GiveBetter x Denver

Harm Reduction Action Center

Low-barrier harm reduction and overdose prevention

Research time: ~14 min on GPT-6 Astra Light + ~4 min on GPT-6 Astra Medium + ~8 min on GPT-6.1 Sol + ~less than 1 min on an unrecorded AI model
  • Research — reviewed programs, finances and impact evidence.
  • Source audit — checked claims, assumptions and calculations.

Updated: 2026-10-18

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Summary

What do they do? HRAC provides naloxone, safer-use supplies and a low-barrier Denver drop-in space. Visitors can obtain overdose-response training, hygiene items, phone and mail access, snacks, testing and service referrals. The project also undertakes outreach and advocacy with local partners.

Why we’re interested in this organization:

  • Audited project schedules identify full accounting expense without adding sponsor totals again.

  • Original community naloxone research supports the mortality mechanism, while current recipient sources establish actual services.

  • The model jointly assesses health and signed household resources and retains full exposure burdens when clinical benefits fail.

Our main reservations:

  • Unique annual opioid-risk participants, incremental efficacy, survival and local residence remain judgments.

  • Whole annual cost against selected pathways leaves other benefits unknown and does not establish marginal donation capacity.

  • Donor HOLD: the exact official donation endpoint returned 404; a domain-only login redirect is not a verified checkout.

What do you get for your dollar? $36K per DALY in Denver. 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. Conditional whole-sponsored-project annual cost against overdose mortality and personal-assistance resource hypotheses; not empirically calibrated portfolio EV or marginal-gift value..

Original council presentation p29 describes over 4,000 individuals annually. N=4,000 is a rounded annual service proxy, not an audited matched cohort or measured annual opioid-risk population. Original PDF retrieval succeeded. Monthly 797-client and convenience-sample survey observations are not annualized. Exact cost/cohort matching remains unverified.

1. What do they do?

HRAC provides naloxone, safer-use supplies and a low-barrier Denver drop-in space. Visitors can obtain overdose-response training, hygiene items, phone and mail access, snacks, testing and service referrals. The project also undertakes outreach and advocacy with local partners. Current morning attendance and cumulative signups are not unique annual outcomes.

2. Monitoring and information sharing

Original DDPHE 2023 SAP needs assessment PDF pp13-16 describes 946 respondents, 923 retained, convenience recruitment at HRAC and Access Point, uneven recruitment protocols and a 25-dollar incentive. It pools sites and records housing status rather than county residence. Thus it cannot supply HRAC annual unique reach, a representative HRAC opioid exposure fraction, or MSA attribution. Its drug-use factsheet explicitly does not account for concurrent drugs. August 2026 contract exhibit p8 contains targets, not completed outputs. ARPA period runs January 2024 through September 2026, OAF January through December 2026. Do not annualize the ARPA target, add overlapping people across funding streams, or turn kits into deaths averted. Both streams include third-party kit recipients. Current service page describes over 12,000 signups over ten years and 125–180 visits per morning, neither a matched annual unique opioid-risk cohort. Report annual people, repeat visits, opioid-risk subgroup, reversals and residence separately; none demonstrates deaths prevented.

3. Qualitative assessment

Walley’s original ecological interrupted time-series of 19 Massachusetts communities found lower overdose mortality with community overdose education and naloxone distribution, but does not identify HRAC-specific causal efficacy. Doe-Simkins found no overall change in heroin-use frequency in 325 repeat respondents, not proof of zero harm. The retained 10% incremental mortality reduction remains judgment beyond public supply and alternative services. The alpha model additionally multiplied by .4 marginal-gift funding additionality despite using full annual cost; that extra donor factor is removed for the annual-work reference. Its ten already-discounted healthy years are retained without discounting them twice. Explicit timing reinterpretations and strong public-alternative cases show uncertainty, not confidence intervals.

4. What do you get for your dollar?

FY2024 HRAC whole sponsored-project accounting expense is $2,017,429, including $266,735 intercompany support, recorded in-kind program resources, personal assistance and event costs. The audited combining schedule supplies project-specific detail. No additional sponsor gross-up or current fee is added. This is observed accounting cost, not a verified complete economic opportunity-cost denominator. Medical in-kind wholesale valuation, unrecorded volunteer work and external partner inputs retain uncertainty. FY2025 project expense is $1,884,959 and is used only as cost sensitivity because matched 2025 reach is unverified. Contract service location is City and County of Denver. Service eligibility/location is not client residence. Retain g=.95 only as judgment within OMB-23-01 Denver-Aurora-Centennial MSA, excluding Boulder, Greeley and Colorado Springs. Direct personal assistance of $87,517 anchors a judged 10% otherwise-paid consumption fraction, 25% benefit withdrawal and 25% household recipient share. Positive resource gains receive a .5 overlap factor; full $10 participation/access burdens do not. Resources are jointly logged within each household-year, without retail supply values or ordinary survivor salaries. Central health is 56.62 healthy years and signed income is -1.137200581 equivalent years, giving $36K per DALY versus the original $88K clinical-only reference. The change mainly repairs annual-versus-marginal attribution; it is not measured improvement. Recognized in-kind and intercompany costs are already included; outside resource and full transfer-counterparty sensitivities are separate, not automatic second additions.

Model, assumptions and sensitivity

FY2024 HRAC whole sponsored-project accounting expense is $2,017,429, including $266,735 intercompany support, recorded in-kind program resources, personal assistance and event costs. The audited combining schedule supplies project-specific detail. No additional sponsor gross-up or current fee is added. This is observed accounting cost, not a verified complete economic opportunity-cost denominator. Medical in-kind wholesale valuation, unrecorded volunteer work and external partner inputs retain uncertainty. FY2025 project expense is $1,884,959 and is used only as cost sensitivity because matched 2025 reach is unverified.

HRAC explicitly serves Denver people who inject drugs, with Denver fixed/mobile services. g=.95 is a judged recipient residence share within OMB-23-01 Denver-Aurora-Centennial MSA, not a measured address distribution. Boulder, Greeley and Colorado Springs are excluded from the local numerator.

Clinical=(N*k*p*netReduction*L_effective - N*harm*discount(delay))*g; resources=sum .5*households*log(after/before)*discount*localShare; price10=10*C/(clinical+signed resources).

C
2017429 USD/year (observed). FY2024 HRAC whole sponsored-project accounting expense is $2,017,429, including $266,735 intercompany support, recorded in-kind program resources, personal assistance and event costs. The audited combining schedule supplies project-specific detail. No additional sponsor gross-up or current fee is added. This is observed accounting cost, not a verified complete economic opportunity-cost denominator. Medical in-kind wholesale valuation, unrecorded volunteer work and external partner inputs retain uncertainty. FY2025 project expense is $1,884,959 and is used only as cost sensitivity because matched 2025 reach is unverified. [audit24]
N
4000 historical annual people proxy (observed). Original council presentation p29 describes over 4,000 individuals annually. N=4,000 is a rounded annual service proxy, not an audited matched cohort or measured annual opioid-risk population. Original PDF retrieval succeeded. Monthly 797-client and convenience-sample survey observations are not annualized. Exact cost/cohort matching remains unverified. [native]
k
0.5 model parameter (judgment). Explicit conditional hypothesis; not an observed recipient outcome or empirical causal coefficient.
p
0.03 model parameter (judgment). Explicit conditional hypothesis; not an observed recipient outcome or empirical causal coefficient.
netReduction
0.1 model parameter (judgment). Judged incremental annual program mortality reduction beyond alternatives; no additional new-gift funding multiplier.
healthyYears
10 model parameter (judgment). Ten already-discounted quality-adjusted remaining years retained from alpha, not a measured survival distribution.
horizon
10 model parameter (judgment). Distribution length used only when explicitly reinterpreting L as undiscounted in sensitivity.
r
0.03 model parameter (judgment). Explicit conditional hypothesis; not an observed recipient outcome or empirical causal coefficient.
delay
0 model parameter (judgment). Explicit conditional hypothesis; not an observed recipient outcome or empirical causal coefficient.
g
0.95 model parameter (judgment). Explicit conditional hypothesis; not an observed recipient outcome or empirical causal coefficient.
harm
0.0001 model parameter (judgment). Explicit conditional hypothesis; not an observed recipient outcome or empirical causal coefficient.
unique
0.8 model parameter (judgment). Explicit conditional hypothesis; not an observed recipient outcome or empirical causal coefficient.
assistance
87517 USD/year (observed). Observed FY2024 direct personal assistance; cash conversion and recipient incidence separately judged. [audit24]
cashFraction
0.1 model parameter (judgment). Explicit conditional hypothesis; not an observed recipient outcome or empirical causal coefficient.
benefitOffset
0.25 model parameter (judgment). Explicit conditional hypothesis; not an observed recipient outcome or empirical causal coefficient.
cashRecipientShare
0.25 model parameter (judgment). Explicit conditional hypothesis; not an observed recipient outcome or empirical causal coefficient.
overlap
0.5 model parameter (judgment). Explicit conditional hypothesis; not an observed recipient outcome or empirical causal coefficient.
workGain
0 model parameter (judgment). Explicit conditional hypothesis; not an observed recipient outcome or empirical causal coefficient.
cost
10 model parameter (judgment). Explicit conditional hypothesis; not an observed recipient outcome or empirical causal coefficient.
baseline
12000 model parameter (judgment). Explicit conditional hypothesis; not an observed recipient outcome or empirical causal coefficient.
payerLossFraction
0 model parameter (judgment). Explicit conditional hypothesis; not an observed recipient outcome or empirical causal coefficient.
externalCost
0 model parameter (judgment). Explicit conditional hypothesis; not an observed recipient outcome or empirical causal coefficient.
payerPeople
10000 model parameter (judgment). Explicit conditional hypothesis; not an observed recipient outcome or empirical causal coefficient.
payerBaseline
50000 model parameter (judgment). Explicit conditional hypothesis; not an observed recipient outcome or empirical causal coefficient.

central: Cost: $2.0M; Denver health QALYs: 56.62; all-population health QALYs: 59.60. Income-equivalent healthy years: -1.14. Whole FY2024 sponsored-project cost and unmatched historical4000annual service proxy, not a measured opioid-risk cohort or marginal-gift EV. Net mortality reduction, finite healthy-year distribution, cash displacement/recipient distribution, household baseline and full access burden are explicit judgments. Omitted infection/nonfatal/advocacy benefits unknown, notzero.

retained initial funding net effect: Cost: $2.0M; Denver health QALYs: 22.42; all-population health QALYs: 23.60. Income-equivalent healthy years: -1.14. Whole FY2024 sponsored-project cost and unmatched historical4000annual service proxy, not a measured opioid-risk cohort or marginal-gift EV. Net mortality reduction, finite healthy-year distribution, cash displacement/recipient distribution, household baseline and full access burden are explicit judgments. Omitted infection/nonfatal/advocacy benefits unknown, notzero.

new undiscounted ten year timing hypothesis: Cost: $2.0M; Denver health QALYs: 49.70; all-population health QALYs: 52.32. Income-equivalent healthy years: -1.14. Whole FY2024 sponsored-project cost and unmatched historical4000annual service proxy, not a measured opioid-risk cohort or marginal-gift EV. Net mortality reduction, finite healthy-year distribution, cash displacement/recipient distribution, household baseline and full access burden are explicit judgments. Omitted infection/nonfatal/advocacy benefits unknown, notzero.

new undiscounted timing with retained net effect: Cost: $2.0M; Denver health QALYs: 19.65; all-population health QALYs: 20.69. Income-equivalent healthy years: -1.14. Whole FY2024 sponsored-project cost and unmatched historical4000annual service proxy, not a measured opioid-risk cohort or marginal-gift EV. Net mortality reduction, finite healthy-year distribution, cash displacement/recipient distribution, household baseline and full access burden are explicit judgments. Omitted infection/nonfatal/advocacy benefits unknown, notzero.

clinical null: Cost: $2.0M; Denver health QALYs: -0.38; all-population health QALYs: -0.40. Income-equivalent healthy years: -1.14. Whole FY2024 sponsored-project cost and unmatched historical4000annual service proxy, not a measured opioid-risk cohort or marginal-gift EV. Net mortality reduction, finite healthy-year distribution, cash displacement/recipient distribution, household baseline and full access burden are explicit judgments. Omitted infection/nonfatal/advocacy benefits unknown, notzero.

financial only: Cost: $2.0M; Denver health QALYs: 0.00; all-population health QALYs: 0.00. Income-equivalent healthy years: 1.30. Whole FY2024 sponsored-project cost and unmatched historical4000annual service proxy, not a measured opioid-risk cohort or marginal-gift EV. Net mortality reduction, finite healthy-year distribution, cash displacement/recipient distribution, household baseline and full access burden are explicit judgments. Omitted infection/nonfatal/advocacy benefits unknown, notzero.

failed clinical benefit full resource burdens: Cost: $2.0M; Denver health QALYs: -0.38; all-population health QALYs: -0.40. Income-equivalent healthy years: -1.14. Whole FY2024 sponsored-project cost and unmatched historical4000annual service proxy, not a measured opioid-risk cohort or marginal-gift EV. Net mortality reduction, finite healthy-year distribution, cash displacement/recipient distribution, household baseline and full access burden are explicit judgments. Omitted infection/nonfatal/advocacy benefits unknown, notzero.

failed all benefits full burdens: Cost: $2.0M; Denver health QALYs: -0.38; all-population health QALYs: -0.40. Income-equivalent healthy years: -1.27. Whole FY2024 sponsored-project cost and unmatched historical4000annual service proxy, not a measured opioid-risk cohort or marginal-gift EV. Net mortality reduction, finite healthy-year distribution, cash displacement/recipient distribution, household baseline and full access burden are explicit judgments. Omitted infection/nonfatal/advocacy benefits unknown, notzero.

no exposure: Cost: $2.0M; Denver health QALYs: 0.00; all-population health QALYs: 0.00. Income-equivalent healthy years: 0.00. Whole FY2024 sponsored-project cost and unmatched historical4000annual service proxy, not a measured opioid-risk cohort or marginal-gift EV. Net mortality reduction, finite healthy-year distribution, cash displacement/recipient distribution, household baseline and full access burden are explicit judgments. Omitted infection/nonfatal/advocacy benefits unknown, notzero.

no gift no exposure: Cost: $0; Denver health QALYs: 0.00; all-population health QALYs: 0.00. Income-equivalent healthy years: 0.00. Whole FY2024 sponsored-project cost and unmatched historical4000annual service proxy, not a measured opioid-risk cohort or marginal-gift EV. Net mortality reduction, finite healthy-year distribution, cash displacement/recipient distribution, household baseline and full access burden are explicit judgments. Omitted infection/nonfatal/advocacy benefits unknown, notzero.

adverse: Cost: $2.0M; Denver health QALYs: -3.80; all-population health QALYs: -4.00. Income-equivalent healthy years: -4.32. Whole FY2024 sponsored-project cost and unmatched historical4000annual service proxy, not a measured opioid-risk cohort or marginal-gift EV. Net mortality reduction, finite healthy-year distribution, cash displacement/recipient distribution, household baseline and full access burden are explicit judgments. Omitted infection/nonfatal/advocacy benefits unknown, notzero.

unknown: Cost: unknown; Denver health QALYs: unknown; all-population health QALYs: unknown. Whole FY2024 sponsored-project cost and unmatched historical4000annual service proxy, not a measured opioid-risk cohort or marginal-gift EV. Net mortality reduction, finite healthy-year distribution, cash displacement/recipient distribution, household baseline and full access burden are explicit judgments. Omitted infection/nonfatal/advocacy benefits unknown, notzero.

strong public alternative: Cost: $2.0M; Denver health QALYs: 5.32; all-population health QALYs: 5.60. Income-equivalent healthy years: -1.14. Whole FY2024 sponsored-project cost and unmatched historical4000annual service proxy, not a measured opioid-risk cohort or marginal-gift EV. Net mortality reduction, finite healthy-year distribution, cash displacement/recipient distribution, household baseline and full access burden are explicit judgments. Omitted infection/nonfatal/advocacy benefits unknown, notzero.

no extra donor multiplier hypothesis: Cost: $2.0M; Denver health QALYs: 56.62; all-population health QALYs: 59.60. Income-equivalent healthy years: -1.14. Whole FY2024 sponsored-project cost and unmatched historical4000annual service proxy, not a measured opioid-risk cohort or marginal-gift EV. Net mortality reduction, finite healthy-year distribution, cash displacement/recipient distribution, household baseline and full access burden are explicit judgments. Omitted infection/nonfatal/advocacy benefits unknown, notzero.

no clinical contribution: Cost: $2.0M; Denver health QALYs: -0.38; all-population health QALYs: -0.40. Income-equivalent healthy years: -1.14. Whole FY2024 sponsored-project cost and unmatched historical4000annual service proxy, not a measured opioid-risk cohort or marginal-gift EV. Net mortality reduction, finite healthy-year distribution, cash displacement/recipient distribution, household baseline and full access burden are explicit judgments. Omitted infection/nonfatal/advocacy benefits unknown, notzero.

lower baseline mortality risk: Cost: $2.0M; Denver health QALYs: 18.62; all-population health QALYs: 19.60. Income-equivalent healthy years: -1.14. Whole FY2024 sponsored-project cost and unmatched historical4000annual service proxy, not a measured opioid-risk cohort or marginal-gift EV. Net mortality reduction, finite healthy-year distribution, cash displacement/recipient distribution, household baseline and full access burden are explicit judgments. Omitted infection/nonfatal/advocacy benefits unknown, notzero.

higher baseline mortality risk: Cost: $2.0M; Denver health QALYs: 94.62; all-population health QALYs: 99.60. Income-equivalent healthy years: -1.14. Whole FY2024 sponsored-project cost and unmatched historical4000annual service proxy, not a measured opioid-risk cohort or marginal-gift EV. Net mortality reduction, finite healthy-year distribution, cash displacement/recipient distribution, household baseline and full access burden are explicit judgments. Omitted infection/nonfatal/advocacy benefits unknown, notzero.

half risk exposed: Cost: $2.0M; Denver health QALYs: 28.12; all-population health QALYs: 29.60. Income-equivalent healthy years: -1.14. Whole FY2024 sponsored-project cost and unmatched historical4000annual service proxy, not a measured opioid-risk cohort or marginal-gift EV. Net mortality reduction, finite healthy-year distribution, cash displacement/recipient distribution, household baseline and full access burden are explicit judgments. Omitted infection/nonfatal/advocacy benefits unknown, notzero.

all risk exposed: Cost: $2.0M; Denver health QALYs: 113.62; all-population health QALYs: 119.60. Income-equivalent healthy years: -1.14. Whole FY2024 sponsored-project cost and unmatched historical4000annual service proxy, not a measured opioid-risk cohort or marginal-gift EV. Net mortality reduction, finite healthy-year distribution, cash displacement/recipient distribution, household baseline and full access burden are explicit judgments. Omitted infection/nonfatal/advocacy benefits unknown, notzero.

fewer unique annual participants: Cost: $2.0M; Denver health QALYs: 28.31; all-population health QALYs: 29.80. Income-equivalent healthy years: -0.50. Whole FY2024 sponsored-project cost and unmatched historical4000annual service proxy, not a measured opioid-risk cohort or marginal-gift EV. Net mortality reduction, finite healthy-year distribution, cash displacement/recipient distribution, household baseline and full access burden are explicit judgments. Omitted infection/nonfatal/advocacy benefits unknown, notzero.

five expected healthy years: Cost: $2.0M; Denver health QALYs: 28.12; all-population health QALYs: 29.60. Income-equivalent healthy years: -1.14. Whole FY2024 sponsored-project cost and unmatched historical4000annual service proxy, not a measured opioid-risk cohort or marginal-gift EV. Net mortality reduction, finite healthy-year distribution, cash displacement/recipient distribution, household baseline and full access burden are explicit judgments. Omitted infection/nonfatal/advocacy benefits unknown, notzero.

three expected healthy years: Cost: $2.0M; Denver health QALYs: 16.72; all-population health QALYs: 17.60. Income-equivalent healthy years: -1.14. Whole FY2024 sponsored-project cost and unmatched historical4000annual service proxy, not a measured opioid-risk cohort or marginal-gift EV. Net mortality reduction, finite healthy-year distribution, cash displacement/recipient distribution, household baseline and full access burden are explicit judgments. Omitted infection/nonfatal/advocacy benefits unknown, notzero.

five year survival timing: Cost: $2.0M; Denver health QALYs: 53.39; all-population health QALYs: 56.21. Income-equivalent healthy years: -1.14. Whole FY2024 sponsored-project cost and unmatched historical4000annual service proxy, not a measured opioid-risk cohort or marginal-gift EV. Net mortality reduction, finite healthy-year distribution, cash displacement/recipient distribution, household baseline and full access burden are explicit judgments. Omitted infection/nonfatal/advocacy benefits unknown, notzero.

twenty year survival timing: Cost: $2.0M; Denver health QALYs: 43.29; all-population health QALYs: 45.57. Income-equivalent healthy years: -1.14. Whole FY2024 sponsored-project cost and unmatched historical4000annual service proxy, not a measured opioid-risk cohort or marginal-gift EV. Net mortality reduction, finite healthy-year distribution, cash displacement/recipient distribution, household baseline and full access burden are explicit judgments. Omitted infection/nonfatal/advocacy benefits unknown, notzero.

undiscounted clinical diagnostic: Cost: $2.0M; Denver health QALYs: 57.00; all-population health QALYs: 60.00. Income-equivalent healthy years: 0.00. Whole FY2024 sponsored-project cost and unmatched historical4000annual service proxy, not a measured opioid-risk cohort or marginal-gift EV. Net mortality reduction, finite healthy-year distribution, cash displacement/recipient distribution, household baseline and full access burden are explicit judgments. Omitted infection/nonfatal/advocacy benefits unknown, notzero.

lower local share: Cost: $2.0M; Denver health QALYs: 29.80; all-population health QALYs: 59.60. Income-equivalent healthy years: -0.60. Whole FY2024 sponsored-project cost and unmatched historical4000annual service proxy, not a measured opioid-risk cohort or marginal-gift EV. Net mortality reduction, finite healthy-year distribution, cash displacement/recipient distribution, household baseline and full access burden are explicit judgments. Omitted infection/nonfatal/advocacy benefits unknown, notzero.

no local share: Cost: $2.0M; Denver health QALYs: 0.00; all-population health QALYs: 0.00. Income-equivalent healthy years: 0.00. Whole FY2024 sponsored-project cost and unmatched historical4000annual service proxy, not a measured opioid-risk cohort or marginal-gift EV. Net mortality reduction, finite healthy-year distribution, cash displacement/recipient distribution, household baseline and full access burden are explicit judgments. Omitted infection/nonfatal/advocacy benefits unknown, notzero.

no otherwise paid cash displacement: Cost: $2.0M; Denver health QALYs: 56.62; all-population health QALYs: 59.60. Income-equivalent healthy years: -1.27. Whole FY2024 sponsored-project cost and unmatched historical4000annual service proxy, not a measured opioid-risk cohort or marginal-gift EV. Net mortality reduction, finite healthy-year distribution, cash displacement/recipient distribution, household baseline and full access burden are explicit judgments. Omitted infection/nonfatal/advocacy benefits unknown, notzero.

higher cash displacement: Cost: $2.0M; Denver health QALYs: 56.62; all-population health QALYs: 59.60. Income-equivalent healthy years: -0.62. Whole FY2024 sponsored-project cost and unmatched historical4000annual service proxy, not a measured opioid-risk cohort or marginal-gift EV. Net mortality reduction, finite healthy-year distribution, cash displacement/recipient distribution, household baseline and full access burden are explicit judgments. Omitted infection/nonfatal/advocacy benefits unknown, notzero.

full resource benefit withdrawal: Cost: $2.0M; Denver health QALYs: 56.62; all-population health QALYs: 59.60. Income-equivalent healthy years: -1.27. Whole FY2024 sponsored-project cost and unmatched historical4000annual service proxy, not a measured opioid-risk cohort or marginal-gift EV. Net mortality reduction, finite healthy-year distribution, cash displacement/recipient distribution, household baseline and full access burden are explicit judgments. Omitted infection/nonfatal/advocacy benefits unknown, notzero.

cash concentrated households: Cost: $2.0M; Denver health QALYs: 56.62; all-population health QALYs: 59.60. Income-equivalent healthy years: -1.14. Whole FY2024 sponsored-project cost and unmatched historical4000annual service proxy, not a measured opioid-risk cohort or marginal-gift EV. Net mortality reduction, finite healthy-year distribution, cash displacement/recipient distribution, household baseline and full access burden are explicit judgments. Omitted infection/nonfatal/advocacy benefits unknown, notzero.

wider cash recipient households: Cost: $2.0M; Denver health QALYs: 56.62; all-population health QALYs: 59.60. Income-equivalent healthy years: -1.14. Whole FY2024 sponsored-project cost and unmatched historical4000annual service proxy, not a measured opioid-risk cohort or marginal-gift EV. Net mortality reduction, finite healthy-year distribution, cash displacement/recipient distribution, household baseline and full access burden are explicit judgments. Omitted infection/nonfatal/advocacy benefits unknown, notzero.

household deduplication: Cost: $2.0M; Denver health QALYs: 56.62; all-population health QALYs: 59.60. Income-equivalent healthy years: -0.66. Whole FY2024 sponsored-project cost and unmatched historical4000annual service proxy, not a measured opioid-risk cohort or marginal-gift EV. Net mortality reduction, finite healthy-year distribution, cash displacement/recipient distribution, household baseline and full access burden are explicit judgments. Omitted infection/nonfatal/advocacy benefits unknown, notzero.

full donor transfer counterparty: Cost: $2.0M; Denver health QALYs: 56.62; all-population health QALYs: 59.60. Income-equivalent healthy years: -1.22. Whole FY2024 sponsored-project cost and unmatched historical4000annual service proxy, not a measured opioid-risk cohort or marginal-gift EV. Net mortality reduction, finite healthy-year distribution, cash displacement/recipient distribution, household baseline and full access burden are explicit judgments. Omitted infection/nonfatal/advocacy benefits unknown, notzero.

outside provider resource cost: Cost: $2.0M; Denver health QALYs: 56.62; all-population health QALYs: 59.60. Income-equivalent healthy years: -1.90. Whole FY2024 sponsored-project cost and unmatched historical4000annual service proxy, not a measured opioid-risk cohort or marginal-gift EV. Net mortality reduction, finite healthy-year distribution, cash displacement/recipient distribution, household baseline and full access burden are explicit judgments. Omitted infection/nonfatal/advocacy benefits unknown, notzero.

no access burden: Cost: $2.0M; Denver health QALYs: 56.62; all-population health QALYs: 59.60. Income-equivalent healthy years: 0.13. Whole FY2024 sponsored-project cost and unmatched historical4000annual service proxy, not a measured opioid-risk cohort or marginal-gift EV. Net mortality reduction, finite healthy-year distribution, cash displacement/recipient distribution, household baseline and full access burden are explicit judgments. Omitted infection/nonfatal/advocacy benefits unknown, notzero.

higher access burden: Cost: $2.0M; Denver health QALYs: 56.62; all-population health QALYs: 59.60. Income-equivalent healthy years: -6.22. Whole FY2024 sponsored-project cost and unmatched historical4000annual service proxy, not a measured opioid-risk cohort or marginal-gift EV. Net mortality reduction, finite healthy-year distribution, cash displacement/recipient distribution, household baseline and full access burden are explicit judgments. Omitted infection/nonfatal/advocacy benefits unknown, notzero.

positive work access not survival earnings: Cost: $2.0M; Denver health QALYs: 56.62; all-population health QALYs: 59.60. Income-equivalent healthy years: 0.44. Whole FY2024 sponsored-project cost and unmatched historical4000annual service proxy, not a measured opioid-risk cohort or marginal-gift EV. Net mortality reduction, finite healthy-year distribution, cash displacement/recipient distribution, household baseline and full access burden are explicit judgments. Omitted infection/nonfatal/advocacy benefits unknown, notzero.

negative overlap zero: Cost: $2.0M; Denver health QALYs: 56.62; all-population health QALYs: 59.60. Income-equivalent healthy years: -4.45. Whole FY2024 sponsored-project cost and unmatched historical4000annual service proxy, not a measured opioid-risk cohort or marginal-gift EV. Net mortality reduction, finite healthy-year distribution, cash displacement/recipient distribution, household baseline and full access burden are explicit judgments. Omitted infection/nonfatal/advocacy benefits unknown, notzero.

negative overlap one: Cost: $2.0M; Denver health QALYs: 56.62; all-population health QALYs: 59.60. Income-equivalent healthy years: -4.45. Whole FY2024 sponsored-project cost and unmatched historical4000annual service proxy, not a measured opioid-risk cohort or marginal-gift EV. Net mortality reduction, finite healthy-year distribution, cash displacement/recipient distribution, household baseline and full access burden are explicit judgments. Omitted infection/nonfatal/advocacy benefits unknown, notzero.

latestFY2025cost only: Cost: $1.9M; Denver health QALYs: 56.62; all-population health QALYs: 59.60. Income-equivalent healthy years: -1.14. Whole FY2024 sponsored-project cost and unmatched historical4000annual service proxy, not a measured opioid-risk cohort or marginal-gift EV. Net mortality reduction, finite healthy-year distribution, cash displacement/recipient distribution, household baseline and full access burden are explicit judgments. Omitted infection/nonfatal/advocacy benefits unknown, notzero.

full unrecognized resource cost: Cost: $2.5M; Denver health QALYs: 56.62; all-population health QALYs: 59.60. Income-equivalent healthy years: -1.14. Whole FY2024 sponsored-project cost and unmatched historical4000annual service proxy, not a measured opioid-risk cohort or marginal-gift EV. Net mortality reduction, finite healthy-year distribution, cash displacement/recipient distribution, household baseline and full access burden are explicit judgments. Omitted infection/nonfatal/advocacy benefits unknown, notzero.

one year delay: Cost: $2.0M; Denver health QALYs: 54.97; all-population health QALYs: 57.86. Income-equivalent healthy years: -1.10. Whole FY2024 sponsored-project cost and unmatched historical4000annual service proxy, not a measured opioid-risk cohort or marginal-gift EV. Net mortality reduction, finite healthy-year distribution, cash displacement/recipient distribution, household baseline and full access burden are explicit judgments. Omitted infection/nonfatal/advocacy benefits unknown, notzero.

Counterfactual: Public naloxone, other syringe programs, EMS and otherwise-paid household consumption. Annual program efficacy is separate from marginal-gift funding; current supply capacity unverified.

Attribution: Walley’s original ecological interrupted time-series of 19 Massachusetts communities found lower overdose mortality with community overdose education and naloxone distribution, but does not identify HRAC-specific causal efficacy. Doe-Simkins found no overall change in heroin-use frequency in 325 repeat respondents, not proof of zero harm. The retained 10% incremental mortality reduction remains judgment beyond public supply and alternative services. The alpha model additionally multiplied by .4 marginal-gift funding additionality despite using full annual cost; that extra donor factor is removed for the annual-work reference. Its ten already-discounted healthy years are retained without discounting them twice. Explicit timing reinterpretations and strong public-alternative cases show uncertainty, not confidence intervals.

All causal, survival, resource-conversion and residence coefficients are judgments. Source-anchored cost/service envelopes do not establish calibrated EV. Null, negative, unknown, counterparty and cost-scope scenarios are explicit.

Sensitivity

  • Retained .04 net-effect diagnostic isolates the original extra funding factor; .1 annual reference is still a causal judgment.
  • Ten already-discounted healthy years are not discounted again; alternative undiscounted timing is explicitly a new hypothesis.
  • Full access burdens persist when mortality benefit fails; negative resources are never overlap-erased.
  • Personal-assistance cash displacement and payer incidence can be positive or negative; omitted pathways remain unknown.

Unresolved inputs

  • Annual opioid-risk-exposed unique participants and conditional fatal-overdose risk
  • Recipient incremental mortality effect and quality-adjusted survival after an averted death
  • Participant residence within the Denver MSA; g=.95 remains judgment
  • Current marginal gift capacity and additionality after public/free supply and other providers
  • Complete economic resource valuation beyond recorded accounting expense
  • Successful donation checkout and final receipt recipient; official linked endpoint returned HTTP 404 on direct retrieval

Health and income breakdown

For the modeled $2.0M: 56.62 health QALYs + -1.14 income-equivalent healthy years in Denver: $36K per DALY. Income equivalents are welfare comparisons, not observed QALYs or DALYs.

Method and caveats.

5. Funding and previous grants

Organization says gifts support service expansion, naloxone and supplies and its drop-in site. It does not give a priced incremental staff shift, unique cohort, stockout, or match opportunity. Denver adopted resolution 26-1273 on August 31, 2026. The third amendment changes ARPA scope to operations and retains OAF building-purchase language in the legislative title; no agreement capacity or term increase. The attached exhibit mixes procurement-of-facility labeling with operating services. It cannot be used as a clean whole-project annual budget. Exhibit A-03 p7 prints ARPA 489376 and OAF 239345 (sum 728721), while the earlier amended agreement total was 968127 and April's increase was 239375. Preserve this discrepancy; do not silently correct the exhibit or sum its numbers as the current full agreement amount. These are HRAC project columns, unlike sponsor-wide reserves. Restricted net assets may include ordinary project-purpose restrictions and are not necessarily locked capital; the schedules do not split individual donor restrictions. Neither cash nor a 149-dollar unrestricted balance alone establishes liquidity crisis, spare capacity, or additionality. The original b=.4 remains a marginal-funding diagnostic, not an extra annual-work multiplier. Public naloxone support, other local providers and the new operating grant use create substitution questions; state June 2025 award maintained free naloxone through June 2026 but does not establish September 2026 availability at HRAC. Official donation page links https://acefzmsz.donorsupport.co/-/XCYYADTX; direct audit retrieval returned HTTP 404, so checkout success is unverified. Fresh direct GET and HEAD of the exact linked /-/XCYYADTX endpoint returned 404; root’s separate domain-only redirect to login does not contradict this or establish checkout. June 2025 state support was explicitly through June 2026; no extension or current stock capacity is assumed.

Annual expenses

Annual size figure used in comparisons

$1.9M — FY2025 reported project expenses. FY2025.

HRAC project combining schedule in CNDC’s audited statements, with in-relation-to coverage; not a separate HRAC audit. Includes recorded intercompany support and recognized in-kind resources. Sponsor-wide expenses and extra fee gross-ups are excluded. Not a three-year mean.

CNDC 2025 audited financial statements and project combining schedules · Reviewed 2026-10-18.

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

  • FY 2022: $1.7M; HRAC fiscally sponsored project, 12-month period, Original Form 990 HRAC program-service expense observation; detailed support and in-kind reconciliation not audited here. Source
  • FY 2023: $1.8M; HRAC fiscally sponsored project, 12-month period, Original Form 990 HRAC program-service expense observation; detailed support and in-kind reconciliation not audited here. Source
  • FY 2024: $2.0M; HRAC fiscally sponsored project, 12-month period, Audited supplementary HRAC project combining schedule; recorded intercompany support and in-kind included. Source
  • FY 2025: $1.9M; HRAC fiscally sponsored project, 12-month period, Audited supplementary HRAC project combining schedule; recorded intercompany support and in-kind included. Source

6. Sources

  1. CNDC2024 original tax return. CNDC. Published: not stated; retrieved: 2026-09-29.
  2. Original Denver council presentation, p29; full PDF inspected. City and County of Denver. Published: not stated; retrieved: 2026-09-29.
  3. CNDC 2023 original Form 990. Colorado Nonprofit Development Center. Published: not stated; retrieved: 2026-09-29.
  4. CNDC 2022 original Form 990. Colorado Nonprofit Development Center. Published: not stated; retrieved: 2026-09-29.
  5. Loy et al., Barriers to Hepatitis C Treatment, 2024. Open Forum Infectious Diseases. Published: not stated; retrieved: 2026-09-29.
  6. Denver 2025 contract amendment request. City and County of Denver. Published: not stated; retrieved: 2026-09-29.
  7. HRAC current service description. Harm Reduction Action Center. Published: not stated; retrieved: 2026-09-29.
  8. Follow-on original source 1. CNDC, research authors or Denver government. Published: not stated; retrieved: 2026-09-29.
  9. Follow-on original source 2. CNDC, research authors or Denver government. Published: not stated; retrieved: 2026-09-29.
  10. Follow-on original source 3. CNDC, research authors or Denver government. Published: not stated; retrieved: 2026-09-29.
  11. Follow-on original source 4. CNDC, research authors or Denver government. Published: not stated; retrieved: 2026-09-29.
  12. Follow-on original source 5. CNDC, research authors or Denver government. Published: not stated; retrieved: 2026-09-29.
  13. Follow-on original source 6. CNDC, research authors or Denver government. Published: not stated; retrieved: 2026-09-29.
  14. CNDC 2024 audited financial statements and project combining schedules. Colorado Nonprofit Development Center. Published: not stated; retrieved: 2026-09-29.
  15. CNDC 2025 audited financial statements and project combining schedules. Colorado Nonprofit Development Center. Published: not stated; retrieved: 2026-09-29.
  16. 24-1791 Needle Exchange Program Ordinance presentation v6. Original source publisher. Published: not stated; retrieved: 2026-09-29.
  17. 26-1273 third amendatory agreement and Exhibit A-03. Original source publisher. Published: not stated; retrieved: 2026-09-29.
  18. Denver 26-1273 adoption August 31, 2026. Original source publisher. Published: not stated; retrieved: 2026-09-29.
  19. HRAC donation use description. Harm Reduction Action Center. Published: not stated; retrieved: 2026-09-29.
  20. Walley et al. 2013 Massachusetts OEND interrupted time series. Original source publisher. Published: not stated; retrieved: 2026-09-29.
  21. Padmanabhan et al. 2026 hypothetical Denver OPC simulation. Original source publisher. Published: not stated; retrieved: 2026-09-29.
  22. Colorado AG June 24, 2025 naloxone bulk-fund grant. Original source publisher. Published: not stated; retrieved: 2026-09-29.
  23. DDPHE 2023 Syringe Access Program Needs Assessment full report. Original source publisher. Published: not stated; retrieved: 2026-09-29.
  24. DDPHE 2023 needs assessment drug-use factsheet. Original source publisher. Published: not stated; retrieved: 2026-09-29.
  25. Cost-effectiveness framework. Coefficient Giving. Published: not stated; retrieved: 2026-10-07.
  26. Community overdose education and naloxone distribution: original study. BMJ / PubMed. Published: not stated; retrieved: 2026-10-07.
  27. Overdose rescues and drug-use patterns: original study. BMC Public Health / PubMed. Published: not stated; retrieved: 2026-10-07.