government Gavin Newsom wants to spend hundreds of millions of dollars over the next four years to supply Narcan, the naloxone nasal spray that can snatch someone from an opioid overdose, to counter the deadly rise of fentanyl in California.

But many community groups that routinely hand out the life-saving medication fear their workers will soon be laid off, with the disappearance of a major grant that helped pay for day-to-day expenses at “harm reduction” organizations across the state.

If that grant money goes away, “we’re dead,” said Tom Ewing, executive director of the Sierra Harm Reduction Coalition in El Dorado County.

Such groups hand out clean syringes and other supplies to help drug users avoid dangerous and deadly infections. In California, they have played an outsized role in handing out Narcan and injectable naloxone to the people likely to use it: By early May, they had received 31% of the free doses allocated through a program in California, but accounted for 60% of overdose reversals with that medication that were reported.

“Clearly they’re the best people to do it,” Mary Sylla, director of overdose prevention policy and strategy for the National Harm Reduction Coalition, told an advocacy group that received some of the funding to help beneficiaries. If California doesn’t provide funding for people who routinely get naloxone for those who need it, there’s a risk that “we’ll end up with a bunch of Narcan sitting on the shelves in Sacramento.”

The California Harm Reduction Initiative grant program provided $15.2 million to support dozens of programs after state legislatures approved the money four years ago.

The median annual grant was $112,500, nearly half the median budget for groups receiving the money, an analysis by research group RTI International found. Many harm reduction programs in the state depended on the grants to pay for staff and other day-to-day expenses.

In El Dorado County, Ewing said the state grant was the only funding the Sierra Harm Reduction Coalition had received, other than small donations. It only has two employees, including Ewing himself, who works part time

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time as Executive Director.

“It made us a viable organization that effectively supported our community,” said Ewing, who provided mobile services like Narcan distribution at least five days a week. “I now hand out probably 2,000 to 3,000 doses of Narcan a month. I hand out 120,000 syringes a year,” and collect used syringes to prevent waste, he said.

The group has helped dozens of people each year who decided they wanted to stop using drugs altogether and seek treatment, regularly help people get health insurance and find them places to live, Ewing said. It also offers test strips that people can use to check their medications for fentanyl.

“We take care of people every day,” he said. “We’re the people on the street who really listen to what’s going on.”

Between 2020 and 2022, more than 22,000 people trained to prevent naloxone deaths, according to the California Department of Public Health. They distributed naloxone to 73% more people than programs that received no state funding, the RTI analysis found.

That grant money will run out later this year, and Newsom has not proposed any new funding to replace the program in its budget plans.

That’s “counterproductive,” says Braunz E. Courtney, executive director of Alameda County’s HIV Education and Prevention Project. His organization has used the grant money to pay employees for the Black Drug Users Health Hub, which connects people to a range of services, including drugs to help with addiction treatment.

The result would be “to cut programs already funded for naloxone overdose prevention, education and distribution,” Courtney said.

In light of the overdose crisis, the governor has proposed spending more than $220 million over four years on the state program that provides free naloxone; pouring $30 million into efforts to develop a cheaper, generic version of the nasal spray; other additional spending to expand access to test strips that detect fentanyl, among other things.

The governor is working closely with the legislature to develop this year’s budget and fight the ongoing opioid epidemic,” Newsom spokesperson Brandon Richards said in a statement, referring to a plan unveiled by the governor earlier this year. to tackle the opioid crisis.

When asked about concerns that harm reduction groups that distribute naloxone may have to lay off workers because of the loss of the grant money, Richards pointed to government investment in training and support

healthcare

employees, including those dealing with substance use disorders.

Newsom significantly increased his proposed spending on naloxone when he revised his budget plan in May, compared to his original proposal in January. As California stares at a budget deficit, Newsom has proposed paying for such programs with money from legal settlements with opioid manufacturers.

Harm reduction groups gathered in Sacramento this month, arguing that funding for the California Harm Reduction Initiative needs to be extended to save lives. To support harm reduction programs, the National Harm Reduction Coalition is urging California to allocate $61 million to the community groups over four years, possibly using opioid settlement funds. State Senator Scott Wiener (D-San Francisco) is one of the lawmakers championing the $61 million budget request.

“I really appreciate the governor’s proposal to invest aggressively in Narcan,” Wiener said, calling it “incredibly important.” But “we need to get Narcan into people’s hands. And you do that through community infrastructure” like personnel “that can push the Narcan out.”

Other groups and agencies are given free Narcan to distribute through the state distribution program, including police, fire and schools. But harm reduction groups have a specific mission to serve people who use drugs, to help them without judgment, which helps them reach people who don’t like to go elsewhere, said Jenna Haywood, co-chair of the End the Epidemics coalition, which focuses on HIV. sexually transmitted diseases, viral hepatitis and overdoses. “Stigma is the No. 1 barrier for many people to enter into any kind of service, receive health care or get drugs like naloxone,” Haywood said.