DENVER — On a recent afternoon, on a busy street corner across from the Harm Reduction Action Center offices, employees of the nonprofit education and advocacy organization handed out free naloxone kits to passersby.
Distribution of opioid reversal medication is essential to the center’s work to reduce fatal overdoses in the community. But how long the group will be able to continue doing so is in question. The center relies on the Colorado Opioid Antagonist Bulk Purchase Fund, also known as the Naloxone Bulk Purchase Fund, which now lacks a recurring source of money, despite hundreds of millions of dollars in cash in settlements. of national opioid lawsuits flow to the state.
“Our concern is that we won’t have access to naloxone and that means more people will die from a very preventable overdose,” said Lisa Raville, the center’s executive director.
The bulk fund was created in 2019 to provide free naloxone to organizations like the Harm Reduction Action Center. The fund’s annual budget grew from just over $300,000 in fiscal year 2019 to more than $8.5 million in fiscal year 2022, according to legislative reports from the state’s Overdose Prevention Unit.
The fund has increased availability of the drug throughout Colorado, which passed a law in 2013 granting legal immunity to medical providers who prescribe the drug and anyone who administers it to someone who overdoses. Currently, the fund provides more than $550,000 in naloxone kits to various entities each month.
Despite the increased availability of naloxone, fatal opioid overdoses continued to increase. In 2023, 1,292 people in Colorado died from opioid overdoses, according to data from the Colorado Department of Public Health and Environment. There were 132 more people than the previous year.
And now, one of the fund’s main sources of money, the American Rescue Plan passed by Congress in response to the Covid-19 pandemic, is set to expire next year. As of September, Colorado’s fund had $8.6 million left, according to Vanessa Bernal, a spokeswoman for the state health department.
The fund got a boost in September when the state Behavioral Health Administration provided it with $3 million from a one-time block grant for substance use prevention, treatment and recovery services and nearly $850,000 through a state disaster response grant. opioids. Colorado Attorney General Phil Weiser said his office “will ensure the necessary budget remains in place for the next year.”
The amount of that funding and where it will come from has yet to be determined, and long-term solutions are also being considered. One option to shore up the fund beyond next year is to use Colorado’s portion of the national opioid lawsuit settlement funds, said Mary Sylla, former director of overdose prevention policy and strategy at the National Drug Reduction Coalition. Damage.
“It’s completely ironic that something that addresses the opioid overdose crisis is underfunded at the same time these settlement funds are flowing,” Sylla said. “There couldn’t be a better use for them.”
As of July, Colorado had received and distributed more than $110 million in opioid settlement money to regions, local governments, state entities and infrastructure projects, according to the Colorado attorney general’s office, and the total is expected to reach more than $750. million by 2038.
However, more than half of the settlement money Colorado has received so far has already been disbursed to its 19 Regional Opioid Reduction Councils, which have created their own plans to distribute money to programs such as substance abuse treatment centers. , public education campaigns and training. for emergency providers.
For example, the Denver council, which has received more than $18 million since 2022, has disbursed money to organizations in two- and three-year contracts, most not including the purchase of naloxone.
“We thought we could all continue to receive (naloxone) from the state health department and the Naloxone Bulk Purchase Fund,” Raville said.
The Denver council is working on a plan for the next few years, expected to come out in mid-2025, and is considering decreasing money from the fund, said Marie Curran, program coordinator for Denver’s opioid reduction funds. .
Lawrence Pacheco, a spokesman for the attorney general’s office, which manages 10% of the state’s opioid settlement dollars, said the office “is working on options to ensure this life-saving medication can continue to be part of the state’s effort.” to mitigate the opioid crisis. .” Those options have not yet been made public.
California, where Sylla works, has used the settlement money for a distribution program similar to Colorado’s. In Washington and Kentucky, as part of the states’ agreements with Teva Pharmaceuticals, tens of thousands of free naloxone kits will be available to residents. Each state uses its opioid settlement funds differently, and while many provide naloxone to residents in some way, including through vending machines, there is no central tracking of naloxone distribution programs.
Over the past five years, the Colorado fund has distributed more than half a million doses of the opioid reversal drug to hundreds of organizations and schools across the state. Last year, the Harm Reduction Action Center received 7,284 doses from the fund, which Raville said helped save more than 4,500 lives.
Unless additional money is found, the wholesale fund risks having to limit distribution even further, leaving the hundreds of organizations that rely on it with little to no access to free naloxone. While the drug became available without a prescription nationwide last fall, the $45 price tag per two-dose package means it may remain out of reach of those who need it most.
In May, the state announced a plan to prioritize which groups get drugs from the bulk fund with four categories, from “essential” to “low need,” based on how often an entity directly encounters people who are most at risk. of experiencing or witnessing an overdose. The Harm Reduction Action Center has been classified in the “essential” category. School districts, as well as colleges and universities, are in the next highest category.
Another organization, The Naloxone Project, said it was misclassified by not being placed in the highest priority level. As a result, he said, he only received 1,200 doses of naloxone from the fund this year, instead of the 6,000 he requested.
“We would argue that we would fall into the ‘essential’ category because many of our programs are public-facing and consistently provide naloxone to people who use drugs and are at highest risk of overdose,” said Rachael Duncan, associate director of The Naloxone Project.
The group, which has chapters in 12 states, provides nasal and injectable forms of naloxone to more than 90% of Colorado hospitals, to give to patients before they are discharged from the emergency department or delivery units. . More than half of the 12,000 naloxone kits the project has distributed to Colorado medical entities come from the bulk fund.
Another organization, the UCHealth Center for Dependency, Addiction and Rehabilitation, known as CeDAR, which offers residential, outpatient and telehealth treatment, is no longer eligible to receive free naloxone because its patients are generally insured or can pay out of pocket.
Karli Yarnell, a medical assistant at CeDAR, said even when someone can afford it, that doesn’t mean they can go to a pharmacy to pick up the medication.
And Duncan worries what the loss of doses will mean for organizations like The Naloxone Project and CeDAR.
“What I fear will happen is a scarcity mentality on the part of organizations competing for funding,” Duncan said. “But I’m also worried that places that are used to having it so reliably will sell out.”
