GiveBetter x California

Harm Reduction Services

Harm reduction, HIV care navigation and community health

Research time: ~28 min on GPT-6 Astra Light + ~13 min on GPT-6 Astra Medium + ~13 min on GPT-6.1 Sol
  • Research — reviewed programs, finances and impact evidence.

Updated: 2026-10-01

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Summary

What do they do? Harm Reduction Services provides free harm reduction and health-navigation services in Sacramento and nearby California communities. Its portfolio includes sterile equipment and naloxone distribution, infection testing, HIV case management, treatment navigation and a partner free clinic. Staff combine practical supplies with nonjudgmental support and connections to medical care.

Why we’re interested in this organization:

  • A physical site and mobile services can reach people who face stigma and practical barriers to conventional care.

  • Naloxone rescue and reduced infection exposure have plausible direct health pathways supported by wider intervention evidence.

  • The CARES Foundation independently describes continued Project Reach activity in its 2025 grantee report.

Our main reservations:

  • No current HRS-specific dataset links additional unrestricted dollars to unique people, use of supplies, deaths prevented or sustained treatment.

  • State supplies, grant-funded operations, other providers and emergency response make total service counts a poor measure of a new donor's contribution.

  • Original recent returns now anchor total cost, but repeated self-reported reach and unmeasured marginal funding yield leave the numerical estimate highly judgment-dependent. A 2026 library outreach pilot was paused in May; current advertised main services should not be confused with every previously offered route.

What do you get for your dollar? $685K per DALY in California. DALY is our one-year comparison unit. QALY-based health gains and income-welfare equivalents retain their original assumptions; they are not measured clinical DALYs. Full ordinary unrestricted gift charged against a low-confidence overdose-prevention pathway only. Total-recipient expense proxy includes recognized noncash supplies; other portfolio health and unmeasured additional partner/public resources are excluded, with a separate resource-cost scenario. Not measured portfolio return or a donor endorsement..

Illustrative $100,000 produces 32.911232875846714 supplied person-equivalents, partitioned into 32.25300821832978 additionally protected nonpurchaser equivalents and 0.5924021917652409 distinct purchaser households. These are modeled distinct risk/resource units, not observed kits, deaths averted or verified delivery. Current all-population health .14869548013586217, California health .14572157053314494; California household-resource equivalents .0002164901213409561. No additional-survivor wages or current first-year deaths-prevented count is claimed.

1. What do they do?

HRS's current service page lists a Sacramento counter and weekday mobile distribution of sterile equipment, naloxone and safer-use supplies. Ryan White case managers help people with HIV enter and remain in care, including practical transport and support. ERA helps people navigate treatment and Medi-Cal enrollment; a referral is not verified treatment initiation or retention. The Joan Viteri Memorial Clinic is a partner clinic staffed by UC Davis medical students with physician oversight. Its contribution cannot be credited entirely to HRS.

The library partner confirms an early-2026 pilot but says it was paused May 14. We exclude that route from claims of current delivery; the separate HRS counter and mobile listings remain live. No fresh verified annual service total was recovered.

2. Monitoring and information sharing

The 2025 CARES grantee report confirms Project Reach's equipment, overdose prevention, testing and street-clinic activities. It does not provide HRS-specific incremental health results. The prior 2024 funder summary reports totals across multiple grantees; its 2.2 million syringes and other aggregate outputs must not be attributed to HRS. A useful monitoring dataset would distinguish unique recipients from visits and repeat kits; record kits actually used, reported rescues, independent mortality outcomes and sustained linkage to care; and document whether recipients would otherwise obtain equivalent supplies. Confidential service delivery is valuable, but privacy-preserving aggregate follow-up is needed for this estimate.

New original-return review adds self-reported annual SSP scale, but not a fresh outcome series. The FY2025 and FY2023 Schedule O repeat the same program descriptions and reach figures. We therefore use reported scale only as a discounted cost-model anchor, not as verified current unique people or donor-caused health.

The beta review distinguishes recipients, rescuers and people at overdose risk. One trained family member may protect somebody else; repeated kits may reach the same network. The model therefore uses a single expected risk-person cohort and an explicit network-translation assumption, not training attendance or kits as independent lives saved. No linked privacy-preserving current dataset resolves this bridge. Counts for SSP, testing, case management, navigation and clinic attendance must not be summed.

3. Qualitative assessment

CDC's SSP overview describes an association with lower HIV/HCV incidence and no increase in crime or illegal drug use. This supports the service mechanism, not a measured HRS effect. Walley and colleagues found lower community overdose mortality associated with Massachusetts overdose education/naloxone implementation in 2002–2009; the ecological, nonrandomized design and pre-fentanyl setting limit transfer to current Sacramento. Neither a naloxone kit nor a reported reversal equals a death prevented: another responder might have intervened and some overdoses would resolve. Survivors also face subsequent mortality. A QALY bridge must estimate additional survival and its quality over time. Respectful low-barrier care and relationships may help reach people missed elsewhere, but that advantage is not measured here.

A more recent counterweight is the HEALing Communities cluster-randomized trial: its bundled intervention produced an overdose-mortality rate ratio of 0.91 (95% CI 0.76–1.09), without a statistically significant primary effect. It neither isolates naloxone nor estimates HRS, but cautions against transferring large early community associations directly. California post-overdose ED records and an Ontario cohort inform the model's risk scale; these selected patients are not representative of all SSP recipients. The model's individual 10% incremental hazard reduction remains a subjective prior.

Trial implementation delay limits what the HEALing result rules out; its null-compatible estimate still restrains a large transferred effect. Additional survival remains subject to recurrent overdose and competing mortality after naloxone protection ends. CDC dose-comparison evidence documents withdrawal burden but does not estimate HRS-versus-no-HRS harm. Separate hypothetical burden, negative-effect and zero-activity harm scenarios are safeguards, not findings of HRS harm.

4. What do you get for your dollar?

## What does a donation support?

HRS offers free sterile equipment, naloxone and practical navigation through a Sacramento counter and mobile services. The modeled health pathway is additional usable overdose protection: access to medicine and response knowledge can reduce fatal overdose risk when alternatives would not reach someone in time. This is not a claim that each distributed kit prevents a death.

Our current estimate is $685K per DALY in California, or ten combined health and income-equivalent years. Per illustrative $100,000 budget, the calculation produces 0.15 California health years plus 0.0002164901213409561 household-resource-equivalent years, totaling 0.1459380606544859. The exact ratio is $6,852,222.069522628. Household resources are translated using the common income/health equivalence convention; these are welfare equivalents, not measured extra clinical QALYs. The estimate covers a partial overdose pathway, not every benefit of HRS's portfolio.

## What changed?

The prior health-only estimate was $309K. Its original calculator and assumptions remain available as history. We reconsidered the original risk and delivery-cost anchors rather than subtracting income from a fixed health total. Annual fatal opioid risk is now an explicit 1% planning prior rather than 2%, and recipient cost normalization uses the $1,899,047.67 three-year expense mean instead of the latest $1,695,969 year. A small purchaser savings partition is added independently.

The original California and Ontario emergency-care cohorts had recently overdosed, so their subsequent mortality need not describe average SSP recipients. The older California UFO cohort followed young street-recruited injection drug users and supplies a useful population-type counterweight, but predates fentanyl and has a different age mix. It does not establish current Sacramento mortality. Our 1% central choice remains a judgment, with 0.5%, 2% and 3% alternatives; higher contemporary risk could make the central estimate too pessimistic. (UFO cohort

## From spending to additional protection

Original July–June Form 990s report expenses of $1,938,389, $2,062,785 and $1,695,969 in FY2023, FY2024 and FY2025. Supplies fell while nominal output descriptions were repeated, so smoothing across three years avoids treating one low accounting year as demonstrated cheaper delivery. Recognized donated supplies remain within recipient accounting; we neither subtract their revenue as cash spending nor add it again. This is average-cost normalization, not an identified marginal procurement offer.

The nominal 5,000 SSP people are discounted by three independent 50% judgments: distinct current reach, marginal funded delivery and relevant usable naloxone coverage. A network multiplier of one and a 100-person cap yield about 32.9 additional supplied risk-person equivalents. These are not observed additional users or a verified expansion tranche. County funding cannot automatically replace this pathway: HRS explicitly says the county does not finance SSP services or drug-use supplies. Free public medicine may coexist with valuable cash-funded outreach. (HRS SSP

## Health effects and time

Two percent of supplied equivalents are assumed to be people who would otherwise purchase equivalent medicine. They receive potential savings but no additional clinical-access benefit. The remaining 32.25 equivalents receive the modeled health pathway. We assume a 10% incremental reduction in fatal opioid hazard, already allowing competing responses; the community evidence does not identify HRS's individual effect. The randomized HEALING intervention combined several approaches and did not show a statistically clear overall mortality reduction. It restrains extrapolation rather than proving zero naloxone value.

Coverage lasts one additional year after a 0.125-year delivery lag. Survival differences are integrated for ten years under recurrent opioid and competing mortality, utility 0.7 and 3% continuous health discounting. We do not assign a full new lifetime to every rescue or assume ten years of distribution. Immediate delivery, shorter horizons, higher subsequent mortality, zero benefit and adverse clinical cases remain visible.

## Household income and consumption

The central economic channel is one avoided $19 twin-pack purchase among the assumed 2% purchasers, allowing 0.9 distinct household budgets per supplied equivalent. A $25,000 annual household-resource reference is a low-income planning assumption, not observed HRS earnings. The payment is credited once at the funded-year midpoint plus delivery lag; it does not recur over the survival horizon. Collection costs are assumed unchanged centrally, while negative savings and gift-induced failed-access burdens test the opposite.

HRS also provides treatment navigation, transport and other practical support. Those channels can affect employment or household consumption, but expenses and referrals do not identify incremental net participant gains. We assess them rather than silently equating missing evidence with no real benefit. Conditional cases allow positive or negative net employment resources among baseline-alive recipients, after taxes, benefit withdrawal, work costs and alternative employment. No speculative lifetime wages of extra survivors, wholesale voucher expenses or insurer bills are added.

Health, income and applicant burdens have separate California shares, each 98% centrally. Shared-provider benefit assignment occurs once; explicitly donor-induced failed attempts or independent health harms cannot disappear solely because benefit attribution is zero. Other effects of infection prevention and navigation remain unquantified, so this partial estimate is not a guaranteed lower bound.

## What would improve this estimate?

The most valuable evidence is fresh unique opioid-risk reach, actual additional stock/staffing/route capacity, current fatal and competing mortality, and net purchaser, transport, treatment and employment incidence. The 37 cases are unweighted assumptions, not confidence bounds. Gross external partner resources are shown separately from donor spending and household benefit. Before scaling a gift, the key practical question is what additional service HRS can deliver beyond existing funding and free alternatives.

Model, assumptions and sensitivity

Donor budget normalized to three-year recipient accounting expenses; partial overdose pathway with disjoint net household resources. No complete societal-cost claim.

Separate California health, income and induced-burden shares are each .98 centrally, based on Sacramento service geography with uncertain migration. Each share is applied once; zero-California scenario removes all local benefit/burden. This calculator does not provide SF or Bay denominators.

M=min(gift/expense*nominalPeople*uniqueCurrent*additionality*naloxoneRelevant*network,capacity); N=M*(1-purchaserShare). Exact finite competing-risk survival integral gives health. Household receipt=.5*M*householdShare*purchaserShare*log1p(netSaving/resourceBaseline)/(1+discount)^incomeDelay. Add separately signed baseline-alive conditional earnings and induced losses; apply each geographic share once. Price=donor cost/(California health+income).

Illustrative donor budget
100000 USD (judgment). Explicit analyst planning judgment; inspect source discussion and cases, not an empirical causal estimate.
Three-year recipient expense mean
1899047.6666666667 USD (observed). Mean FY2023–2025 original returns, including recipient noncash accounting; not measured marginal cash need. [hrs-990-2023] [hrs-990-2024] [hrs-990-2025]
Reported annual SSP scale
5000 person/household equivalents (observed). Repeated self-reported annual scale, not a fresh unique-person outcome series. [hrs-o-2025]
Distinct current share
0.5 model parameter (judgment). Explicit analyst planning judgment; inspect source discussion and cases, not an empirical causal estimate.
Marginal delivery additionality
0.5 model parameter (judgment). Explicit analyst planning judgment; inspect source discussion and cases, not an empirical causal estimate.
Usable relevant naloxone share
0.5 model parameter (judgment). Explicit analyst planning judgment; inspect source discussion and cases, not an empirical causal estimate.
Distinct risk-person network multiplier
1 model parameter (judgment). Explicit analyst planning judgment; inspect source discussion and cases, not an empirical causal estimate.
Additional supplied person cap
100 person/household equivalents (judgment). Explicit analyst planning judgment; inspect source discussion and cases, not an empirical causal estimate.
Counterfactual purchaser partition
0.02 model parameter (judgment). Explicit analyst planning judgment; inspect source discussion and cases, not an empirical causal estimate.
Distinct household resource units per person
0.9 model parameter (judgment). Explicit analyst planning judgment; inspect source discussion and cases, not an empirical causal estimate.
One actual avoided purchase net saving
19 USD (judgment). Conditional avoided $19 twin-pack expenditure; incidence, netness and household baseline unmeasured.
Annual household resource reference
25000 USD (judgment). Explicit analyst planning judgment; inspect source discussion and cases, not an empirical causal estimate.
One-off receipt delay
0.625 years (judgment). Explicit analyst planning judgment; inspect source discussion and cases, not an empirical causal estimate.
Annual fatal opioid hazard
0.01 model parameter (judgment). General SSP reach is less selected than emergency post-overdose cohorts; older young-PWID UFO evidence provides a population counterweight, not a measured HRS .01 rate.
Annual competing mortality hazard
0.03 model parameter (judgment). Explicit analyst planning judgment; inspect source discussion and cases, not an empirical causal estimate.
Incremental relative fatal opioid risk reduction
0.1 model parameter (judgment). Explicit analyst planning judgment; inspect source discussion and cases, not an empirical causal estimate.
Additional protection duration
1 years (judgment). Explicit analyst planning judgment; inspect source discussion and cases, not an empirical causal estimate.
Finite survival accounting horizon
10 years (judgment). Explicit analyst planning judgment; inspect source discussion and cases, not an empirical causal estimate.
Health-state utility
0.7 model parameter (judgment). Explicit analyst planning judgment; inspect source discussion and cases, not an empirical causal estimate.
Discount rate
0.03 model parameter (judgment). Explicit analyst planning judgment; inspect source discussion and cases, not an empirical causal estimate.
Delivery lag
0.125 years (judgment). Explicit analyst planning judgment; inspect source discussion and cases, not an empirical causal estimate.
Post-protection opioid hazard
0.01 model parameter (judgment). Explicit analyst planning judgment; inspect source discussion and cases, not an empirical causal estimate.
Post-protection competing hazard
0.03 model parameter (judgment). Explicit analyst planning judgment; inspect source discussion and cases, not an empirical causal estimate.
California health share
0.98 model parameter (judgment). Explicit analyst planning judgment; inspect source discussion and cases, not an empirical causal estimate.
California income share
0.98 model parameter (judgment). Explicit analyst planning judgment; inspect source discussion and cases, not an empirical causal estimate.
California induced-burden share
0.98 model parameter (judgment). Explicit analyst planning judgment; inspect source discussion and cases, not an empirical causal estimate.
Nonduplicated portfolio benefit assignment
1 model parameter (judgment). Explicit analyst planning judgment; inspect source discussion and cases, not an empirical causal estimate.
Acute health loss per protected person
0 model parameter (judgment). Explicit analyst planning judgment; inspect source discussion and cases, not an empirical causal estimate.
Independent donor-induced health harm
0 model parameter (judgment). Explicit analyst planning judgment; inspect source discussion and cases, not an empirical causal estimate.
Gift-induced unsuccessful applicants
0 person/household equivalents (judgment). Explicit analyst planning judgment; inspect source discussion and cases, not an empirical causal estimate.
Net applicant resource loss
0 USD (judgment). Explicit analyst planning judgment; inspect source discussion and cases, not an empirical causal estimate.
Applicant loss delay
0.125 years (judgment). Explicit analyst planning judgment; inspect source discussion and cases, not an empirical causal estimate.
Conditional baseline-alive earner share
0 model parameter (judgment). Explicit analyst planning judgment; inspect source discussion and cases, not an empirical causal estimate.
Net conditional annual worker resources
0 USD (judgment). Explicit analyst planning judgment; inspect source discussion and cases, not an empirical causal estimate.
Conditional earnings duration
1 years (judgment). Explicit analyst planning judgment; inspect source discussion and cases, not an empirical causal estimate.
Conditional earnings start
0.625 years (judgment). Explicit analyst planning judgment; inspect source discussion and cases, not an empirical causal estimate.
Additional donor fee share
0 model parameter (judgment). Explicit analyst planning judgment; inspect source discussion and cases, not an empirical causal estimate.
Gross incremental external resource cost
0 USD (judgment). Explicit analyst planning judgment; inspect source discussion and cases, not an empirical causal estimate.

Central estimate: Cost: $100K; California health QALYs: 0.15; all-population health QALYs: 0.15. Income-equivalent healthy years: 0.00. {"gift":100000,"expense":1899047.6666666667,"nominalPeople":5000,"uniqueCurrent":0.5,"additionality":0.5,"naloxoneRelevant":0.5,"network":1,"capacity":100,"purchaserShare":0.02,"householdShare":0.9,"netSaving":19,"resourceBaseline":25000,"incomeDelay":0.625,"lambda":0.01,"mu":0.03,"effect":0.1,"activeYears":1,"horizon":10,"utility":0.7,"discount":0.03,"delay":0.125,"postLambda":0.01,"postMu":0.03,"healthCA":0.98,"incomeCA":0.98,"burdenCA":0.98,"assignment":1,"harmPerProtected":0,"independentHealthHarm":0,"inducedApplicants":0,"applicantLoss":0,"applicantDelay":0.125,"conditionalWorkerShare":0,"netAnnualWorkerGain":0,"workerYears":1,"workerDelay":0.625,"fee":0,"extraResources":0}; transferred causal inputs are judgments, not measured HRS marginal outcomes or weighted confidence bounds.

prior Exact: Cost: $100K; California health QALYs: 0.32; all-population health QALYs: 0.33. Income-equivalent healthy years: 0.00. {"gift":100000,"expense":1695969,"nominalPeople":5000,"uniqueCurrent":0.5,"additionality":0.5,"naloxoneRelevant":0.5,"network":1,"capacity":100,"purchaserShare":0,"householdShare":0.9,"netSaving":19,"resourceBaseline":25000,"incomeDelay":0.625,"lambda":0.02,"mu":0.03,"effect":0.1,"activeYears":1,"horizon":10,"utility":0.7,"discount":0.03,"delay":0,"postLambda":0.02,"postMu":0.03,"healthCA":0.98,"incomeCA":0.98,"burdenCA":0.98,"assignment":1,"harmPerProtected":0,"independentHealthHarm":0,"inducedApplicants":0,"applicantLoss":0,"applicantDelay":0.125,"conditionalWorkerShare":0,"netAnnualWorkerGain":0,"workerYears":1,"workerDelay":0.625,"fee":0,"extraResources":0}; transferred causal inputs are judgments, not measured HRS marginal outcomes or weighted confidence bounds.

latest Expense: Cost: $100K; California health QALYs: 0.16; all-population health QALYs: 0.17. Income-equivalent healthy years: 0.00. {"gift":100000,"expense":1695969,"nominalPeople":5000,"uniqueCurrent":0.5,"additionality":0.5,"naloxoneRelevant":0.5,"network":1,"capacity":100,"purchaserShare":0.02,"householdShare":0.9,"netSaving":19,"resourceBaseline":25000,"incomeDelay":0.625,"lambda":0.01,"mu":0.03,"effect":0.1,"activeYears":1,"horizon":10,"utility":0.7,"discount":0.03,"delay":0.125,"postLambda":0.01,"postMu":0.03,"healthCA":0.98,"incomeCA":0.98,"burdenCA":0.98,"assignment":1,"harmPerProtected":0,"independentHealthHarm":0,"inducedApplicants":0,"applicantLoss":0,"applicantDelay":0.125,"conditionalWorkerShare":0,"netAnnualWorkerGain":0,"workerYears":1,"workerDelay":0.625,"fee":0,"extraResources":0}; transferred causal inputs are judgments, not measured HRS marginal outcomes or weighted confidence bounds.

prior Risk: Cost: $100K; California health QALYs: 0.28; all-population health QALYs: 0.28. Income-equivalent healthy years: 0.00. {"gift":100000,"expense":1899047.6666666667,"nominalPeople":5000,"uniqueCurrent":0.5,"additionality":0.5,"naloxoneRelevant":0.5,"network":1,"capacity":100,"purchaserShare":0.02,"householdShare":0.9,"netSaving":19,"resourceBaseline":25000,"incomeDelay":0.625,"lambda":0.02,"mu":0.03,"effect":0.1,"activeYears":1,"horizon":10,"utility":0.7,"discount":0.03,"delay":0.125,"postLambda":0.02,"postMu":0.03,"healthCA":0.98,"incomeCA":0.98,"burdenCA":0.98,"assignment":1,"harmPerProtected":0,"independentHealthHarm":0,"inducedApplicants":0,"applicantLoss":0,"applicantDelay":0.125,"conditionalWorkerShare":0,"netAnnualWorkerGain":0,"workerYears":1,"workerDelay":0.625,"fee":0,"extraResources":0}; transferred causal inputs are judgments, not measured HRS marginal outcomes or weighted confidence bounds.

low Risk: Cost: $100K; California health QALYs: 0.07; all-population health QALYs: 0.08. Income-equivalent healthy years: 0.00. {"gift":100000,"expense":1899047.6666666667,"nominalPeople":5000,"uniqueCurrent":0.5,"additionality":0.5,"naloxoneRelevant":0.5,"network":1,"capacity":100,"purchaserShare":0.02,"householdShare":0.9,"netSaving":19,"resourceBaseline":25000,"incomeDelay":0.625,"lambda":0.005,"mu":0.03,"effect":0.1,"activeYears":1,"horizon":10,"utility":0.7,"discount":0.03,"delay":0.125,"postLambda":0.005,"postMu":0.03,"healthCA":0.98,"incomeCA":0.98,"burdenCA":0.98,"assignment":1,"harmPerProtected":0,"independentHealthHarm":0,"inducedApplicants":0,"applicantLoss":0,"applicantDelay":0.125,"conditionalWorkerShare":0,"netAnnualWorkerGain":0,"workerYears":1,"workerDelay":0.625,"fee":0,"extraResources":0}; transferred causal inputs are judgments, not measured HRS marginal outcomes or weighted confidence bounds.

high Risk: Cost: $100K; California health QALYs: 0.40; all-population health QALYs: 0.41. Income-equivalent healthy years: 0.00. {"gift":100000,"expense":1899047.6666666667,"nominalPeople":5000,"uniqueCurrent":0.5,"additionality":0.5,"naloxoneRelevant":0.5,"network":1,"capacity":100,"purchaserShare":0.02,"householdShare":0.9,"netSaving":19,"resourceBaseline":25000,"incomeDelay":0.625,"lambda":0.03,"mu":0.03,"effect":0.1,"activeYears":1,"horizon":10,"utility":0.7,"discount":0.03,"delay":0.125,"postLambda":0.03,"postMu":0.03,"healthCA":0.98,"incomeCA":0.98,"burdenCA":0.98,"assignment":1,"harmPerProtected":0,"independentHealthHarm":0,"inducedApplicants":0,"applicantLoss":0,"applicantDelay":0.125,"conditionalWorkerShare":0,"netAnnualWorkerGain":0,"workerYears":1,"workerDelay":0.625,"fee":0,"extraResources":0}; transferred causal inputs are judgments, not measured HRS marginal outcomes or weighted confidence bounds.

low Incremental Effect: Cost: $100K; California health QALYs: 0.04; all-population health QALYs: 0.04. Income-equivalent healthy years: 0.00. {"gift":100000,"expense":1899047.6666666667,"nominalPeople":5000,"uniqueCurrent":0.5,"additionality":0.5,"naloxoneRelevant":0.5,"network":1,"capacity":100,"purchaserShare":0.02,"householdShare":0.9,"netSaving":19,"resourceBaseline":25000,"incomeDelay":0.625,"lambda":0.01,"mu":0.03,"effect":0.025,"activeYears":1,"horizon":10,"utility":0.7,"discount":0.03,"delay":0.125,"postLambda":0.01,"postMu":0.03,"healthCA":0.98,"incomeCA":0.98,"burdenCA":0.98,"assignment":1,"harmPerProtected":0,"independentHealthHarm":0,"inducedApplicants":0,"applicantLoss":0,"applicantDelay":0.125,"conditionalWorkerShare":0,"netAnnualWorkerGain":0,"workerYears":1,"workerDelay":0.625,"fee":0,"extraResources":0}; transferred causal inputs are judgments, not measured HRS marginal outcomes or weighted confidence bounds.

higher Incremental Effect: Cost: $100K; California health QALYs: 0.29; all-population health QALYs: 0.30. Income-equivalent healthy years: 0.00. {"gift":100000,"expense":1899047.6666666667,"nominalPeople":5000,"uniqueCurrent":0.5,"additionality":0.5,"naloxoneRelevant":0.5,"network":1,"capacity":100,"purchaserShare":0.02,"householdShare":0.9,"netSaving":19,"resourceBaseline":25000,"incomeDelay":0.625,"lambda":0.01,"mu":0.03,"effect":0.2,"activeYears":1,"horizon":10,"utility":0.7,"discount":0.03,"delay":0.125,"postLambda":0.01,"postMu":0.03,"healthCA":0.98,"incomeCA":0.98,"burdenCA":0.98,"assignment":1,"harmPerProtected":0,"independentHealthHarm":0,"inducedApplicants":0,"applicantLoss":0,"applicantDelay":0.125,"conditionalWorkerShare":0,"netAnnualWorkerGain":0,"workerYears":1,"workerDelay":0.625,"fee":0,"extraResources":0}; transferred causal inputs are judgments, not measured HRS marginal outcomes or weighted confidence bounds.

zero Effect: Cost: $100K; California health QALYs: 0.00; all-population health QALYs: 0.00. Income-equivalent healthy years: 0.00. {"gift":100000,"expense":1899047.6666666667,"nominalPeople":5000,"uniqueCurrent":0.5,"additionality":0.5,"naloxoneRelevant":0.5,"network":1,"capacity":100,"purchaserShare":0.02,"householdShare":0.9,"netSaving":19,"resourceBaseline":25000,"incomeDelay":0.625,"lambda":0.01,"mu":0.03,"effect":0,"activeYears":1,"horizon":10,"utility":0.7,"discount":0.03,"delay":0.125,"postLambda":0.01,"postMu":0.03,"healthCA":0.98,"incomeCA":0.98,"burdenCA":0.98,"assignment":1,"harmPerProtected":0,"independentHealthHarm":0,"inducedApplicants":0,"applicantLoss":0,"applicantDelay":0.125,"conditionalWorkerShare":0,"netAnnualWorkerGain":0,"workerYears":1,"workerDelay":0.625,"fee":0,"extraResources":0}; transferred causal inputs are judgments, not measured HRS marginal outcomes or weighted confidence bounds.

no Purchasers: Cost: $100K; California health QALYs: 0.15; all-population health QALYs: 0.15. Income-equivalent healthy years: 0.00. {"gift":100000,"expense":1899047.6666666667,"nominalPeople":5000,"uniqueCurrent":0.5,"additionality":0.5,"naloxoneRelevant":0.5,"network":1,"capacity":100,"purchaserShare":0,"householdShare":0.9,"netSaving":19,"resourceBaseline":25000,"incomeDelay":0.625,"lambda":0.01,"mu":0.03,"effect":0.1,"activeYears":1,"horizon":10,"utility":0.7,"discount":0.03,"delay":0.125,"postLambda":0.01,"postMu":0.03,"healthCA":0.98,"incomeCA":0.98,"burdenCA":0.98,"assignment":1,"harmPerProtected":0,"independentHealthHarm":0,"inducedApplicants":0,"applicantLoss":0,"applicantDelay":0.125,"conditionalWorkerShare":0,"netAnnualWorkerGain":0,"workerYears":1,"workerDelay":0.625,"fee":0,"extraResources":0}; transferred causal inputs are judgments, not measured HRS marginal outcomes or weighted confidence bounds.

purchasers Five Percent: Cost: $100K; California health QALYs: 0.14; all-population health QALYs: 0.14. Income-equivalent healthy years: 0.00. {"gift":100000,"expense":1899047.6666666667,"nominalPeople":5000,"uniqueCurrent":0.5,"additionality":0.5,"naloxoneRelevant":0.5,"network":1,"capacity":100,"purchaserShare":0.05,"householdShare":0.9,"netSaving":19,"resourceBaseline":25000,"incomeDelay":0.625,"lambda":0.01,"mu":0.03,"effect":0.1,"activeYears":1,"horizon":10,"utility":0.7,"discount":0.03,"delay":0.125,"postLambda":0.01,"postMu":0.03,"healthCA":0.98,"incomeCA":0.98,"burdenCA":0.98,"assignment":1,"harmPerProtected":0,"independentHealthHarm":0,"inducedApplicants":0,"applicantLoss":0,"applicantDelay":0.125,"conditionalWorkerShare":0,"netAnnualWorkerGain":0,"workerYears":1,"workerDelay":0.625,"fee":0,"extraResources":0}; transferred causal inputs are judgments, not measured HRS marginal outcomes or weighted confidence bounds.

higher Savings: Cost: $100K; California health QALYs: 0.13; all-population health QALYs: 0.14. Income-equivalent healthy years: 0.00. {"gift":100000,"expense":1899047.6666666667,"nominalPeople":5000,"uniqueCurrent":0.5,"additionality":0.5,"naloxoneRelevant":0.5,"network":1,"capacity":100,"purchaserShare":0.1,"householdShare":0.9,"netSaving":30,"resourceBaseline":25000,"incomeDelay":0.625,"lambda":0.01,"mu":0.03,"effect":0.1,"activeYears":1,"horizon":10,"utility":0.7,"discount":0.03,"delay":0.125,"postLambda":0.01,"postMu":0.03,"healthCA":0.98,"incomeCA":0.98,"burdenCA":0.98,"assignment":1,"harmPerProtected":0,"independentHealthHarm":0,"inducedApplicants":0,"applicantLoss":0,"applicantDelay":0.125,"conditionalWorkerShare":0,"netAnnualWorkerGain":0,"workerYears":1,"workerDelay":0.625,"fee":0,"extraResources":0}; transferred causal inputs are judgments, not measured HRS marginal outcomes or weighted confidence bounds.

zero Resources: Cost: $100K; California health QALYs: 0.15; all-population health QALYs: 0.15. Income-equivalent healthy years: 0.00. {"gift":100000,"expense":1899047.6666666667,"nominalPeople":5000,"uniqueCurrent":0.5,"additionality":0.5,"naloxoneRelevant":0.5,"network":1,"capacity":100,"purchaserShare":0.02,"householdShare":0.9,"netSaving":0,"resourceBaseline":25000,"incomeDelay":0.625,"lambda":0.01,"mu":0.03,"effect":0.1,"activeYears":1,"horizon":10,"utility":0.7,"discount":0.03,"delay":0.125,"postLambda":0.01,"postMu":0.03,"healthCA":0.98,"incomeCA":0.98,"burdenCA":0.98,"assignment":1,"harmPerProtected":0,"independentHealthHarm":0,"inducedApplicants":0,"applicantLoss":0,"applicantDelay":0.125,"conditionalWorkerShare":0,"netAnnualWorkerGain":0,"workerYears":1,"workerDelay":0.625,"fee":0,"extraResources":0}; transferred causal inputs are judgments, not measured HRS marginal outcomes or weighted confidence bounds.

negative Resources: Cost: $100K; California health QALYs: 0.15; all-population health QALYs: 0.15. Income-equivalent healthy years: 0.00. {"gift":100000,"expense":1899047.6666666667,"nominalPeople":5000,"uniqueCurrent":0.5,"additionality":0.5,"naloxoneRelevant":0.5,"network":1,"capacity":100,"purchaserShare":0.02,"householdShare":0.9,"netSaving":-10,"resourceBaseline":25000,"incomeDelay":0.625,"lambda":0.01,"mu":0.03,"effect":0.1,"activeYears":1,"horizon":10,"utility":0.7,"discount":0.03,"delay":0.125,"postLambda":0.01,"postMu":0.03,"healthCA":0.98,"incomeCA":0.98,"burdenCA":0.98,"assignment":1,"harmPerProtected":0,"independentHealthHarm":0,"inducedApplicants":0,"applicantLoss":0,"applicantDelay":0.125,"conditionalWorkerShare":0,"netAnnualWorkerGain":0,"workerYears":1,"workerDelay":0.625,"fee":0,"extraResources":0}; transferred causal inputs are judgments, not measured HRS marginal outcomes or weighted confidence bounds.

reference50 K: Cost: $100K; California health QALYs: 0.15; all-population health QALYs: 0.15. Income-equivalent healthy years: 0.00. {"gift":100000,"expense":1899047.6666666667,"nominalPeople":5000,"uniqueCurrent":0.5,"additionality":0.5,"naloxoneRelevant":0.5,"network":1,"capacity":100,"purchaserShare":0.02,"householdShare":0.9,"netSaving":19,"resourceBaseline":50000,"incomeDelay":0.625,"lambda":0.01,"mu":0.03,"effect":0.1,"activeYears":1,"horizon":10,"utility":0.7,"discount":0.03,"delay":0.125,"postLambda":0.01,"postMu":0.03,"healthCA":0.98,"incomeCA":0.98,"burdenCA":0.98,"assignment":1,"harmPerProtected":0,"independentHealthHarm":0,"inducedApplicants":0,"applicantLoss":0,"applicantDelay":0.125,"conditionalWorkerShare":0,"netAnnualWorkerGain":0,"workerYears":1,"workerDelay":0.625,"fee":0,"extraResources":0}; transferred causal inputs are judgments, not measured HRS marginal outcomes or weighted confidence bounds.

reference100 K: Cost: $100K; California health QALYs: 0.15; all-population health QALYs: 0.15. Income-equivalent healthy years: 0.00. {"gift":100000,"expense":1899047.6666666667,"nominalPeople":5000,"uniqueCurrent":0.5,"additionality":0.5,"naloxoneRelevant":0.5,"network":1,"capacity":100,"purchaserShare":0.02,"householdShare":0.9,"netSaving":19,"resourceBaseline":100000,"incomeDelay":0.625,"lambda":0.01,"mu":0.03,"effect":0.1,"activeYears":1,"horizon":10,"utility":0.7,"discount":0.03,"delay":0.125,"postLambda":0.01,"postMu":0.03,"healthCA":0.98,"incomeCA":0.98,"burdenCA":0.98,"assignment":1,"harmPerProtected":0,"independentHealthHarm":0,"inducedApplicants":0,"applicantLoss":0,"applicantDelay":0.125,"conditionalWorkerShare":0,"netAnnualWorkerGain":0,"workerYears":1,"workerDelay":0.625,"fee":0,"extraResources":0}; transferred causal inputs are judgments, not measured HRS marginal outcomes or weighted confidence bounds.

household Dedup Half: Cost: $100K; California health QALYs: 0.15; all-population health QALYs: 0.15. Income-equivalent healthy years: 0.00. {"gift":100000,"expense":1899047.6666666667,"nominalPeople":5000,"uniqueCurrent":0.5,"additionality":0.5,"naloxoneRelevant":0.5,"network":1,"capacity":100,"purchaserShare":0.02,"householdShare":0.5,"netSaving":19,"resourceBaseline":25000,"incomeDelay":0.625,"lambda":0.01,"mu":0.03,"effect":0.1,"activeYears":1,"horizon":10,"utility":0.7,"discount":0.03,"delay":0.125,"postLambda":0.01,"postMu":0.03,"healthCA":0.98,"incomeCA":0.98,"burdenCA":0.98,"assignment":1,"harmPerProtected":0,"independentHealthHarm":0,"inducedApplicants":0,"applicantLoss":0,"applicantDelay":0.125,"conditionalWorkerShare":0,"netAnnualWorkerGain":0,"workerYears":1,"workerDelay":0.625,"fee":0,"extraResources":0}; transferred causal inputs are judgments, not measured HRS marginal outcomes or weighted confidence bounds.

no Funding: Cost: $100K; California health QALYs: 0.00; all-population health QALYs: 0.00. Income-equivalent healthy years: 0.00. {"gift":100000,"expense":1899047.6666666667,"nominalPeople":5000,"uniqueCurrent":0.5,"additionality":0,"naloxoneRelevant":0.5,"network":1,"capacity":100,"purchaserShare":0.02,"householdShare":0.9,"netSaving":19,"resourceBaseline":25000,"incomeDelay":0.625,"lambda":0.01,"mu":0.03,"effect":0.1,"activeYears":1,"horizon":10,"utility":0.7,"discount":0.03,"delay":0.125,"postLambda":0.01,"postMu":0.03,"healthCA":0.98,"incomeCA":0.98,"burdenCA":0.98,"assignment":1,"harmPerProtected":0,"independentHealthHarm":0,"inducedApplicants":0,"applicantLoss":0,"applicantDelay":0.125,"conditionalWorkerShare":0,"netAnnualWorkerGain":0,"workerYears":1,"workerDelay":0.625,"fee":0,"extraResources":0}; transferred causal inputs are judgments, not measured HRS marginal outcomes or weighted confidence bounds.

no Assignment: Cost: $100K; California health QALYs: 0.00; all-population health QALYs: 0.00. Income-equivalent healthy years: 0.00. {"gift":100000,"expense":1899047.6666666667,"nominalPeople":5000,"uniqueCurrent":0.5,"additionality":0.5,"naloxoneRelevant":0.5,"network":1,"capacity":100,"purchaserShare":0.02,"householdShare":0.9,"netSaving":19,"resourceBaseline":25000,"incomeDelay":0.625,"lambda":0.01,"mu":0.03,"effect":0.1,"activeYears":1,"horizon":10,"utility":0.7,"discount":0.03,"delay":0.125,"postLambda":0.01,"postMu":0.03,"healthCA":0.98,"incomeCA":0.98,"burdenCA":0.98,"assignment":0,"harmPerProtected":0,"independentHealthHarm":0,"inducedApplicants":0,"applicantLoss":0,"applicantDelay":0.125,"conditionalWorkerShare":0,"netAnnualWorkerGain":0,"workerYears":1,"workerDelay":0.625,"fee":0,"extraResources":0}; transferred causal inputs are judgments, not measured HRS marginal outcomes or weighted confidence bounds.

no California: Cost: $100K; California health QALYs: 0.00; all-population health QALYs: 0.15. Income-equivalent healthy years: 0.00. {"gift":100000,"expense":1899047.6666666667,"nominalPeople":5000,"uniqueCurrent":0.5,"additionality":0.5,"naloxoneRelevant":0.5,"network":1,"capacity":100,"purchaserShare":0.02,"householdShare":0.9,"netSaving":19,"resourceBaseline":25000,"incomeDelay":0.625,"lambda":0.01,"mu":0.03,"effect":0.1,"activeYears":1,"horizon":10,"utility":0.7,"discount":0.03,"delay":0.125,"postLambda":0.01,"postMu":0.03,"healthCA":0,"incomeCA":0,"burdenCA":0,"assignment":1,"harmPerProtected":0,"independentHealthHarm":0,"inducedApplicants":0,"applicantLoss":0,"applicantDelay":0.125,"conditionalWorkerShare":0,"netAnnualWorkerGain":0,"workerYears":1,"workerDelay":0.625,"fee":0,"extraResources":0}; transferred causal inputs are judgments, not measured HRS marginal outcomes or weighted confidence bounds.

training Denominator: Cost: $100K; California health QALYs: 0.01; all-population health QALYs: 0.01. Income-equivalent healthy years: 0.00. {"gift":100000,"expense":1899047.6666666667,"nominalPeople":500,"uniqueCurrent":0.5,"additionality":0.5,"naloxoneRelevant":0.5,"network":1,"capacity":100,"purchaserShare":0.02,"householdShare":0.9,"netSaving":19,"resourceBaseline":25000,"incomeDelay":0.625,"lambda":0.01,"mu":0.03,"effect":0.1,"activeYears":1,"horizon":10,"utility":0.7,"discount":0.03,"delay":0.125,"postLambda":0.01,"postMu":0.03,"healthCA":0.98,"incomeCA":0.98,"burdenCA":0.98,"assignment":1,"harmPerProtected":0,"independentHealthHarm":0,"inducedApplicants":0,"applicantLoss":0,"applicantDelay":0.125,"conditionalWorkerShare":0,"netAnnualWorkerGain":0,"workerYears":1,"workerDelay":0.625,"fee":0,"extraResources":0}; transferred causal inputs are judgments, not measured HRS marginal outcomes or weighted confidence bounds.

half Network: Cost: $100K; California health QALYs: 0.07; all-population health QALYs: 0.07. Income-equivalent healthy years: 0.00. {"gift":100000,"expense":1899047.6666666667,"nominalPeople":5000,"uniqueCurrent":0.5,"additionality":0.5,"naloxoneRelevant":0.5,"network":0.5,"capacity":100,"purchaserShare":0.02,"householdShare":0.9,"netSaving":19,"resourceBaseline":25000,"incomeDelay":0.625,"lambda":0.01,"mu":0.03,"effect":0.1,"activeYears":1,"horizon":10,"utility":0.7,"discount":0.03,"delay":0.125,"postLambda":0.01,"postMu":0.03,"healthCA":0.98,"incomeCA":0.98,"burdenCA":0.98,"assignment":1,"harmPerProtected":0,"independentHealthHarm":0,"inducedApplicants":0,"applicantLoss":0,"applicantDelay":0.125,"conditionalWorkerShare":0,"netAnnualWorkerGain":0,"workerYears":1,"workerDelay":0.625,"fee":0,"extraResources":0}; transferred causal inputs are judgments, not measured HRS marginal outcomes or weighted confidence bounds.

five Person Cap: Cost: $100K; California health QALYs: 0.02; all-population health QALYs: 0.02. Income-equivalent healthy years: 0.00. {"gift":100000,"expense":1899047.6666666667,"nominalPeople":5000,"uniqueCurrent":0.5,"additionality":0.5,"naloxoneRelevant":0.5,"network":1,"capacity":5,"purchaserShare":0.02,"householdShare":0.9,"netSaving":19,"resourceBaseline":25000,"incomeDelay":0.625,"lambda":0.01,"mu":0.03,"effect":0.1,"activeYears":1,"horizon":10,"utility":0.7,"discount":0.03,"delay":0.125,"postLambda":0.01,"postMu":0.03,"healthCA":0.98,"incomeCA":0.98,"burdenCA":0.98,"assignment":1,"harmPerProtected":0,"independentHealthHarm":0,"inducedApplicants":0,"applicantLoss":0,"applicantDelay":0.125,"conditionalWorkerShare":0,"netAnnualWorkerGain":0,"workerYears":1,"workerDelay":0.625,"fee":0,"extraResources":0}; transferred causal inputs are judgments, not measured HRS marginal outcomes or weighted confidence bounds.

half Year Protection: Cost: $100K; California health QALYs: 0.08; all-population health QALYs: 0.08. Income-equivalent healthy years: 0.00. {"gift":100000,"expense":1899047.6666666667,"nominalPeople":5000,"uniqueCurrent":0.5,"additionality":0.5,"naloxoneRelevant":0.5,"network":1,"capacity":100,"purchaserShare":0.02,"householdShare":0.9,"netSaving":19,"resourceBaseline":25000,"incomeDelay":0.625,"lambda":0.01,"mu":0.03,"effect":0.1,"activeYears":0.5,"horizon":10,"utility":0.7,"discount":0.03,"delay":0.125,"postLambda":0.01,"postMu":0.03,"healthCA":0.98,"incomeCA":0.98,"burdenCA":0.98,"assignment":1,"harmPerProtected":0,"independentHealthHarm":0,"inducedApplicants":0,"applicantLoss":0,"applicantDelay":0.125,"conditionalWorkerShare":0,"netAnnualWorkerGain":0,"workerYears":1,"workerDelay":0.625,"fee":0,"extraResources":0}; transferred causal inputs are judgments, not measured HRS marginal outcomes or weighted confidence bounds.

one Year Accounting: Cost: $100K; California health QALYs: 0.01; all-population health QALYs: 0.01. Income-equivalent healthy years: 0.00. {"gift":100000,"expense":1899047.6666666667,"nominalPeople":5000,"uniqueCurrent":0.5,"additionality":0.5,"naloxoneRelevant":0.5,"network":1,"capacity":100,"purchaserShare":0.02,"householdShare":0.9,"netSaving":19,"resourceBaseline":25000,"incomeDelay":0.625,"lambda":0.01,"mu":0.03,"effect":0.1,"activeYears":1,"horizon":1,"utility":0.7,"discount":0.03,"delay":0.125,"postLambda":0.01,"postMu":0.03,"healthCA":0.98,"incomeCA":0.98,"burdenCA":0.98,"assignment":1,"harmPerProtected":0,"independentHealthHarm":0,"inducedApplicants":0,"applicantLoss":0,"applicantDelay":0.125,"conditionalWorkerShare":0,"netAnnualWorkerGain":0,"workerYears":1,"workerDelay":0.625,"fee":0,"extraResources":0}; transferred causal inputs are judgments, not measured HRS marginal outcomes or weighted confidence bounds.

five Year Accounting: Cost: $100K; California health QALYs: 0.08; all-population health QALYs: 0.08. Income-equivalent healthy years: 0.00. {"gift":100000,"expense":1899047.6666666667,"nominalPeople":5000,"uniqueCurrent":0.5,"additionality":0.5,"naloxoneRelevant":0.5,"network":1,"capacity":100,"purchaserShare":0.02,"householdShare":0.9,"netSaving":19,"resourceBaseline":25000,"incomeDelay":0.625,"lambda":0.01,"mu":0.03,"effect":0.1,"activeYears":1,"horizon":5,"utility":0.7,"discount":0.03,"delay":0.125,"postLambda":0.01,"postMu":0.03,"healthCA":0.98,"incomeCA":0.98,"burdenCA":0.98,"assignment":1,"harmPerProtected":0,"independentHealthHarm":0,"inducedApplicants":0,"applicantLoss":0,"applicantDelay":0.125,"conditionalWorkerShare":0,"netAnnualWorkerGain":0,"workerYears":1,"workerDelay":0.625,"fee":0,"extraResources":0}; transferred causal inputs are judgments, not measured HRS marginal outcomes or weighted confidence bounds.

twenty Year Accounting: Cost: $100K; California health QALYs: 0.22; all-population health QALYs: 0.23. Income-equivalent healthy years: 0.00. {"gift":100000,"expense":1899047.6666666667,"nominalPeople":5000,"uniqueCurrent":0.5,"additionality":0.5,"naloxoneRelevant":0.5,"network":1,"capacity":100,"purchaserShare":0.02,"householdShare":0.9,"netSaving":19,"resourceBaseline":25000,"incomeDelay":0.625,"lambda":0.01,"mu":0.03,"effect":0.1,"activeYears":1,"horizon":20,"utility":0.7,"discount":0.03,"delay":0.125,"postLambda":0.01,"postMu":0.03,"healthCA":0.98,"incomeCA":0.98,"burdenCA":0.98,"assignment":1,"harmPerProtected":0,"independentHealthHarm":0,"inducedApplicants":0,"applicantLoss":0,"applicantDelay":0.125,"conditionalWorkerShare":0,"netAnnualWorkerGain":0,"workerYears":1,"workerDelay":0.625,"fee":0,"extraResources":0}; transferred causal inputs are judgments, not measured HRS marginal outcomes or weighted confidence bounds.

higher Post Mortality: Cost: $100K; California health QALYs: 0.12; all-population health QALYs: 0.12. Income-equivalent healthy years: 0.00. {"gift":100000,"expense":1899047.6666666667,"nominalPeople":5000,"uniqueCurrent":0.5,"additionality":0.5,"naloxoneRelevant":0.5,"network":1,"capacity":100,"purchaserShare":0.02,"householdShare":0.9,"netSaving":19,"resourceBaseline":25000,"incomeDelay":0.625,"lambda":0.01,"mu":0.03,"effect":0.1,"activeYears":1,"horizon":10,"utility":0.7,"discount":0.03,"delay":0.125,"postLambda":0.04,"postMu":0.06,"healthCA":0.98,"incomeCA":0.98,"burdenCA":0.98,"assignment":1,"harmPerProtected":0,"independentHealthHarm":0,"inducedApplicants":0,"applicantLoss":0,"applicantDelay":0.125,"conditionalWorkerShare":0,"netAnnualWorkerGain":0,"workerYears":1,"workerDelay":0.625,"fee":0,"extraResources":0}; transferred causal inputs are judgments, not measured HRS marginal outcomes or weighted confidence bounds.

immediate Delivery: Cost: $100K; California health QALYs: 0.15; all-population health QALYs: 0.15. Income-equivalent healthy years: 0.00. {"gift":100000,"expense":1899047.6666666667,"nominalPeople":5000,"uniqueCurrent":0.5,"additionality":0.5,"naloxoneRelevant":0.5,"network":1,"capacity":100,"purchaserShare":0.02,"householdShare":0.9,"netSaving":19,"resourceBaseline":25000,"incomeDelay":0.5,"lambda":0.01,"mu":0.03,"effect":0.1,"activeYears":1,"horizon":10,"utility":0.7,"discount":0.03,"delay":0,"postLambda":0.01,"postMu":0.03,"healthCA":0.98,"incomeCA":0.98,"burdenCA":0.98,"assignment":1,"harmPerProtected":0,"independentHealthHarm":0,"inducedApplicants":0,"applicantLoss":0,"applicantDelay":0.125,"conditionalWorkerShare":0,"netAnnualWorkerGain":0,"workerYears":1,"workerDelay":0.625,"fee":0,"extraResources":0}; transferred causal inputs are judgments, not measured HRS marginal outcomes or weighted confidence bounds.

six Month Delay: Cost: $100K; California health QALYs: 0.14; all-population health QALYs: 0.14. Income-equivalent healthy years: 0.00. {"gift":100000,"expense":1899047.6666666667,"nominalPeople":5000,"uniqueCurrent":0.5,"additionality":0.5,"naloxoneRelevant":0.5,"network":1,"capacity":100,"purchaserShare":0.02,"householdShare":0.9,"netSaving":19,"resourceBaseline":25000,"incomeDelay":1,"lambda":0.01,"mu":0.03,"effect":0.1,"activeYears":1,"horizon":10,"utility":0.7,"discount":0.03,"delay":0.5,"postLambda":0.01,"postMu":0.03,"healthCA":0.98,"incomeCA":0.98,"burdenCA":0.98,"assignment":1,"harmPerProtected":0,"independentHealthHarm":0,"inducedApplicants":0,"applicantLoss":0,"applicantDelay":0.125,"conditionalWorkerShare":0,"netAnnualWorkerGain":0,"workerYears":1,"workerDelay":0.625,"fee":0,"extraResources":0}; transferred causal inputs are judgments, not measured HRS marginal outcomes or weighted confidence bounds.

worker Conditional Positive: Cost: $100K; California health QALYs: 0.15; all-population health QALYs: 0.15. Income-equivalent healthy years: 0.03. {"gift":100000,"expense":1899047.6666666667,"nominalPeople":5000,"uniqueCurrent":0.5,"additionality":0.5,"naloxoneRelevant":0.5,"network":1,"capacity":100,"purchaserShare":0.02,"householdShare":0.9,"netSaving":19,"resourceBaseline":25000,"incomeDelay":0.625,"lambda":0.01,"mu":0.03,"effect":0.1,"activeYears":1,"horizon":10,"utility":0.7,"discount":0.03,"delay":0.125,"postLambda":0.01,"postMu":0.03,"healthCA":0.98,"incomeCA":0.98,"burdenCA":0.98,"assignment":1,"harmPerProtected":0,"independentHealthHarm":0,"inducedApplicants":0,"applicantLoss":0,"applicantDelay":0.125,"conditionalWorkerShare":0.05,"netAnnualWorkerGain":1000,"workerYears":1,"workerDelay":0.625,"fee":0,"extraResources":0}; transferred causal inputs are judgments, not measured HRS marginal outcomes or weighted confidence bounds.

worker Conditional Adverse: Cost: $100K; California health QALYs: 0.15; all-population health QALYs: 0.15. Income-equivalent healthy years: -0.03. {"gift":100000,"expense":1899047.6666666667,"nominalPeople":5000,"uniqueCurrent":0.5,"additionality":0.5,"naloxoneRelevant":0.5,"network":1,"capacity":100,"purchaserShare":0.02,"householdShare":0.9,"netSaving":19,"resourceBaseline":25000,"incomeDelay":0.625,"lambda":0.01,"mu":0.03,"effect":0.1,"activeYears":1,"horizon":10,"utility":0.7,"discount":0.03,"delay":0.125,"postLambda":0.01,"postMu":0.03,"healthCA":0.98,"incomeCA":0.98,"burdenCA":0.98,"assignment":1,"harmPerProtected":0,"independentHealthHarm":0,"inducedApplicants":0,"applicantLoss":0,"applicantDelay":0.125,"conditionalWorkerShare":0.05,"netAnnualWorkerGain":-1000,"workerYears":1,"workerDelay":0.625,"fee":0,"extraResources":0}; transferred causal inputs are judgments, not measured HRS marginal outcomes or weighted confidence bounds.

induced Failed Access: Cost: $100K; California health QALYs: 0.00; all-population health QALYs: 0.00. Income-equivalent healthy years: 0.00. {"gift":100000,"expense":1899047.6666666667,"nominalPeople":5000,"uniqueCurrent":0.5,"additionality":0,"naloxoneRelevant":0.5,"network":1,"capacity":100,"purchaserShare":0.02,"householdShare":0.9,"netSaving":19,"resourceBaseline":25000,"incomeDelay":0.625,"lambda":0.01,"mu":0.03,"effect":0.1,"activeYears":1,"horizon":10,"utility":0.7,"discount":0.03,"delay":0.125,"postLambda":0.01,"postMu":0.03,"healthCA":0.98,"incomeCA":0.98,"burdenCA":0.98,"assignment":1,"harmPerProtected":0,"independentHealthHarm":0,"inducedApplicants":20,"applicantLoss":10,"applicantDelay":0.125,"conditionalWorkerShare":0,"netAnnualWorkerGain":0,"workerYears":1,"workerDelay":0.625,"fee":0,"extraResources":0}; transferred causal inputs are judgments, not measured HRS marginal outcomes or weighted confidence bounds.

independent Health Harm: Cost: $100K; California health QALYs: -0.05; all-population health QALYs: -0.05. Income-equivalent healthy years: 0.00. {"gift":100000,"expense":1899047.6666666667,"nominalPeople":5000,"uniqueCurrent":0.5,"additionality":0,"naloxoneRelevant":0.5,"network":1,"capacity":100,"purchaserShare":0.02,"householdShare":0.9,"netSaving":19,"resourceBaseline":25000,"incomeDelay":0.625,"lambda":0.01,"mu":0.03,"effect":0.1,"activeYears":1,"horizon":10,"utility":0.7,"discount":0.03,"delay":0.125,"postLambda":0.01,"postMu":0.03,"healthCA":0.98,"incomeCA":0.98,"burdenCA":0.98,"assignment":1,"harmPerProtected":0,"independentHealthHarm":0.05,"inducedApplicants":0,"applicantLoss":0,"applicantDelay":0.125,"conditionalWorkerShare":0,"netAnnualWorkerGain":0,"workerYears":1,"workerDelay":0.625,"fee":0,"extraResources":0}; transferred causal inputs are judgments, not measured HRS marginal outcomes or weighted confidence bounds.

acute Burden: Cost: $100K; California health QALYs: 0.11; all-population health QALYs: 0.12. Income-equivalent healthy years: 0.00. {"gift":100000,"expense":1899047.6666666667,"nominalPeople":5000,"uniqueCurrent":0.5,"additionality":0.5,"naloxoneRelevant":0.5,"network":1,"capacity":100,"purchaserShare":0.02,"householdShare":0.9,"netSaving":19,"resourceBaseline":25000,"incomeDelay":0.625,"lambda":0.01,"mu":0.03,"effect":0.1,"activeYears":1,"horizon":10,"utility":0.7,"discount":0.03,"delay":0.125,"postLambda":0.01,"postMu":0.03,"healthCA":0.98,"incomeCA":0.98,"burdenCA":0.98,"assignment":1,"harmPerProtected":0.001,"independentHealthHarm":0,"inducedApplicants":0,"applicantLoss":0,"applicantDelay":0.125,"conditionalWorkerShare":0,"netAnnualWorkerGain":0,"workerYears":1,"workerDelay":0.625,"fee":0,"extraResources":0}; transferred causal inputs are judgments, not measured HRS marginal outcomes or weighted confidence bounds.

negative Clinical: Cost: $100K; California health QALYs: -0.07; all-population health QALYs: -0.07. Income-equivalent healthy years: 0.00. {"gift":100000,"expense":1899047.6666666667,"nominalPeople":5000,"uniqueCurrent":0.5,"additionality":0.5,"naloxoneRelevant":0.5,"network":1,"capacity":100,"purchaserShare":0.02,"householdShare":0.9,"netSaving":19,"resourceBaseline":25000,"incomeDelay":0.625,"lambda":0.01,"mu":0.03,"effect":-0.05,"activeYears":1,"horizon":10,"utility":0.7,"discount":0.03,"delay":0.125,"postLambda":0.01,"postMu":0.03,"healthCA":0.98,"incomeCA":0.98,"burdenCA":0.98,"assignment":1,"harmPerProtected":0,"independentHealthHarm":0,"inducedApplicants":0,"applicantLoss":0,"applicantDelay":0.125,"conditionalWorkerShare":0,"netAnnualWorkerGain":0,"workerYears":1,"workerDelay":0.625,"fee":0,"extraResources":0}; transferred causal inputs are judgments, not measured HRS marginal outcomes or weighted confidence bounds.

gross Extra Resources: Cost: $100K; California health QALYs: 0.15; all-population health QALYs: 0.15. Income-equivalent healthy years: 0.00. {"gift":100000,"expense":1899047.6666666667,"nominalPeople":5000,"uniqueCurrent":0.5,"additionality":0.5,"naloxoneRelevant":0.5,"network":1,"capacity":100,"purchaserShare":0.02,"householdShare":0.9,"netSaving":19,"resourceBaseline":25000,"incomeDelay":0.625,"lambda":0.01,"mu":0.03,"effect":0.1,"activeYears":1,"horizon":10,"utility":0.7,"discount":0.03,"delay":0.125,"postLambda":0.01,"postMu":0.03,"healthCA":0.98,"incomeCA":0.98,"burdenCA":0.98,"assignment":1,"harmPerProtected":0,"independentHealthHarm":0,"inducedApplicants":0,"applicantLoss":0,"applicantDelay":0.125,"conditionalWorkerShare":0,"netAnnualWorkerGain":0,"workerYears":1,"workerDelay":0.625,"fee":0,"extraResources":100000}; transferred causal inputs are judgments, not measured HRS marginal outcomes or weighted confidence bounds.

Historical prior health-only estimate: Cost: $100K; California health QALYs: 0.32; all-population health QALYs: 0.33. Historical September model, not current. {"C":100000,"E":1695969,"Y":5000,"d":0.5,"m":0.5,"x":0.5,"network":1,"K":100,"lambda":0.02,"mu":0.03,"e":0.1,"tau":1,"T":10,"u":0.7,"r":0.03,"g":0.98,"delay":0,"postLambda":0.02,"postMu":0.03,"harmPerProtected":0,"independentHarm":0,"extraResources":0}; all new and clinical/marginal parameters are explicit judgments, not confidence limits or offers.

Counterfactual: Existing free medicine, other distributors, informal networks, EMS and treatment remain available. Purchasers receive savings but no added access health. Do not credit repeated kits, extra-survivor lifetime wages or public procurement as household resources.

Attribution: Benefit assignment prevents cross-provider duplication. Explicit independent gift-induced failed-access/health harms survive zero benefit assignment. California shares follow Sacramento service geography, not population allocation.

All local marginal capacity, incidence, utility and mortality transfers remain judgments. Scenarios are unweighted; no confidence interval, verified expansion tranche or complete benefit inventory.

Sensitivity

  • priorExact: $309K per DALY. Unweighted case; negative or zero combined benefit has no positive finite ratio.
  • latestExpense: $612K per DALY. Unweighted case; negative or zero combined benefit has no positive finite ratio.
  • priorRisk: $359K per DALY. Unweighted case; negative or zero combined benefit has no positive finite ratio.
  • lowRisk: $1.3M per DALY. Unweighted case; negative or zero combined benefit has no positive finite ratio.
  • highRisk: $251K per DALY. Unweighted case; negative or zero combined benefit has no positive finite ratio.
  • lowIncrementalEffect: $2.7M per DALY. Unweighted case; negative or zero combined benefit has no positive finite ratio.
  • higherIncrementalEffect: $343K per DALY. Unweighted case; negative or zero combined benefit has no positive finite ratio.
  • zeroEffect: $461.9M per DALY. Unweighted case; negative or zero combined benefit has no positive finite ratio.
  • noPurchasers: $673K per DALY. Unweighted case; negative or zero combined benefit has no positive finite ratio.
  • purchasersFivePercent: $705K per DALY. Unweighted case; negative or zero combined benefit has no positive finite ratio.
  • higherSavings: $738K per DALY. Unweighted case; negative or zero combined benefit has no positive finite ratio.
  • zeroResources: $686K per DALY. Unweighted case; negative or zero combined benefit has no positive finite ratio.
  • negativeResources: $687K per DALY. Unweighted case; negative or zero combined benefit has no positive finite ratio.
  • reference50K: $686K per DALY. Unweighted case; negative or zero combined benefit has no positive finite ratio.
  • reference100K: $686K per DALY. Unweighted case; negative or zero combined benefit has no positive finite ratio.
  • householdDedupHalf: $686K per DALY. Unweighted case; negative or zero combined benefit has no positive finite ratio.
  • noFunding: no finite positive estimate. Unweighted case; negative or zero combined benefit has no positive finite ratio.
  • noAssignment: no finite positive estimate. Unweighted case; negative or zero combined benefit has no positive finite ratio.
  • noCalifornia: no finite positive estimate. Unweighted case; negative or zero combined benefit has no positive finite ratio.
  • trainingDenominator: $6.9M per DALY. Unweighted case; negative or zero combined benefit has no positive finite ratio.
  • halfNetwork: $1.4M per DALY. Unweighted case; negative or zero combined benefit has no positive finite ratio.
  • fivePersonCap: $4.5M per DALY. Unweighted case; negative or zero combined benefit has no positive finite ratio.
  • halfYearProtection: $1.3M per DALY. Unweighted case; negative or zero combined benefit has no positive finite ratio.
  • oneYearAccounting: $12.1M per DALY. Unweighted case; negative or zero combined benefit has no positive finite ratio.
  • fiveYearAccounting: $1.2M per DALY. Unweighted case; negative or zero combined benefit has no positive finite ratio.
  • twentyYearAccounting: $444K per DALY. Unweighted case; negative or zero combined benefit has no positive finite ratio.
  • higherPostMortality: $844K per DALY. Unweighted case; negative or zero combined benefit has no positive finite ratio.
  • immediateDelivery: $673K per DALY. Unweighted case; negative or zero combined benefit has no positive finite ratio.
  • sixMonthDelay: $724K per DALY. Unweighted case; negative or zero combined benefit has no positive finite ratio.
  • workerConditionalPositive: $579K per DALY. Unweighted case; negative or zero combined benefit has no positive finite ratio.
  • workerConditionalAdverse: $846K per DALY. Unweighted case; negative or zero combined benefit has no positive finite ratio.
  • inducedFailedAccess: no finite positive estimate. Unweighted case; negative or zero combined benefit has no positive finite ratio.
  • independentHealthHarm: no finite positive estimate. Unweighted case; negative or zero combined benefit has no positive finite ratio.
  • acuteBurden: $874K per DALY. Unweighted case; negative or zero combined benefit has no positive finite ratio.
  • negativeClinical: no finite positive estimate. Unweighted case; negative or zero combined benefit has no positive finite ratio.
  • grossExtraResources: $685K per DALY. Unweighted case; negative or zero combined benefit has no positive finite ratio.

Unresolved inputs

  • Fresh privacy-preserving annual unique SSP reach and overlap with training, opioid use and actual response networks.
  • Marginal staffing/outreach plan and unrestricted cash requirement; current grants, replacement behavior, restricted balances and capacity.
  • California client baseline fatality risk and differential timely response with versus without HRS, not reported reversal counts.
  • Duration of useful protection, recurrent mortality, utility and migration follow-up.
  • Joint non-overlapping HIV/HCV, treatment and clinic effects; incremental public/partner resource costs.
  • Whether the paused library route was replaced elsewhere; current access constraints and a feasible protected-person expansion cap.
  • Current opioid-settlement and other public/private grant values, allowed SSP versus other costs, current NDP/clearinghouse inventory and restrictions.
  • Independent CPA statements and donated clinical partner resource quantities needed for full societal cost; 990 audit checkboxes and blank Schedule D reconciliations do not fill this gap.

Health and income breakdown

For the modeled $100K: 0.15 health QALYs + 0.00 income-equivalent healthy years in California: $685K per DALY. Income equivalents are welfare comparisons, not observed QALYs or DALYs.

Method and caveats.

5. Funding and previous grants

The donation page describes a broad range of uses for gifts and offers a direct donation route; no purchase or transaction was made. HRS expressly says Sacramento County does not fund its SSP or drug-use supplies. That does not establish that all SSP costs are donor-dependent. California's NDP FAQ says qualified organizations can obtain free naloxone and test strips, subject to approval and funding; HRS's current allocation was not verified. The 2025 CARES report identifies HRS as a grantee, without establishing an unfilled marginal budget. Additional donations may finance outreach that makes free supplies useful, replace other funding, or build reserves. A costed expansion or threatened-service plan, current liquid resources, grant restrictions and delivery capacity are needed before making a donor-ready claim.

Fresh FY2025 accounts report $540,198 without donor restrictions and $234,490 with restrictions. These are net assets, not available cash or verified funding room. Schedule M reports $384,175 of donated drugs/medical supplies at fair market value; it does not identify naloxone units, remaining stock or the next donation's use. The model does not subtract that contribution from expenses or presume unlimited donated supply.

Historical county opioid-settlement materials name HRS alongside other providers, qualifying any inference that its whole overdose portfolio lacks public support. Direct retrieval of those older PDFs failed; indexed primary excerpts are retained as historical leads only. Current contract values, restrictions, replacement behavior and NDP allocations remain unresolved. The paused library pilot illustrates that money is not the only capacity constraint.

FY2025 cash and savings totaled $619,377, versus $410,237 in FY2024 and $564,212 in FY2023; those historical balances are not current available cash or a runway calculation. The return reports $234,490 restricted net assets, which is not synonymous with restricted cash. California now offers approved organizations generic nasal naloxone through NDP and advertises a retail twin-pack at $19. Neither channel makes all delivery resources free, and neither identifies HRS’s next-gift margin. No drug-price addback is stacked on already retained supplies.

Expense appendix: FY2025 program/management/fundraising expense was $1,496,873/$190,757/$8,339. The corresponding FY2024 totals were $1,899,810/$142,100/$20,875; FY2023 totals were $1,793,371/$130,663/$14,355. Each sums to the filed recipient total. These accounting categories do not identify the budget or health return of the overdose pathway. The $384,175 donated-goods revenue is not an audited same-year cost reconciliation and is not an additional expense by itself.

Annual expenses

Organization-level spending, including programs, administration and fundraising. The research list averages three comparable, consecutive full fiscal years when available.

  • FY 2023: $1.9M; Harm Reduction Services Inc., EIN 68-0300656, 12-month period, Original Form 990; accrual; July–June 12-month fiscal year; recipient total expenses including noncash accounting. Source
  • FY 2024: $2.1M; Harm Reduction Services Inc., EIN 68-0300656, 12-month period, Original Form 990; accrual; July–June 12-month fiscal year; recipient total expenses including noncash accounting. Source
  • FY 2025: $1.7M; Harm Reduction Services Inc., EIN 68-0300656, 12-month period, Original Form 990; accrual; July–June 12-month fiscal year; recipient total expenses including noncash accounting. Source

6. Sources

  1. Harm Reduction Services home. Harm Reduction Services. Published: not stated; retrieved: 2026-09-13.
  2. Syringe Service Program. Harm Reduction Services. Published: not stated; retrieved: 2026-09-14.
  3. Ryan White Case Management. Harm Reduction Services. Published: not stated; retrieved: 2026-09-14.
  4. Education, Response and Access. Harm Reduction Services. Published: not stated; retrieved: 2026-09-14.
  5. Joan Viteri Memorial Clinic. Harm Reduction Services. Published: not stated; retrieved: 2026-09-14.
  6. Donations. Harm Reduction Services. Published: not stated; retrieved: 2026-09-14.
  7. Funding Sources. Harm Reduction Services. Published: not stated; retrieved: 2026-09-14.
  8. 2025 Grantees: Summary of Accomplishments. The CARES Foundation. Published: 2026-04-30; retrieved: 2026-09-14.
  9. 2024 Grantees: Summary of Accomplishments. The CARES Foundation. Published: 2025-04-29; retrieved: 2026-09-13.
  10. Harm Reduction Services Inc IRS expense extracts. ProPublica Nonprofit Explorer / IRS. Published: not stated; retrieved: 2026-09-13.
  11. Naloxone Distribution Project FAQ. California Department of Health Care Services. Published: not stated; retrieved: 2026-09-14.
  12. Strengthening Syringe Services Programs. CDC. Published: 2024-03-20; retrieved: 2026-09-13.
  13. Opioid overdose rates and implementation of overdose education and nasal naloxone distribution in Massachusetts. Walley et al. / BMJ. Published: 2013-01-31; retrieved: 2026-09-13.
  14. Form 990, fiscal year July 2022–June 2023. Harm Reduction Services / IRS. Published: not stated; retrieved: 2026-09-14.
  15. Form 990, fiscal year July 2023–June 2024. Harm Reduction Services / IRS. Published: not stated; retrieved: 2026-09-14.
  16. Form 990, fiscal year July 2024–June 2025. Harm Reduction Services / IRS. Published: not stated; retrieved: 2026-09-14.
  17. FY2025 Form 990 Schedule O program descriptions. Harm Reduction Services / IRS. Published: not stated; retrieved: 2026-09-14.
  18. FY2023 Form 990 Schedule O program descriptions. Harm Reduction Services / IRS. Published: not stated; retrieved: 2026-09-14.
  19. FY2025 Form 990 Schedule M noncash contributions. Harm Reduction Services / IRS. Published: not stated; retrieved: 2026-09-14.
  20. Mortality Following Nonfatal Opioid and Sedative/Hypnotic Drug Overdose. Goldman-Mellor et al. / American Journal of Preventive Medicine. Published: not stated; retrieved: 2026-09-14.
  21. One-Year Mortality After Emergency Department Visit for Nonfatal Opioid Poisoning. Annals of Emergency Medicine. Published: not stated; retrieved: 2026-09-13.
  22. Community-Based Cluster-Randomized Trial to Reduce Opioid Overdose Deaths. HEALing Communities Study Consortium / New England Journal of Medicine. Published: not stated; retrieved: 2026-09-14.
  23. HRS community outreach. hrssac.org. Published: not stated; retrieved: 2026-09-14.
  24. Library HRS mobile partnership update. www.saclibrary.org. Published: 2026-02-25; retrieved: 2026-09-14.
  25. CalRx naloxone price. calrx.ca.gov. Published: not stated; retrieved: 2026-09-14.
  26. California harm reduction supplies clearinghouse (publication month 2022-03; exact day unknown). www.cdph.ca.gov. Published: not stated; retrieved: 2026-09-14.
  27. Sacramento opioid remediation activities (publication month 2024-07; exact day unknown). dhs.saccounty.gov. Published: not stated; retrieved: 2026-09-14.
  28. Sacramento directors report April 2024 (publication month 2024-04; exact day unknown). ha.saccounty.gov. Published: not stated; retrieved: 2026-09-14.
  29. Sacramento draft integrated behavioral health plan. dhs.saccounty.gov. Published: not stated; retrieved: 2026-09-14.
  30. 4mg versus 8mg naloxone observational field comparison. www.cdc.gov. Published: 2024-02-08; retrieved: 2026-09-14.
  31. FY2023 Schedule D. projects.propublica.org. Published: not stated; retrieved: 2026-09-14.
  32. FY2024 Schedule D. projects.propublica.org. Published: not stated; retrieved: 2026-09-14.
  33. FY2025 Schedule D. projects.propublica.org. Published: not stated; retrieved: 2026-09-14.
  34. Mortality in young injection drug users: the UFO cohort. American Journal of Epidemiology. Published: not stated; retrieved: 2026-10-02.
  35. What is Narcan?. Harm Reduction Services. Published: not stated; retrieved: 2026-10-02.