Exclusive: New Fund Seeks to Redefine Opioid Crisis Response

A frank assessment of the most common responses to the opioid crisis drives Colin Dwyer's mission to define a new course.

Dwyer believes that a public sector inclined to adopt what's popular, and a private sector attracted to solutions promising a return on investment, cannot succeed in saving the most lives as the epidemic rages. A social entrepreneur with a Stanford MBA, Dwyer is therefore going into communities and identifying local heroes, who with fewer resources have the capacity to reach the most vulnerable more effectively.

In doing so, Dwyer's Opioid Crisis Response Fund could end up accomplishing another feat: putting a mainstream face on harm reduction, a concept still significantly misunderstood even in professional circles. The fund's first initiative seeks to give its grantees enough money to pay for as much naloxone as they can reasonably distribute in their communities in a year.

“I did not come to harm reduction out of an anarchist, street activism background,” Dwyer says with a laugh. His interest lies more in the numbers.

'Rational decision-making'

Dwyer, whose business background afforded him the opportunity to work with Allegheny County, Pa., officials on opioid crisis response as part of a fellowship, learned broadly from that experience that government leaders are incentivized to support what's popular.

Programs for veterans and children are easier sells than programs for marginalized populations such as opioid addicts who inject, he says. Lawsuits against drug manufacturers, which may not generate a tangible benefit for years, are pursued more eagerly than public health initiatives that could save lives today.

Meanwhile, the private sector will tend to support what will make the most money, and that won't necessarily match up with what could save the most lives the quickest, Dwyer says. The largest philanthropic organizations face constraints of their own, he says, often bound by geographic or other limits in their overall mission.

The Opioid Crisis Response Fund, which Dwyer says is essentially operating as a subsidiary of the Harm Reduction Coalition, professes instead to be governed by a model of “rational decision-making.” Here, initiatives will be judged not on the basis of a philosophical orientation, but on unmet life-saving potential. This will take into account both the potential size of the impact and the timing of when it would be felt.

Syringe exchange is at center

The fund's first initiative is seeking to improve naloxone distribution rates dramatically through a strategy that will be executed by local syringe exchange organizations.

Fund leaders cite a staggering 2017 statistic out of San Francisco, where residents who were trained in a program made up mainly of ex-addicts (the D.O.P.E. Project) reversed more than 1,250 overdoses in the same period that San Francisco police reported only 27 uses of naloxone in their department. Many naloxone distribution efforts in communities focus on the efforts of police and other first responders rather than harm reduction organizations that may be closer to the efforts' target population.

Six organizations, in Connecticut, Indiana, Iowa, Louisiana, Ohio and Wisconsin, received initial funding under the Opioid Crisis Response Fund's first initiative last October. Many of the groups share a history similar to that of the Iowa effort, started by a Davenport woman who had lost a son to an overdose.

“She started the first naloxone distribution in Iowa, which was funded through church rummage sales,” Dwyer says. The organization, with no paid employees, uses street outreach to identify the individuals most at risk of overdose in the community.

Another funded project, called Project 414 in Chillicothe, Ohio, is led by an activist who is “the only person in the state getting intramuscular naloxone to people who use drugs,” Dwyer says.

More organizations could be added in this first initiative, depending on the availability of funds. Dwyer says he already has conceptualized the next two likely steps for the fund: supporting take-home naloxone and harm reduction education for individuals leaving hospital emergency departments, and ensuring that inmates leaving custody receive naloxone and related support upon discharge.

According to the fund's leaders, the first six programs to be funded could end up distributing a total of 30,000 doses of naloxone among them.

Mix of donors

Supporters of the fund are a diverse mix that includes the policy reform-focused Open Society Foundations, the Addiction Policy Forum and the Yagan Family Foundation, the latter a connection established by Dwyer at Stanford.

He says that when anyone suggests that the initial efforts promoted by the fund won't accomplish much beyond overdose rescue alone, he points to data showing that the vast majority of overdose survivors are alive a year later—buying important time for them to be linked to services, insurance enrollment or other support.

Moreover, he says, the syringe exchange programs that his fund is emphasizing facilitate access to care for around one-quarter of their clients—thus reaching a stigmatized population that traditional efforts have largely failed.