Beyond the Needle
How Whatcom County is Increasing Public Health and Safety.
By: Olivia Marty
Illustration by Sam Fozard
When you walk around downtown Bellingham, Washington, you are bound to see the impacts of drug abuse, and it’s a sad sight to see; needles on the street and people in crisis. Since 2019, opioid-related deaths have more than doubled in Washington state and increased by 190% from 2005 to 2022, according to a study by the University of Washington Addictions, Drug & Alcohol Institute (UW ADAI). This same study found that in Whatcom County, the number of deaths related to opioids per 100,000 residents has increased by over 220% from 2004 to 2022, which exceeds the increase in population.
Another thing you may see downtown is a series of pop-up tents and blue shipping containers. These are manned by caring staff and volunteers from Whatcom County Health and Community Services’ Syringe Services Program (SSP). This program aims to help those impacted by addiction through a nonjudgmental approach, offering hope to an often-overlooked part of the community through a variety of services.
About the Syringe Services Program
The Syringe Services Program (SSP) has been operating in Whatcom County since 1999, providing several types of services for those struggling with addiction and in need of care. Nurses and volunteers help swap used equipment, such as needles, for sterile ones, which prevents the further spread of infection and bloodborne illnesses. They also test for these illnesses and provide further medical care and resources.
These additional resources include wound care, referrals to treatment facilities and connections to housing. All of these aim to provide a rounded strategy of care for their clients who may not normally have access to them.
“I think a lot of our clients function in survival mode, which is a high release of stress hormones, which has significant negative health impacts on them. So, if you can just address and meet some of those basic needs, you can improve health outcomes,” said Lela Riherd, a public health nurse and supervisor of the Harm Reduction Program, which oversees the SSP.
She said that SSP’s main benefit is its ability to provide this wide range of services and that Whatcom County Health and Community Services is continuing to adapt its amenities to fit the needs of a changing population.
“We're taking a big focus and recognizing that the population that we're serving doesn't tend to be able to participate in traditional health care,” Riherd said.
This lack of access to medical care has several complex factors for those who need it. Not only can it be difficult to physically and financially access medical care, but it can also be emotionally difficult.
The biggest thing that Riherd sees from this program is it allows SSP staff to interact and build rapport with a population that historically has been criminalized. The program takes a more humane approach by engaging with those dealing with addiction and providing support, rather than penalizing them, Riherd said.
“It's a different route, it's a different avenue, giving them a kind of exit ramp, a different opportunity,” Riherd said.
A different approach
Every state, county and city has its own way of addressing drug abuse and addiction. While the use of many opioids and heroin is illegal, criminalizing users has been found ineffective. A 2016 study by Human Rights Watch found that it often further devastates people's lives and does nothing to help those who need or want treatment.
Criminalizing drug use creates a stigma which in turn creates an intense feeling of shame. SSP and the Harm Reduction Program’s approach aims to minimize stigma, creating a safer environment for clients to seek treatment and care.
“Instead of judging someone for using substances or taking this zero-tolerance approach, it's based on acknowledging that as much as we would prefer that people not be injecting drugs. That's a reality that's going to continue and so if people are choosing to do that, we make it as safe as possible,” said Greg Thompson, a health officer for Whatcom County Health and Community Services.
They have seen this more empathetic approach leads to trust developing between the SSP and clients, which encourages clients to reach out for additional services. Staff and volunteers meet these people at their level and are approachable and friendly, Thompson said. They talk with some clients regularly and get to know them personally, making a positive change in their lives.
“This kind of stigma-free environment encourages people to access care when they would refuse to get it in other places,” Thompson said.
Dennis Tso and Sarah Best work closely with community members seeking SSP’s services and have developed personal connections with them. Tso, a retired registered nurse, has been a volunteer since 2012.
“I always found it amazing that once they felt comfortable talking to us and coming to us, all the amazing stories that they would tell us,” Tso said.
When Tso retired, he felt he owed it to his community to give back and that volunteering opened his eyes to an overlooked part of the population. Clients have always treated him with respect and kindness, and he said that these people should not be stereotyped.
Best, a nurse of 10 years, is the coordinator for the Harm Reduction Program services. She said these programs that run through Whatcom County Health and Community Services try to create a safe space for clients who have had negative and traumatizing experiences with the traditional medical system.
"I think that it really increases people's hope, and really increases their feelings of having autonomy over their own body,” Best said. “We have a saying within harm reduction circles: stigma kills.”
Harm Reduction Programs like the SSP are often somewhat controversial. A study by Westminster University found that many believe they encourage more drug use, increase crime, and do nothing to solve the real issue.
Best said people are going to make the choices they make, and there is no harm in helping people be healthier and supporting them. Pinnacle Treatment Centers, which facilitate drug rehabilitation, assert that programs like these decrease crime and are effective at keeping streets clean and people safe.
Rising addiction rates extend far beyond Whatcom County and can be seen in nearly every city across America.
Beyond Whatcom County
The opioid epidemic and the increase in drug use are common subjects in most modern households. People see the effects of it wherever they go. But what are the real numbers, and what is the real issue?
In America, opioid-related deaths rose by 15% from 2020 to 2021, and synthetic opioid-related deaths rose by 22%, according to the Centers for Disease Control and Prevention. These synthetic opioids are the most common cause of overdoses, especially fentanyl.
Fentanyl is a synthetic opioid created for treating severe pain and is 50 to 100 times more potent than morphine. The CDC cites that it is more common in its illegally made form, and is commonly mixed with heroin or cocaine, often without a user’s knowledge.
The Addictions, Drug and Alcohol Institute at the University of Washington (ADAI) states that in Washington, nearly 90% of all opioid-involved deaths in 2022 were from synthetic opioids like fentanyl. In contrast, the previous popular drug, heroin, is seeing a decrease in deaths, from 42% of opioid deaths in 2015 to only about 8% in 2022.
This decrease in heroin use and rise in fentanyl is seen in Whatcom County. Deaths per 100,000 residents involving fentanyl is over five times that of heroin, according to the UW ADAI. So how is this impacting the SSP?
Changes in the program
The SSP and Harm Reduction Program is now seeing less use of injecting drugs and a rise in smoking, especially when it comes to fentanyl. This change in pattern is causing them to have to shift their services to reach people more directly, Thompson said.
They are now focusing on their additional services, such as wound care, hygiene products and housing and treatment connections, while still operating as a safe disposal site and sterile needle exchange. These help people stay clean and healthy, which makes people more likely to decrease or stop use, Thompson said.
“Though things change, I'm always grateful as a volunteer that the health department is able to keep up with the changes and serve the needs of the clients. Especially with the rise of fentanyl that we've been able to still provide what the clients need,” Tso said.
Additionally, the SSP has dealt with location changes in recent years. In 2020, the SSP could no longer operate in the Health Department building and has been operating in a temporary location since. Currently, they are waiting for their new location to be built so that they can better serve the community in an established location; though it is currently under construction, staff are eager to move in.
How to help
Every Monday and Thursday, off York Street in downtown Bellingham from 2 to 4 p.m., nurses and volunteers from the SSP provide aid under a pop-up tent and blue shipping containers. The friendly and approachable staff are happy to provide the community who needs them with anything from a snack to treatment referrals. They reach out to everyone with the kindness and respect that they deserve as human beings.
“It's such a blessing working with this community because everybody is so kind and once they feel comfortable and safe, and like you're not gonna judge them, they open up a lot,” Best said.
For those who would also like to make a difference, many paths are available to get involved. One way is by carrying Narcan, or Naloxone, which is used to prevent overdose deaths. The SSP gives out Narcan for free and can be requested here from Whatcom Overdose Protection, a multi-agency group.
By emailing Whatcom County Health and Community Services at health@whatcomcounty.us, anyone can sign up to be added to a waitlist for volunteer opportunities with the SSP or other Harm Reduction Programs.
The Syringe Services Program is just one of the many programs in the country taking on the uphill battle of opioid addiction. They are a light in the Bellingham community, keeping the streets clean and people safe.