Money is flowing to Colorado to stop opioid deaths, but funding for drugs to prevent overdoses is drying up

by Claire Cleveland

On a busy street corner one afternoon in front of the Harm Reduction Action offices

At the center, employees of the nonprofit education and advocacy group handed out free naloxone kits to passersby.

Distribution of opioid reversal medications is critical to the center’s work to reduce fatal overdoses in the community. However, it is questionable how long the group can continue to do this. The center relies on Colorado’s Opioid Antagonist Bulk Purchase Fund, also known as the Naloxone Bulk Purchase Fund, which now lacks a recurring source of money — even though hundreds of millions of dollars in national funds are flowing into the state to settle opioid lawsuits.

“Our concern is that we don’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 collection 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 Overdose Prevention Unit.

The fund has increased the drug’s availability throughout Colorado, which passed a law in 2013 giving legal immunity to doctors who prescribe the drug and to any person who administers it to someone suffering an overdose. The fund currently provides more than $550,000 worth of naloxone kits to various companies each month.

Despite the increasing availability of naloxone, fatal opioid overdoses continued to rise. According to the Colorado Department of Public Health and Environment, 1,292 people in Colorado died from an opioid overdose in 2023. That was 132 more people than the year before.

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. The Colorado fund had $8.6 million left as of September, according to Vanessa Bernal, a spokeswoman for the state health department.

The fund got a boost in September when the state Behavioral Health Administration gave it $3 million from a one-time substance use prevention, treatment and recovery block grant and nearly $850,000 from a state opioid response grant. Colorado Attorney General Phil Weiser said his office will “ensure the necessary budget remains in place for next year.”

The amount of these funds and their source still need to be determined, and long-term solutions are also still being examined. One way to increase the fund beyond next year is to use Colorado’s share of settlement funds from the national opioid lawsuits, said Mary Sylla, former director of overdose prevention policy and strategy at the National Harm Reduction Coalition.

“It’s just completely ironic that something that addresses the opioid overdose crisis is underfunded at the same time that these settlement dollars are flowing,” Sylla said. “There couldn’t be a better use for them.”

According to the Colorado Attorney General’s Office, as of July 2038, Colorado had received more than $110 million in opioid settlement funds and distributed them to regions, local governments, state agencies and infrastructure projects.

But more than half of the settlement money Colorado has received so far has already been paid out to its 19 Regional Opioid Abatement Councils, which have created their own plans to distribute the money to programs such as substance abuse treatment centers, public education campaigns and training for emergency service providers.

For example, the Denver City Council, which has received more than $18 million since 2022, has paid out money to organizations in two- and three-year contracts, the majority of which did not include the purchase of naloxone.

“We thought we could all move forward [naloxone] from the state health department and the Naloxone Bulk Purchase Fund,” Raville said.

The Denver council is working on a plan for the coming years, expected to be released in mid-2025, taking into account dwindling capital fund resources, said Marie Curran, program coordinator for Denver’s opioid control funds.

Lawrence Pacheco, a spokesman for the attorney general’s office, which manages 10% of the state’s opioid settlement funds, said the agency is “working on options to ensure that this life-saving drug can continue to be part of the state’s efforts to curb the opioid crisis.” These options have not yet been published.

California, where Sylla works, used settlement funds for a distribution program similar to that in Colorado. In Washington and Kentucky, tens of thousands of free naloxone kits are being made available to residents as part of the states’ agreements with Teva Pharmaceuticals. Each state uses its opioid relief funds differently, and while many states provide naloxone to their residents in one way or another, including through vending machines, there is no central oversight of naloxone distribution programs.

Over the past five years, Colorado’s 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 estimates helped save more than 4,500 lives.

If additional money is not found, the major fund risks having to further restrict distribution, leaving the hundreds of organizations that rely on it with little or no access to free naloxone. Although the drug became available over the counter nationwide last fall, its price of $45 per two-dose pack means it may remain out of reach for those who need it most.

In May, the state announced a plan to prioritize the groups that will receive the drugs from the main fund, with four categories, from “essential” to “low need,” based on how often a facility encounters directly with people who are most vulnerable are at risk of receiving medication or witnessing an overdose. The Harm Reduction Action Center was placed in the “essential” category. School districts and colleges and universities are in the next highest category.

Another organization, The Naloxone Project, said it was misclassified because it was not assigned to the highest priority level. For this reason, the company only received 1,200 naloxone doses from the fund this year, instead of the 6,000 requested.

“We would argue that we would fall under ‘essential’ because many of our programs are open to the public and regularly provide naloxone to people who use drugs and who are at highest risk of an overdose,” said Rachael Duncan, deputy director of The Naloxone Project.

The group, which has offices in 12 states, supplies more than 90% of Colorado hospitals with nasal and injectable forms of naloxone to give to patients before they are discharged from the emergency room or maternity ward. More than half of the 12,000 naloxone kits the project has distributed to medical facilities in Colorado came from the collection fund.

Another organization, UCHealth’s Center for Dependency, Addiction and Rehabilitation, known as CeDAR, which provides inpatient, outpatient and telemedicine treatments, is no longer eligible for free naloxone because its patients typically have insurance or can pay out of pocket .

Karli Yarnell, a physician assistant at CeDAR, said even if someone can pay for it, that doesn’t mean they can go to the pharmacy to pick up the medication.

And Duncan is worried about what the loss of doses will mean for organizations like The Naloxone Project and CeDAR.

“What I fear is a scarcity mentality from organizations competing for funding,” Duncan said. “But I’m also worried about places where it runs out so reliably.”

This article first appeared in KFF Health News, a national newsroom that produces in-depth journalism on health issues and is one of the core operating programs of KFF – an independent source of health policy research, polling and journalism. Find out more about KFF.