to get up and walk away under his own power.
As of this writing, the Seattle police have performed a total of 13 of these rescues — the latest on Oct. 20, 2016. Fowler and Myers were involved in another one of these rescues as well.
"I've heard [naloxone] referred to as, like, a miracle drug," said Fowler, "and that might be a bit strong, but — right place, right time, right people — it's a great confluence."
The data about these saves is being given over to scientists at the University of Washington, who will assess the efficacy of the program. But for the cops themselves, using the drug seems to be an easy decision. The training is simple and the drug itself is cheap and lightweight. Sergeant Whitcomb said there's been essentially no pushback in Seattle. Everyone seems keen on it.
In the end, all of this is about saving lives, which is a clear win for everyone.
"So much of police work exists in the gray area," said Fowler. You're doing the right thing, but it might not be easy and it may look different to different people. But this new program doesn't feel gray, according to Fowler.
"Getting the opportunity to do something so simple, but so impactful as saving a life, it's a good moment for a police officer."
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