{"edition":"seattle","organization":"People’s Harm Reduction Alliance","organizationId":"org:peoples-harm-reduction-alliance","boundaryVersion":"OMB-23-01-2023-07-21","updated":"2026-09-29","display":{"metric":{"id":"daly-equivalent","years":1,"label":"DALY","priceLabel":"$ / DALY"},"priceUSD":203065.7076936369,"canonicalPriceUSDPerTenEquivalentYears":2030657.076936369,"conversion":"display only; QALYs and income equivalents are not measured clinical DALYs"},"listDisplay":{"metric":{"id":"daly-equivalent","years":1,"label":"DALY","priceLabel":"$ / DALY"},"priceUSD":203065.7076936369,"canonicalPriceUSDPerTenEquivalentYears":2030657.076936369,"conversion":"display only; QALYs and income equivalents are not measured clinical DALYs"},"model":{"version":"phra-seattle-alpha-v1","costScope":"Whole-recipient 2024 gross reported expense $2,727,457; not audited expense or cash spending; external clinical resources and volunteer time omitted.","geographicAttribution":"King/Pierce/Snohomish only; central naloxone .50, MOUD/HCV .90 and injection/wound .80 are assumed local shares.","formula":"## Inspectable finite model\n\nCentral naloxone coverage is 98,382 doses ÷ 2 doses/kit ÷ 6 kits/annual network person × .5 relevant-network conversion × .5 local share = 2,049.625 synthetic local people. This is not a finding that PHRA served exactly that many unique high-risk people. Kit recipients may be rescuers rather than patients, and multiple rescuers can cover the same patient; the divisor and conversion jointly address this unresolved mapping. A person faces one prospective overdose opportunity annually with otherwise-fatal probability .1, baseline rescue .75 and an additional .03 rescue probability. The constructed baseline mortality hazard is .025 other causes + .1 × (1 − .75) = .05, avoiding addition of overdose to an already all-cause hazard.\n\nFor one support year, survival is exp(−hazard×time), followed by common .05 mortality in both counterfactual arms. Integrating their difference over 10 years, utility .65 and 3% discount yields finite health. Repeated events do not restart lifetime benefits. The buprenorphine subcohort is embedded within the same opioid cohort: only the incremental joint-survival difference beyond rescue is added. Treatment exposure is represented as full-year person equivalents, an approximation to the timing of shorter courses, not observed one-year retention. All mortality and utility horizons are priors; no life is assigned perpetual perfect health.\n\nInfection benefits use full-coverage equivalents derived from syringe counts, low annual infection risks and finite 10-year morbidity only. Susceptible people whose infection is prevented and already-infected people whose HCV is cured are conceptually disjoint; no HIV/HCV mortality or downstream transmission is credited. Incremental buprenorphine quality and short wound-care gains are separate from survival but remain weakly supported local priors.\n\nFinally, a .5 whole-budget response discounts proportional activity for the ability of cash to expand or preserve publicly supported services. It is conceptually different from alternative rescue at an overdose and alternative treatment for a patient, but these uncertainties may be correlated; the full-response diagnostic makes that potential overlapping conservatism visible. It gives a central price of $1,015,329. Halving the rescue increment gives $3,889,301; a five-year survival horizon gives $3,471,836. Raising whole expense 25% for unmatched cost/service years gives weighted $997,078. No coefficients were changed after observing the first result.\n\n","counterfactual":"Alternative timely rescue, treatment and public supplies remain available. Baseline rescue .75 and increment .03 are judgments.","attribution":"MOUD additionality .35 and PHRA share .65, HCV additionality .25 and PHRA share .60, injection additionality .30, and budget response .50 are uncertain and may correlate.","uncertainty":"Subjective signed worlds: adverse .05, null .20, cautious .20, central .45, favorable .10. No calibrated probability claim.","nativeOutcomes":"Supplies and encounters observed through self-report; synthetic risk cohorts, cures and QALYs modeled.","inputs":[{"name":"expense","value":2727457,"unit":"2024 USD","basis":"observed","sourceIds":["irs2024"],"rationale":"Derived gross original-return expense; not audited or cash cost."},{"name":"doses","value":98382,"unit":"2025 supplies","basis":"observed","sourceIds":["activity"],"rationale":"Self-reported distribution; not unique local patients."},{"name":"syringes","value":1254550,"unit":"2025 supplies","basis":"observed","sourceIds":["activity"],"rationale":"Self-reported distribution; not unique local patients."},{"name":"dosesPerKit","value":2,"unit":"model parameter; see formula","basis":"judgment","sourceIds":[],"rationale":"Explicit conditional model parameter, not a verified PHRA local causal observation."},{"name":"kitsPerPerson","value":6,"unit":"model parameter; see formula","basis":"judgment","sourceIds":[],"rationale":"Explicit conditional model parameter, not a verified PHRA local causal observation."},{"name":"riskNetwork","value":0.5,"unit":"model parameter; see formula","basis":"judgment","sourceIds":[],"rationale":"Explicit conditional model parameter, not a verified PHRA local causal observation."},{"name":"local","value":0.5,"unit":"model parameter; see formula","basis":"judgment","sourceIds":[],"rationale":"Explicit conditional model parameter, not a verified PHRA local causal observation."},{"name":"opportunities","value":1,"unit":"model parameter; see formula","basis":"judgment","sourceIds":[],"rationale":"Explicit conditional model parameter, not a verified PHRA local causal observation."},{"name":"otherwiseFatal","value":0.1,"unit":"model parameter; see formula","basis":"judgment","sourceIds":[],"rationale":"Explicit conditional model parameter, not a verified PHRA local causal observation."},{"name":"baselineRescue","value":0.75,"unit":"model parameter; see formula","basis":"judgment","sourceIds":[],"rationale":"Explicit conditional model parameter, not a verified PHRA local causal observation."},{"name":"rescueIncrement","value":0.03,"unit":"model parameter; see formula","basis":"judgment","sourceIds":[],"rationale":"Explicit conditional model parameter, not a verified PHRA local causal observation."},{"name":"otherHazard","value":0.025,"unit":"model parameter; see formula","basis":"judgment","sourceIds":[],"rationale":"Explicit conditional model parameter, not a verified PHRA local causal observation."},{"name":"postHazard","value":0.05,"unit":"model parameter; see formula","basis":"judgment","sourceIds":[],"rationale":"Explicit conditional model parameter, not a verified PHRA local causal observation."},{"name":"horizon","value":10,"unit":"model parameter; see formula","basis":"judgment","sourceIds":[],"rationale":"Explicit conditional model parameter, not a verified PHRA local causal observation."},{"name":"utility","value":0.65,"unit":"model parameter; see formula","basis":"judgment","sourceIds":[],"rationale":"Explicit conditional model parameter, not a verified PHRA local causal observation."},{"name":"discount","value":0.03,"unit":"model parameter; see formula","basis":"judgment","sourceIds":[],"rationale":"Explicit conditional model parameter, not a verified PHRA local causal observation."},{"name":"budgetResponse","value":0.5,"unit":"model parameter; see formula","basis":"judgment","sourceIds":[],"rationale":"Explicit conditional model parameter, not a verified PHRA local causal observation."},{"name":"moudStarts","value":60,"unit":"model parameter; see formula","basis":"judgment","sourceIds":[],"rationale":"Explicit conditional model parameter, not a verified PHRA local causal observation."},{"name":"moudYears","value":0.5,"unit":"model parameter; see formula","basis":"judgment","sourceIds":[],"rationale":"Explicit conditional model parameter, not a verified PHRA local causal observation."},{"name":"moudAdditional","value":0.35,"unit":"model parameter; see formula","basis":"judgment","sourceIds":[],"rationale":"Explicit conditional model parameter, not a verified PHRA local causal observation."},{"name":"moudAttribution","value":0.65,"unit":"model parameter; see formula","basis":"judgment","sourceIds":[],"rationale":"Explicit conditional model parameter, not a verified PHRA local causal observation."},{"name":"moudLocal","value":0.9,"unit":"model parameter; see formula","basis":"judgment","sourceIds":[],"rationale":"Explicit conditional model parameter, not a verified PHRA local causal observation."},{"name":"moudHazardReduction","value":0.0052,"unit":"model parameter; see formula","basis":"judgment","sourceIds":[],"rationale":"Explicit conditional model parameter, not a verified PHRA local causal observation."},{"name":"moudUtility","value":0.05,"unit":"model parameter; see formula","basis":"judgment","sourceIds":[],"rationale":"Explicit conditional model parameter, not a verified PHRA local causal observation."},{"name":"syringesPerPerson","value":730,"unit":"model parameter; see formula","basis":"judgment","sourceIds":[],"rationale":"Explicit conditional model parameter, not a verified PHRA local causal observation."},{"name":"injectionLocal","value":0.8,"unit":"model parameter; see formula","basis":"judgment","sourceIds":[],"rationale":"Explicit conditional model parameter, not a verified PHRA local causal observation."},{"name":"injectionAdditional","value":0.3,"unit":"model parameter; see formula","basis":"judgment","sourceIds":[],"rationale":"Explicit conditional model parameter, not a verified PHRA local causal observation."},{"name":"hivRisk","value":0.001,"unit":"model parameter; see formula","basis":"judgment","sourceIds":[],"rationale":"Explicit conditional model parameter, not a verified PHRA local causal observation."},{"name":"hivReduction","value":0.34,"unit":"model parameter; see formula","basis":"judgment","sourceIds":[],"rationale":"Explicit conditional model parameter, not a verified PHRA local causal observation."},{"name":"hcvSusceptible","value":0.4,"unit":"model parameter; see formula","basis":"judgment","sourceIds":[],"rationale":"Explicit conditional model parameter, not a verified PHRA local causal observation."},{"name":"hcvRisk","value":0.03,"unit":"model parameter; see formula","basis":"judgment","sourceIds":[],"rationale":"Explicit conditional model parameter, not a verified PHRA local causal observation."},{"name":"hcvReduction","value":0.15,"unit":"model parameter; see formula","basis":"judgment","sourceIds":[],"rationale":"Explicit conditional model parameter, not a verified PHRA local causal observation."},{"name":"infectionUtility","value":0.03,"unit":"model parameter; see formula","basis":"judgment","sourceIds":[],"rationale":"Explicit conditional model parameter, not a verified PHRA local causal observation."},{"name":"infectionYears","value":10,"unit":"model parameter; see formula","basis":"judgment","sourceIds":[],"rationale":"Explicit conditional model parameter, not a verified PHRA local causal observation."},{"name":"hcvStarts","value":20,"unit":"model parameter; see formula","basis":"judgment","sourceIds":[],"rationale":"Explicit conditional model parameter, not a verified PHRA local causal observation."},{"name":"hcvSvr","value":0.9,"unit":"model parameter; see formula","basis":"judgment","sourceIds":[],"rationale":"Explicit conditional model parameter, not a verified PHRA local causal observation."},{"name":"hcvAdditional","value":0.25,"unit":"model parameter; see formula","basis":"judgment","sourceIds":[],"rationale":"Explicit conditional model parameter, not a verified PHRA local causal observation."},{"name":"hcvAttribution","value":0.6,"unit":"model parameter; see formula","basis":"judgment","sourceIds":[],"rationale":"Explicit conditional model parameter, not a verified PHRA local causal observation."},{"name":"hcvLocal","value":0.9,"unit":"model parameter; see formula","basis":"judgment","sourceIds":[],"rationale":"Explicit conditional model parameter, not a verified PHRA local causal observation."},{"name":"woundEpisodes","value":100,"unit":"model parameter; see formula","basis":"judgment","sourceIds":[],"rationale":"Explicit conditional model parameter, not a verified PHRA local causal observation."},{"name":"woundAdditional","value":0.3,"unit":"model parameter; see formula","basis":"judgment","sourceIds":[],"rationale":"Explicit conditional model parameter, not a verified PHRA local causal observation."},{"name":"woundLocal","value":0.8,"unit":"model parameter; see formula","basis":"judgment","sourceIds":[],"rationale":"Explicit conditional model parameter, not a verified PHRA local causal observation."},{"name":"woundUtility","value":0.1,"unit":"model parameter; see formula","basis":"judgment","sourceIds":[],"rationale":"Explicit conditional model parameter, not a verified PHRA local causal observation."},{"name":"woundDays","value":14,"unit":"model parameter; see formula","basis":"judgment","sourceIds":[],"rationale":"Explicit conditional model parameter, not a verified PHRA local causal observation."}],"scenarios":[{"id":"adverse","label":"adverse conditional scenario","costUSD":2727457,"allPopulationQalys":null,"editionQalys":-2.1620171576929548,"weight":0.05,"assumptions":"Negative rescue and infection effects; no treatment or wound gains.","parameterOverrides":{"rescueIncrement":-0.005,"moudHazardReduction":0,"moudUtility":0,"hivReduction":-0.05,"hcvReduction":-0.05,"hcvAdditional":0,"woundAdditional":0}},{"id":"null","label":"null conditional scenario","costUSD":2727457,"allPopulationQalys":null,"editionQalys":0,"weight":0.2,"assumptions":"Zero budget response.","parameterOverrides":{"budgetResponse":0}},{"id":"cautious","label":"cautious conditional scenario","costUSD":2727457,"allPopulationQalys":null,"editionQalys":0.3640986577714733,"weight":0.2,"assumptions":"12 kits/person, .30 network, .35 local, .01 rescue increment, .08 post-hazard, 5-year horizon, .25 response, 20 MOUD and 5 HCV starts.","parameterOverrides":{"kitsPerPerson":12,"riskNetwork":0.3,"local":0.35,"rescueIncrement":0.01,"postHazard":0.08,"horizon":5,"budgetResponse":0.25,"moudStarts":20,"hcvStarts":5}},{"id":"central","label":"central conditional scenario","costUSD":2727457,"allPopulationQalys":null,"editionQalys":13.431401249268959,"weight":0.45,"assumptions":"Disclosed default judgments; central is not weighted mixture.","parameterOverrides":{}},{"id":"favorable","label":"favorable conditional scenario","costUSD":2727457,"allPopulationQalys":null,"editionQalys":281.8427436561143,"weight":0.1,"assumptions":"3 kits/person, .70 network, .65 local, .08 rescue increment, .035 post-hazard, 15-year horizon, .80 response, 120 MOUD and 40 HCV starts.","parameterOverrides":{"kitsPerPerson":3,"riskNetwork":0.7,"local":0.65,"rescueIncrement":0.08,"postHazard":0.035,"horizon":15,"budgetResponse":0.8,"moudStarts":120,"hcvStarts":40}}],"sensitivity":["Signed weighted mixture: $797,662 per 10 modeled local QALYs. The favorable case contributes 82.43% of net signed QALYs.","Excluding the favorable case and renormalizing the remaining weights gives $4,085,160 per 10 modeled local QALYs."],"missingInputs":["Annual unique at-risk network people and overlap among rescuers, recipients and overdose patients","Residence-specific King/Pierce/Snohomish share, rather than service address","Counterfactual timely alternative rescue and incremental probability of rescue","Treatment starts, retention, cures and partner attribution","Current expansion or preservation capacity per additional unrestricted dollar","Same-year cash/in-kind consumption bridge; independent financial-statement audit not reported."]},"sources":[{"id":"irs2024","title":"Original PHRA 2024 IRS Form990","url":"https://projects.propublica.org/nonprofits/full_text/202513219349302771/IRS990","period":"2024; filed2025-11-14","accessed":"2026-09-29","type":"primary","limitation":"Direct original return; whole expense, revenue, function and balance-sheet fields. Not an audit.","publisher":"IRS, hosted by ProPublica","retrieved":"2026-09-29","published":null},{"id":"scheduleI","title":"Original ScheduleI","url":"https://projects.propublica.org/nonprofits/full_text/202513219349302771/IRS990ScheduleI","period":"2024","accessed":"2026-09-29","type":"primary","limitation":"Noncash assistance and inconsistent encounter/recipient fields; no unique-person denominator.","publisher":"IRS, hosted by ProPublica","retrieved":"2026-09-29","published":null},{"id":"scheduleM","title":"Original ScheduleM","url":"https://projects.propublica.org/nonprofits/full_text/202513219349302771/IRS990ScheduleM","period":"2024","accessed":"2026-09-29","type":"primary","limitation":"$1.5m recognized donated drugs/medical supplies; no complete consumption reconciliation.","publisher":"IRS, hosted by ProPublica","retrieved":"2026-09-29","published":null},{"id":"activity","title":"PHRA organization-managed Washington Gives profile","url":"https://www.wagives.org/organization/Phra","period":"2025 activities; undated page","accessed":"2026-09-29","type":"primary","limitation":"Self-report distribution/encounter counts, not unique recipients or outcomes.","publisher":"www.wagives.org","retrieved":"2026-09-29","published":null},{"id":"mail","title":"Official mail program","url":"https://phra.org/washinton-state-free-naloxone-by-mail","period":"undated current page","accessed":"2026-09-29","type":"primary","limitation":"Statewide public partnership; non-MSA benefit must excluded.","publisher":"phra.org","retrieved":"2026-09-29","published":null},{"id":"oend","title":"Washington OEND presentation","url":"https://www.hca.wa.gov/assets/program/oend-presentation-20260115.pdf","period":"2026-01-15","accessed":"2026-09-29","type":"primary","limitation":"Pages15–17,33–34 read in-memory via pypdf: budget reduction, caps, alternatives. Not a priced PHRA offer.","publisher":"www.hca.wa.gov","retrieved":"2026-09-29","published":null},{"id":"survey","title":"UW 2025 SSP survey","url":"https://adai.uw.edu/syringe-survey-2025/","period":"2026-04; survey2025","accessed":"2026-09-29","type":"primary","limitation":"Convenience sample; local needs/access anchors, not PHRA outcomes.","publisher":"adai.uw.edu","retrieved":"2026-09-29","published":null},{"id":"treatment","title":"PHRA treatment","url":"https://phra.org/treatment","period":"undated","accessed":"2026-09-29","type":"primary","limitation":"Co-location/referral role; no annual retention.","publisher":"phra.org","retrieved":"2026-09-29","published":null},{"id":"partner","title":"WA Recovery Helpline program directory","url":"https://search.warecoveryhelpline.org/search/9f9dbcf2-d5d8-53e7-9de7-6c2c3f4badd7","period":"undated current directory","accessed":"2026-09-29","type":"primary","limitation":"We Care Daily Clinics provider and insurance acceptance; directory not audited contract.","publisher":"search.warecoveryhelpline.org","retrieved":"2026-09-29","published":null},{"id":"hcv","title":"Official HCV service","url":"https://phra.org/hep-c-testing-treatment","period":"undated","accessed":"2026-09-29","type":"primary","limitation":"In-house eligibility limited to Suboxone enrollees, others referred.","publisher":"phra.org","retrieved":"2026-09-29","published":null},{"id":"walley","title":"Walley etal OEND interrupted time series","url":"https://pubmed.ncbi.nlm.nih.gov/23372174/","period":"2013","accessed":"2026-09-29","type":"primary","limitation":"Observational pre-fentanyl community association, not kit-level causal yield.","publisher":"pubmed.ncbi.nlm.nih.gov","retrieved":"2026-09-29","published":null},{"id":"heal","title":"HEALing Communities randomized trial","url":"https://www.nejm.org/doi/full/10.1056/NEJMoa2401177","period":"2024","accessed":"2026-09-29","type":"primary","limitation":"Overall mortality null-compatible; adverse transfer evidence.","publisher":"www.nejm.org","retrieved":"2026-09-29","published":null},{"id":"moud","title":"Sordo mortality meta-analysis","url":"https://www.bmj.com/content/357/bmj.j1550","period":"2017","accessed":"2026-09-29","type":"primary","limitation":"Buprenorphine difference .0052/year; observational and uncertain.","publisher":"www.bmj.com","retrieved":"2026-09-29","published":null},{"id":"hiv","title":"Aspinall syringe-program meta-analysis","url":"https://pubmed.ncbi.nlm.nih.gov/24374889/","period":"2014","accessed":"2026-09-29","type":"primary","limitation":"All-studyRR.66, not conclusively causal.","publisher":"pubmed.ncbi.nlm.nih.gov","retrieved":"2026-09-29","published":null},{"id":"hcvtrial","title":"Platt HCV review","url":"https://pubmed.ncbi.nlm.nih.gov/28922449/","period":"2017","accessed":"2026-09-29","type":"primary","limitation":"High-coverage syringe effect uncertain; clinical prior not direct measured reduction.","publisher":"pubmed.ncbi.nlm.nih.gov","retrieved":"2026-09-29","published":null},{"id":"localhiv","title":"KingCounty HIV epidemiology","url":"https://cdn.kingcounty.gov/-/media/king-county/depts/dph/documents/health-safety/disease-illness/hiv-sti/hiv-epi-annual-reports/2024-hiv-aids-epidemiology-annual-report.pdf","period":"2024 report;2023 data","accessed":"2026-09-29","type":"primary","limitation":"New diagnosis rate not susceptible incidence.","publisher":"cdn.kingcounty.gov","retrieved":"2026-09-29","published":null},{"id":"pipe","title":"PHRA Seattle pipe pilot","url":"https://link.springer.com/article/10.1186/s12954-022-00685-7","period":"2022;2019 study","accessed":"2026-09-29","type":"primary","limitation":"Pre/post uncontrolled, behavioral outcome, no separately credited QALYs.","publisher":"link.springer.com","retrieved":"2026-09-29","published":null},{"id":"olfson","title":"Olfson post-overdose mortality","url":"https://pubmed.ncbi.nlm.nih.gov/29926090/","period":"2018","accessed":"2026-09-29","type":"primary","limitation":"Short follow-up selected survivors; not calibrated PHRA hazard.","publisher":"pubmed.ncbi.nlm.nih.gov","retrieved":"2026-09-29","published":null},{"id":"larochelle","title":"Larochelle post-overdose cohort","url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC6387681/","period":"2018","accessed":"2026-09-29","type":"primary","limitation":"Mortality anchor with selection/temporal-transfer limitations.","publisher":"pmc.ncbi.nlm.nih.gov","retrieved":"2026-09-29","published":null},{"id":"donate","title":"Official PHRA donation page","url":"https://phra.org/donate","period":"undated","accessed":"2026-09-29","type":"primary","limitation":"Recipient route; no verified priced incremental offer.","publisher":"phra.org","retrieved":"2026-09-29","published":null},{"id":"repair20","title":"PartsXI-XII","publisher":"projects.propublica.org","url":"https://projects.propublica.org/nonprofits/full_text/202513219349302771/IRS990ScheduleD","retrieved":"2026-09-29","published":null},{"id":"repair21","title":"PartVI SectionC line19","publisher":"projects.propublica.org","url":"https://projects.propublica.org/nonprofits/full_text/202513219349302771/IRS990ScheduleO","retrieved":"2026-09-29","published":null},{"id":"repair22","title":"pp19-21","publisher":"doh.wa.gov","url":"https://doh.wa.gov/sites/default/files/2026-01/150335-OverdoseEducationNaloxoneDistributionDataReport2025Q3.pdf","retrieved":"2026-09-29","published":null},{"id":"repair23","title":"King County routes","publisher":"phra.org","url":"https://phra.org/king-county-mobile-outreach-delivery","retrieved":"2026-09-29","published":null},{"id":"repair24","title":"Seattle address and services","publisher":"phra.org","url":"https://phra.org/university-district-exchange","retrieved":"2026-09-29","published":null},{"id":"repair25","title":"Alternative access routes","publisher":"doh.wa.gov","url":"https://doh.wa.gov/you-and-your-family/drug-user-health/overdose-education-naloxone-distribution","retrieved":"2026-09-29","published":null},{"id":"repair26","title":"Portland case-report affiliation; excluded from Seattle count calibration","publisher":"pmc.ncbi.nlm.nih.gov","url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC8815644/","retrieved":"2026-09-29","published":null}]}