Michael was the second visitor of the day. He has side-swept jet black hair and the beginnings of a mustache. He has track marks on his arm, sores on his face and a dirty wife beater on his back under a heavy black coat. He’s high on meth.

He just turned 18 and has been using since he was 14.

“I ran out of what you guys gave me last week,” he says. “I’ve just been going on with what other people gave me.”

Michael exchanges about 100 used syringes for the week, which seems like a lot.

(Julia Karns, who works at Kittitas County Public health and runs the Kittitas County Needle Exchange Program, says he’s using even more than he’s turning in. “Meth users use a lot of syringes,” she says. She makes a stabbing motion with her hand at her arm. “Pfft, pfft, pfft.”)

But Michael had plans to go back to rehab on Feb. 2–his fourth time. After the last one, he was clean for 11 and a half months. Until he moved back to Ellensburg.

“So you moved back and saw the same kind of people?” asks Sue Kendell, one of the volunteers.

“Yeah. First day, I relapsed,” he says.

“What’s different this time? You got a better plan in your head?” Julia asks.

“Hopefully.”

“Well, what’re you gonna do when you run into the hood rats again?” Julia fires back.

“I don’t know. Eat some candy?” Michael says, hidden behind a chuckle. “Helps with the cravings.”

He turns to exit.

“Alright, I gotta go. My ride’s here. Hopefully I see you next week, if not, the week after that,” he says.

“Well, won’t you be in treatment by then?” Sue reminds him.

“Oh yeah, huh? Yup.”

Once he’s out the door and far from earshot, Julia shares the real Michael. How his parents know about his drug use, and how he’s probably malnourished. How he “crushes” her heart and how she wants to “take him around the neck and slam him against the wall and say, ‘You’ve got to save your life!’” How she has two daughters, and if either of them used, how she wouldn’t know what to do, what to think, how to act.

She shares the story of how Michael shoots up his drugs, which he showed her once. He takes the syringe in his mouth, pulls off the cap with his fingers and shoots the meth into his veins. “Bam!” she exclaims. Then, he turns and scratches the needle on the wall to bend it so he’s not tempted to use it again.

Julia is the person who is solely in charge of Kittitas County’s only needle-exchange program. She’s been doing it for six years. She meets people every week she wishes she could save.

When Julia doesn’t see her “clients” for a few weeks, she has to wonder if it’s overdose, jail time or laziness. On the weekends, she doesn’t go out, doesn’t want to see them.

“I just can’t,” she says. “I have to turn that part of my brain off. It’s too much.”

The door is hard to find. Though a sign on the front reads “Entrance through the alleyway,” it’s not there.

A guy and a girl both wearing a black Central sweatshirt are hanging out in the alleyway, talking about their Narcotics Anonymous group.

They talk about their struggle with addiction and how they’re getting better. They talk about how they smoke cigarettes to curb their cravings. They talk about people they know who still use. They talk about people they no longer know, about that guy, Chase Wade, who overdosed in Kiwanis Park three years ago.

Just as doubt starts to set in, Julia pulls up in her silver Subaru Crosstrek.

Her car slid on the ice as she tries to back into a space. She steps out of her car and walks briskly past the two recovering addicts, out of site around the corner.

The Kittitas County Public Health nametag underneath her coat reminding people she means business.

She opens the door with the misleading sign as an eager-looking gentleman follows her in.

Before the Kittitas County Needle Exchange Program moved to the “hippest church in town”–the First United Methodist Church–Julia used to dole out syringes from her desk at Kittitas County Public Health.

This year marks her 16 anniversary. She’s a public health worker, and she says she’s survived round after round of budget cuts for two reasons: she’s bilingual, (she actually lived in Mexico City for much of her life) and she has a “helluva personality.”

What started as a handful of syringes passed out in an office turned into a modest 1,000 syringes exchanged in the first year. In 2015, the program gave out about 8,000 needles, and brought in around 15,000 from the streets.

Throughout it all, Julia says the county has fought her at every turn. First, it was a battle over funding. She won by having the county match funds the program receives from a Coordinated Prevention Grant – a grant from the state Department of Ecology that is used to facilitate waste reduction.

Then it was public perception, which she is still fighting to this day. Even as heroin use reached all-time highs in Washington, according to the University of Washington Alcohol & Drug Abuse Institute, Julia says many community members still look down on the needle-exchange program as promoting drug use.

Even employees at Kittitas County Public Health don’t see eye to eye with her.

“There are very few, but in our department, I was surprised to encounter them, because I believe the best in everyone,” she says.

As clients came in, Julia and Sue sprung to life to help people choose needle sizes (meth users prefer a smaller needle). They also offer free Hepatitis C screenings, or just shoot the shit for a few minutes.

Julia says she used to focus more on offering help and advice, but after seeing the same faces over and over, she instead decided warm conversation might be what they need.

But the most important function of the exchange is to do just that: exchange. Every person who comes in swaps used needles for a fresh bag of sharps.

Some addicts are tidier and keep their needles in a plastic container. Others forget, and bring needles in plastic bottles or leftover coffee filter bags.

Each time the heavy, green door swung open, Julia and Sue act as though they are briefly reunited with their own children. They both shout “Hello!” as they quickly move to the front of the room to strike up a conversation.

“Hi,” the first guest of the day says.

His speech is slurred. He could easily be mistaken as homeless, though he did say he was “on his lunch break.”

He doesn’t say much. His denim jacket hid a container of sharps, which he exchanges for about 30 new needles. He also took about 25 cotton balls, a few tourniquets and sanitary pads.

Before he departs, Julia adds, in a motherly tone, “the idea is that you use something clean.”

A friendly reminder.

In-between visitors, Julia and Sue keep warm with conversation and an old heating furnace that swirls lukewarm air at foot level.

A Narcotics Anonymous group sings chants outside the window–a dash of irony not lost on the two.

“I requested the exchange to be at a different time than the group meeting,” Julia says.

But once the meeting got moved, there wasn’t much she could do.

“I just hope nobody is upset,” Julia says.

The room is concrete and cold. It looks like a doctor’s office waiting room, but smells like a damp church carpet.

Pamphlets are fanned out on a table amid drug paraphernalia–tourniquets, small cups for cooking meth or heroin, cotton balls which are used to filter heroin before it hits the syringe. (Some users will save used ones for when the heroin runs out. Just add water and, presto, a small amount in the nick of time.)

Julia says the room was likely used for Sunday school or something like that. The chalkboard in the corner indicates she’s right.

Sue Kendell, with short grey hair and half-moon spectacles, is Julia’s best volunteer and a recovering addict.

The two women–who are energetic and talkative–show up every Thursday right after lunch time and stay for two and a half hours.

Sometimes, Julia has more volunteers. She says she usually gets one or two students from Central to help out, but no luck this year.

One of the first things they tell people is how needles should be stored after each use. Never reuse them, never share them, they says.

The CDC estimates about 3.5 million people are living with a chronic hepatitis C infection–and a large number of cases come from needle sharing. But Julia says the number is probably much higher. She calls it the “very important emerging silent epidemic.”

When a needle is reused–even if it’s only the second time–it can tear the skin. This is how track marks are formed and how veins become abscessed or collapsed. Even some of the worst junkies know this.

At this program, and like many others across the state in Seattle and Everett, drug users have access to clean needles and just about anything else they need to stay safe.

Richard, who wore a green camouflage bandana to keep back his long brown hair, comes in weekly to exchange needles and pick up a new tourniquet or two.

Julia and Sue know him well and says he’s one of the smartest junkies around. Often when he comes in, he’ll talk for a few minutes about whatever’s on his mind.

This week, it’s the tale of the acid tab he has hidden in his freezer.

“My mom was mad at me over something one day and she says, ‘I know what this is! I’m gonna take this for myself and just have a great evening!’” he says. “My parents are such hippies.”

He’s proud of his sanitary habit; how he uses a new, fresh needle every time. He shows the room his arms, pleased that he doesn’t have any track marks, except for the tiniest dot near the inside of his left arm. But it’s okay­–it blends in with his tattoo.

“Only thing I’m looking forward to is my 30 birthday,” he exclaimed, just before exiting.

The last visitor of the day is Rachel. (She doesn’t share her real name, not even with Julia and Sue). She also has a street name which she picked up at the age of 18.

She was an “Ave Rat”–a homeless person living near the University District in Seattle.

“I had 24, 25-year-olds calling me momma, and I was only 16,” she says. “I’m a nurturer. I still do that with people.”

Rachel doesn’t shoot heroin or meth–though she did have a meth addiction for seven years.

She instead shoots Percosets, a prescription painkiller she crushes and mixes with water in old pill bottles. She then filters it through a coffee filter (she doesn’t use shirts like some users, which leaves a “gross residue”) and shoots it in her arm.

She came in to exchange 180 needles for two weeks.

Rachel insists she doesn’t have a drug problem. She has friends who use meth and heroin to “get high and nod out.” She doesn’t understand that. She uses the Percosets to relieve her chronic back pain.

“I’m not a full addict,” she says. “I know you hear that occasionally from addicts, but I can go two weeks without. I can go and not have any shakes, not have any shudders. None of it.”

Even though she never shares her real name, and even though she forbids any physical description of her, she’s still paranoid that her doctor will somehow figure out it’s her in this story. That he’ll know she’s doing what she’s not supposed to.

“My doctor knows that I don’t take my Percosets traditionally, which is by mouth, but he doesn’t necessarily know that I’ve been shooting them up,” she says. “If he gets ahold of that, then I could get them taken away.”

When it’s time to pack up for the week, Julia and Sue push in their chairs and tidy up. They wrap their scarves around their necks, readying to brave the cold again. They leave the room much the same way they found it.

Julia says today was one of their slower days, but with visits from some of their more colorful characters.

All in all, seven people came in to use the needle exchange, though only about half stopped and talked. Some hid behind the brim of their hat, while others went about their business quickly.

The box of used needles–a biohazard, according to the CDC–is left on the table along with the reading material and supplies. The sign outside is brought in and propped up against the wall. “Never share” it reads with big, bold letters.

Sue had to hurry out. She has another engagement. She also volunteers as a hospice and home care provider. As Julia gets ready to lock up and leave, she glances up and notices another three minutes lingering on the clock. Another three minutes before she can hang up her needle-exchange hat and return to her life as a public health worker.

“I have to stay a little while longer,” she says, as she turns to head back inside. “In case anyone [else] decides to show up.”