Against fentanyl’s deadly odds, Seattle team gets creative to help youth

Johnny Ohta walks by teens camped out on a stairwell at the University District Youth Center, a drop-in center where he’s connected with youth in addiction for the better part of two decades.

A little white dog is off its leash, and rainbow chains cut from construction paper float above doorways. On a blackboard, someone has written: “We love UDYC.”

Ohta, a 69-year-old substance use disorder professional, has just learned this Seattle youth center — one of few across a city contending with an extraordinarily deadly fentanyl crisis — is ending nearly all of its drop-in programming.

An intense need for addiction services here has never been enough to stop their corrosion, even as opioids have killed, on average, more than three Washingtonians under age 25 every week for the past two years.

Ohta, whose grit beats his grief, absorbs the news about the closure by doing the only things that have ever made sense to him.

Show up. Check in. Get to work.

As the number of young people killed by overdoses accelerates, Ohta is competing against the dissolution of the system meant to save them. Ohta and three colleagues, who together make up one of the city’s most nimble addiction teams, have bettered countless young people’s lives. But with little funding or structural support, they’re running purely on force of will and are playing an outsize role in a treatment and financial landscape that makes it near impossible to scale their success.

Ohta’s four-person team exists outside conventional medical realms — in part out of necessity but also because it’s simpler and faster. Their young clients often are skeptical of doctors’ offices and emergency departments. “Treatment” isn’t a word Ohta uses to describe his work.

The team shows up at clients’ homes, schools, shelters or encampments. They give them rides to appointments, pick up medications, locate critical documents like birth certificates and source laptops they need to apply for jobs or finish their GED (“Basically, we don’t say no very much,” Ohta said). One team member — a substance use disorder professional named Abbie Woods — knows the housing world inside and out. Another member — Kaiser Permanente family medicine physician Dr. Taryn Hansen — meets youth at parks and restaurants to prescribe addiction medication.

“No one on the planet is doing what they’re doing,” said Diana Quall, a King County juvenile probation counselor who recently called Ohta about a kid taking street Xanax laced with PCP. Ohta was at the youth’s home within four hours.

Strikingly, the team also operates in defiance of one of the biggest factors driving how health care is provided: money.

Funded by philanthropy and about $540,000 in annual government contracts, the team has found a way around the low reimbursement rates and red tape of private and government insurers. It gives them flexibility, but it also means they’re walking on a financial tightrope.

Ohta is one of Seattle’s most visible and well-known recovery emissaries. Through his special kind of physics — one that calmly but persistently cracks the hardened shells of kids kicked to the curb — he convinces many of them to accept help. His own recovery experience counts for a lot when he’s first getting to know a kid in use (It’s obvious he’s “been through some shit,” Ohta said).

Over and over, though, his goodwill is confronted by the quicksilver system surrounding him.

“A lot of kids are not alive anymore,” he said. “Part of moving forward and doing a bunch of different things for young people is so you don’t get stuck in the sadness of it all.”

On the periphery

History repeats itself: Half a century ago, Washington was faced with a surging youth drug crisis, and people who cared built the foundations of a treatment system that rose up and then broke down. Now, Ohta, whose recovery story parallels the ebbs and flows of treatment here, is caught in the middle as the system again faces an inflection point: Whether to accelerate or backpedal on-demand services for young people addicted to deadly drugs.

Ohta grew up next to housing projects on Potrero Hill in San Francisco. His parents — a longshoreman and a union worker — took him and his four siblings to Vietnam War protests and instilled the idea that, “If you’re not doing something for someone else, well then you’re just not living.”

When he dropped out of high school in ninth grade, they sent him to a wilderness camp to keep him off the streets; he learned to sail, to backpack. But it was the late 1960s, and changes in youth culture and the availability of drugs were explosive on the West Coast.

Ohta began using.

Nearly 1,000 miles north, a rise in adolescent drug arrests jolted Seattle’s attention. A government report from the time described Seattle much like you might today: “Attractive to its own youngsters and to other youths throughout the country … It has become a summertime mecca for runaways, many drawn by the relatively wide-open drug scene and the relaxed atmosphere.”

But the adolescent addiction treatment landscape was “barren,” said Fritz Wrede, who worked in state, King County and private youth addiction programs for 44 years. In response, a group of University of Washington-affiliated volunteers found a building on the corner of 50th and Roosevelt in the University District and built a free walk-in addiction clinic that offered care around the clock.

“People didn’t want to go to a traditional physician,” said Wrede, who worked at the clinic for five and a half years. “They focused on the drugs and told them to stop.”

In 1974, at least 20 grassroots clinics dotted King County’s map. By the late 1970s, though, punitive, not compassionate, approaches were in favor. And like the many addiction programs that would follow them, the clinics operated on the periphery: Structural or funding support didn’t exist. They started to close.

In California, Ohta would spend nine months out of the year in use, then return every summer to the wilderness camp — eventually, as a counselor — where he’d hike into the mountains and get sober.

He was locked in this pattern until 1985, when, with $50 in his pocket and a backpack of belongings, he followed a girlfriend north to Seattle, where his addiction deepened.

By the time he was ready to quit, it was the ‘90s. When his dad offered to drive him to a residential rehab facility in Yakima, he threw himself into recovery. He later enrolled at Seattle Central College and landed an internship working with Black and Latino adolescents who were on their own addiction paths. Kids who’d grown up during the height of the crack epidemic. Some who’d been convicted of serious crimes, like murder.

He remembers thinking, “Oh my God, what am I doing?” Before long, though, he’d adopted the tactics others used to motivate his own recovery. He invited kids to play basketball at Green Lake and persuaded them to hike with him to Carkeek Park. “I just started doing stuff I knew how to do.”

“Where you’re at”

Ohta fortifies himself with coffee at a Belltown cafe where he’s meeting his teammate Tal Rizzo, who fizzes with enthusiasm. Rizzo, dressed in a Smokey Bear shirt with the all-caps slogan “Only you can prevent overdoses,” is a case manager who is also in recovery.

Today, Rizzo and Hansen, the team’s physician, plan to follow up with a longtime client. Last time, Rizzo recalls, they met at a Top Pot doughnut shop to discuss the client’s next injection of the opioid use treatment Sublocade.

“His girlfriend texted him and was like, ‘What kind of (expletive) doctor meets at Top Pot? Sounds like a (expletive) scam.’ And he’s like, ‘It’s a chill doctor.’ “

Ohta laughs, “That’s a perfect example!”

“This is a doctor who will physically meet you where you’re at,” Rizzo says.

Ohta: “That’s our motto.”

“We meet you where you’re at,” rehearses Rizzo. “But we don’t leave you where you are!”

Fentanyl has become an increasingly perilous drug among youth. Emergency responses to young people suspected of overdosing, state data shows, climbed from 70 in 2019 to nearly 300 last year.

Ohta’s team is mostly unburdened from paperwork that can delay lifesaving care.

Instead of filling out lengthy, formalized substance use assessments, Ohta might ask, “Do you smoke fentanyl every day? Do you have withdrawals?” Clients’ answers are enough to clue him in to next steps. Substance use professionals in many other settings have to “live by” formal assessments, Ohta says, “One, to just get people in. Two, to get paid. Which is maybe the biggest thing.”

Instead of waiting on insurance approvals and specialty pharmacy deliveries, Dr. Hansen can get her young patients long-acting injectable medications the same or the next day.

“That’s so fast,” said Dr. Collin Schenk, associate program director of the Swedish Addiction Medicine Fellowship. It can feel like “moving heaven and Earth to get it” for his adult patients, he said.

There’s an allure to the team’s methods. And Ohta himself has a certain energy. He commutes by bike and rotates between Golden State Warriors gear and shirts sporting recovery messages. Out on the street, he’s constantly running into people who know him. He’s generous in his praise for his younger colleagues (they’re “superstars”). And blunt about the reality of their grind (“We foster passion to get you to work and drive with us for low pay. And I am the leader of that fostering!”).

Ohta’s friends in the addiction treatment world encourage him to scale up. It’s tough for him to imagine how.

Answering certain texts and phone calls from clients, driving them to appointments, showing up to their homes — those consequential, hyperpersonalized aspects of addiction care the team prioritizes — generally aren’t paid for by insurance or built into the foundations of medical treatment.

“The funding streams certainly shape the availability and flexibility of the care models,” Schenk said. “Let’s celebrate what they’re doing. But also recognize that it’s not actually (the) true system change that needs to happen.”

“Don’t disappear”

In pouring rain, Ohta slow-pedals his bike to a stop outside Ryther, a long-standing treatment center in northeast Seattle.

He heads downstairs to a tiny office stuffed with boxes of clothes, tampons and hand warmers. He peels off his rain boots, digs through a bin looking for “homeless client socks” before deciding to stick with his wet ones, then dials a client.

“Be ready at 10 o’clock, man,” Ohta says, getting ready to hop into his black Ford Transit van to meet across town for a substance use assessment.

“Don’t run away. Don’t disappear.”

Ryther, one of the city’s longest-running treatment centers for vulnerable youth, employs Ohta, Rizzo and their colleague Abbie Woods. On average, they interact with 5-10 kids and young adults on a daily basis and another 15 or so once or twice a week. Recovery is lifelong, so the team is in touch with another several dozen people as needed.

The team is relatively new. Shortly before the pandemic, Ryther Executive Director Karen Brady said, the county was offering funding for a new kind of medically assisted addiction treatment team. A Kaiser Permanente doctor already collaborating with Ohta agreed to participate. And a family with close ties to the team’s mission kicks in annual donations.

“It was essentially born out of a really desperate situation,” Brady said.

After the grassroots clinics started to close in the 1970s, a renewed focus on young people using dangerous substances, and a willingness by insurance companies to pay for treatment, spurred a shift toward building up youth residential treatment in the 1980s. Then, a series of policy and societal decisions led to its collapse.

Boys’ and girls’ treatment programs opened by Ryther in 1983 were the first of their kind in the state, said Stephen Bogan, who spent 16 years leading the state’s Division of Alcohol and Substance Abuse and worked at Ryther. The organization soon added a recovery house, where kids transitioning out of treatment could live, go to school and work.

By 1993, the state paid for 145 youth treatment beds spread across 17 different facilities. The state was so involved that it maintained a massive database on those who received publicly funded addiction treatment, which helped guide lawmakers’ budget decisions.

Quall, the probation counselor who used to work at a now-closed adolescent inpatient facility, remembers receiving a regularly updated, state-authored list of substance use treatment beds. “There was no guesswork,” she said.

Then, in the mid- to late 2000s, “all of a sudden, there was this massive shift. And things started shutting down.”

Youths’ drug of choice had switched from alcohol to marijuana — a drug that wasn’t as closely associated with a need for residential rehabilitation, especially once marijuana was legalized, Bogan said. (Many youth did receive inpatient treatment for marijuana dependence, Ohta points out, but those programs declined nonetheless.)

Public school districts largely stopped punishing students for drug use. Ohta said it was a well-intentioned move, but in the process, they also stopped referring students to residential treatment, letting some kids slide deeper into addiction without support.

And new approaches to treatment offered alternatives to long stays away from home — street medicine, for example, and in later years, medication like buprenorphine for opioid use.

Then, Medicaid started covering addiction, care it had previously excluded. But payments from Medicaid — and in many cases, private insurance — didn’t keep pace with the costs to run addiction programs.

These pressures took a heavy toll on places like Ryther. Every other day, Bogan said, employees would tell him they’d found a higher-paying job. “It was a brain drain of epic proportions,” he said.

Many years later, “rates continue to be really abysmally low,” said Ryther’s current head, Brady. “It’s just not financially sustainable.”

Only a handful of youth beds remain. Among the four facilities that accept public insurance, only 108 residential beds are operational statewide; one facility, Healing Lodge of the Seven Nations in Spokane Valley, has a waitlist of 40, plus 106 more currently applying for treatment.

On the Ryther campus, Ohta points to a cottage that used to house “a good, old-school program back in the day,” he says: residential treatment for boys in addiction.

The building is mostly empty. So is another building that once housed the girl’s program. The recovery house, where Ohta worked from 1996 to 1997, is closed too.

“I didn’t know the beauty of what I was witnessing,” he said. “And then it was gone.”

“We just stay”

Ohta keeps what he calls his “retirement” stored neatly in a desk drawer. He’s stowed away a thick pile of art, photographs, notes and other ephemera from clients present and past.

“I haven’t made much money,” he said. “Like, no money.” The mementos, he said, will have to be enough.

The notes are decorated with drawings of bikes, bike locks and sailboats. Some clients, far enough along in their healing, understand how deeply Ohta’s recovery path is tied to their own.

“Thank you for the hope you’ve given me,” Ohta reads aloud. “My dream is to end up like you.”

Wrote another, “I need three more people like you in this world.”

Then, Abbie Woods walks in.

Woods, 28, is the team’s coordinator, and her zeal for this work is remarkably similar to Ohta’s. Woods, who was homeless and addicted at 15, learned the basics of outreach after she got sober. Her brother was using, and it felt natural to try to help him. “All the stuff that I’ve been through is gonna help someone else,” she decided, so she trained as a substance use disorder professional.

But the pay is low — just enough to cover rent, her car payment and groceries. She once tried to quit for a higher-paying job in addiction services, but “I felt like they weren’t really helping people that much,” she said. So she came back.

Ohta, a perpetual mood lightener, butts in: “We’re about to grind. Ride or die!” he says, laughing.

Woods offers a half smile. “I just have to figure out a way to make more money. Then I’ll do it for the rest of my life.”

Woods and Rizzo are supposed to be the next generation of “Johnnys.”

But Woods senses she’s at a crossroads.

The whole structure of the treatment system needs to change, she says. “I have to do something else” to make a living, she added. “And it sucks because I feel like it’s very important. We’re literally alongside EMTs responding to this crisis that’s going on. And we just get shit. But we love the work … So we just stay.”

Ohta is often asked about the “solution.” But the notion that addiction could be eliminated, “solved” — that feels impossible and isn’t what occupies him day-to-day.

Instead, he thinks about how his parents trained him to be a soldier. Always in service to others.

As he appraises his retirement, the weight of this service is heavy. “That client is not alive anymore. That client is not alive anymore,” he says, piecing through his keepsakes.

“I’m not trying to have anybody die right now for a little while so we can do our thing. And not get the phone call,” he says.

“But we’re regrouping in our preparation for that. For that to happen again. And again. And again.”

Hannah Furfaro reported this story while participating in an Association of Health Care Journalists fellowship, which is supported by the Commonwealth Fund.

Credits:

Reporter: Hannah Furfaro

Editor: Diana Samuels

Photography: Ivy Ceballo

Videography: Lauren Frohne

Photo editor: Bettina Hansen

Copy editor: Laura Gordon

Audience engagement: Taylor Blatchford and Nicole Pasia