GiveBetter x USA

End Overdose

Naloxone access, training and overdose prevention

Research time: ~7 min on GPT-6 Astra Light + ~40 min on GPT-6 Astra Medium + ~5 min on GPT-6.1 Sol
  • Research — reviewed programs, finances and impact evidence.
  • Modeling — estimated costs, QALYs and uncertainty.
  • Source audit — checked claims, assumptions and calculations.

Updated: 2026-10-02

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Summary

What do they do? End Overdose teaches people to recognize opioid overdose and respond with naloxone, rescue breathing and emergency assistance. It distributes prevention supplies through online certification, schools, college chapters, music events and community partners, including rural outreach in Arkansas. The main health benefit occurs when its work equips an otherwise unprotected witness to provide effective help early enough to change a person's outcome.

Why we’re interested in this organization:

  • Naloxone has a direct clinical mechanism, and the organization delivers tangible training and supplies rather than reporting awareness alone.

  • The original quarterly report and independent public-health partners document substantial real activity, including publicly supplied medication distributed through End Overdose.

  • The current giving page identifies the nonprofit and offers both a general fund and program designations, making a future, specifically costed community-delivery proposal practical to investigate.

Our main reservations:

  • No public evidence identifies how many additional high-risk recipients an ordinary gift would reach with usable medication, or how often they would add a rescue beyond existing protection.

  • Manufacturer donations, public supplies and funded partnerships may complement private delivery spending, but their inventory, restrictions, remaining funding and substitution effects are not reconciled.

  • Follow-up and financial reconciliations are incomplete, and recipient shipping can reduce household resources; our estimate remains sensitive to targeting, other rescuers and delivery costs.

What do you get for your dollar? $271K per DALY in USA. 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 partial donation-dollar estimate; full donation cost includes unquantified work. No verified capacity offer..

Per $10,000:162.5 nominal offers,73.125 additional offers,54.84375 delivered two-dose kits,52.1015625 nonpurchaser clinical-eligible kits,.0421241 credited administrations,.00505489 added three-day survivors,.0381258 USA clinical years and−.00125505 signed resource equivalents. Conditional model outputs, not observed services per dollar.

1. What do they do?

End Overdose combines education, direct supply distribution and outreach. Its 2026 campaign supports digital instruction, instructor certification, chapters and state operations as well as naloxone. Ordinary unrestricted support therefore cannot be modeled as a purchase of medication alone. This review counts health accruing to residents of the 50 states and DC; attendance at a US event does not by itself establish residence.

A July 2026 Arkansas announcement describes 12 grant-funded rural cabinets and reports 89,000 doses distributed in that state to date. Claims that cabinets were rapidly claimed show demand for placement, not independently confirmed installation, continuing restocking or extra rescues. The Arkansas bulk form offers free shipping and asks applicants how supplies will be used. This is a different delivery channel from the national store, where certified recipients are asked to pay shipping.

The official donation checkout identifies END OVERDOSE as a 501(c)(3). Its default is General Fund Project; other designations include Community Organizations & Treatment Facilities, Middle & High Schools, and Nightlife & Music Festivals. The receiving organization's original tax return identifies EIN 83-0696963 and endoverdose.net. This review remains a general-fund analysis: a menu designation alone does not establish an enforceable restriction or an unfunded delivery opportunity.

2. Monitoring and information sharing

The original July–September 2024 report reports 44,952 people trained and 71,733 naloxone doses distributed. It separately describes a school pilot with 1,797 kits; those kits are not added to the quarter's doses or treated as unique rescues. The 2024 filing reports over 230,000 trainees for the year. These measures have different periods and units and do not establish a matched cohort of trained people receiving and retaining kits.

Public partners corroborate distribution activity. The Overdose Response Strategy account says Southern Nevada Health District supplied 30,000 doses for EDC 2025. Los Angeles County's announcement describes joint festival outreach. Neither provides an experimental estimate of End Overdose's incremental mortality impact.

The report index still exposed the original summer PDF; the displayed annual-report label did not yield a separately retrievable 2024 annual document in this review. Public totals lack a reconciled stock-flow ledger, channel-specific costs, unique recipient follow-up, and linked rescue and survival records. Necessary monitoring would track certification, dispatch, receipt, usable carriage or access, witnessed overdose, other available rescuers, timely administration, three-day survival and subsequent mortality. Repeated trainees, shared scenes and repeat rescues of the same person require linked, privacy-preserving accounting.

Information quality also affects usable supply. The bulk-order page broadly says doses can remain effective 30 years after expiration. The study behind that familiar claim tested expired injectable solutions, not clinical effectiveness of this organization's intranasal inventory over 30 years. FDA guidance advises observing the printed expiry for the relevant product. This does not establish that End Overdose ships expired medicine; it means current product, storage and expiration records are needed before treating all stock as equally usable.

The current kit page remains internally ambiguous about stock and certification-gated purchasing. Neither the badge nor structured product metadata identifies additional funded slots. Recipient shipping amounts and the counterfactual cost of obtaining equivalent supplies elsewhere are not observed. A fiscal deficit is not a measured funding-response coefficient.

3. Qualitative assessment

The strongest case is for funding otherwise unavailable, reliable delivery to people likely to witness an overdose. Naloxone's clinical action is well established, but a drug's efficacy does not identify the value of another general-fund dollar. The Rhode Island simulation emphasizes saturation, targeting and witnessing; it is neither an End Overdose evaluation nor an estimate that transfers automatically to other states. The HEALing Communities randomized trial found no statistically significant primary mortality difference for its broader intervention bundle: adjusted rate ratio 0.91, 95% CI 0.76–1.09. Only 38% of implemented strategies had begun by the comparison year's start, so this is a caution about achieved implementation and timing, not a clean test of naloxone alone.

A Colorado festival survey found that 55.5% of 227 participants carried naloxone in some context and 8.4% had ever administered it. The selected, cross-sectional sample suggests both relevant exposure and substantial existing protection; its lifetime reports cannot be divided into an annual rescue rate. A Rikers visitor cohort reached 226 of 283 enrollees at six months; 40 respondents witnessed 70 overdoses. It supports the plausibility of higher-risk channels while illustrating repeated events and loss to follow-up. It is not a rate for the organization's students or event attendees.

Rescue also does not confer normal remaining life expectancy. In a Massachusetts EMS cohort, 7.5% of those alive three days after treatment died by one year. The related ED cohort found 5.5% one-year mortality, and a King County study reported 5.2 all-cause deaths per 100 person-years. These are different cohorts, endpoints and periods, not interchangeable exact hazards. They justify explicit continuing mortality and finite health horizons. Future mortality and utility in End Overdose's additional survivors remain unknown; patient-reported OUD utility research also cautions against assigning low quality of life solely from general-public stereotypes.

Our assessment is therefore conditional rather than an endorsement. Community and rural distribution could be worthwhile, especially where free stock does not reach likely witnesses. Broad awareness, reduced stigma, fentanyl-test use, care referrals and family effects may also matter, but are not valued here. Their omission is not evidence that they are zero, nor does it make the quantified pathway a proven lower bound on the whole organization's value.

The October 2026 revision independently reconsiders the clinical pathway and signed household resources. Its central price is a conditional, partial comparison, not an identified expected unrestricted-gift return. Carriage surveys and selected high-risk cohorts support plausible pathways but do not calibrate the marginal recipient mix. We therefore retain explicit one-way challenges to the revised cost, opportunity, deduplication and survival judgments rather than treating refreshed citations as validation of them.

4. What do you get for your dollar?

Our conditional estimate is about $270K per DALY in the USA, counting ten combined health and household-resource equivalents. The model charges the full donation, including work whose benefits are not quantified. Its best case is timely delivery to people likely to witness an overdose who would otherwise lack effective protection; donated medication can make that last-mile work relatively inexpensive. The numbers are analyst judgments, not measured services per dollar or an available delivery offer.

What does a dollar enable? A modeled $10,000 supports 162.5 nominal training-and-kit offers. After allowing for replacement funding and incomplete fulfillment, it adds 54.84 delivered two-dose kits, or about $182 per additional kit. The $40 cash budget per nominal offer assumes $15 paid equipment and $25 paid fulfillment, education, administration and fundraising, including failed offers. Another $15 of equipment is contributed. This half-contributed equipment hypothesis is not an audited unit cost or a national procurement quote. Sixty-five percent of the gift enters this pathway; the entire gift remains in the price numerator.

How do kits become health benefits? We exclude the 5% assumed to purchase equivalent naloxone without the gift. Among remaining recipients, the model assumes a 0.7% one-year relevant overdose opportunity, 55% timely usable access, 35% help additional to equivalent timely rescue by others, and 60% unique-patient credit. This yields 0.0421 additional timely administrations per $10,000. The separate 12-percentage-point three-day survival advantage applies only to those genuinely additional administrations: spontaneous recovery, incomplete reversal and subsequent acute care can still limit their effect. Other naloxone or EMS replacement is handled in the 35% factor, not discounted again here. These fractions are not End Overdose measurements.

The resulting 0.00505 added three-day survivors receive a finite 20-year survival proxy: 8% first-year mortality, 5% later annual mortality, utility 0.8 and 3% discounting. It gives 7.58 discounted clinical QALYs per added survivor at the gift date, rather than normal remaining life expectancy. With a judged 99.5% USA-resident share, clinical benefit is 0.04 QALYs per $10,000, or $262K per DALY. The historical Massachusetts EMS study informs prognosis after three-day survival; it does not identify the causal survival advantage or the prognosis of End Overdose's otherwise-fatal beneficiaries.

What happens to household resources? Five percent of delivered-kit recipients are assumed to avoid an actual $20 purchase; 40% incur $6 incremental shipping compared with their without-gift alternative. The official kit page asks for shipping payment but supplies no verified dollar amount. Both amounts, recipient shares and $30,000 baseline annual disposable resources are judgments. Four buyer/nonbuyer × mailed/unmailed groups receive separate signed logarithmic welfare calculations: +$14, +$20, −$6 or $0. This avoids logging an average cash change. Purchase savings total $54.57 and shipping expense $130.97 in the USA, a net −$76.40. Their −0.001255 household-resource equivalents reduce total benefit to 0.04 combined equivalents per $10,000, giving $271K per DALY. The Coefficient Giving crosswalk compares resources with health; these equivalents are not observed clinical QALYs.

People who would already buy the medicine do not also receive full added-access health credit. Ordinary earnings of newly surviving people are not added to survival value. Separate signed cash scenarios for people alive under either treatment remain unmeasured, with explicit independence and nonoverlap assumptions. Equal alternative postage makes incremental shipping zero, producing $256K with clinical benefit unchanged. No actual purchase savings, adverse cash burdens and unknown income are separately inspectable.

Why did the estimate change? The preserved earlier USA health-only estimate was $176K per DALY. The revision reconsiders cash cost, program allocation, funding replacement, completion, targeting, other rescuers, deduplication and survival. New clinical benefit is about 67% of the old normalized benefit; household costs worsen the combined price slightly further. None of the revised coefficients is presented as a newly measured organizational effect. Restoring the earlier $50 cost, 0.5% opportunity and 50% unique-patient credit together yields $583K, while halving the causal survival advantage yields $562K. These are assumption challenges, not confidence intervals.

The gross institutional-resource companion is $13,758.56 per modeled gift, or $373K per DALY. It adds $15 contributed stock and $8 unpaid support per nominal offer plus $500 emergency response per credited administration. It intentionally covers nominal commitments, including unsuccessful/nonadditional offers, not measured induced delivery or net societal expenditure. Recipient shipping is a separate household burden rather than charged again. Future care, travel, work effects and other program benefits remain unknown.

Favorable targeting, weak targeting, clinical null, funding/allocation/completion zero, independent harm and unknown-component cases are retained in the calculator. Negative net benefit has no positive price; unknown benefit is not zero. The $10,000 normalization and $100,000 mathematical ceiling do not demonstrate current capacity or unlimited linear scaling.

Model, assumptions and sensitivity

Full donor gift in numerator; judged $40 comprehensive cash per nominal offer. Separate gross institutional companion values contributed stock/unpaid inputs per nominal offer and emergency response per credited administration, not measured induced net societal cost. Signed recipient shipping enters welfare, not twice into the companion.

USA means residents of the 50 states and DC. Domestic program and partner records support a predominantly domestic footprint but do not measure patient residence. All scenario shares g, including reference 0.99, are analyst judgments. Territorial and international attendee benefits fall outside edition QALYs and are not separately identified. No California, Bay Area or population-share allocation is inherited. Do not sum this report with nested state or metro benefits.

N=G*a/c; A=N*b; D=A*q; R=D*(1-purchaseShare)*e*k*t*d; Z=R*f; L=sum finite trapezoidal survival after day3, discounted at year-.5+delay; H=g*(Z*L-R*h-donorHarm). Separate buyer×shipping cohorts each add .5*people*log1p(net cash/baseline)*g/(1+discount)^delay. Combined=H+signed resource equivalents; price=10*G/combined when positive. Unknown is not zero.

FY2022 recipient spending
516362 USD per calendar year (observed). Original 2022 Part IX; same EIN, 12 months, cash accounting. [eo-99022]
FY2023 recipient spending
942519 USD per calendar year (observed). Original 2023 Part IX; same EIN, 12 months, cash accounting. [eo-99023]
FY2024 recipient spending
970440 USD per calendar year (observed). Original 2024 Parts I and IX agree. Part III is not used for program allocation. [eo-99024]
Kit content
2 intranasal doses per national store kit (observed). Not a definition of the campaign's manufacturer units or all bulk order packaging. [eo-kit] [eo-bulk]
Current remaining usable inventory
null doses, by source and expiry (unknown). Campaign reports a past contribution; current stock-flow and fulfillment capacity are not published. [eo-campaign] [eo-kit]
CalRx acquisition benchmark
19 USD per twin-pack (observed). Current California procurement benchmark. It is neither an End Overdose invoice nor the opportunity cost of a donated medicine. [calrx-price]
Actual additional completed delivery per gift
null kits per USD (unknown). Requires allocation, funding replacement, inventory and labor constraints, shipment completion and recipient charges. [eo-bulk] [eo-ors]
Observed EMS survivor mortality benchmark
0.075 risk of death by one year conditional on three-day survival (observed). Massachusetts 2013–15 cohort: 668 deaths among 8,927 three-day survivors, rounded. Not an End Overdose parameter. [naloxone-ems-survival]
Unpriced downstream net costs
null USD (unknown). Patient time, future net medical costs, alternative uses of contributed stock and other portfolio consequences remain unmeasured.
G
10000 explicit model parameter (see equation and cost section) (judgment). Finite analyst judgment, not newly identified organizational effect; source/model memo and independent challenge explain counterfactual boundaries.
a
0.65 explicit model parameter (see equation and cost section) (judgment). Finite analyst judgment, not newly identified organizational effect; source/model memo and independent challenge explain counterfactual boundaries.
c
40 explicit model parameter (see equation and cost section) (judgment). Finite analyst judgment, not newly identified organizational effect; source/model memo and independent challenge explain counterfactual boundaries.
b
0.45 explicit model parameter (see equation and cost section) (judgment). Finite analyst judgment, not newly identified organizational effect; source/model memo and independent challenge explain counterfactual boundaries.
q
0.75 explicit model parameter (see equation and cost section) (judgment). Finite analyst judgment, not newly identified organizational effect; source/model memo and independent challenge explain counterfactual boundaries.
e
0.007 explicit model parameter (see equation and cost section) (judgment). Finite analyst judgment, not newly identified organizational effect; source/model memo and independent challenge explain counterfactual boundaries.
k
0.55 explicit model parameter (see equation and cost section) (judgment). Finite analyst judgment, not newly identified organizational effect; source/model memo and independent challenge explain counterfactual boundaries.
t
0.35 explicit model parameter (see equation and cost section) (judgment). Finite analyst judgment, not newly identified organizational effect; source/model memo and independent challenge explain counterfactual boundaries.
d
0.6 explicit model parameter (see equation and cost section) (judgment). Finite analyst judgment, not newly identified organizational effect; source/model memo and independent challenge explain counterfactual boundaries.
f
0.12 explicit model parameter (see equation and cost section) (judgment). Finite analyst judgment, not newly identified organizational effect; source/model memo and independent challenge explain counterfactual boundaries.
m1
0.08 explicit model parameter (see equation and cost section) (judgment). Finite analyst judgment, not newly identified organizational effect; source/model memo and independent challenge explain counterfactual boundaries.
m
0.05 explicit model parameter (see equation and cost section) (judgment). Finite analyst judgment, not newly identified organizational effect; source/model memo and independent challenge explain counterfactual boundaries.
T
20 explicit model parameter (see equation and cost section) (judgment). Finite analyst judgment, not newly identified organizational effect; source/model memo and independent challenge explain counterfactual boundaries.
u
0.8 explicit model parameter (see equation and cost section) (judgment). Finite analyst judgment, not newly identified organizational effect; source/model memo and independent challenge explain counterfactual boundaries.
g
0.995 explicit model parameter (see equation and cost section) (judgment). Finite analyst judgment, not newly identified organizational effect; source/model memo and independent challenge explain counterfactual boundaries.
delay
0.5 explicit model parameter (see equation and cost section) (judgment). Finite analyst judgment, not newly identified organizational effect; source/model memo and independent challenge explain counterfactual boundaries.
discount
0.03 explicit model parameter (see equation and cost section) (judgment). Finite analyst judgment, not newly identified organizational effect; source/model memo and independent challenge explain counterfactual boundaries.
h
0 explicit model parameter (see equation and cost section) (judgment). Finite analyst judgment, not newly identified organizational effect; source/model memo and independent challenge explain counterfactual boundaries.
donorHarm
0 explicit model parameter (see equation and cost section) (judgment). Finite analyst judgment, not newly identified organizational effect; source/model memo and independent challenge explain counterfactual boundaries.
stock
15 explicit model parameter (see equation and cost section) (judgment). Finite analyst judgment, not newly identified organizational effect; source/model memo and independent challenge explain counterfactual boundaries.
unpaid
8 explicit model parameter (see equation and cost section) (judgment). Finite analyst judgment, not newly identified organizational effect; source/model memo and independent challenge explain counterfactual boundaries.
ems
500 explicit model parameter (see equation and cost section) (judgment). Finite analyst judgment, not newly identified organizational effect; source/model memo and independent challenge explain counterfactual boundaries.
purchaseShare
0.05 explicit model parameter (see equation and cost section) (judgment). Finite analyst judgment, not newly identified organizational effect; source/model memo and independent challenge explain counterfactual boundaries.
purchaseCash
20 explicit model parameter (see equation and cost section) (judgment). Finite analyst judgment, not newly identified organizational effect; source/model memo and independent challenge explain counterfactual boundaries.
shippingShare
0.4 explicit model parameter (see equation and cost section) (judgment). Finite analyst judgment, not newly identified organizational effect; source/model memo and independent challenge explain counterfactual boundaries.
incrementalShippingCash
6 explicit model parameter (see equation and cost section) (judgment). Finite analyst judgment, not newly identified organizational effect; source/model memo and independent challenge explain counterfactual boundaries.
incomeBefore
30000 explicit model parameter (see equation and cost section) (judgment). Finite analyst judgment, not newly identified organizational effect; source/model memo and independent challenge explain counterfactual boundaries.
incomeIndependent
1 explicit model parameter (see equation and cost section) (judgment). Finite analyst judgment, not newly identified organizational effect; source/model memo and independent challenge explain counterfactual boundaries.
commonAliveShare
0 explicit model parameter (see equation and cost section) (judgment). Finite analyst judgment, not newly identified organizational effect; source/model memo and independent challenge explain counterfactual boundaries.
commonAliveIncomeDelta
0 explicit model parameter (see equation and cost section) (judgment). Finite analyst judgment, not newly identified organizational effect; source/model memo and independent challenge explain counterfactual boundaries.
commonAliveIncomeBefore
22000 explicit model parameter (see equation and cost section) (judgment). Finite analyst judgment, not newly identified organizational effect; source/model memo and independent challenge explain counterfactual boundaries.
commonAliveIndependent
0 explicit model parameter (see equation and cost section) (judgment). Finite analyst judgment, not newly identified organizational effect; source/model memo and independent challenge explain counterfactual boundaries.

Conditional donor health and household resources: Cost: $10K; USA health QALYs: 0.04; all-population health QALYs: 0.04. Income-equivalent healthy years: 0.00. {"id":"central-judgment","G":10000,"a":0.65,"c":40,"b":0.45,"q":0.75,"e":0.007,"k":0.55,"t":0.35,"d":0.6,"f":0.12,"m1":0.08,"m":0.05,"T":20,"u":0.8,"g":0.995,"delay":0.5,"discount":0.03,"h":0,"donorHarm":0,"stock":15,"unpaid":8,"ems":500,"purchaseShare":0.05,"purchaseCash":20,"shippingShare":0.4,"incrementalShippingCash":6,"incomeBefore":30000,"incomeIndependent":1,"commonAliveShare":0,"commonAliveIncomeDelta":0,"commonAliveIncomeBefore":22000,"commonAliveIndependent":0}; coefficients are judgments, not measured effects. {"health":false,"income":false,"response":false}

prior cash cost: Cost: $10K; USA health QALYs: 0.03; all-population health QALYs: 0.03. Income-equivalent healthy years: 0.00. {"id":"prior-cash-cost","G":10000,"a":0.65,"c":50,"b":0.45,"q":0.75,"e":0.007,"k":0.55,"t":0.35,"d":0.6,"f":0.12,"m1":0.08,"m":0.05,"T":20,"u":0.8,"g":0.995,"delay":0.5,"discount":0.03,"h":0,"donorHarm":0,"stock":15,"unpaid":8,"ems":500,"purchaseShare":0.05,"purchaseCash":20,"shippingShare":0.4,"incrementalShippingCash":6,"incomeBefore":30000,"incomeIndependent":1,"commonAliveShare":0,"commonAliveIncomeDelta":0,"commonAliveIncomeBefore":22000,"commonAliveIndependent":0}; coefficients are judgments, not measured effects. {"health":false,"income":false,"response":false}

prior opportunity rate: Cost: $10K; USA health QALYs: 0.03; all-population health QALYs: 0.03. Income-equivalent healthy years: 0.00. {"id":"prior-opportunity-rate","G":10000,"a":0.65,"c":40,"b":0.45,"q":0.75,"e":0.005,"k":0.55,"t":0.35,"d":0.6,"f":0.12,"m1":0.08,"m":0.05,"T":20,"u":0.8,"g":0.995,"delay":0.5,"discount":0.03,"h":0,"donorHarm":0,"stock":15,"unpaid":8,"ems":500,"purchaseShare":0.05,"purchaseCash":20,"shippingShare":0.4,"incrementalShippingCash":6,"incomeBefore":30000,"incomeIndependent":1,"commonAliveShare":0,"commonAliveIncomeDelta":0,"commonAliveIncomeBefore":22000,"commonAliveIndependent":0}; coefficients are judgments, not measured effects. {"health":false,"income":false,"response":false}

prior deduplication: Cost: $10K; USA health QALYs: 0.03; all-population health QALYs: 0.03. Income-equivalent healthy years: 0.00. {"id":"prior-deduplication","G":10000,"a":0.65,"c":40,"b":0.45,"q":0.75,"e":0.007,"k":0.55,"t":0.35,"d":0.5,"f":0.12,"m1":0.08,"m":0.05,"T":20,"u":0.8,"g":0.995,"delay":0.5,"discount":0.03,"h":0,"donorHarm":0,"stock":15,"unpaid":8,"ems":500,"purchaseShare":0.05,"purchaseCash":20,"shippingShare":0.4,"incrementalShippingCash":6,"incomeBefore":30000,"incomeIndependent":1,"commonAliveShare":0,"commonAliveIncomeDelta":0,"commonAliveIncomeBefore":22000,"commonAliveIndependent":0}; coefficients are judgments, not measured effects. {"health":false,"income":false,"response":false}

prior cost opportunity dedup: Cost: $10K; USA health QALYs: 0.02; all-population health QALYs: 0.02. Income-equivalent healthy years: 0.00. {"id":"prior-cost-opportunity-dedup","G":10000,"a":0.65,"c":50,"b":0.45,"q":0.75,"e":0.005,"k":0.55,"t":0.35,"d":0.5,"f":0.12,"m1":0.08,"m":0.05,"T":20,"u":0.8,"g":0.995,"delay":0.5,"discount":0.03,"h":0,"donorHarm":0,"stock":15,"unpaid":8,"ems":500,"purchaseShare":0.05,"purchaseCash":20,"shippingShare":0.4,"incrementalShippingCash":6,"incomeBefore":30000,"incomeIndependent":1,"commonAliveShare":0,"commonAliveIncomeDelta":0,"commonAliveIncomeBefore":22000,"commonAliveIndependent":0}; coefficients are judgments, not measured effects. {"health":false,"income":false,"response":false}

survival effect halved: Cost: $10K; USA health QALYs: 0.02; all-population health QALYs: 0.02. Income-equivalent healthy years: 0.00. {"id":"survival-effect-halved","G":10000,"a":0.65,"c":40,"b":0.45,"q":0.75,"e":0.007,"k":0.55,"t":0.35,"d":0.6,"f":0.06,"m1":0.08,"m":0.05,"T":20,"u":0.8,"g":0.995,"delay":0.5,"discount":0.03,"h":0,"donorHarm":0,"stock":15,"unpaid":8,"ems":500,"purchaseShare":0.05,"purchaseCash":20,"shippingShare":0.4,"incrementalShippingCash":6,"incomeBefore":30000,"incomeIndependent":1,"commonAliveShare":0,"commonAliveIncomeDelta":0,"commonAliveIncomeBefore":22000,"commonAliveIndependent":0}; coefficients are judgments, not measured effects. {"health":false,"income":false,"response":false}

later mortality .08: Cost: $10K; USA health QALYs: 0.03; all-population health QALYs: 0.03. Income-equivalent healthy years: 0.00. {"id":"later-mortality-.08","G":10000,"a":0.65,"c":40,"b":0.45,"q":0.75,"e":0.007,"k":0.55,"t":0.35,"d":0.6,"f":0.12,"m1":0.08,"m":0.08,"T":20,"u":0.8,"g":0.995,"delay":0.5,"discount":0.03,"h":0,"donorHarm":0,"stock":15,"unpaid":8,"ems":500,"purchaseShare":0.05,"purchaseCash":20,"shippingShare":0.4,"incrementalShippingCash":6,"incomeBefore":30000,"incomeIndependent":1,"commonAliveShare":0,"commonAliveIncomeDelta":0,"commonAliveIncomeBefore":22000,"commonAliveIndependent":0}; coefficients are judgments, not measured effects. {"health":false,"income":false,"response":false}

no incremental shipping: Cost: $10K; USA health QALYs: 0.04; all-population health QALYs: 0.04. Income-equivalent healthy years: 0.00. {"id":"no-incremental-shipping","G":10000,"a":0.65,"c":40,"b":0.45,"q":0.75,"e":0.007,"k":0.55,"t":0.35,"d":0.6,"f":0.12,"m1":0.08,"m":0.05,"T":20,"u":0.8,"g":0.995,"delay":0.5,"discount":0.03,"h":0,"donorHarm":0,"stock":15,"unpaid":8,"ems":500,"purchaseShare":0.05,"purchaseCash":20,"shippingShare":0.4,"incrementalShippingCash":0,"incomeBefore":30000,"incomeIndependent":1,"commonAliveShare":0,"commonAliveIncomeDelta":0,"commonAliveIncomeBefore":22000,"commonAliveIndependent":0}; coefficients are judgments, not measured effects. {"health":false,"income":false,"response":false}

favorable targeting: Cost: $10K; USA health QALYs: 2.57; all-population health QALYs: 2.59. Income-equivalent healthy years: 0.01. {"id":"favorable-targeting","G":10000,"a":0.8,"c":30,"b":0.75,"q":0.9,"e":0.025,"k":0.75,"t":0.5,"d":0.75,"f":0.2,"m1":0.055,"m":0.03,"T":30,"u":0.85,"g":0.995,"delay":0.5,"discount":0.03,"h":0,"donorHarm":0,"stock":15,"unpaid":5,"ems":500,"purchaseShare":0.1,"purchaseCash":30,"shippingShare":0.2,"incrementalShippingCash":4,"incomeBefore":30000,"incomeIndependent":1,"commonAliveShare":0,"commonAliveIncomeDelta":0,"commonAliveIncomeBefore":22000,"commonAliveIndependent":0}; coefficients are judgments, not measured effects. {"health":false,"income":false,"response":false}

downside: Cost: $10K; USA health QALYs: 0.00; all-population health QALYs: 0.00. Income-equivalent healthy years: 0.00. {"id":"downside","G":10000,"a":0.4,"c":75,"b":0.2,"q":0.5,"e":0.002,"k":0.3,"t":0.15,"d":0.4,"f":0.05,"m1":0.12,"m":0.08,"T":10,"u":0.7,"g":0.995,"delay":0.5,"discount":0.03,"h":0,"donorHarm":0,"stock":15,"unpaid":15,"ems":500,"purchaseShare":0,"purchaseCash":20,"shippingShare":0.6,"incrementalShippingCash":10,"incomeBefore":30000,"incomeIndependent":1,"commonAliveShare":0,"commonAliveIncomeDelta":0,"commonAliveIncomeBefore":22000,"commonAliveIndependent":0}; coefficients are judgments, not measured effects. {"health":false,"income":false,"response":false}

zero funding: Cost: $10K; USA health QALYs: 0.00; all-population health QALYs: 0.00. Income-equivalent healthy years: 0.00. {"id":"zero-funding","G":10000,"a":0.65,"c":40,"b":0,"q":0.75,"e":0.007,"k":0.55,"t":0.35,"d":0.6,"f":0.12,"m1":0.08,"m":0.05,"T":20,"u":0.8,"g":0.995,"delay":0.5,"discount":0.03,"h":0,"donorHarm":0,"stock":15,"unpaid":8,"ems":500,"purchaseShare":0.05,"purchaseCash":20,"shippingShare":0.4,"incrementalShippingCash":6,"incomeBefore":30000,"incomeIndependent":1,"commonAliveShare":0,"commonAliveIncomeDelta":0,"commonAliveIncomeBefore":22000,"commonAliveIndependent":0}; coefficients are judgments, not measured effects. {"health":false,"income":false,"response":false}

zero completion: Cost: $10K; USA health QALYs: 0.00; all-population health QALYs: 0.00. Income-equivalent healthy years: 0.00. {"id":"zero-completion","G":10000,"a":0.65,"c":40,"b":0.45,"q":0,"e":0.007,"k":0.55,"t":0.35,"d":0.6,"f":0.12,"m1":0.08,"m":0.05,"T":20,"u":0.8,"g":0.995,"delay":0.5,"discount":0.03,"h":0,"donorHarm":0,"stock":15,"unpaid":8,"ems":500,"purchaseShare":0.05,"purchaseCash":20,"shippingShare":0.4,"incrementalShippingCash":6,"incomeBefore":30000,"incomeIndependent":1,"commonAliveShare":0,"commonAliveIncomeDelta":0,"commonAliveIncomeBefore":22000,"commonAliveIndependent":0}; coefficients are judgments, not measured effects. {"health":false,"income":false,"response":false}

zero allocation: Cost: $10K; USA health QALYs: 0.00; all-population health QALYs: 0.00. Income-equivalent healthy years: 0.00. {"id":"zero-allocation","G":10000,"a":0,"c":40,"b":0.45,"q":0.75,"e":0.007,"k":0.55,"t":0.35,"d":0.6,"f":0.12,"m1":0.08,"m":0.05,"T":20,"u":0.8,"g":0.995,"delay":0.5,"discount":0.03,"h":0,"donorHarm":0,"stock":15,"unpaid":8,"ems":500,"purchaseShare":0.05,"purchaseCash":20,"shippingShare":0.4,"incrementalShippingCash":6,"incomeBefore":30000,"incomeIndependent":1,"commonAliveShare":0,"commonAliveIncomeDelta":0,"commonAliveIncomeBefore":22000,"commonAliveIndependent":0}; coefficients are judgments, not measured effects. {"health":false,"income":false,"response":false}

no added rescue: Cost: $10K; USA health QALYs: 0.00; all-population health QALYs: 0.00. Income-equivalent healthy years: 0.00. {"id":"no-added-rescue","G":10000,"a":0.65,"c":40,"b":0.45,"q":0.75,"e":0.007,"k":0.55,"t":0,"d":0.6,"f":0.12,"m1":0.08,"m":0.05,"T":20,"u":0.8,"g":0.995,"delay":0.5,"discount":0.03,"h":0,"donorHarm":0,"stock":15,"unpaid":8,"ems":500,"purchaseShare":0.05,"purchaseCash":20,"shippingShare":0.4,"incrementalShippingCash":6,"incomeBefore":30000,"incomeIndependent":1,"commonAliveShare":0,"commonAliveIncomeDelta":0,"commonAliveIncomeBefore":22000,"commonAliveIndependent":0}; coefficients are judgments, not measured effects. {"health":false,"income":false,"response":false}

mortality null: Cost: $10K; USA health QALYs: 0.00; all-population health QALYs: 0.00. Income-equivalent healthy years: 0.00. {"id":"mortality-null","G":10000,"a":0.65,"c":40,"b":0.45,"q":0.75,"e":0.007,"k":0.55,"t":0.35,"d":0.6,"f":0,"m1":0.08,"m":0.05,"T":20,"u":0.8,"g":0.995,"delay":0.5,"discount":0.03,"h":0,"donorHarm":0,"stock":15,"unpaid":8,"ems":500,"purchaseShare":0.05,"purchaseCash":20,"shippingShare":0.4,"incrementalShippingCash":6,"incomeBefore":30000,"incomeIndependent":1,"commonAliveShare":0,"commonAliveIncomeDelta":0,"commonAliveIncomeBefore":22000,"commonAliveIndependent":0}; coefficients are judgments, not measured effects. {"health":false,"income":false,"response":false}

independent harm at zero activity: Cost: $10K; USA health QALYs: -0.01; all-population health QALYs: -0.01. Income-equivalent healthy years: 0.00. {"id":"independent-harm-at-zero-activity","G":10000,"a":0.65,"c":40,"b":0,"q":0.75,"e":0.007,"k":0.55,"t":0.35,"d":0.6,"f":0.12,"m1":0.08,"m":0.05,"T":20,"u":0.8,"g":0.995,"delay":0.5,"discount":0.03,"h":0,"donorHarm":0.01,"stock":15,"unpaid":8,"ems":500,"purchaseShare":0.05,"purchaseCash":20,"shippingShare":0.4,"incrementalShippingCash":6,"incomeBefore":30000,"incomeIndependent":1,"commonAliveShare":0,"commonAliveIncomeDelta":0,"commonAliveIncomeBefore":22000,"commonAliveIndependent":0}; coefficients are judgments, not measured effects. {"health":false,"income":false,"response":false}

acute harm only: Cost: $10K; USA health QALYs: 0.00; all-population health QALYs: 0.00. Income-equivalent healthy years: 0.00. {"id":"acute-harm-only","G":10000,"a":0.65,"c":40,"b":0.45,"q":0.75,"e":0.007,"k":0.55,"t":0.35,"d":0.6,"f":0,"m1":0.08,"m":0.05,"T":20,"u":0.8,"g":0.995,"delay":0.5,"discount":0.03,"h":0.001,"donorHarm":0,"stock":15,"unpaid":8,"ems":500,"purchaseShare":0.05,"purchaseCash":20,"shippingShare":0.4,"incrementalShippingCash":6,"incomeBefore":30000,"incomeIndependent":1,"commonAliveShare":0,"commonAliveIncomeDelta":0,"commonAliveIncomeBefore":22000,"commonAliveIndependent":0}; coefficients are judgments, not measured effects. {"health":false,"income":false,"response":false}

cash savings positive: Cost: $10K; USA health QALYs: 0.03; all-population health QALYs: 0.03. Income-equivalent healthy years: 0.00. {"id":"cash-savings-positive","G":10000,"a":0.65,"c":40,"b":0.45,"q":0.75,"e":0.007,"k":0.55,"t":0.35,"d":0.6,"f":0.12,"m1":0.08,"m":0.05,"T":20,"u":0.8,"g":0.995,"delay":0.5,"discount":0.03,"h":0,"donorHarm":0,"stock":15,"unpaid":8,"ems":500,"purchaseShare":0.15,"purchaseCash":30,"shippingShare":0.2,"incrementalShippingCash":4,"incomeBefore":30000,"incomeIndependent":1,"commonAliveShare":0,"commonAliveIncomeDelta":0,"commonAliveIncomeBefore":22000,"commonAliveIndependent":0}; coefficients are judgments, not measured effects. {"health":false,"income":false,"response":false}

no actual purchase savings: Cost: $10K; USA health QALYs: 0.04; all-population health QALYs: 0.04. Income-equivalent healthy years: 0.00. {"id":"no-actual-purchase-savings","G":10000,"a":0.65,"c":40,"b":0.45,"q":0.75,"e":0.007,"k":0.55,"t":0.35,"d":0.6,"f":0.12,"m1":0.08,"m":0.05,"T":20,"u":0.8,"g":0.995,"delay":0.5,"discount":0.03,"h":0,"donorHarm":0,"stock":15,"unpaid":8,"ems":500,"purchaseShare":0,"purchaseCash":0,"shippingShare":0.4,"incrementalShippingCash":6,"incomeBefore":30000,"incomeIndependent":1,"commonAliveShare":0,"commonAliveIncomeDelta":0,"commonAliveIncomeBefore":22000,"commonAliveIndependent":0}; coefficients are judgments, not measured effects. {"health":false,"income":false,"response":false}

common alive financial burden: Cost: $10K; USA health QALYs: 0.04; all-population health QALYs: 0.04. Income-equivalent healthy years: 0.00. {"id":"common-alive-financial-burden","G":10000,"a":0.65,"c":40,"b":0.45,"q":0.75,"e":0.007,"k":0.55,"t":0.35,"d":0.6,"f":0.12,"m1":0.08,"m":0.05,"T":20,"u":0.8,"g":0.995,"delay":0.5,"discount":0.03,"h":0,"donorHarm":0,"stock":15,"unpaid":8,"ems":500,"purchaseShare":0.05,"purchaseCash":20,"shippingShare":0.4,"incrementalShippingCash":6,"incomeBefore":30000,"incomeIndependent":1,"commonAliveShare":0.5,"commonAliveIncomeDelta":-200,"commonAliveIncomeBefore":22000,"commonAliveIndependent":1}; coefficients are judgments, not measured effects. {"health":false,"income":false,"response":false}

common alive financial gain: Cost: $10K; USA health QALYs: 0.04; all-population health QALYs: 0.04. Income-equivalent healthy years: 0.00. {"id":"common-alive-financial-gain","G":10000,"a":0.65,"c":40,"b":0.45,"q":0.75,"e":0.007,"k":0.55,"t":0.35,"d":0.6,"f":0.12,"m1":0.08,"m":0.05,"T":20,"u":0.8,"g":0.995,"delay":0.5,"discount":0.03,"h":0,"donorHarm":0,"stock":15,"unpaid":8,"ems":500,"purchaseShare":0.05,"purchaseCash":20,"shippingShare":0.4,"incrementalShippingCash":6,"incomeBefore":30000,"incomeIndependent":1,"commonAliveShare":0.5,"commonAliveIncomeDelta":200,"commonAliveIncomeBefore":22000,"commonAliveIndependent":0.5}; coefficients are judgments, not measured effects. {"health":false,"income":false,"response":false}

Ontario first year stress: Cost: $10K; USA health QALYs: 0.04; all-population health QALYs: 0.04. Income-equivalent healthy years: 0.00. {"id":"Ontario-first-year-stress","G":10000,"a":0.65,"c":40,"b":0.45,"q":0.75,"e":0.007,"k":0.55,"t":0.35,"d":0.6,"f":0.12,"m1":0.09,"m":0.05,"T":20,"u":0.8,"g":0.995,"delay":0.5,"discount":0.03,"h":0,"donorHarm":0,"stock":15,"unpaid":8,"ems":500,"purchaseShare":0.05,"purchaseCash":20,"shippingShare":0.4,"incrementalShippingCash":6,"incomeBefore":30000,"incomeIndependent":1,"commonAliveShare":0,"commonAliveIncomeDelta":0,"commonAliveIncomeBefore":22000,"commonAliveIndependent":0}; coefficients are judgments, not measured effects. {"health":false,"income":false,"response":false}

ten year survival: Cost: $10K; USA health QALYs: 0.03; all-population health QALYs: 0.03. Income-equivalent healthy years: 0.00. {"id":"ten-year-survival","G":10000,"a":0.65,"c":40,"b":0.45,"q":0.75,"e":0.007,"k":0.55,"t":0.35,"d":0.6,"f":0.12,"m1":0.08,"m":0.05,"T":10,"u":0.8,"g":0.995,"delay":0.5,"discount":0.03,"h":0,"donorHarm":0,"stock":15,"unpaid":8,"ems":500,"purchaseShare":0.05,"purchaseCash":20,"shippingShare":0.4,"incrementalShippingCash":6,"incomeBefore":30000,"incomeIndependent":1,"commonAliveShare":0,"commonAliveIncomeDelta":0,"commonAliveIncomeBefore":22000,"commonAliveIndependent":0}; coefficients are judgments, not measured effects. {"health":false,"income":false,"response":false}

five percent discount: Cost: $10K; USA health QALYs: 0.03; all-population health QALYs: 0.03. Income-equivalent healthy years: 0.00. {"id":"five-percent-discount","G":10000,"a":0.65,"c":40,"b":0.45,"q":0.75,"e":0.007,"k":0.55,"t":0.35,"d":0.6,"f":0.12,"m1":0.08,"m":0.05,"T":20,"u":0.8,"g":0.995,"delay":0.5,"discount":0.05,"h":0,"donorHarm":0,"stock":15,"unpaid":8,"ems":500,"purchaseShare":0.05,"purchaseCash":20,"shippingShare":0.4,"incrementalShippingCash":6,"incomeBefore":30000,"incomeIndependent":1,"commonAliveShare":0,"commonAliveIncomeDelta":0,"commonAliveIncomeBefore":22000,"commonAliveIndependent":0}; coefficients are judgments, not measured effects. {"health":false,"income":false,"response":false}

utility .6: Cost: $10K; USA health QALYs: 0.03; all-population health QALYs: 0.03. Income-equivalent healthy years: 0.00. {"id":"utility-.6","G":10000,"a":0.65,"c":40,"b":0.45,"q":0.75,"e":0.007,"k":0.55,"t":0.35,"d":0.6,"f":0.12,"m1":0.08,"m":0.05,"T":20,"u":0.6,"g":0.995,"delay":0.5,"discount":0.03,"h":0,"donorHarm":0,"stock":15,"unpaid":8,"ems":500,"purchaseShare":0.05,"purchaseCash":20,"shippingShare":0.4,"incrementalShippingCash":6,"incomeBefore":30000,"incomeIndependent":1,"commonAliveShare":0,"commonAliveIncomeDelta":0,"commonAliveIncomeBefore":22000,"commonAliveIndependent":0}; coefficients are judgments, not measured effects. {"health":false,"income":false,"response":false}

complete alternative purchase: Cost: $10K; USA health QALYs: 0.00; all-population health QALYs: 0.00. Income-equivalent healthy years: 0.02. {"id":"complete-alternative-purchase","G":10000,"a":0.65,"c":40,"b":0.45,"q":0.75,"e":0.007,"k":0.55,"t":0.35,"d":0.6,"f":0.12,"m1":0.08,"m":0.05,"T":20,"u":0.8,"g":0.995,"delay":0.5,"discount":0.03,"h":0,"donorHarm":0,"stock":15,"unpaid":8,"ems":500,"purchaseShare":1,"purchaseCash":20,"shippingShare":0.4,"incrementalShippingCash":6,"incomeBefore":30000,"incomeIndependent":1,"commonAliveShare":0,"commonAliveIncomeDelta":0,"commonAliveIncomeBefore":22000,"commonAliveIndependent":0}; coefficients are judgments, not measured effects. {"health":false,"income":false,"response":false}

no conditional alive independent credit: Cost: $10K; USA health QALYs: 0.04; all-population health QALYs: 0.04. Income-equivalent healthy years: 0.00. {"id":"no-conditional-alive-independent-credit","G":10000,"a":0.65,"c":40,"b":0.45,"q":0.75,"e":0.007,"k":0.55,"t":0.35,"d":0.6,"f":0.12,"m1":0.08,"m":0.05,"T":20,"u":0.8,"g":0.995,"delay":0.5,"discount":0.03,"h":0,"donorHarm":0,"stock":15,"unpaid":8,"ems":500,"purchaseShare":0.05,"purchaseCash":20,"shippingShare":0.4,"incrementalShippingCash":6,"incomeBefore":30000,"incomeIndependent":1,"commonAliveShare":0.5,"commonAliveIncomeDelta":200,"commonAliveIncomeBefore":22000,"commonAliveIndependent":0}; coefficients are judgments, not measured effects. {"health":false,"income":false,"response":false}

income unknown: Cost: $10K; USA health QALYs: 0.04; all-population health QALYs: 0.04. {"id":"income-unknown","G":10000,"a":0.65,"c":40,"b":0.45,"q":0.75,"e":0.007,"k":0.55,"t":0.35,"d":0.6,"f":0.12,"m1":0.08,"m":0.05,"T":20,"u":0.8,"g":0.995,"delay":0.5,"discount":0.03,"h":0,"donorHarm":0,"stock":15,"unpaid":8,"ems":500,"purchaseShare":0.05,"purchaseCash":20,"shippingShare":0.4,"incrementalShippingCash":6,"incomeBefore":30000,"incomeIndependent":1,"commonAliveShare":0,"commonAliveIncomeDelta":0,"commonAliveIncomeBefore":22000,"commonAliveIndependent":0}; coefficients are judgments, not measured effects. {"health":false,"income":true,"response":false}

health unknown: Cost: $10K; USA health QALYs: unknown; all-population health QALYs: unknown. Income-equivalent healthy years: 0.00. {"id":"health-unknown","G":10000,"a":0.65,"c":40,"b":0.45,"q":0.75,"e":0.007,"k":0.55,"t":0.35,"d":0.6,"f":0.12,"m1":0.08,"m":0.05,"T":20,"u":0.8,"g":0.995,"delay":0.5,"discount":0.03,"h":0,"donorHarm":0,"stock":15,"unpaid":8,"ems":500,"purchaseShare":0.05,"purchaseCash":20,"shippingShare":0.4,"incrementalShippingCash":6,"incomeBefore":30000,"incomeIndependent":1,"commonAliveShare":0,"commonAliveIncomeDelta":0,"commonAliveIncomeBefore":22000,"commonAliveIndependent":0}; coefficients are judgments, not measured effects. {"health":true,"income":false,"response":false}

response unknown: Cost: $10K; USA health QALYs: unknown; all-population health QALYs: unknown. {"id":"response-unknown","G":10000,"a":0.65,"c":40,"b":0.45,"q":0.75,"e":0.007,"k":0.55,"t":0.35,"d":0.6,"f":0.12,"m1":0.08,"m":0.05,"T":20,"u":0.8,"g":0.995,"delay":0.5,"discount":0.03,"h":0,"donorHarm":0,"stock":15,"unpaid":8,"ems":500,"purchaseShare":0.05,"purchaseCash":20,"shippingShare":0.4,"incrementalShippingCash":6,"incomeBefore":30000,"incomeIndependent":1,"commonAliveShare":0,"commonAliveIncomeDelta":0,"commonAliveIncomeBefore":22000,"commonAliveIndependent":0}; coefficients are judgments, not measured effects. {"health":true,"income":true,"response":true}

Historical USA clinical-only estimate, retained for comparison: Cost: $100K; USA health QALYs: 0.57; all-population health QALYs: 0.57. Historical model, not current result. {"G":100000,"a":0.75,"c":50,"b":0.5,"q":0.8,"e":0.005,"k":0.5,"t":0.5,"d":0.5,"f":0.2,"m1":0.075,"m":0.04,"T":20,"u":0.75,"g":0.99,"delay":0.5,"h":0,"stock":0,"unpaid":10,"recipientCash":0,"ems":1000}

Counterfactual: Without the gift, existing End Overdose funding, already funded cabinets, manufacturer and public stock, other distributors, trained witnesses and EMS remain. b represents the share of nominal offers made additional by the gift, after replacement funding. q represents actual completed delivery; k usable access at the opportunity; t clinical timing beyond other available response. These are distinct counterfactual steps. Public stock may enable donor-funded last-mile work rather than make it redundant, but the current overlap is unmeasured.

Attribution: Would-be actual purchasers are excluded before t. t excludes equivalent timely other rescue in the remaining pool; f is residual absolute extra three-day survival conditional on genuinely additional administrations, not a second EMS/other-naloxone discount. Repeat-event d and funding b are separate judgments. Ordinary survivor earnings excluded. Always-alive cash pool share<=1-abs(f), with explicit independence.

The central naloxone-pathway estimate is a subjective best guess, not a whole-portfolio expected return. Its inputs and joint stress tests are not probability-weighted estimates, confidence intervals or bounds. Older EMS and ED survivor cohorts do not identify the survival of otherwise-fatal cases rescued by this organization in 2026; future hazards and utility are explicit judgments. Endpoints, cohort composition and annual rates versus risks differ. Capacity constraints may make the linear gift model fail. Unpriced portfolio effects can be positive or negative, so the naloxone pathway is not a proven lower bound on the whole organization's value.

Sensitivity

  • Current conditional donor combined price$271K; health-only$262K versus historical clinical-only$176K. Crosswalk equivalents are not measured clinical QALYs.
  • Restoring old cost/opportunity/dedup together produces$5,830,531; fhalved$5,615,504. These expose judgment dependence, not posterior confidence intervals.
  • Zero incremental shipping yields$256K with unchanged health. Positive/negative cash, survival and independent harms remain separately inspectable.
  • Unknown health/income/response nulls combined price; true no-additionality is zero. Mathematical ceiling is not verified donor capacity.

Unresolved inputs

  • Costed, currently unfunded capacity and the share of unrestricted next dollars allocated to added high-risk delivery.
  • Manufacturer/public/purchased inventory reconciliation by dose, package, expiry, remaining stock, restrictions and distribution channel.
  • Actual fulfillment completion, recipient shipping receipts, paid and unpaid labor, and current workload constraints.
  • Marginal recipient exposure, usable access and other available witnesses or EMS; linked unique scene and patient follow-up.
  • Additional survival probability versus no added response, subsequent mortality, utility, adverse effects and future net costs.
  • USA-resident outcomes separated from territorial and foreign attendee spillovers.
  • Reconciled 2022–24 program totals and 2022–23 net-asset roll-forwards; current management accounts, debt, restrictions and funding commitments.
  • Effects of education, test strips, stigma, referrals and other portfolio activity, including possible harms; no whole-organization lower bound is established.
  • Actual counterfactual household purchase, incremental shipping, disposable resources, always-alive cash changes and independence; finite judgments are not measurements.

Health and income breakdown

For the modeled $10K: 0.04 health QALYs + 0.00 income-equivalent healthy years in USA: $271K per DALY. Income equivalents are welfare comparisons, not observed QALYs or DALYs.

Method and caveats.

5. Funding and previous grants

The current campaign reports a manufacturer contribution of 25,000 naloxone units, but does not define that unit or reconcile receipts, inventory, dispatches, returns and expirations. It must not be combined automatically with the older public donation or converted into 25,000 two-dose kits. The national kit page says two intranasal doses, recipient-paid shipping and a 7–14-day shipping notice. Its extracted HTML contains a generic Sold out badge, but its product structured data says InStock and the purchasing control is restricted by certification. We therefore retract the initial report's implication that this text demonstrated a stockout. Neither the badge nor the structured data verifies a fulfillable donor-funded queue.

Public supply is a concrete alternative and potential complement. California's NDP provides free medication and shipping to eligible organizations; it does not distribute directly to individuals. This can leave real last-mile work for private support. The Nevada partner's donation and Arkansas' funded cabinets similarly do not prove that a new private gift adds inventory or capacity. A useful next proposal would specify the intended higher-risk channel, committed stock and other funds, unmet orders, additional paid hours, completed-delivery target and follow-up plan. No current costed, unfunded proposal meeting those conditions was located. An old match announcement in the 2024 report is not treated as a current match.

Annual spending appendix: the original 2022, 2023 and 2024 returns are all 12-month calendar-year, cash-basis filings for EIN 83-0696963. Part IX reports total spending of $516,362, $942,519 and $970,440, averaging $809,774. The respective program / management / fundraising splits are $464,735 / $51,627 / $0; $786,575 / $155,944 / $0; and $730,276 / $207,274 / $32,890. These are consistent total-cost accounting figures, not a marginal allocation to high-risk naloxone delivery or full values of contributed medicines and labor.

There are unresolved financial discrepancies. Part III program totals are $272,610, $1,199,424 and $980,427, respectively, and disagree with Part IX. The 2022 and 2023 Part XI net-asset roll-forwards miss $3,277 and $9,081; the latter Schedule O does not explain the difference. These discrepancies do not prove wrongdoing, but require reconciliation before relying on reserve or program-efficiency claims. At year-end 2024 the return reports $20,042 cash, $36,709 liabilities and negative $16,572 net assets; the 2024 roll-forward does reconcile. The filing index and targeted search yielded no newer original return. These historical figures cannot establish October 2026 runway, restrictions or funding room. The 2023–24 returns report compiled or reviewed statements, not audited statements.

Annual expenses

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

  • FY 2022: $516K; End Overdose, EIN 83-0696963, 12-month period, Original Form 990 Part IX total expenses; cash basis; calendar year; excludes unpriced ecosystem resources. Source
  • FY 2023: $943K; End Overdose, EIN 83-0696963, 12-month period, Original Form 990 Part IX total expenses; cash basis; calendar year; excludes unpriced ecosystem resources. Source
  • FY 2024: $970K; End Overdose, EIN 83-0696963, 12-month period, Original Form 990 Part IX total expenses; cash basis; calendar year; excludes unpriced ecosystem resources. Source

6. Sources

  1. 2022 original Form 990, calendar year, Parts I, III, IX, X, XI and XII. End Overdose / IRS, reproduced by ProPublica. Published: 2023-03-01; retrieved: 2026-10-02.
  2. 2023 original Form 990, calendar year, Parts I, III, IX, X, XI and XII. End Overdose / IRS, reproduced by ProPublica. Published: 2024-04-25; retrieved: 2026-10-02.
  3. 2024 original Form 990, calendar year, Parts I, III, IX, X, XI and XII. End Overdose / IRS, reproduced by ProPublica. Published: 2025-03-25; retrieved: 2026-10-02.
  4. 2023 original Form 990 Schedule O. End Overdose / IRS, reproduced by ProPublica. Published: 2024-04-25; retrieved: 2026-09-14.
  5. 2024 original Form 990 Schedule O. End Overdose / IRS, reproduced by ProPublica. Published: 2025-03-25; retrieved: 2026-09-14.
  6. Available filing index; latest return located is calendar 2024. ProPublica Nonprofit Explorer. Published: not stated; retrieved: 2026-10-02.
  7. Summer 2024 Impact Report, July–September, pages 4–8. End Overdose. Published: 2024-10-01; retrieved: 2026-09-14.
  8. Impact report index. End Overdose. Published: not stated; retrieved: 2026-09-14.
  9. August 2026 Overdose Awareness Month campaign. End Overdose. Published: not stated; retrieved: 2026-10-02.
  10. Naloxone Kit; visible description and product structured data. End Overdose. Published: not stated; retrieved: 2026-10-02.
  11. Official donation checkout: receiving organization and program designations. End Overdose / GoFundMe Pro. Published: not stated; retrieved: 2026-09-14.
  12. End Overdose Distributes Free Naloxone Boxes Throughout Arkansas. End Overdose. Published: 2026-07-02; retrieved: 2026-09-14.
  13. Arkansas bulk naloxone order, product units and fulfillment terms. End Overdose. Published: not stated; retrieved: 2026-10-02.
  14. Nevada ORS Team Facilitates Partnership for Naloxone Distribution. Overdose Response Strategy. Published: not stated; retrieved: 2026-10-02.
  15. County announces End Overdose partnership at 2025 music and cultural festivals. Los Angeles County Department of Public Health, issued through PR Newswire. Published: 2025-01-23; retrieved: 2026-09-14.
  16. Naloxone Savings; $19 twin-pack price effective January 1, 2026. California CalRx. Published: not stated; retrieved: 2026-09-14.
  17. Naloxone Distribution Project FAQ, including April 2026 update. California Department of Health Care Services. Published: not stated; retrieved: 2026-10-02.
  18. Evaluation of Strategies to Enhance Community-Based Naloxone Distribution Supported by an Opioid Settlement. Zang et al. / JAMA Network Open. Published: 2024-05-30; retrieved: 2026-09-14.
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  25. Patient-reported health-state utilities in NIDA treatment-study data. Quality of Life Research; author manuscript hosted by PMC. Published: not stated; retrieved: 2026-09-14.
  26. Comparison of 8-mg and 4-mg intranasal naloxone in New York law enforcement. Payne et al. / CDC MMWR. Published: 2024-02-08; retrieved: 2026-10-02.
  27. Quality Assessment of Expired Naloxone Products from First-Responders' Supplies. Research article / PubMed. Published: not stated; retrieved: 2026-09-14.
  28. FDA shelf-life extension announcement for newly manufactured NARCAN 4-mg nasal spray. US Food and Drug Administration. Published: not stated; retrieved: 2026-09-14.
  29. Health and income cost-effectiveness reference. Coefficient Giving. Published: not stated; retrieved: 2026-09-30.
  30. One-year mortality among opioid overdose survivors: Ontario cohort. PubMed / original JAMA article. Published: 2026-05-07; retrieved: 2026-10-02.