BEGINNING LAST MARCH, Patrick Smith's life would have made great fodder for an Alfred Hitchcock movie.

The 62-year-old began waking up with strange bites on his arms and legs, no bigger than that of a small mosquito bite. He couldn't find any clues around his bed, or in his navy blue bed sheets—yet small red spots continued to appear all over his body. He developed an allergy. "There would be a welt the size of a sand dollar," he says, referring to the places where he'd been mysteriously bitten.

Then, one day, he spotted something crawling up his wall. Smith caught it with a glass jar. It was a bedbug.

He starting using white sheets, and one morning found three of these bugs in his bed. Small specks of Smith's own blood dotted the sheets. "I couldn't sleep in my own bed," Smith says. "I had to sleep in other places."

A resident of the St. Francis Apartments, a low-income, affordable apartment building in downtown Portland owned by the Housing Authority of Portland (HAP), Smith says he began sleeping on the floor in empty apartments—anywhere other than at his place. He did this for four months, until a heat treatment and three chemical applications finally killed the bugs.

Smith's experience is only one of many shared by tenants of rental housing throughout Portland and Multnomah County. Bedbugs—once unheard of in the United States because of the toxic pesticide DDT—are infesting mattresses, box springs, and couches. They are even inside apartment walls, crawling in through minute cracks and crevices, making their way into another apartment. And another. And another.

And they're not just in affordable or low-income housing. Hotels are also getting hit. "They are the everyday ones you and I would use. Even the upper-end [hotels]," says Larry Durant, who consults with organizations on how to get rid of bedbugs.

Portland's bedbug problem is not at epidemic levels, as in New York City. But the presence of bedbugs has increased tremendously in the last four years, making it the most pressing issue faced by affordable housing providers and advocates.

"They're everywhere," says Ed Blackburn, executive director of the social service agency Central City Concern.

"It's pretty severe. They're widespread in Multnomah County," says Melissa Greeney, a safety net specialist for Multnomah County's Aging and Disability Services office.

Providers have scrambled to find a solution to a problem they are beginning to realize they can only manage—because bedbugs are most likely here to stay.

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Bedbugs are simple creatures. They're most active at night. They do not fly; they crawl. They're only able to crawl up rough surfaces, and would slide down or be unable to climb up something smooth like plastic or metal.

Black and flat, they're tiny—no bigger than a pinhead when fully grown, which takes two to four months. Eggs, which a female bedbug lays each week in batches of five to seven, hatch within 10 days. If a female eats regularly, she can produce 200 to 500 eggs in her lifetime. "They produce very quickly," says Margaret Mahoney, the property management director of affordable housing provider REACH Community Development.

Bedbugs can live for 12 to 18 months without eating. They only ingest blood. When they bite, people don't feel it because the bedbug injects anesthesia. And 30 percent of people don't react to being bitten at all.

Even though they suck blood, bedbugs are not considered vectors of blood-borne illness and disease, like mosquitoes, but they do cause other health and livability problems.

"In terms of personal comfort," Mahoney says, "it can be quite uncomfortable."

Ben Duncan, a program development specialist at Multnomah County's public health office and the creator of an ad hoc taskforce on bedbugs that began meeting last year, lists insomnia, anxiety, and paranoia as some mental health issues faced by people dealing with bedbugs.

"There are mental health effects following something that only comes out at night and bites you when you're in bed," he says.

"Can you imagine bugs half the size of your pinkie fingernail crawling around in bed with you while you're sleeping and sucking your blood?" Smith says. "It's grotesque and disgusting."

Peak feeding hours, says Durant, are between one and five in the morning.

"Then they will be very elusive and go back to the bottom of the box springs, into the wall, into spots you and I typically don't see," he says. "We don't see them running across the floor like a cockroach when we flip a light switch."

"A lot of times, people have no clue," says Cathy Morris from Northwest Pest Control.

These many unique characteristics make them difficult to wipe out. And the result is disastrous if they are not detected early.

"If you don't take them out right away, they spread very rapidly," Mahoney says.

Bedbugs spread mainly through travel. They can latch onto luggage, clothes, and upholstered furniture, and move from place to place. Increased travel in the last few decades is cited as one of the main reasons why bedbugs are flourishing. And once inside the walls of one apartment unit, they can eventually infest the entire building.

Rodger Moore, director of public housing for HAP, says an infestation can mean thousands of bedbugs living in the walls.

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Both REACH and HAP began noticing large numbers of bedbugs in their properties between one and three years ago.

Both providers aggressively jumped on the problem, and began using a pest control model called "integrated pest-control management." It uses a variety of means to both prevent and kill bedbugs—including chemical and heat treatments, frequent inspections, caulking and sealing any cracks or crevices in the walls or baseboards of a room, and a tenant education and awareness campaign.

"It really takes everything in the toolbox to do a good job," Durant says.

A year and a half ago, Central City Concern saw the peak of its infestations. Adrienne Karecki, Central City Concern's director of business enterprises, says her organization began using the integrated pest-control model, and estimates the number of bedbugs has decreased by 60 percent. Central City Concern has also begun administering full chemical treatments on its buildings every three months.

"It's very proactive," she says. "We're stopping them before they can keep moving from room to room."

HAP already employed pest control staff. "We thought we had the knowledge and the manpower to deal with it," Moore says. "A year ago, we were losing the battle."

Five out of HAP's 42 public housing buildings were "substantially hit" by bedbugs, Moore says. All those buildings house elderly and disabled people.

HAP began a pilot project using integrated pest-control management eight months ago at Williams Plaza, one of its properties. Chemical treatments using cedar oil are applied via a fog to baseboards, walls, and other areas of the apartment. The treatment takes several hours.

Bedbugs die if directly exposed to cedar oil—but if not directly exposed, it can take up to two weeks before bugs die. Three treatments over the course of 18 months, Moore says, are required to make sure bedbugs are gone for good.

HAP, like REACH, also uses heat treatments. Heating pipes are moved into a room, heated to 130 degrees, and a fan blows the dry heat throughout the room for several hours. It kills the bugs and any eggs in the room explode.

The entire treatment process can take up to a year and a half, and cost between $800 and $1,200 per unit.

Another strategy people are pushing to deal with bedbugs is tenant awareness and education. Many stereotypes exist about bedbugs. For instance, a connection is often made between infestation and a person's hygiene and cleanliness. Moore says a room can be "spick-and-span," but still have bedbugs.

And tenants are often afraid, Mahoney says, that reporting bedbugs will lead to their eviction—as if the tenant has committed some egregious fault. HAP's lease agreement, for instance, requires tenants to maintain safe and sanitary premises, peaceful conditions for themselves and their neighbors, and keep their residence as pest free as possible. But one cannot be evicted simply because of the presence of bedbugs.

Breaking down those stereotypes and stigmas among tenants is as crucial to ridding an apartment of bedbugs as extermination measures.

"If you're scared you're going to have a financial liability or eviction, your incentive to report an infestation is limited. Then the probability the infestation will grow until it is a building-wide problem increases. Then the costs to the management and the owner increase as well," Duncan says.

HAP is starting to see progress. Two cedar oil treatments have been implemented, and a third is planned in the coming weeks. One pest control staffer is now solely dedicated to inspecting rooms for bedbugs.

HAP is also considering installing heat rooms in each of its properties. The strategy has proven effective in Vancouver, British Columbia. The room heats a new tenant's furniture until any potential bedbugs are dead.

The first heating rooms are planned to be installed in the new homeless shelter, the Resource Access Center, scheduled to open in May 2011.

Patrick Smith is a witness to the time-intensive and almost paranoid thoroughness required to treat a bedbug-infested room. Smith's room was first treated with heat. Smith had to put all his possessions into heavy-duty plastic bags. All his clothes were washed.

"I had to go page by page through every book I didn't want to throw out," he recounts. It took three days to pack everything once it passed inspection.

"It can take a lot," Mahoney agrees.

Smith waited three weeks before a second heating, while keeping all his possessions in the bags.

Unfortunately, the heat treatment did not work. Next came the chemical treatment. The bedbugs were still there after nine weeks. In the end, Smith completely deconstructed his bed, and found the bugs inside the joints.

And then, finally, they were gone. When all was said and done, and the umpteenth inspection was completed with no trace of bedbugs, Smith could finally, "sleep like a baby."

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No one thinks it is possible to completely eradicate Portland's bedbug population. "Minimizing the impact is probably more realistic," says Duncan of the public health office.

There is also no centralized effort in Portland to get rid of bedbugs—because they are not vectors, the health department doesn't have a program to eradicate them. And though they are considered by Portland's housing code to be a pest and a nuisance, there's no special categorization or treatment given to bedbugs when it comes to policy.

"We don't have enough organized control until a government entity or some other entity steps in and gets hold of a control program," Durant says. "We have that for weeds and mosquitoes—all kinds of pests. We need to have some type of regimentation about what needs to be done, and how it needs to be done."

Central City Concern's Ed Blackburn thinks that until some governmental authority takes bedbugs seriously, bedbugs will continue to thrive.

"We need a better communication system. A way to map out how these bugs are likely to be transmitted," he says. "If we're all doing our own thing, I don't think we can be effective."