{"edition":"california","organization":"End Overdose","organizationId":"org:end-overdose","boundaryVersion":"US-CA-state-v1","updated":"2026-09-13","model":{"version":"ca-end-overdose-alpha-v2-conditional-geography","costScope":"Full ordinary recipient gift across all functions. National model conservatively quantifies the naloxone pathway while costing unquantified activities; C=100000 is normalization only.","geographicAttribution":"An explicit subjective geographic allocation replaces the null: p=0.15 is the share of marginal exposure/person-time provisionally assigned to California before relative yield; rho=0.75 is California's incremental health yield relative to elsewhere. g_CA=p*rho/(1-p+p*rho)=0.1168831169. p accounts for patient location and later mobility once; rho accounts for relative incremental yield after local alternatives. Neither is an observed resident, chapter or dose share. Normalization calibrates the two regional yields to the fixed national mean: it reallocates, rather than reduces, national benefit. CA and USA totals must not be added. The unchanged all-population health total is divided between CA and elsewhere consistently. This is a weak prior, not a geographic finding.","formula":"Offers=G*a/c. Unique additional deaths prevented=Offers*e*d*r*f*b. L=sum(k=1..T)[u*(1-m)^k/(1.03)^k]. All-populationQALYs=deaths*L/1.03 for rescue at end ofyear1. CaliforniaQALYs=allQALYs*g_CA. DonorUSD/10CaliforniaQALYs=10G/CaliforniaQALYs. Gross resources=G+Offers*(unpaid labor+donated stock value). Central parameters: a=.75,c=50,e=.005,d=.5,r=.2,f=.2,b=.5,u=.75,m=.04,T=30. Geographic extension only: g_CA=p*rho/(1-p+p*rho), Q_CA=Q_all*g_CA. Central p=.15,rho=.75; favorable p=.5,rho=1.5; pessimistic p=.02,rho=.25. National clinical parameters and Q_all remain unchanged. p is a modeled marginal exposure/person-time allocation, not a chapter-count ratio; rho reallocates relative local effectiveness without applying a second blanket discount to national benefit.","counterfactual":"Other free distribution, public stock, purchase and emergency responders remain available; only changes in timely rescue and subsequent survival beyond those alternatives count. Ordinary gifts may replace funding or support national expansion outside California. Geographic p may be zero if the marginal gift supports only out-of-state work. rho distinguishes local alternatives from the already included nationwide average rescue and budget additionality; it is not another medication-stock replacement factor.","attribution":"Funding additionality is distinct from incremental rescue; donated stock is a complement with no assumed cash purchase cost. Public/partner contributions and repeated rescues cannot each receive full causal health credit.","uncertainty":"The original California share remains empirically unidentified. This version provides a deliberately subjective conditional central rather than pretending lack of measurement requires no scenario. Historic event doses, current California chapters and a CA-specific offer establish substantial delivery presence, but no calibrated distribution for p or rho. The central is not a statistical expectation, and finite stress scenarios are not bounds. A California-only null can coexist with positive national health. This quantifies the naloxone mortality pathway while retaining all recipient costs; unmodeled morbidity/test-strip/education effects are not demonstrated zero.","nativeOutcomes":"Additional two-dose kit opportunities; unique otherwise unprotected overdose situations; additional timely rescues; unique-person survival and quality-adjusted life-years, not gross doses or training completions. New geographic bridge distinguishes venue/delivery outputs from where additional patient health occurs; no observed dose or chapter is mechanically converted to a California QALY.","inputs":[{"name":"FY 2024 recipient spending","value":970440,"unit":"USD/year","basis":"observed","rationale":"PartI andIX total agree; PartIII allocation does not and is not used.","sourceIds":["eo-99024"]},{"name":"Naloxone package content","value":2,"unit":"doses/package","basis":"observed","rationale":"Current recipient-facing kit description. Quarterly dose counts are not package counts.","sourceIds":["eo-kit"]},{"name":"2026 manufacturer contribution","value":25000,"unit":"reported naloxone units","basis":"observed","rationale":"Campaign statement; unit definition, remaining stock and recurring availability not verified.","sourceIds":["eo-campaign"]},{"name":"CalRx procurement benchmark","value":19,"unit":"USD/twin-pack","basis":"observed","rationale":"California2026 price; not an EO invoice or automatically available national price. Central$50 cash package can be read as$19 stock plus$31 implementation, both transfer assumptions.","sourceIds":["calrx-price"]},{"name":"a","value":0.75,"unit":"fraction","basis":"judgment","rationale":"Gift share supporting costed training-plus-kit pathway; other work receives zero quantified benefit.","sourceIds":["eo-campaign"]},{"name":"c","value":50,"unit":"USD/offered package","basis":"judgment","rationale":"All-in marginal cash delivery assumption, not historical average cost per training.","sourceIds":[]},{"name":"e","value":0.005,"unit":"fraction","basis":"judgment","rationale":"0.5% annual opportunity is a deliberately cautious broad-audience prior, not derived by annualizing lifetime festival reports. High-risk jail visitors witnessed far more events; actual EO channel mix remains unknown.","sourceIds":["naloxone-rikers","naloxone-festival"]},{"name":"d","value":0.5,"unit":"fraction","basis":"judgment","rationale":"Conservative duplicate-scene/person adjustment; needs unique-recipient follow-up.","sourceIds":[]},{"name":"r","value":0.2,"unit":"fraction","basis":"judgment","rationale":"Incremental timely rescue after completion, availability and existing rescuers; do not add another adherence multiplier.","sourceIds":["naloxone-festival","naloxone-zang"]},{"name":"f","value":0.2,"unit":"fraction","basis":"judgment","rationale":"Absolute episode mortality reduction from extra timely rescue; not survival after reported reversal.","sourceIds":[]},{"name":"b","value":0.5,"unit":"fraction","basis":"judgment","rationale":"Only half nominal delivery assumed additional to other funding. Current campaign supports plausibility, not proof.","sourceIds":["eo-campaign"]},{"name":"u","value":0.75,"unit":"fraction","basis":"judgment","rationale":"Utility while alive; not measured in EO recipients.","sourceIds":[]},{"name":"m","value":0.04,"unit":"fraction","basis":"judgment","rationale":"Annual competing mortality, capturing continued overdose and other risks.","sourceIds":[]},{"name":"T","value":30,"unit":"years","basis":"judgment","rationale":"Finite modeled health horizon, not measured life expectancy.","sourceIds":[]},{"name":"unpaid","value":10,"unit":"USD/offered package","basis":"judgment","rationale":"Volunteer/support resource envelope, not marginal opportunity cost.","sourceIds":[]},{"name":"p_CA","value":0.15,"unit":"modeled marginal exposure/person-time share before local yield","basis":"judgment","rationale":"A cautious 15% prior, not derived by equating outputs to health. Named CA events account for 7.36% of all reported summer-2024 doses, but highlights omit other events/channels; current directory lists 16 of62 CA chapters, while newer campaign says80+ nationally. CA events and separate kit offer support nontrivial presence; national online delivery and expansion justify not assuming a dominant CA share. Future patient residence and marginal allocation are unmeasured. Stress2%–50% is subjective, not a bound.","sourceIds":["impact24","chapters","campaign","ca-kit","eo-events-2026"]},{"name":"rho_CA","value":0.75,"unit":"California incremental health yield relative to non-California","basis":"judgment","rationale":"25% lower local incremental yield is a cautious relative-effect prior for public naloxone availability and other rescue, not a measured state comparison; targeted gaps might instead make CA more productive. Stress0.25–1.5. National average clinical total remains unchanged rather than being discounted twice.","sourceIds":["dhcs","ca-kit","eo-events-2026"]},{"name":"g_CA","value":0.11688311688311688,"unit":"California fraction of unchanged national modeled QALYs","basis":"judgment","rationale":"Derived .15*.75/(.85+.15*.75)=.1168831169; not a measured allocation. Normalization assigns complementary modeled benefit outside California.","sourceIds":["chapters","campaign","impact24"]}],"scenarios":[{"id":"central","label":"Conditional central — subjective California share","costUSD":100000,"allPopulationQalys":0.6582866193834341,"editionQalys":0.0769425918759858,"assumptions":"{\"a\":0.75,\"c\":50,\"e\":0.005,\"d\":0.5,\"r\":0.2,\"f\":0.2,\"b\":0.5,\"u\":0.75,\"m\":0.04,\"T\":30,\"g_CA\":0.11688311688311688,\"unpaid\":10}; calculated offers=1500; unique deaths=0.07500000000000001; finiteQALYs/death=9.040469572865828; gross resourceUSD=115000 Geographic assumptions p=0.15, rho=0.75, g_CA=0.11688311688311688. All-population QALYs unchanged; these geography values are judgments, not measured shares."},{"id":"favorable","label":"Favorable clinical and geographic stress","costUSD":100000,"allPopulationQalys":97.67351879512003,"editionQalys":58.604111277072015,"assumptions":"{\"a\":0.85,\"c\":35,\"e\":0.05,\"d\":0.8,\"r\":0.3,\"f\":0.3,\"b\":0.8,\"u\":0.85,\"m\":0.02,\"T\":40,\"g_CA\":0.6,\"unpaid\":5}; calculated offers=2428.5714285714284; unique deaths=6.9942857142857155; finiteQALYs/death=14.383702420604887; gross resourceUSD=112142.85714285714 Geographic assumptions p=0.5, rho=1.5, g_CA=0.6. All-population QALYs unchanged; these geography values are judgments, not measured shares."},{"id":"pessimistic","label":"Adverse clinical and geographic stress","costUSD":100000,"allPopulationQalys":0.00013462860801852008,"editionQalys":6.833939493325894e-7,"assumptions":"{\"a\":0.5,\"c\":100,\"e\":0.001,\"d\":0.25,\"r\":0.05,\"f\":0.05,\"b\":0.1,\"u\":0.65,\"m\":0.08,\"T\":15,\"g_CA\":0.005076142131979696,\"unpaid\":25}; calculated offers=500; unique deaths=0.00003125000000000001; finiteQALYs/death=4.4373589202904204; gross resourceUSD=112500 Geographic assumptions p=0.02, rho=0.25, g_CA=0.005076142131979696. All-population QALYs unchanged; these geography values are judgments, not measured shares."},{"id":"donatedstock","label":"Donated stock; central subjective California share","costUSD":100000,"allPopulationQalys":1.0617526119087648,"editionQalys":0.1241009546386868,"assumptions":"{\"a\":0.75,\"c\":31,\"e\":0.005,\"d\":0.5,\"r\":0.2,\"f\":0.2,\"b\":0.5,\"u\":0.75,\"m\":0.04,\"T\":30,\"g_CA\":0.11688311688311688,\"unpaid\":10,\"stockResource\":19}; calculated offers=2419.3548387096776; unique deaths=0.1209677419354839; finiteQALYs/death=9.040469572865828; gross resourceUSD=170161.29032258067 Geographic assumptions p=0.15, rho=0.75, g_CA=0.11688311688311688. All-population QALYs unchanged; these geography values are judgments, not measured shares."},{"id":"no-additionality","label":"No additional national rescue","costUSD":100000,"allPopulationQalys":0,"editionQalys":0,"assumptions":"Setb=0orr=0; no finite favorable health price, regardless of observed total reach. Geographic assumptions p=0.15, rho=0.75, g_CA=0.11688311688311688. All-population QALYs unchanged; these geography values are judgments, not measured shares."},{"id":"ca-zero","label":"National benefit, no California marginal benefit","costUSD":100000,"allPopulationQalys":0.6582866193834341,"editionQalys":0,"assumptions":"Hold central national clinical yield; set p=0 if marginal gift delivery and subsequent patient health are entirely outside California. No finite California price."},{"id":"geography-low","label":"Central clinical yield; 1% California share","costUSD":100000,"allPopulationQalys":0.6582866193834341,"editionQalys":0.0065828661938343415,"assumptions":"Direct g_CA=0.01 sensitivity only; not a measured or probabilistic bound. All clinical assumptions held central."},{"id":"geography-high","label":"Central clinical yield; 50% California share","costUSD":100000,"allPopulationQalys":0.6582866193834341,"editionQalys":0.32914330969171707,"assumptions":"Direct g_CA=0.5 sensitivity only; not a measured or probabilistic bound. All clinical assumptions held central."}],"sensitivity":["Conditional central Q_CA=0.0769425918759858 per $100,000 gives $12996702.80943714 per ten California QALYs. This is the naloxone mortality pathway with all recipient costs, not a comprehensive portfolio estimate.","Geography alone, holding clinical yield central, gives roughly $3.04 million at g=50% and $151.91 million at g=1%. No evidence establishes either as a bound.","At p=.15, changing rho from .75 to1 removes the relative CA-yield adjustment: g=.15, price about $10.13 million. Public alternatives do not automatically erase the value of last-mile outreach.","Combined favorable and pessimistic clinical/geographic cases inherit the national stress assumptions and should not be advertised as alternative donation offers. Zero California benefit is possible even with positive national benefit.","With all clinical inputs central, even g=1 costs about $1.52 million per ten QALYs. Geographic concentration alone cannot reach the $1 million benchmark; better targeting or delivery yield is required.","Venue, shipping address, chapter count and eventual California patient health are distinct. A state-by-channel fulfilled-kit and unique-patient follow-up dataset should replace p/rho before the point estimate is treated as decision-grade."],"missingInputs":["Outcome-weighted California marginal share by channel and recipient, with migration/health-location treatment.","Current unrestricted funding allocation and inventory/fulfillment bottleneck, distinguishing donated units and two-dose kits.","Unique-person exposure, alternative rescue and finite follow-up; repeat rescue deduplication.","California-specific substitution relative to state, pharmacy, community and emergency-responder supply.","Channel shares of marginal delivery, geographic exposure and relative state-level incremental rescue; no weights were observed.","No probability distribution supports a statistical best estimate for geographic allocation. This model is a disclosed weak prior, to be updated rather than presented as measurement."]},"sources":[{"id":"solution","title":"Our Solution","publisher":"End Overdose","url":"https://endoverdose.net/about/solution/","published":null,"retrieved":"2026-09-13"},{"id":"chapters","title":"Chapter directory","publisher":"End Overdose","url":"https://endoverdose.net/about/chapters/","published":null,"retrieved":"2026-09-13"},{"id":"ca-kit","title":"Naloxone Kit (CA residents)","publisher":"End Overdose","url":"https://store.endoverdose.net/products/narcan-kit-ca-residents","published":null,"retrieved":"2026-09-13"},{"id":"campaign","title":"Overdose Awareness Month August 2026","publisher":"End Overdose","url":"https://endoverdose.net/campaign/","published":null,"retrieved":"2026-09-13"},{"id":"impact24","title":"July–September 2024 impact report","publisher":"End Overdose","url":"https://cdn.sanity.io/files/03xshhuu/production/fc944226581fe8e9a80cd6d39aa74f59574d954e.pdf","published":null,"retrieved":"2026-09-13"},{"id":"dhcs","title":"Naloxone Distribution Project Frequently Asked Questions","publisher":"California Department of Health Care Services","url":"https://www.dhcs.ca.gov/individuals/naloxone-distribution-project/ndp-frequently-asked-questions/","published":null,"retrieved":"2026-09-13"},{"id":"eo-99024","title":"2024 Form990, PartsI/III/IX/X","publisher":"End Overdose / IRS, reproduced by ProPublica","url":"https://projects.propublica.org/nonprofits/full_text/202530849349300213/IRS990","published":null,"retrieved":"2026-09-13"},{"id":"eo-99023","title":"2023 Form990, current and prior-year expenses","publisher":"End Overdose / IRS, reproduced by ProPublica","url":"https://projects.propublica.org/nonprofits/full_text/202411169349302221/IRS990","published":null,"retrieved":"2026-09-13"},{"id":"eo-program","title":"Our Solution","publisher":"End Overdose","url":"https://endoverdose.net/about/solution/","published":null,"retrieved":"2026-09-13"},{"id":"eo-quarter","title":"Summer2024 Impact Report, July–September","publisher":"End Overdose","url":"https://cdn.sanity.io/files/03xshhuu/production/fc944226581fe8e9a80cd6d39aa74f59574d954e.pdf","published":"2024-10-01","retrieved":"2026-09-13"},{"id":"eo-campaign","title":"August 2026 Overdose Awareness Month campaign","publisher":"End Overdose","url":"https://endoverdose.net/campaign/","published":null,"retrieved":"2026-09-13"},{"id":"eo-kit","title":"Naloxone Kit","publisher":"End Overdose","url":"https://store.endoverdose.net/products/nasal-nalonxone-kit","published":null,"retrieved":"2026-09-13"},{"id":"eo-donate","title":"Official donation route linked from current impact page","publisher":"End Overdose","url":"https://donate.endoverdose.net/give/546264","published":null,"retrieved":"2026-09-13"},{"id":"naloxone-walley","title":"Overdose education/naloxone implementation: interrupted time-series study","publisher":"Walley et al. / BMJ","url":"https://pubmed.ncbi.nlm.nih.gov/23372174/","published":"2013-01-30","retrieved":"2026-09-13"},{"id":"naloxone-zang","title":"Strategies to Enhance Community-Based Naloxone Distribution","publisher":"Zang et al. / JAMA Network Open","url":"https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2819204","published":"2024-05-30","retrieved":"2026-09-13"},{"id":"naloxone-hcs","title":"Community-Based Cluster-Randomized Trial to Reduce Opioid Overdose Deaths","publisher":"HEALing Communities Study Consortium / NEJM","url":"https://pubmed.ncbi.nlm.nih.gov/38884347/","published":"2024-06-16","retrieved":"2026-09-13"},{"id":"calrx-price","title":"Naloxone Savings, price effective January2026","publisher":"California CalRx","url":"https://calrx.ca.gov/naloxone/savings/","published":null,"retrieved":"2026-09-13"},{"id":"ndp","title":"Naloxone Distribution Project FAQ, April2026 product update","publisher":"California Department of Health Care Services","url":"https://www.dhcs.ca.gov/individuals/naloxone-distribution-project/ndp-frequently-asked-questions/","published":null,"retrieved":"2026-09-13"},{"id":"naloxone-festival","title":"Naloxone Use, Carrying Practices, Prior Training, and Confidence at a Colorado Music Festival","publisher":"Piercey, Pince and Karoly / Journal of Addiction Medicine","url":"https://pubmed.ncbi.nlm.nih.gov/41430526/","published":"2025-12-23","retrieved":"2026-09-13"},{"id":"naloxone-rikers","title":"Witnessed overdoses and naloxone use among trained Rikers Island visitors","publisher":"Huxley-Reicher et al. / Addictive Behaviors","url":"https://pubmed.ncbi.nlm.nih.gov/29175025/","published":"2017-11-16","retrieved":"2026-09-13"},{"id":"eo-events-2026","title":"Current event directory, first page","publisher":"End Overdose","url":"https://endoverdose.net/events/","published":null,"retrieved":"2026-09-13"}]}