"The Opioid Epidemic" has been in the headlines for years. Deaths from opioid overdose are now much higher than the total number of American deaths during 20 years in Vietnam. And yet...we're still waiting for Federal and state governments to organize and fund a successful response. The business sector, relying on market forces, hasn't been any more effective than government in stopping this crisis. Why have the US government and private sector both failed to solve a public health emergency that everyone agrees is important?
The problem is that neither government nor the private sector has a natural incentive to respond to the overdose epidemic by doing what would save as many lives as possible, as quickly as possible.
Government (at all levels) is incented to do things that are popular, not necessarily things that are effective. This is why you see government pursuing responses to the epidemic that enjoy wide public support (e.g. suing pharmaceutical companies, more aggressive law enforcement), whether or not they save as many lives as possible.
Hospitals and other privatized healthcare providers are incented to supply the healthcare services that make the most money, not necessarily the healthcare services that save the most lives. This is why you see them building new dermatology or sports medicine centers, rather than new facilities to treat drug & alcohol dependence.
There is a need for an independent non-profit effort: to prioritize opioid response opportunities on the basis of saving as many lives as possible, as quickly as possible; to organize the financial and operational resources required for implementation; and to see these opportunities into execution with the appropriate level of urgency. This is the space OCRF is trying to fill.
OCRF’s mission is to save as many lives as possible, as quickly as possible from opiate-related overdose. Our hope is that the success of OCRF will encourage a reset of Federal and state priorities in response to the crisis.
OCRF is based on the vision of:
gathering up every response to fatal opiate-related overdose that has any life-saving potential (evidence-based prevention education, better access to legitimate treatment, better housing for people in early recovery, and so on),
force-ranking these responses on the bases of (1) how quickly each response could realistically start saving lives, and (2) how many lives each response could save once scaled up,
on that basis, deciding which opioid overdose interventions to pursue first, second, third, twelfth, and thirty-seventh,
and organizing the financial & operational resources required to put these interventions into practice with the appropriate level of urgency.
To act on this vision, and to put in place a response to the national overdose epidemic that saves as many lives as possible, as quickly as possible, would give us a response to this crisis that is in accordance with justice. That is, it would give us a response in which all human lives are valued equally, and through which no one can impose non-evidence-based preferences that shift the response away from what would save the most lives.
The logical first step to saving as many lives as possible, as quickly as possible, is to get the intervention that works fastest to the the people who are most likely to die. No intervention (prevention education, recovery support, housing) works faster than naloxone to prevent death, and with a higher probability of success. So, our highest-and-best opportunity to save lives from opiate-related overdose is to make sure the organizations serving opioid-dependent people on a day-to-day basis are financed to distribute as much naloxone as they usefully can.
We have established a fund to finance naloxone distribution by organizations that directly serve the most at-risk populations (people who are currently opioid-dependent, recent overdose survivors, the recently detoxed). These organizations tend to be local harm reduction programs that have been boot-strapped by their founders, and have little (if any) access to government funding. OCRF is working with its fiscal sponsor, Harm Reduction Coalition, to identify the under-financed community-based naloxone distribution efforts across the US that could have the greatest incremental impact with additional funding.
Our focus is currently on overdose survival, but we believe our work will have a powerful effect on increasing the population of individuals in long-term recovery as well. If we want as many people as possible to achieve long-term recovery, the best way to start is to have the largest possible population of overdose survivors to build from in the first place.
In the nine months from Oct ‘18 through June ‘19, funding from OCRF saved 983 lives (3.6 per day), at an average cost of $135.86 per life saved. We believe this is probably the highest rate of effectiveness across all funders of response to the Opioid Epidemic nationwide.
We are funded through grants and donations from the Open Society Foundations, the Addiction Policy Forum, the Kaiser Family Foundation, the Sandgaard Foundation, the Yagan Family Foundation, an anonymous major donor, and many individual donors.
We have negotiated and executed a contract of fiscal sponsorship with Harm Reduction Coalition (HRC). During the term of the contract: OCRF is under the oversight of HRC's Board of Directors; OCRF will raise funds under HRC's tax-exempt status; and HRC is performing OCRF's financial, administrative, and tax compliance functions. It is anticipated that after a period of incubation under HRC's stewardship, OCRF will be spun out as an independent non-profit organization by its founder.
OCRF is currently funding opioid overdose response in: Michigan, Ohio, West Virginia, Indiana, Wisconsin, Iowa, Louisiana, and Connecticut.
Colin Dwyer, OCRF’s founder, has been appointed the social entrepreneur in-residence at the Stanford University Graduate School of Business for the 2019-20 academic year.
Depending on our fundraising success, OCRF may look beyond community-based naloxone distribution to identify the 2nd, 3rd, 4th, and nth, highest-and-best opportunities to save as many lives as possible from fatal overdose, and assess how we can support their implementation. In pursuit of these opportunities, OCRF may evolve out of its current role as a pure funder to encompass a broader range of activities, including the organization of direct actions. Ultimately, OCRF could act as an aggregator of privately-sourced funding for opioid response, premised on the guarantee that (vs public sector actors) we will apply all funding received to its evidence-based highest-and-best use.