One Year In, DESC’s ORCA Program Is Changing How Seattle Responds to the Opioid Crisis

SEATTLE — Almost one year after opening its doors, DESC’s Opioid Recovery & Care Access (ORCA) Center, in partnership with the longer-standing ORCA Patient Outreach Division (POD), is demonstrating what is possible when lifesaving opioid use disorder treatment is available when and where people need it.

The ORCA program includes the ORCA Center, DESC’s brick-and-mortar treatment and post-overdose care center, and ORCA POD, its mobile outreach team that brings treatment and care directly to people in the Seattle community, with a focus on supportive housing and shelter sites.

Since the ORCA Center’s opening on Sept. 2, 2025, the ORCA Center and POD have:

• Provided care through more than 10,000 encounters

• Provided care to more than 500 people following an overdose

• Started nearly 800 people on medication for opioid use disorder (MOUD)

• Started more than 400 people on long-acting injectable (LAI) buprenorphine

The milestone comes as King County is seeing encouraging progress in the overdose crisis. Fatal overdoses are down 25% this year compared to the same period last year. While this progress reflects many factors and mirrors a nationwide decline in fatal overdoses, Seattle has also been transforming its local response — starting treatment in the field, stabilizing people after an overdose, and connecting them directly to ongoing care.

“The ORCA Center shows what can happen when we stop expecting people in crisis to navigate a complicated health care system and instead build care around what they actually need,” said Daniel Malone, executive director of DESC. “In just one year, ORCA has created a new pathway into treatment for hundreds of people who too often have been left cycling between the streets, emergency rooms, and overdose. This is innovation in the truest sense: first responders, medical providers, outreach teams, peers and behavioral health professionals working together to make lifesaving treatment easier to access and easier to stay connected to.”

Filling a gap in the health care system

The ORCA Center was created in response to a persistent gap in traditional overdose care.

Hospital emergency departments excel at treating an immediate medical emergency and saving someone’s life after an overdose. But they are not designed to provide the ongoing addiction treatment, intensive engagement, and wraparound support many people need after that crisis. Too often, people survive an overdose only to leave without getting connected to treatment for the underlying opioid use disorder.

The ORCA Center was created to fill that gap. DESC developed the model in partnership with the University of Washington (UW), the Seattle Fire Department, and other community partners, reimagining what care immediately following an overdose could look like.

Located inside DESC’s Downtown Behavioral Health Clinic at 515 Third Avenue, the ORCA Center provides 24/7 post-overdose stabilization and daily walk-in access to treatment from 9 a.m. to 11 p.m. Anyone can walk through the doors seeking help with opioid use — no prior relationship with DESC or complicated referral process required.

People can meet with a nurse and medical provider, discuss what they want from treatment and, when appropriate, begin long-term medication treatment for opioid use disorder that same day.

But medication treatment is only the beginning.

The ORCA Center serves as a “front door” to a much broader network of care at DESC. People can access hot meals, showers, bathrooms, laundry, and peer support while connecting to programs that provide additional behavioral health care including treatment for psychiatric conditions and substance use disorder, case management, shelter, housing resources, and other DESC services. 

Staff work to keep people connected after their first visit, whether that means scheduling appointments, coordinating follow-up care, or bringing treatment directly to people through ORCA POD — the outreach team that brings treatment directly to people in the Seattle community, with a focus on permanent supportive housing and shelters.

“What makes the ORCA Center special isn’t just the medications, new protocols, or innovation — it’s how we meet people where they are with what they need in that moment,” said Dr. Callan Fockele, senior medical lead for the ORCA Center. “That might look like offering someone a warm blanket and a Cup of Noodles while they receive an injection of long-acting buprenorphine — a medication used to treat opioid use disorder. It’s providing a hot meal, a shower, a bathroom, or a place to do laundry. It’s treating people like human beings, with dignity, that makes all the difference.”

That welcoming approach is central to the ORCA Center’s model. Care is voluntary and low-barrier, and people do not have to commit to treatment to receive support. Whether someone arrives by ambulance immediately after an overdose or walks in on their own looking for help, the goal is the same: provide compassionate care without judgment and make the next step as easy as possible. This approach is helping drive demand for treatment. As people share their positive experiences at the ORCA Center, more people are coming through the door for care.

Innovation that makes treatment easier to start — and stay on

ORCA is also putting new approaches to opioid use disorder treatment into practice, including an innovative protocol for administering long-acting injectable buprenorphine — developed by ORCA POD (formerly the Opioid Treatment Network) and published in collaboration with colleagues at UW Medicine. 

Starting buprenorphine can be particularly difficult for people who regularly use fentanyl because traditional approaches can be complicated and may require them to first stop using opioids and go through significant withdrawal. DESC’s “injectable-only overlapping” buprenorphine protocol offers another path.

The three-day protocol uses gradually increasing doses of long-acting injectable buprenorphine and does not require patients to stop using fentanyl before or during the process, making it easier to start treatment. Once patients reach a therapeutic dose of buprenorphine, cravings for fentanyl — and fentanyl use itself — are often reduced or eliminated. “We developed this protocol around a simple question: How do we make an effective, life-saving medication easier for people who use fentanyl to start and stay on?” said Dr. Richard Waters, medical director at DESC. “Traditional approaches to starting buprenorphine can have barriers that are especially difficult to overcome for people experiencing homelessness or living with complex health needs. We are seeing that when we adapt treatment to the realities of people’s lives — rather than asking people to adapt to a health care system that isn’t designed to meet their needs — we can achieve improved engagement and retention.”

The protocol is now offered as one of several pathways to start buprenorphine by ORCA Center staff and the POD team.

(Read the peer-reviewed study: Injectable-Only Overlapping Buprenorphine Starting Protocol in a Low-Threshold Setting, JAMA Network Open.)

A new pathway after overdose

ORCA is part of a larger transformation in Seattle’s overdose response.

The Seattle Fire Department became the first fire-based EMS system in the country to enable specially trained basic life support crews to initiate buprenorphine in the field after an overdose. Rather than automatically transporting every patient to an emergency department, eligible patients can be taken directly to ORCA, where staff can continue their medical care, initiate or continue medications for opioid use disorder, and connect them to longer-term services.

Today, 65% of the Seattle Fire Department’s Health 99 post-overdose transports are brought to the ORCA Center for care, many of whom might otherwise have been taken to a local hospital emergency department.

The result is a continuum that did not exist before: respond to the overdose, begin treatment as quickly as possible, provide a welcoming place to stabilize, and create a pathway to ongoing care.

Jon Ehrenfeld, Mobile Integrated Health program manager at the Seattle Fire Department, calls ORCA a “game changer”:

“It is no exaggeration to say that the ORCA Center has been a game changer for the Seattle Fire Department, its overdose response team, and for clients around Seattle with opioid use disorders,” Ehrenfeld said. “The benefits of a specialized post-overdose receiving center cannot be overstated. Our team has witnessed firsthand how the ORCA Center enables a true continuum of care for overdose survivors: beginning with a specialized response in the field and continuing to a patient-centered wraparound clinic that alleviates the strain on hospital emergency rooms. The relationship with the ORCA Center has developed into a cornerstone of the department’s overdose response and will continue to set a national standard for best practices in delivering unparalleled care to this challenging patient population.”

What others are saying about the ORCA Center:

“What DESC and the ORCA Center team have done has been incredible. They’ve built a genuinely person-centered care model, and preliminary data from surveys with clients and firefighters indicates a high level of satisfaction with the services and the care team. We look forward to continued partnership as we document utilization patterns along with health and cost outcomes.” - Dr. Caleb Banta-Green, PhD, research professor at the UW School of Medicine

“As an emergency physician, I see firsthand the significant barriers people experiencing homelessness and opioid use disorder can face in accessing and staying connected to treatment. The ORCA Center is both intuitive and innovative in its approach, addressing multiple barriers that can prevent people with opioid use disorder from accessing and staying engaged in care. By making evidence-based treatment readily accessible and connecting people to services that address their broader health and social needs, ORCA bridges the gap between emergency overdose care and the ongoing treatment and support that people need. It is one of the most promising cross-sector interventions I have seen for people simultaneously confronting homelessness and opioid use disorder.” - Kelly Doran, M.D., MHS, emergency physician and associate director of research at the Health x Housing Lab at NYU Grossman School of Medicine 

About the ORCA Program

ORCA Center is a 24/7, low-barrier facility operated by Downtown Emergency Service Center (DESC) that provides immediate, compassionate care following an opioid overdose and same-day access to medications for opioid use disorder. Located in DESC’s Downtown Behavioral Health Clinic at 515 Third Avenue in Seattle, the center also connects people to ongoing behavioral health care, peer support, basic needs, shelter, housing, and other services. Walk-in treatment is available daily from 9 a.m. to 11 p.m.

ORCA Patient Outreach Division (POD) (formerly the Opioid Treatment Network) is a mobile outreach team that brings treatment and care directly to Seattle community members, focusing on supportive housing and shelter sites.

About DESC

Downtown Emergency Service Center (DESC) is a Seattle-based nonprofit organization providing integrated services, including permanent supportive housing, mental health and behavioral health care, substance use disorder treatment, crisis response, shelter, and outreach to people experiencing homelessness and complex health needs.

SEATTLE — Almost one year after opening its doors, DESC’s Opioid Recovery & Care Access (ORCA) Center, in partnership with the longer-standing ORCA Patient Outreach Division (POD), is demonstrating what is possible when lifesaving opioid use disorder treatment is available when and where people need it.

The ORCA program includes the ORCA Center, DESC’s brick-and-mortar treatment and post-overdose care center, and ORCA POD, its mobile outreach team that brings treatment and care directly to people in the Seattle community, with a focus on supportive housing and shelter sites.

Since the ORCA Center’s opening on Sept. 2, 2025, the ORCA Center and POD have:

• Provided care through more than 10,000 encounters

• Provided care to more than 500 people following an overdose

• Started nearly 800 people on medication for opioid use disorder (MOUD)

• Started more than 400 people on long-acting injectable (LAI) buprenorphine

The milestone comes as King County is seeing encouraging progress in the overdose crisis. Fatal overdoses are down 25% this year compared to the same period last year. While this progress reflects many factors and mirrors a nationwide decline in fatal overdoses, Seattle has also been transforming its local response — starting treatment in the field, stabilizing people after an overdose, and connecting them directly to ongoing care.

“The ORCA Center shows what can happen when we stop expecting people in crisis to navigate a complicated health care system and instead build care around what they actually need,” said Daniel Malone, executive director of DESC. “In just one year, ORCA has created a new pathway into treatment for hundreds of people who too often have been left cycling between the streets, emergency rooms, and overdose. This is innovation in the truest sense: first responders, medical providers, outreach teams, peers and behavioral health professionals working together to make lifesaving treatment easier to access and easier to stay connected to.”

Filling a gap in the health care system

The ORCA Center was created in response to a persistent gap in traditional overdose care.

Hospital emergency departments excel at treating an immediate medical emergency and saving someone’s life after an overdose. But they are not designed to provide the ongoing addiction treatment, intensive engagement, and wraparound support many people need after that crisis. Too often, people survive an overdose only to leave without getting connected to treatment for the underlying opioid use disorder.

The ORCA Center was created to fill that gap. DESC developed the model in partnership with the University of Washington (UW), the Seattle Fire Department, and other community partners, reimagining what care immediately following an overdose could look like.

Located inside DESC’s Downtown Behavioral Health Clinic at 515 Third Avenue, the ORCA Center provides 24/7 post-overdose stabilization and daily walk-in access to treatment from 9 a.m. to 11 p.m. Anyone can walk through the doors seeking help with opioid use — no prior relationship with DESC or complicated referral process required.

People can meet with a nurse and medical provider, discuss what they want from treatment and, when appropriate, begin long-term medication treatment for opioid use disorder that same day.

But medication treatment is only the beginning.

The ORCA Center serves as a “front door” to a much broader network of care at DESC. People can access hot meals, showers, bathrooms, laundry, and peer support while connecting to programs that provide additional behavioral health care including treatment for psychiatric conditions and substance use disorder, case management, shelter, housing resources, and other DESC services. 

Staff work to keep people connected after their first visit, whether that means scheduling appointments, coordinating follow-up care, or bringing treatment directly to people through ORCA POD — the outreach team that brings treatment directly to people in the Seattle community, with a focus on permanent supportive housing and shelters.

“What makes the ORCA Center special isn’t just the medications, new protocols, or innovation — it’s how we meet people where they are with what they need in that moment,” said Dr. Callan Fockele, senior medical lead for the ORCA Center. “That might look like offering someone a warm blanket and a Cup of Noodles while they receive an injection of long-acting buprenorphine — a medication used to treat opioid use disorder. It’s providing a hot meal, a shower, a bathroom, or a place to do laundry. It’s treating people like human beings, with dignity, that makes all the difference.”

That welcoming approach is central to the ORCA Center’s model. Care is voluntary and low-barrier, and people do not have to commit to treatment to receive support. Whether someone arrives by ambulance immediately after an overdose or walks in on their own looking for help, the goal is the same: provide compassionate care without judgment and make the next step as easy as possible. This approach is helping drive demand for treatment. As people share their positive experiences at the ORCA Center, more people are coming through the door for care.

Innovation that makes treatment easier to start — and stay on

ORCA is also putting new approaches to opioid use disorder treatment into practice, including an innovative protocol for administering long-acting injectable buprenorphine — developed by ORCA POD (formerly the Opioid Treatment Network) and published in collaboration with colleagues at UW Medicine. 

Starting buprenorphine can be particularly difficult for people who regularly use fentanyl because traditional approaches can be complicated and may require them to first stop using opioids and go through significant withdrawal. DESC’s “injectable-only overlapping” buprenorphine protocol offers another path.

The three-day protocol uses gradually increasing doses of long-acting injectable buprenorphine and does not require patients to stop using fentanyl before or during the process, making it easier to start treatment. Once patients reach a therapeutic dose of buprenorphine, cravings for fentanyl — and fentanyl use itself — are often reduced or eliminated. “We developed this protocol around a simple question: How do we make an effective, life-saving medication easier for people who use fentanyl to start and stay on?” said Dr. Richard Waters, medical director at DESC. “Traditional approaches to starting buprenorphine can have barriers that are especially difficult to overcome for people experiencing homelessness or living with complex health needs. We are seeing that when we adapt treatment to the realities of people’s lives — rather than asking people to adapt to a health care system that isn’t designed to meet their needs — we can achieve improved engagement and retention.”

The protocol is now offered as one of several pathways to start buprenorphine by ORCA Center staff and the POD team.

(Read the peer-reviewed study: Injectable-Only Overlapping Buprenorphine Starting Protocol in a Low-Threshold Setting, JAMA Network Open.)

A new pathway after overdose

ORCA is part of a larger transformation in Seattle’s overdose response.

The Seattle Fire Department became the first fire-based EMS system in the country to enable specially trained basic life support crews to initiate buprenorphine in the field after an overdose. Rather than automatically transporting every patient to an emergency department, eligible patients can be taken directly to ORCA, where staff can continue their medical care, initiate or continue medications for opioid use disorder, and connect them to longer-term services.

Today, 65% of the Seattle Fire Department’s Health 99 post-overdose transports are brought to the ORCA Center for care, many of whom might otherwise have been taken to a local hospital emergency department.

The result is a continuum that did not exist before: respond to the overdose, begin treatment as quickly as possible, provide a welcoming place to stabilize, and create a pathway to ongoing care.

Jon Ehrenfeld, Mobile Integrated Health program manager at the Seattle Fire Department, calls ORCA a “game changer”:

“It is no exaggeration to say that the ORCA Center has been a game changer for the Seattle Fire Department, its overdose response team, and for clients around Seattle with opioid use disorders,” Ehrenfeld said. “The benefits of a specialized post-overdose receiving center cannot be overstated. Our team has witnessed firsthand how the ORCA Center enables a true continuum of care for overdose survivors: beginning with a specialized response in the field and continuing to a patient-centered wraparound clinic that alleviates the strain on hospital emergency rooms. The relationship with the ORCA Center has developed into a cornerstone of the department’s overdose response and will continue to set a national standard for best practices in delivering unparalleled care to this challenging patient population.”

What others are saying about the ORCA Center:

“What DESC and the ORCA Center team have done has been incredible. They’ve built a genuinely person-centered care model, and preliminary data from surveys with clients and firefighters indicates a high level of satisfaction with the services and the care team. We look forward to continued partnership as we document utilization patterns along with health and cost outcomes.” - Dr. Caleb Banta-Green, PhD, research professor at the UW School of Medicine

“As an emergency physician, I see firsthand the significant barriers people experiencing homelessness and opioid use disorder can face in accessing and staying connected to treatment. The ORCA Center is both intuitive and innovative in its approach, addressing multiple barriers that can prevent people with opioid use disorder from accessing and staying engaged in care. By making evidence-based treatment readily accessible and connecting people to services that address their broader health and social needs, ORCA bridges the gap between emergency overdose care and the ongoing treatment and support that people need. It is one of the most promising cross-sector interventions I have seen for people simultaneously confronting homelessness and opioid use disorder.” - Kelly Doran, M.D., MHS, emergency physician and associate director of research at the Health x Housing Lab at NYU Grossman School of Medicine 

About the ORCA Program

ORCA Center is a 24/7, low-barrier facility operated by Downtown Emergency Service Center (DESC) that provides immediate, compassionate care following an opioid overdose and same-day access to medications for opioid use disorder. Located in DESC’s Downtown Behavioral Health Clinic at 515 Third Avenue in Seattle, the center also connects people to ongoing behavioral health care, peer support, basic needs, shelter, housing, and other services. Walk-in treatment is available daily from 9 a.m. to 11 p.m.

ORCA Patient Outreach Division (POD) (formerly the Opioid Treatment Network) is a mobile outreach team that brings treatment and care directly to Seattle community members, focusing on supportive housing and shelter sites.

About DESC

Downtown Emergency Service Center (DESC) is a Seattle-based nonprofit organization providing integrated services, including permanent supportive housing, mental health and behavioral health care, substance use disorder treatment, crisis response, shelter, and outreach to people experiencing homelessness and complex health needs.