Residents gathered in Boulder’s Central Park this week to commemorate 54 homeless or formerly homeless people who died this year in Boulder County. The memorial underscored the dangers of living outside, and the growing presence of fentanyl, an inexpensive and highly addictive synthetic opioid.
Of those who were named at the memorial, at least nine people died with fentanyl in their system, according to autopsy reports. All but one had consumed other substances, too, such as methamphetamine.
Fentanyl, intended to treat pain, has been available in the illicit drug market for years. Its potency and widespread availability has fueled a staggering rise in overdoses, becoming one of the leading causes of death in the U.S.
And in Boulder, fentanyl is disproportionately affecting homeless people, given that the county’s estimated overall homeless population is around 800 people.
Overdoses due to fentanyl began rising in the City of Boulder in late 2020, according to law enforcement officials. It has been found in the form of a blue pill and, more recently, as a powder. Xanax, percocet, oxycodone, methamphetamine and other recreational drugs may be laced with fentanyl.
This year, the Boulder Police Department has received 108 calls reporting a drug overdose, according to data provided to Boulder Reporting Lab through an open records request. At least 10 of those calls resulted in a fatality. Because Boulder only started collecting data in July 2022, it is hard to put the increase in context. The data provided also does not include overdose cases still under investigation.
These calls come in from all over the city. But the highest concentration is from the downtown area around Central Park. In August, Police Chief Maris Herold said the city stationed an ambulance at the park to respond to a wave of overdoses.
Several people who sleep outside in Boulder told Boulder Reporting Lab they carry naloxone, a nasal spray that can reverse the effects of an opioid overdose. Narcan, the brand name for naloxone, is free at local supermarkets, pharmacies and harm-reduction centers, such as the Boulder County Aids Project.
Daniel Guggenheim, 45, who is on the waiting list to get subsidized housing, said he has responded to several overdoses while spending his days downtown. This involves calling 911 and administering naloxone. If someone is not breathing, he said he turns the person on their side, clears their airway using a stick or plastic fork and begins mouth-to-mouth resuscitation.
Guggenheim said he frequently has to administer three Narcan sprays before someone regains consciousness, possibly due to fentanyl pills being laced with xylazine, or tranq, a powerful veterinary sedative. Lately, he has also seen fentanyl powder, which he said could prompt more severe overdoses because people don’t know how much to take.
“That’s our biggest threat,” he said. “I hate fentanyl with a passion.”
When someone overdoses on fentanyl, they may lose consciousness. In these cases, naloxone can at least temporarily help them regain consciousness. In other cases, people may go into cardiac arrest and stop breathing.
Jenna Steege, the division chief of Emergency Medical Services at Boulder Fire-Rescue, said if someone is not breathing, the city’s dispatchers are trained to guide bystanders through “telephone CPR.”
The city then responds using a strategy known as “pit crew resuscitation,” Steege said. This involves sending eight people, each with a specific role, to the scene, as well as two fire engines and an ambulance. The ultimate goal is to increase the odds of survival and prevent permanent neurological damage.
“It is very, very labor intensive,” Steege said. “Personnel is definitely something that we desperately need to be able to give people the best outcome possible.”
After the person is revived, they may go to the hospital. Others may sign a waiver to decline further medical services.
In either scenario, they’re likely to end up back on the streets.
Steege said the city’s newly launched Community Assistance Response and Engagement (CARE) program, a non-police alternative to 911 calls, is intended to get people connected with services like the Boulder Shelter for the Homeless and Mental Health Partners.
This helps, she said. But many service providers offering inpatient mental health and substance use treatment are maxed out.
“It’s heartbreaking knowing that you can resuscitate somebody and get them the immediate help they need, but know that services might not be available long-term,” Steege said. “The system is broken and overwhelmed.”
‘We don’t have the treatment’
Jen Livovich, who was homeless in Boulder from 2012 to 2017, and has launched nonprofits to help homeless people, has been advocating for the city, county and state to invest in treatment. She said homeless people need more than harm reduction, a strategy that addresses potential drug use dangers, such as providing clean needles to prevent Hepatitis C or naloxone to reverse an overdose.
“That entire philosophy believes in tools like Narcan to revive people to give them another chance to live another day for recovery,” Livovich said of harm reduction. “Well guess what? We got the Narcan part down. But we don’t have the treatment.”
Mental Health Partners has a 20-bed withdrawal management program, where people can stay for several nights, at its facility on 3180 Airport Rd. The organization also has a 16-bed transitional residential treatment program, where people can stay up to eight weeks, according to a spokeswoman.
Livovich believes this is not enough. She has been advocating for a detox facility where people can stabilize for up to 90 days. She said people also need sober-supported transitional housing where they can stay up to two years. Without this, she said, “all you do is go back to the park and repeat.”
Drug addiction recovery programs are available, according to Victor King, a recovery coach with Mental Health Partners who has experienced homelessness, but the process isn’t straightforward.
In certain situations, for instance, someone who is arrested may be ordered by the court to sign up for certain services, such as getting medication-assisted treatment at the Boulder County Jail. Others may land a spot in a sober living program, such as Harvest Farm in Larimer County or Fort Lyon in Bent County. Ultimately, he said, getting into “housing is going to be the crucial long-term piece.”
King sees seeking treatment as a choice. He mentioned this year’s homeless memorial as a potential motivator.
“If you don’t react to that, then you’re making a choice. When you see the people that have passed away each year, are you going to sit there and blame the system?” he said. “There are people waiting to engage with you when you’re ready to take that step.”
‘We self-medicate’
When asked about treatment options, several homeless people interviewed seemed uninterested. Some people who were smoking substances declined to share their names with Boulder Reporting Lab due to concerns about self-incrimination.
One person, smoking methamphetamine under a bridge on the multi-use path, said he uses it for focus, similar to how people use Adderall and other prescribed medications.
A woman who was smoking fentanyl downtown said she has been addicted for about two years. If she doesn’t smoke it, she said, she feels sick. “When you get high, you just get normal.”
She said she carries naloxone but did not have test strips. She has overdosed, she said. And she went to Mental Health Partners’ detox center for two days. She said it felt like jail, but the food was better. When she got out, she returned to downtown Boulder.
“There’s nowhere else to go,” she said.
A man who said he also smokes fentanyl said he uses it in moderation. He, too, has overdosed. He’s Black and said people told him his face went white. He has also administered naloxone on others.
“Somebody’s life, whether I know them or not, is thrust into my hands,” he said. “That’s when everything hits home.”
Several people said they know people who use fentanyl for depression or pain.
“We self-medicate,” said Anoana Kozlava, 33, who said she was previously addicted to opiates and is now living out of her car in Boulder. “Physical pain. That’s a way people get addicted to this drug. That’s how I got addicted.”
Buprenorphine, a medication to treat opioid addiction, is generally considered to be underprescribed. Many people use fentanyl in addition to other substances, such as methamphetamine, complicating their treatment.
City officials said they found people selling fentanyl pills for as little as $1 per pill. For some people, the affordability complicates matters further.
“We get on drugs so we can survive,” Echo Star, 35, said while he was waiting for the bus to head to the Boulder Shelter for the Homeless. “It’s actually cheaper to stay on drugs and not eat.”
‘It’s up to us’
The city is working to reduce the flow of fentanyl into Boulder by targeting distributors.
But according to City of Boulder Detective Sergeant Patrick Compton, who works as a supervisor with the Boulder County Drug Task Force, investigating overdoses to locate a dealer is a resource-intensive process.
During an investigation, officers interview people who were on the scene, review surveillance and traffic camera footage, and obtain warrants for phone companies, iCloud accounts and Lift or Uber accounts. Oftentimes, he said, the fentanyl is sold from one person to another multiple times before someone consumes it and overdoses.
“It takes a lot of working backwards in time,” Compton said. “It is quite the undertaking.”
Guggenheim said he and others who sleep or congregate in Central Park keep an eye out for people selling fentanyl. He said he looks for people walking or biking around with a backpack. Once the dealer is located, they are forced out of the park, he said. He declined to share details.
Guggenheim compared the regulation of fentanyl to enforcing a speed limit. Some amount is okay. He just wants to make sure people are not dying.
“It’s up to us,” he said. “We’re holding it down.”
Update: This story was updated on Feb. 1, 2024 with a more current figure for the number of beds in MHP’s transitional residential treatment program.
With all due respect, there isn’t any credible or current data to remotely suggest that housing-first reduces substance use disorders. However, there is credible, relevant data to show that housing-first increases isolation and depression.
While people may argue that housing ends homelessness, they fail to acknowledge that the intersection between homelessness, the criminal justice system, and addiction has grown more prevalent over the past several years. So much so that substance use disorder, mental health conditions, and criminal justice involvement, along with other key “acuities” serve as the prioritizations in place to determine who we are housing and who we aren’t. I’d add that the entire housing-first system has not adapted to its growing intersections with the criminal justice system, addiction, or mental health, let alone the tremendous and costly harm that the influx of meth presented the housing-first system.
Placing people with addictions and other concerns directly into housing without interventions to address their concerns certainly doesn’t set the person up or their neighbors for a successful landing or outcome.
If HUD is going to continue to support housing first as a best funded practice, states, counties, and localities have little say in whether or not they participate. They can’t afford not to. However, they can be advocating the need to expand support services to adopt a treatment focus and create access to outpatient treatment care, Medicated Assisted Treatment (MAT), in-home clinicians, peer support, and improve the 15 to 1 client case management ratio. Of course, this is just for the small fraction that are placed into apartments via housing-first. What about the bulk that linger outside, some waiting ilon housing lists that can take years to come to realization? They’ve been left in the cold with cheap to free meth and fentanyl with zero treatment in sight, beyond a two night stay at the detox and a return right back to where they came from. Using the detox phone to call a long list of programs scattered through the state only to be told it’s a six week to six months wait-list, sometimes even longer. Nowhere to gain the required clean time to tap into longer inpatient treatment programs like Fort Lyon (a two year sober transitional housing program in Southeastern Colorado) or the Farm (an all male program that lasts about 9 months.)
We’re in a drug crisis that’s killing 200 people a day across the country and it’s here in Boulder and disproportionately harming our homeless population. We can’t rely solely on Narcan and resort to leaving people that are revived in a park. People that want treatment should have a place to go beyond two nights at the detox. We need a 30/90 stabilization program that leads to a two year transitional housing program or else we are failing in tremendous ways.
It’s crazy sad to realize how people are quite helpless in the face of fentanyl. Interesting how an interviewee said that they patrol for fentanyl dealers and make them leave Central Park. Jen’s wisdom speaks volumes about the need for treatment. And I thank John Herrick and BRL for covering this issue. I’m extremely grateful for this coverage of the actual news.
Spot on. Revolving door.
As Victor King points out, treatment, let alone recovery, is a personal choice. Those who struggle with recovery, despite going through all the programs, know that well. People who are housed abuse substances as well. That is considered acceptable – until they die from an overdose or complications. People who are unhoused understand the consequences of drug use, and it takes a commitment to choose a different path. Not that many people who are homeless in the park are going to choose treatment. Perhaps we should have permanent supportive housing for serious substance abusers with onsite case management.
Nothing about “treatment first” adds up, though. Is everyone doing fentanyl or meth to survive the pain and discomfort of homelessness supposed to be forced into treatment and then into two year transitional sober living program? How does that work? Have police nab them off the streets for misdemeanor drug use, and then what, forced treatment? What people need, in addition to housing, is genuine long-term healthy support systems and networks (like everyone else who manages to thrive in society) to integrate them successfully into life off the streets. That takes a lot of different people coming to the table, not a one size fits all approach to substance use and addiction. We need more options for treatment, but forcing people into treatment they do not want is not doable or likely to succeed.
Well said, Roxanne.
Hello, Roxanne, thanks for your comments. I continue to feel that housing first is just a waste of taxpayer dollars: free & subsidized housing with no strings will just become infested with meth and will cost thousands for every apartment to be sanitized (before it happens again). Jen–see her comments above–has the lived experience to show us the way, namely that these folks need treatment before they get an apartment. I very much like her approach and her emphasis on “the need to expand support services to adopt a treatment focus and create access to outpatient treatment care, Medicated Assisted Treatment (MAT), in-home clinicians, peer support, and improve the 15 to 1 client case management ratio. Of course, this is just for the small fraction that are placed into apartments via housing-first. What about the bulk that linger outside, some waiting on housing lists that can take years to come to realization? They’ve been left in the cold with cheap to free meth and fentanyl with zero treatment in sight, beyond a two night stay at the detox and a return right back to where they came from. ” Thanks for reading!
Nowhere in my comments did I say or insinuate a treatment first approach. With that said, we are using certain factors to determine who gets housed and who doesn’t, which includes SUD. For the minority of the homeless who are actually getting housed through housing first annually, the only support they can expect is a case manager with 14 other clients and possibly peer support. No support for treatment. How is this remotely logical, especially considering we are in a DRUG crisis? We can’t leave out the bulk of homeless waiting years for housing and those that aren’t service engaged who are struggling with SUD. Don’t you think they need a place to go besides the park when they have a moment to seek recovery?
Don’t you think a sober transitional housing program beats the park or an apartment overdosing, sometimes dying? Given the scarce resources and the mere fact that Boulder will never house every homeless person here, wouldn’t creating programming that offers recovery, access to person-centered support, and a familiarization to life skills and good housekeeping, access to job training, employment and educational pathways would increase self-sufficiency, at least in room shares? Denver Metro shot Colorado to the top five of the highest homeless populated states in the country. Half of our renters are already cost burdened. The elderly now are one of the fastest demographics slipping into homelessness. Treatment is the only possible solution to addiction and we need to adapt to reality.
You’ve repeatedly stated on NextDoor that ALL city funding for homelessness should go to treatment, and all other projects are a waste of time (because addiction is what is of interest to you). But you are painting all the unhoused with the same brush. They are not all addicts in need of treatment first, and two year treatment at that, before they can be housed. First of all, maybe 25-30% tops, mainly of the unsheltered, that fit that description of seriously addicted. So ALL resources must be funneled to this segment of the unhoused population, most of whom would not volunteer for treatment, and are not committing crimes beyond misdemeanor use? How do you plan to force them into it? But I do agree, along with almost everyone else, that more addiction AND mental health treatment is needed. There are many people working at the state and county level to try and make it happen.