As the state of Utah funneled hundreds of thousands of taxpayer dollars to a private surveillance company building unproven technology to fight the opioid crisis, public health officials asked if the money could instead be used to buy a life saving drug that stops potentially fatal overdoses, Motherboard has learned.
The money, which Utah gave to a company called Banjo via the state's Department of Health, in this instance totaled $250,000. Emails between the Utah Department of Health, the state's Attorney General's office, and the Drug Enforcement Agency obtained via public records request show that the Department of Health asked if some of the money allocated to Banjo via a program called DEA 360 could be used to buy naloxone (sometimes sold under the brand name Narcan), a medication used to counter the effects of an opioid overdose. The Department of Health said it was facing a funding shortage that would result in a gap in its naloxone supply and believed the money allocated to create an unproven AI would be better spent on the overdose-stopping drug.
"I wanted to follow up regarding the remaining funds for DEA 360 ($250,000)," Anna Fondario, who manages the Violence & Injury Prevention Program at the Utah Department of Health wrote in a March 2019 email to Brian S. Besser and Ciara Gregovich at the DEA and the Utah Attorney General chief of staff Ric Cantrell. "We previously discussed having the AG's Office invoice us for BANJO related activities. Is this still the case?"
Fondario added: "If not, we've identified a need for an additional supply of naloxone kits to cover a potential two month gap before other funding is available for kits, Would you be interested in using some of this funding for naloxone?"
Later that same day, Besser forwarded Fondario's email to Cantrell and Gregovich, saying: "I want these funds (the whole $250K) to go to Banjo … I thought this was already in progress?"
While these funds were not specifically earmarked for the purchase of naloxone, the news shows how governments spend vast amounts of money on private, for-profit companies developing unproven and untested policing technologies while failing to fund projects that pay for medication that can save the lives of people caught in the country's opioid crisis.
In an interview, Fondario said that the Department of Health's ongoing opioid state funding is "very minimal," totaling $250,000 a year for its opioid efforts. She said the Department of Health also gets federal funding, but that it's not allowed to purchase naloxone with that money, which is why it relies on state funds. She said the Department of Health buys intranasal naloxone kits for $75 each. So $250,000, for example, would buy roughly 3,333 naloxone kits. According to a September 2019 report, the Utah Department of Health can currently purchase only 504 naloxone kits per quarter, or 168 kits per month, far below the number of naloxone requests it receives.
"We developed an open-application system so that agencies that needed naloxone could go into the website and apply—there are questions we ask to help prioritize and understand what the need is—but we’ve started getting more demand than we have supply, so we had to scale back how we were disseminating naloxone," Fondario said.
According to the report, 8,040 naloxone kits have been disseminated in Utah (including kits purchased by individuals and organizations), which resulted in 255 known cases where they have saved lives. Fondario said the Department of Health was later able to get a small amount of money from another state agency to survive the funding gap.
"Naloxone is an essential part of our overdose prevention strategy, it should be a part of any community’s overdose prevention strategy," Dr. Sheila Vakharia, deputy director of the Drug Policy Alliance's Department of Research & Academic Engagement, told Motherboard. "It’s absolutely necessary to prioritize the interventions we know work—naloxone is one of those things."
And yet, significant sums of taxpayer money continue to be spent on technology intended to point law enforcement to opioid users without necessarily helping them.
In 2018, Utah's Legislature wanted to give $500,000 to the Drug Enforcement Agency to support its 360 Program, "a comprehensive approach to tackling the cycle of violence and addiction generated by the link between drug cartels, violent gangs, and the rising problem of prescription opioid and heroin abuse in Utah."
Since federal agencies like the DEA can't receive funds directly from states, Utah gave the money to its Department of Health, which could then "disseminate funds supportive of DEA 360 goals." The Utah Department of Health spent $250,000 of those funds transporting 5,000 Utah high school students to participate in the Opioid Solutions Summit, a joint effort by the Utah Attorney General’s Office, Utah Senator Mike Lee, and the DEA, where Banjo's CEO and founder Damien Patton was one of the speakers. The other $250,000 was given to Banjo to build an "opioid module" and "heat map" for its "live time intelligence" product to support the DEA 360's program goals.
Launched in 2015, the DEA's 360 strategy aims to address the opioid crisis with law enforcement and community outreach. The DEA funded Salt Lake City as a DEA 360 city in late 2017 and then extended to the entire state, according to DEA 360 impact report.pdf) from June 2019.
The same DEA 360 impact report describes Banjo as a DEA 360 partner, and explains how the company's Live-Time Intelligence platform can help with opioid misuse prevention.
"With partnerships across key sectors and better access to data, this technology can potentially track clusters of drug overdoses in real time, based on various data signals," according to the report. "The local health departments could then be notified about the trends observed and respond appropriately, deploying resources or alerting partners, such as Utah Naloxone, to provide outreach immediately to individuals in need."
Utah Naloxone, an organization in Utah that also distributes naloxone to communities there, did not respond to a request for comment.
“From a technology standpoint, it was literally about unsiloing the data sources between all of these entities who normally don’t share data," an unnamed "community partner" is quoted as saying in the report. "So the biggest issue I see with the opioid crisis is that we don’t understand where the crisis is right now."
But the Utah Department of Health currently provides a public opioid dashboard which tracks annual opioid deaths, opioid-related emergency department visits, how many naloxone doses were distributed, and more.
In a recent presentation by the Utah Opioid Task Force, Fondario said the Utah Department of Health is "almost ready" to roll out an internal dashboard that local health departments can use to see "almost real time data" on overdoses presented at emergency departments, whether naloxone was disseminated, and a "drug overdose trendline."
"This is to help us make sure we're keeping track of this data and responding if we see anomalies," Fondario said. "Each of the local health departments will be working with their communities to help share this data to make sure they're ready for a response in the event we do see an overdose cluster or spike."
Fondario told Motherboard that the Department of Health met with Banjo a couple of times to try to understand what the company was building but that it "did not feel it would be beneficial for the Department of Health. We didn’t understand how it would be helpful for us with the opioid problem."
Fondario noted that the public dashboard includes a link that lists the Department of Health's principles for using opioid surveillance data.
These principles note that "public health surveillance should provide information that is actionable by those who provide services to people who use drugs and their friends and family members to reduce harm, including the harm of arrest and incarceration, infectious diseases, and overdose." It also explicitly notes that "public health surveillance data should not provide information to law enforcement that will lead to the arrest or incarceration of people who use drugs or of people with whom they associate, including those who witness an overdose."
Ric Cantrell, chief of staff for Utah's Attorney General, said in an interview that Banjo is still building its opioid module and heat map, but described how it would be used.
"If we have an outbreak in West Valley City, a new batch of chemicals from Mexico or China or wherever, I want to be able to put law enforcement resources there, divert more undercover officers there, and stop it before everyone's died," he said. "So Banjo is working on a heat map where they can tell us emergency room visits, morgue visits, naloxone use."
Cantrell also noted that Banjo's opioid module could help with recovery efforts.
"What beds are open and where for addiction recovery. Salt Lake County is actually using the bed side of it right now and then they're still building the modules to build up to the actual heat map," he said.
"I really can’t speak to what the goals of the DEA 360 projects were and what they felt like were their gaps and how they wanted to best use that funding, just what the Department of Health perhaps would have prioritized, because dealing with the opioid epidemic you have to have comprehensive efforts," Fondario said when asked if she thought the $250,000 Utah gave Banjo via the Department of Health could have been better used elsewhere. "There’s so many different agencies working on this with different priorities. So while our priority might be different than the DEA's or attorney general’s, I couldn't say ours is more important than theirs."
Vakharia said that "there’s no evidence that funding a heat map would be the best use of resources and energy. And rather than giving this information to the DEA, it should be given to health officials who can provide naloxone, sterile injecting equipment, and to be there as a referral resource for people who need it."
Additional reporting by Joseph Cox.