OLYMPIA, Wash. (AP) — Every time she got out of jail, Jamie Cline started hustling again for heroin, driven by an addiction she didn't understand.
"You want to get clean so bad. You know something's killing you and you can't stop," said the 33-year-old who used heroin for 10 years.
This spring was different. While in a jail work-release program, she took the medication buprenorphine. It quieted a voice in her brain that told her to keep using.
When she got out of jail, she headed for an Olympia clinic where a doctor is working to spread a philosophy called "medication first." The approach scraps requirements for counseling, abstinence or even a commitment to recovery.
Instead, it starts with fast access to prescribed medicine that prevents withdrawal sickness. After patients start feeling better, they choose their next steps.
In St. Louis, Seattle and San Francisco, people with opioid addictions can start medication on their first day of treatment. Early research suggests the approach can change lives. But it will be a tough sell elsewhere: Nearly two-thirds of U.S. treatment centers do not offer anti-addiction drugs and there's resistance to easy access.
Within two weeks of walking into the Olympia clinic, Cline had a job at a millwork shop. Now, nine months later, she has received a promotion and a raise, rebuilt relationships, found a room in a sober house and is proud to display a chain of "Clean & Serene" key fobs she earned from Narcotics Anonymous. She takes buprenorphine twice daily.
"I've got my life back," she said.
The opioid crisis now kills more Americans than car crashes and is estimated to cost more than $500 billion a year. The epidemic is driving new treatment strategies for the 2 million Americans addicted to opioids.
Bupe, as it's known, is not new. Approved to treat opioid addiction in 2002, it blocks the effect of other opioids and eases withdrawal. It's an opioid, but an imperfect fit for the brain's receptors, so its effect is mild and it does not cause a high. It also reduces the danger of overdose and raises the likelihood a person will stay in treatment.
But finding a prescriber without a waiting list is difficult. Guidelines say bupe should be used with counseling, which some doctors do not feel equipped to provide.
Success stories have persuaded some experts that buprenorphine should be available in homeless camps, syringe exchanges and anywhere people use drugs.
"This is an obvious thing to do," said University of Washington researcher Caleb Banta-Green.
Stabilizing influence or false promise?
Martyn is a 57-year-old former heroin user who goes by one name. He was living in a Seattle homeless camp known as the Jungle, running errands for drug dealers.
"Toward the end, you're not trying to get high anymore," he said. "You're just trying to not be sick."
He got his first bupe prescription at Neighborcare Health, a free downtown clinic. Once stabilized, he found a spot in a sober home with help from a caseworker.
"Now I've got a little room in a house I share with seven other guys." On bupe, Martyn said, "I don't get that high feeling. And that's OK."
But critics worry medication-first clinics will add to the flood of opioids on the street.