Last week, the Downtown Emergency Service Center (DESC) celebrated the grand opening of its new Downtown Behavioral Health Clinic. Included onsite is its Opioid Recovery & Care Access (ORCA) Center, which will provide a safe landing place for people to recover after an overdose.
The new clinic is located at 515 Third Avenue, across from the King County Courthouse and just a block from the Pioneer Square light rail stop. It is set to open for service today (September 2).
The outpatient behavioral health clinic will provide services previously available at DESC’s old space, including psychiatric assessment, substance use disorder treatment, medication prescribing, nursing services, case management, and peer-led support services. DESC’s street outreach program will also be primarily based from the space. Other services provided that help the clinic develop a rapport with its clients include showers, laundry, snacks, and various group activities.
“We will use this space to provide our array of outpatient behavioral health services to people with complicated and long standing psychiatric conditions, to people with hard-to-treat substance use disorder, and people whose lives have been beset by challenges, traumas, and setbacks too numerous to count,” said DESC Executive Director Daniel Malone at the clinic’s grand opening event. “One pithy phrase that captures the spirit of this work is: we meet people where they are, but we don’t lead them there.”
The ORCA Center will provide a new component to DESC’s services, with 24/7 post-overdose stabilization for up to eight people and walk-in opioid use disorder treatment available daily from 9am to 11pm.
“It’s going to really enhance our capabilities in treating opioid use disorder, because we will be available 24/7, not just during the daytime, and able to receive people really in the immediate aftermath of having had an overdose event,” Malone told The Urbanist.
Services will be focused on medically stabilizing people who have just survived an overdose event, including keeping them physically comfortable as they start to experience withdrawal symptoms. Many people may not wish to go to the emergency room after an overdose but might be willing to come to the ORCA Center, a place specifically designed for them and their needs while offering a shorter wait time.
The idea of a post-overdose stabilization center originated with Dr. Caleb Banta-Green, a research professor at the University of Washington Addictions, Drug and Alcohol Institute (ADAI). Banta-Green told The Urbanist that the idea came through conversations with Dr. Michael Sayre, the medical director of Seattle Fire Department’s (SFD) Medic One. They wanted to meet the need for people who had survived overdoses but didn’t want to go to the emergency department.
The ADAI helped to design the new ORCA Center and will be conducting evaluations.
SFDs Mobile Integrated Health Program Manager Jon Ehrenfeld expressed his support for the new ORCA Center, saying his team already makes near-daily use of the DESC Crisis Solutions Center in the Chinatown International District.
“[Crisis centers] are absolutely essential resources for us and unquestionably provide comprehensive, trauma-informed, wraparound crisis services,” Ehrenfeld said. “In a similar vein they are also extremely important tools for diverting our clients away from unneeded hospital stays, thereby helping reserve emergency departments for critical patients.”
Continuing opioid crisis
According to data from Public Health–Seattle & King County (PHSKC), overdose deaths spiked in 2023 before beginning to recede in 2024 and then more or less plateauing. Death numbers remain elevated compared to 2020 and earlier. The majority of the recorded overdose deaths from 2021-2024 were due to fentanyl.
“We don’t know all the factors that may be driving the fluctuations, but it’s clear that we need to continue to advance public health approaches to preventing overdose across our communities,” said Sharon Bogan, a spokesperson for PHSKC.
In addition to supporting efforts like the new ORCA center and the new crisis care centers, King County has begun a 24/7 buprenorphine prescribing hotline in partnership with UW Department of Emergency Medicine and opened vending machines that have supplies such as naloxone and fentanyl test strips.
“We don’t fully understand all the factors at play in recent overdose trends,” Bogan said. She said that supply-side factors may play a role, and future changes in the drug supply could drive the number of fatal overdoses back up.
In 2024, SFD launched a pilot program allowing its paramedics to administer buprenorphine, the first such program in the country. A single dose of buprenorphine protects patients from an opioid overdose for one to two days. SFD recently announced its 100th use of buprenorphine in the field.
At the ORCA Center, patients will also be offered medication treatment for opioid use disorder, with a choice between buprenorphine and methadone. Methadone must be administered daily but can be more comfortable for some patients, whereas after the initial course of treatment, buprenorphine is a monthly injection.
DESC has recently pioneered a new protocol for treatment with buprenorphine that minimizes the discomfort of the process. They use a three-day ramp-up, gradually increasing the injection dose each day, until giving the full monthly dose on the third day.
A study of the new protocol published in mid-August in the Journal of the American Medical Association showed that 75% of individuals completed the three-day course of treatment, and 64% then received a second monthly dose. There are much more favorable results compared to a study on a different protocol using oral doses of buprenorphine, which showed only 35% of individuals completing the protocol and 22% of individuals still engaged after 28 days.
Part of the reason for the success of this new method is that it is often much less painful than the more traditional course of buprenorphine treatment.
That being said, people will only be able to stay at the ORCA Center for up to 24 hours, so in order to complete the initial 3-day protocol, they will have to return for the second and third injections. Malone emphasized how important it will be to find housing for people who want to engage in this treatment.
“We are extremely interested in increasing the opportunities to be able to refer people to places and get them in very quickly,” Malone said.
Local and national obstacles to care
“We take victories where we can,” said Seattle Mayor Bruce Harrell at the grand opening event. “The fact of the matter is that even without this facility, overdose deaths were down 20% last year in the county. This is some great work. Now, imagine the magic we can do now with this facility.”
However, budget pressures are already becoming a reality for the facility. With federal Medicaid cuts looming, DESC could find itself short on funding, as many of the outpatient behavioral health services offered by the clinic are Medicaid dependent. In addition to individuals losing their Medicaid due to new work and other requirements, the Medicaid cuts will place increased stress on the healthcare system as a whole, including hospitals, clinics, and behavioral health services currently provided by King County.
Operations for the ORCA Center in particular are currently being funded with a combination of funds from the state, the City of Seattle, and Medicaid. In addition to the Medicaid cuts coming later in 2026, Washington State was projected to face a $15 billion budget deficit over the next four years, and the City of Seattle is currently facing deficits in 2026 and beyond.
Malone told The Urbanist that Medicaid is also the main source of funding for the medicine DESC uses for addiction treatment. Buprenorphine injections are particularly expensive, even while they are easier for folks to tolerate as they’re getting started with treatment. Cuts to Medicaid could make it harder to pay for DESC’s new successful treatment protocol, leading to fewer opportunities for people seeking treatment.
Due to state and city budget difficulties, Malone said that right now, DESC is focused on making sure essential services will be able to continue.
One possible additional funding source could be the 0.1% public safety tax approved by the legislature this year. Council President Sara Nelson sponsored a resolution earlier this summer that expresses support for spending up to 25% of such a tax on addiction treatment services. Whether this tax will be proposed in Seattle during this fall’s budget season has yet to be determined.
If the Seattle Shield Initiative, the City’s business and occupation (B&O) tax restructure championed by Councilmember Alexis Mercedes Rinck, were to pass this November, it could also potentially fill some gaps in DESC’s funding.
“It’s worth celebrating that we are investing in this critical stage of overdose care, but it’s also not an endpoint,” Katie Wilson, the frontrunner in Seattle’s mayoral race, told The Urbanist. “We need to deepen investments in opioid treatment and recovery housing to support long-term recovery, which evidence shows requires investments in basic needs like housing alongside ongoing wraparound services.”
Challenging Harrell from the left, Wilson led the incumbent by nearly 10 points in the August primary, suggesting she’s the clear favorite heading into a general election rematch. Since his disappointing result, Harrell has been campaigning hard, scheduling plenty of ribbon cuttings, and leaning heavily on City departments to raise his visibility on social media.
When it comes to his response to rising homelessness, Harrell has been under fire for promising 2,000 new shelter beds in his first year in office, a promise he failed to meet. Instead, Seattle currently has 128 fewer beds than when Harrell took office in 2022.
Last year, Harrell also proposed transferring $287 million of JumpStart tax funds, much of which was meant to pay for affordable housing, to plug Seattle’s budget deficit and fund $100 million of his new priorities, which included more money to expand the Unified Care Team so it could perform homeless sweeps on weekends.
This winter Harrell agreed to be the face of the campaign against the initiative to provide a funding source for Seattle’s new social housing developer, which ultimately passed at the ballot box with 63% of the vote.
Harrell’s campaign woes aside, the opening of DESC’s new behavioral health clinic and post-overdose treatment center shows the power of local action, even in the face of federal threats.
“This ORCA Center, a larger sobering center, King County’s first crisis care center, a new residential treatment facility, and the STAR Center all opened within the past 12 months,” said King County Executive Shannon Braddock. “So despite the grim federal landscape that we are seeing, locally we have been able to make headway and, quite literally, open doors.”
Amy Sundberg is the publisher of Notes from the Emerald City, a weekly newsletter on Seattle politics and policy with a particular focus on public safety, police accountability, and the criminal legal system. She also writes science fiction, fantasy, and horror novels. She is particularly fond of Seattle’s parks, where she can often be found walking her little dog.
