Heroin and other opioid use in the U.S.

Our region is in the middle of an opioid use epidemic. Both overdoses and rates of opioid use disorders have skyrocketed. Learn more about medication assisted treatment, the standard of care for this condition.

Learning about opioid use disorders, understanding and advocating for medication assisted treatment, and supporting people with addiction as they undergo treatment are a few ways that you can help.

Stay informed by signing up for our email list.


Friends and Family


ETS questions:

  • What is Evergreen Treatment Services (ETS)?

    Evergreen Treatment Services is a private, 501(c)(3) nonprofit organization which has been delivering evidence-based substance use disorder treatment services in Western Washington since 1973. Since our founding, we have earned a national and regional reputation for excellence. Our interdisciplinary team includes clinicians with advanced degrees in medicine, psychiatry, nursing, psychology, social work, counseling and acupuncture.

    ETS uses a comprehensive approach to treatment which combines medication assisted treatment with wraparound services such as medical monitoring, counseling, and case management services.

  • Why is ETS in our community?

    We are in the midst of a nationwide opioid epidemic. Partnership at Drug Free.org reports that “in 2012, nearly one million Americans, ages 12-25, were abusing or dependent on prescription pain relievers (primarily) or heroin.” Data from the Alcohol and Drug Abuse Institute (ADAI) at the University of Washington shows that, in the same year, heroin was the most common drug of abuse among 18-29 year olds admitted into substance abuse treatment in our state.

  • What does ETS do to ensure that the businesses and communities surrounding are not negatively affected by the treatment clinics?

    ETS has excellent relationships with the communities in which we work and we have open lines of communication with local governments, businesses, law enforcement and social service organizations. Most communities welcome the services provided by ETS as a way to address the pressing problem of opioid use disorders that drains local resources. In the immediate vicinity of our clinics, we work closely with our neighbors and work diligently to making sure that our patients are complying with agency rules.

Opioid use disorder questions:

  • What is an opioid use disorder?

    The difference between being dependent on opioids and an opioid use disorder develops problematic pattern of opioid use leading to clinically significant impairment or distress. Typically this means a maladaptive psychological relationship to the drug that includes drug-seeking behavior, giving up important relationships and activities in favor of the drug, and generally focusing your life more and more on the drug at the expense of everything else. In 2010, 1.9 million people in the U.S. were addicted to prescription opioids and 359,000 were addicted to heroin. An opioid use disorder is considered to be a chronic, relapsing medical conditions, much like diabetes and hypertension, that can be very effectively manage with medication and supportive services.

  • What does it mean that an opioid use disorder is a chronic, relapsing medical condition?

    It means that people with an opioid use disorders typically experience long-lasting physical and psychological symptoms of this condition, even with effective medical treatment. Like diabetes or hypertension, many people require ongoing or lifelong medical treatment to remain stable during their recovery.

  • What are the physiological effects of an opioid use disorder?

    Opioid use disorders alter a person’s brain chemistry. The brain is impacted by a disruption to the naturally occurring reward system and the way it experiences pleasure/pain. It also impacts the decision making processes. These impacts have been shown repeatedly in brain research. This explains why more and more of the drug is needed in order to produce the same effects, a condition known as tolerance, as well as the negative behaviors associated with substance use disorders like dishonesty, and continued use despite negative consequences.

  • How long does it take for a person to be cured of an opioid use disorder?

    Because this is a chronic, relapsing medical condition, the brain changes are often very long-lasting. Despite working very hard at recovery, many patients realize that staying on the medication is the best way to abstain from opioid abuse. The medications have very few side effects and are considered to be safe for long term use. At ETS, we work with patients to manage their condition so they can have safe and productive lives for as long as our patients benefit from working with us.

  • How do opioid use disorders affect the community?

    For people struggling with an opioid use disorder, the next fix becomes an all-consuming focus. Due to the physiological changes created by opioids, this focus is often pursued with little regard to a person’s own health or safety or that of their community. Some people lose their jobs and their stable living situations and turn to petty crime and other illegal activity for income. Family relationships and social networks break down. Health deteriorates; people lose weight and are at a high risk of contracting infectious diseases like Hepatitis C and HIV from unsafe needle use, developing abscesses, bacterial infection, and overdose.

Treatment Questions:

  • What is medication assisted treatment?

    Medication assisted treatment (MAT) is an evidence-based approach that combines brain-stabilizing medication with comprehensive support services including counseling, drug screens, and medical monitoring.


  • What is included in the ETS treatment program?

    ETS uses the gold standard of medication assisted treatment to treat this condition. We combine medications that help patients to manage their opioid use disorder, such as methadone, buprenorphine/ naloxone (Suboxone), or buprenorphine (Subutex) with important rehabilitative services such as medical monitoring, counseling, case management, Hepatitis C and HIV testing, and education about overdose risk and infectious disease prevention. Our full range of services supports our patients and boosts their chances for full, long-term recovery. For a complete list of services, go to the medication assisted treatment page.

  • Why does ETS use medication assisted treatment?

    These treatments work. They are the medical standard of care for opioid use disorders. Research has shown repeatedly that patients in medication assisted treatment have the greatest likelihood of living successfully in recovery. In addition, communities that offer MAT benefit: problems associated with property crime, homelessness, and expensive use of emergency services are all positively impacted when MAT is available

    to people in need. Cost-benefit analyses indicate that for every $1 spent for MAT, a $4- $5 return is realized.

  • Aren’t you just substituting one drug for another?

    No. This is a very common misunderstanding about medication assisted treatment. Similar to other chronic, relapsing medical conditions like diabetes or hypertension, ongoing stabilization of brain chemistry often requires medication. The medications used for treatment at ETS are long-acting and allow patients to stabilize their bodies through use of a long-acting medication prescribed at a dose that keeps withdrawal symptoms, including craving at bay but does not produce euphoria. Once a patient experiences physical stability, they can manage their condition and begin recovery.

  • What about willpower? Can’t people just stop using drugs?

    Because of the extensive brain changes that occur with chronic use of opioids, it is not typically a condition that can be “cured” when patients simply decide they want to stop using their drug. The vast majority of patients in an absence-only approach will relapse — as many as 90% within 12 months. This is why medication assisted treatment and wraparound services are considered the medical standard of care – it works by stabilizing brain chemistry and helps keep people from relapsing. Willpower alone usually doesn’t work to change the biological and psychological reality underlying this medical condition.

  • What can I do to help?

    If you know or suspect that someone you care about is suffering from an opioid use disorder, communicate your concern for them, for their safety, and for their health. This is the first step. Unfortunately, due to the altered physiological and mental state associated with opioid use disorders, your loved one may not be capable of recognizing his or her condition and may not be receptive to your concerns. Recognize that this is a medical condition, not a weakness or moral failure on the part of your loved one. Continue to offer support, know your limits, educate yourself about this condition, and seek available community resources. Check with health care resources to find federally certified opioid treatment programs like ETS or medical doctors in your area that are certified to prescribe Suboxone. Strongly consider purchasing an overdose prevention kit at your local pharmacy. Go to stopverdose.org for more information about this.

    Most importantly, know that this is a difficult and challenging condition and that there are very effective treatments available.

    Outreach Services

    In 1996, ETS founded the REACH team which provides street-based outreach and case management services for adults in the greater Seattle are who are living outside, many of whom who have substance use disorders. The REACH team currently serves more than 1,000 clients with more than 50 staff. REACH also provides the case management services for the Law Enforcement Assisted Diversion (LEAD) program in collaboration with many city and county stakeholders including The Defender Association, Seattle Police Department, and the King County Prosecutor’s office.


    Helping to train future clinicians in empirically-grounded approaches to substance use disorder treatment is an important part of our work. We are a training site for social work, physician assistants, and addiction medicine fellows from Swedish Medical Center and medical residents from the University of Washington Medical Center. We also provide training in acupuncture with our patients to students from Bastyr University.

    Integrity: We are ethical and professional.