Until recently, their only choice would have been a hospital emergency room. But on this cold January night, the paramedics had another option: the D.C. Stabilization Center, a place where people who’ve used drugs or alcohol can safely recover for up to 24 hours under the care of nurses and mentors who have been in their shoes.

In just over three months, the center on K Street Northeast has surpassed 1,000 admissions.

Mayor Muriel E. Bowser opened the center to fanfare last year as part of the District’s overall plan to reduce fatal overdoses, which have killed more than 400 Washingtonians annually for four consecutive years, outpacing the city’s homicide toll.

The facility, one of about 60 across the country in cities such as Baltimore, San Francisco, Houston and St. Louis, aims to link patients with treatment — if and when they are ready. If successful, District officials say, the approach will free up overburdened emergency responders and alleviate strain on hospitals still confronting pandemic-era staffing shortages.

Comprehensive solutions to the opioid crisis have eluded the city as the death toll continues to rise. And while public health advocates have called for the Bowser administration to demonstrate greater urgency and provide more wraparound supports, such as housing, many have hopes that the center will help.

A warm room. A safe place to sleep it off. Someone to talk to who understands. All awaited the man on the curb, if he wanted them.

Paramedics covered him in a pale yellow sheet before loading him onto a stretcher and into the back of an ambulance. Robert Holman, the D.C. Fire and EMS medical director along for the ride this evening, rested a gloved hand on his shoulder and tried to rouse him with basic Spanish. “Cómo sientes?”

The man’s head lolled back under the bright lights as a digital clock ticked off the minutes. 3. Firefighter paramedic Cody Grosch tapped a report on his laptop as paramedics checked his vital signs and discussed his condition.

The radio sprang to life again. The ambulance was on the move.

It was 2018, and the horrors of the pandemic were still years away. Still, medics were taking longer to drop off patients at hospitals as calls were mounting for people on drugs or alcohol, city data shows, reflecting in part a surge of deadly fentanyl into the city’s drug supply.

Holman pushed for a sobering center but knew the city’s Fire and EMS department couldn’t get it done alone. That’s when Barbara J. Bazron, director of the Department of Behavioral Health, reached out, saying she helped set up a similar center in Baltimore and it could work in D.C.

Years later, they are betting millions in city funds annually on the center to help meet a still growing need. There were 427 opioid-related fatal overdoses in D.C. last year through October, according to the most recent data available from the chief medical examiner’s office, putting the District on track to outpace a 2022 high of 461 overdoses.

Bowser declared a public health emergency on opioids in the fall — set to expire Feb. 15 — and a panel of local officials, providers and recovering drug users known as the Opioid Abatement Advisory Commission began meeting in October to make recommendations to Bowser for how to divvy up the settlement funds to prevent and treat substance abuse disorder.

City officials say they know the center won’t solve all the city’s problems with addiction, but it could save lives.

He’s 14. He’s been to five funerals. Can he avoid his own?

The location was an early hurdle. They looked back at a year of data to confirm known hot spots in Columbia Heights and east of the Anacostia River, as well as in central D.C. near Union Station and the homeless shelter at 2nd and D streets Northwest, one of the largest in the nation. Despite pushback from advocates who argued Wards 7 and 8 needed it more, officials chose 35 K St. NE for its central location and the relative ease of using a building where the city already ran an adult behavioral health clinic.

Covid put plans on hold in 2020, and they tried three times to find a local operator before settling on an agency based in Arizona, Community Bridges Inc., to run the center.

Since the center opened in late October, 730 people people have been admitted, some more than once, for a total of 1,019 admissions, city data as of Feb. 5 shows. More than 70 percent of admissions have been Black and 80 percent male. The average age is 45.

Nearly 60 percent of patients used alcohol and at least 10 percent opioids, city data shows, based largely on self-reporting. The opioid antidote naloxone was administered twice, according to city data. The center also sees cases involving PCP, K2 and xylazine.

Nurses typically do a urine drug test and breath analysis on patients, who change into scrubs and can shower and eat if they’d like. Contraband such as weapons or drugs is confiscated.

Officials say they do not yet have a plan for tracking the long-term progress of patients, knowing they may turn down treatment many times before giving it a try. One person visited at least 17 times in just over three months, Bazron said, adding their 18th visit could be the one that does the trick.

About 17 percent of total admissions, 176 patients, have gone to residential treatment or a shelter or gotten a referral for other behavioral health care, city data shows, but for now, that’s where the path ends.

“We’re making an initial hot connection,” Bazron said.

Back on K Street Northeast, the ambulance pulled into the parking lot at the stabilization center, known as Hospital 99 to medics. Flashing red ambulance lights bounced off the beige bricks.

The man lay motionless, his head turned to the side, as paramedics rolled the gurney up a ramp, through glass doors and into the brightly lit lobby. A sign on the wall pledged empathetic care, a safe space to recover and a pathway for a long-term solution.

Nurses were expecting him — and recognized him. The man, 63, had left around noon that same day, they said, planning to go to a shelter. Paramedics found him barely a block away.

“How ya doing? You gonna come stay with us?” the center’s clinical director, Mary Page, asked. He nodded. A wheelchair appeared. “Remember me from this morning? I gave you food?”

Alert to verbal/tactile stimuli? Check. Blood pressure under 200 mmHg. Check. No signs or trauma or need for sutures. Not combative or violent. No chest pain. A nurse searched his jacket and handed a bottle of Taaka vodka to a security officer, who stashed it in a drawer. His clothes and belongings would be catalogued and locked in a bin for him.

They swapped his shoes for grippy socks. His feet dragged on the floor as he was wheeled backward into an intake room. “Feel better,” Holman said after him, as the door closed.

Most patients rest in one of 16 smooth blue reclining chairs under low lights and the soft glow of television, as nurses move around the floor. The average stay is 15 hours.

Paramedics have brought the vast majority of patients to the center — the others come via friends or family or walk in on their own. Not everyone is eligible.

The sobering center is not right for anyone who shows signs of trauma or needs sutures, is combative or violent or has vital signs outside a certain range, among other qualifiers on a 14-point checklist that medics and the center staffer both sign.

Two of these came during another freezing 24-hour shift in January.

At 2:46 p.m., dispatch sent a crew to a reported cardiac arrest — a signal of a possible drug overdose — at Georgia Avenue and Columbia Road Northwest. There, they found a 41-year-old man sitting on the ground in the corner of a bus shelter, clutching the bench seat, his head nodding as he struggled to stay awake.

They suspected alcohol intoxication. The ad behind him showed a hand holding a canister of Narcan. “Be Ready. Save a Life.”

He told paramedics he wanted to get on the bus. At 86 over 70, his blood pressure was too low for the stabilization center. They took him to George Washington University Hospital, where medics spent about an hour and 45 minutes waiting for a bed for the patient, FEMS officials said later.

At 6:33 p.m., it was 26 degrees when dispatchers routed a crew to North Capital and H streets Northwest. Paramedics found a man, 40, shivering and moaning in nothing but a sweatshirt and sweatpants, saying he wanted to kill himself.

Firefighter paramedic Kyle Belton wrapped a blanket over his head and shoulders and propped him up against a building for support.

“Cold,” the man said over and over.

“We’re gonna get you some help,” Belton said.

They pricked his finger to test his blood sugar. At 132 over 78, his blood pressure was elevated. He was shaking too hard for them to get an accurate heart rate. Someone suspected he may have used K2, or synthetic marijuana.

The man wasn’t out of control but was probably off his psychiatric medication, emergency personnel concluded. Suicidal ideation disqualified him from the stabilization center, making a hospital the best choice.

Later, they could arrange a ride for him to a warming center. Belton advised EMTs on their way to prepare heat packs.

Once they eased him into an ambulance, Belton retrieved his sneakers from the street, brushing dirt from the white leather.

“You’re not alone,” Belton told him.