Dennis Sayler pulled the van into the driveway of a double-wide near Yelm. As he shut off the engine, a woman with a knit stocking hat pulled low carrying a large Costco cooler bag emerged from a trailer out back.
Sayler popped out and opened the van’s sliding side door. The pair greeted each other like old friends. Then the woman — Sarah, “with an ‘h’” — emptied the contents of her bag into a large, red bin in the back.
Hundreds of used syringes poured out. About half a month’s worth, Sarah guessed. When she finished, Sayler’s methodical hands quickly started filling her bag with boxes of new syringes, cotton balls, tourniquets, alcohol wipes, heroin-cooking kits and a handful of condoms for good measure.
The driveway interaction was an illustration of the escalating opioid epidemic rampaging through rural Pierce County.
The severity of the epidemic is driven home by the final item Sarah requested, a new dose of Naloxone, commonly known as Narcan — an emergency medication that can reverse the effects of an overdose.
Sayler tossed two vials in Sarah’s bag.
Sarah is one of roughly 2,500 individuals — the vast majority intravenous drug users — who receive clean syringes through the Point Defiance AIDS Projects’ Tacoma Needle Exchange each year.
Living near the Pierce-Thurston county line, Sarah can’t make it to downtown Tacoma to swap out needles at the exchange’s regular stops near Bates Technical College or the Tacoma Pierce County Health Department.
Instead, she depends on the Tacoma Needle Exchange’s rural and suburban delivery route. She’s used the longstanding but little-known service for the last five months, she said.
“The first time I heard about it, I thought no way,” Sarah said of the needle exchange’s delivery service. “It means a lot, not just for me, but there are other people I exchange for as well. This is not simply my own personal use.
“I’ve got probably half the neighborhood going through me now.”
Sayler, a lanky former crack-cocaine user and one-time nightclub bouncer, refers to Sarah as one of his many “secondary exchanges.”
Her home is one of 15 stops Sayler made on Wednesday, traversing from the woods of Gig Harbor to the outskirts of Puyallup and through the sprawl of Parkland and Spanaway. In total, Sayler was on the road for more than eight hours, traveling in excess of 160 miles. Driving down dirt roads and cul-de-sacs, he delivered thousands of new syringes to intravenous drug users across the far-flung parts of the county.
The majority of the recipients were young, in their 20s, frequently challenging the conventional image of what heroin users look like.
“A lot of them don’t fit that stereotype,” Sayler said of the people he serves. “They’re not all just using all day long. A lot of them are going to school, or whatever.”
Still, the need is staggering. Throughout the day, Sayler’s phone constantly buzzes, each call representing another individual looking to schedule a delivery.
“I have stops where it will be 1,000, 2,000, 3,000 syringes,” said Sayler, wearily adjusting his Seahawks hat and the long hair streaming out the back of it.
“Typically those are more than one person.”
In 1988, the Point Defiance AIDS Projects became the first legally sanctioned exchange in the country. It was started by the late Dave Purchase, who made a name setting up a card table downtown to hand out needles in the name of HIV and AIDS prevention.
The effort eventually helped to spawn the North American Syringe Exchange Network — which from its office on Dock Street distributed over 100 million syringes to exchanges across the country last year. The local program’s success makes Tacoma’s needle exchange origin story the stuff of legend.
While the groundbreaking exchange also has delivered to rural Pierce County since the early 1990s, that part of the operation has largely flown under the radar until now.
What’s helping bring it to light is the opioid epidemic. With it, demand for rural needle delivers has grown — so much that Sayler recently was forced to add a second dedicated day of deliveries each week.
According to Point Defiance AIDS Project’s Executive Director Paul LaKosky, the number of clean syringes the exchange distributes has increased by 10 percent each year for the last three years. In 2017, the exchange distributed 2,151,046 syringes, up from 1,544,024 in 2015.
Last year about a quarter of the syringes were distributed in rural parts of the county, LaKosky said.
LaKosky said he sees no slowdown in sight.
Distributing clean needles to drug users has always been controversial. Though state law has generally been interpreted to allow for needle-exchange programs, and court cases have upheld the legality of such programs in Washington, critics frequently contend it amounts to enabling drug use.
LaKosky refutes the notion. Known as harm reduction in the world of public health policy, he said needle-exchange programs like the nonprofit he oversees improve health outcomes for users and prevent the spread of infectious diseases. The Tacoma Needle Exchange has an annual budget of roughly $250,000, raised through private donations, national grant money, in-kind donations and money from the state Department of Health.
While LaKosky said he understands critics’ concerns, he points to “study after study” that have shown the effectiveness of needle-exchange programs. While community outreach workers like Sayler primarily deliver clean syringes, they also connect users to the limited recovery resources available.
That’s important because, as LaKosky noted, “These are people’s brothers and sisters, mothers and grandmothers in some cases.”
“A lot of arguments can be made against needle exchange, but none of them are based in science. They’re all emotional,” he said. “I have never in my entire public health career come across someone who’s a substance user who says, ‘I started using because I had access to a clean needle.’”
For Sayler, the philosophical debates are best left to others. He’s got a job to do, and people depending on him.
“You’ve got to have compassion for people, no matter what, even if you don’t agree with what they’re doing,” he said.
Preventing death, he said, keeps the door open for recovery — which is the ultimate goal.
As the sun began to set, Sayler still had several more stops on his list. One of the last took him to a white, split-level home at the end of a residential road near Spanaway with rhododendrons planted out front. There, a 22-year-old woman walked down the steps with an old paint can filled with dirty needles.
It was the third time Sayler had visited her, and this time she asked for Narcan.
Since it’s the first time she received the emergency drug, Sayler quickly ran through the procedure for administering it, showing the woman how to rub her knuckles down a person’s sternum to make sure her or she has actually overdosed and not just dosed off, before pointing to the major muscles where the drug can be administered.
The woman listened intently.
Next, Sayler stopped at a nondescript home closer to Parkland with a barking German Shepherd out front and muddy paw prints on the door. When he arrived, a man in his early 20s lifted the blinds and peeked out the window before carrying out a big red container full of used syringes.
He asked for Narcan, too. Unlike the previous stop, there was no need for Sayler to run through the tutorial this time.
The man had heard it before.
“What happened to the last dose?” Sayler asked, looking up from his clipboard.
“We saved a guy,” the man answered.
“Here at the house.”