Substance use and overdose are an increasing community health concern across the city of Denver. The DDPHE Community & Behavioral Health division is home to the Overdose Education and Naloxone Distribution Program, which aims to prevent substance use, improve treatment access and retention, and reduce harm associated with drug use.
Explore the information below to learn more and see what resources are available to the community.
Fatal and non-fatal overdoses are preventable. Harm reduction strategies to prevent overdoses vary a bit by the specific type of drug, but generally include using less, testing your drugs, using a less risky method of administration, and not using alone. For opioids, naloxone can be used to reverse the effects of an overdose.
The video below describes how to identify and respond to an opioid overdose using naloxone. Additional information regarding opioids and overdose prevention can be found further down on this page.
View an accessible version of the above graphic(PDF, 161KB)
Opioids are pain relievers, which include opioid analgesics (prescription painkillers), heroin, and fentanyl. Examples include: methadone, oxycodone, hydrocodone (Vicodin), and morphine.
Opioids work by binding with opioid receptors in the brain to:
- Relieve pain
- Relieve withdrawal
- Produce feelings of mental and/or physical comfort
- Cause side effects such as constipation, drowsiness, and respiratory depression
Opioids are NOT:
- Stimulants such as cocaine, crack, or methamphetamines
- Benzodiazepines such as valium, Xanax, klonopin
- Alcohol
- Muscle relaxers
- Sedatives, such as xylazine or ketamine
Note that some non-opioids, such as cocaine, have been found to contain fentanyl (an opioid) in Denver. Therefore, DDPHE encourages anyone who uses illicit substances such as pressed pills and stimulants and/or may be in the position to respond to an overdose to carry naloxone, regardless if they intend to use an opioid.
What is Fentanyl?
Fentanyl is a powerful synthetic opioid that is up to 50 times more potent than heroin and 100 times more potent than morphine. Therefore, overdoses happen faster and are harder to stop. It comes in pills, pure powders, and powder mixed with other drugs. It cannot be seen, tasted or smelled when mixed into other drugs.
Be careful!
It is important for people who use drugs to know there are ways to reduce their likelihood of overdose:
- Don’t use drugs alone. But if you do, let someone know you’re using, so they can check in.
- Fentanyl kills quickly, Naloxone can save a life. Always carry naloxone or make sure those around you do. Naloxone can reverse an opioid overdose.
- Avoid mixing drugs: mixing opioids with alcohol and/or benzodiazepines (such as Xanax, Valium, and Klonopin) increases overdose risk.
- Test the potency of your drugs. This harm-reduction technique encourages you to use less than your normal dose to test potency and strength. This could mean injecting or snorting a smaller amount, or breaking off a piece of a pill.
- If you think it’s an overdose, call 911. Every minute counts.
The presence of fentanyl has led to epidemic levels of overdoses in other parts of the country, including New York City. According to NYC Health, fentanyl was the most common drug involved in overdose deaths at 57% in 2017, with no sign of decreasing.
Denver experienced 209 drug-related deaths in 2018, and as of September 2019, we have endured 77 drug-related deaths. The majority of drug-overdose deaths in Denver involve multiple substances: 64% of drug- related deaths involved three or more drugs in the deceased’s system and 28% involved five or more drugs.
Opioids include strong prescription pain relievers, such as:
- Oxycodone
- Hydrocodone
- Tramadol
- Morphine
- Codeine
Addiction is a disease. Recovery is possible and available.
Denver is focused on preventing substance use, improving treatment access and retention, and reducing harm. By concentrating on prevention, removing barriers to essential support services, and making treatment more readily available, we can reduce unnecessary deaths and the impacts of opioid addiction on our community.
Learn the facts about fentanyl(PDF, 382KB) .
Xylazine is a veterinary tranquilizer, that is not for human consumption. It has been linked to a growing number of overdose deaths across the country. The Denver Police Department has found xylazine mixed with fentanyl in Denver’s drug supply.
Because xylazine is not an opioid, naloxone will not reverse its effects. Still, experts always recommend administering naloxone if someone might be suffering from drug overdose since xylazine is typically cut into illicit opioids. The naloxone will work to remove the burden of the opioids on the body, and while the xylazine will still be present, this can decrease the risk of fatal overdose.
Xylazine causes breathing to slow down or stop (respiratory failure) so giving rescue breaths (one breath very 5 seconds) in between naloxone doses is necessary.
People who inject drug mixtures containing xylazine also can develop severe wounds, including necrosis—the rotting of human tissue—that may lead to amputation. Wounds can develop in various places on the body from consuming xylazine in any manner (including smoking), not just the injection site. It is important for people to access wound care, and tend to wounds as much as possible to decrease the spread of the infection and avoid amputation.
View an accessible version of the above graphic(PDF, 87KB)
Opioid overdoses happen when a person takes too many opioids or a combination of opioids and other drugs that lead to respiratory depression, or slowed breathing.
If a person is not breathing enough, oxygen levels in the blood decrease. The lack of oxygen eventually inhibits the function of other vital organs including the heart and the brain. This can lead to unconsciousness, coma, and ultimately death.
This process is rarely instantaneous; respiratory depression can last over the course of minutes to several hours after the drug was used until a person stops breathing completely. This means there is usually time to intervene between when an overdose starts and the person’s death.
The window to respond to an overdose may be shorter with other synthetic opioids. It is also important to note that certain medical conditions can impact someone’s respiratory function.
Risk Factors for an Overdose
Changes in Tolerance:
- Tolerance is how your body adapts to regular use of a drug over time.
- If someone has not used the drug for a long period of time their tolerance will decrease, meaning that the next time they use the drug they will be highly impacted and at an increased risk of overdose.
- Individuals who have abstained from drug use for any reason—possibly due to isolation and inconsistent access to drugs, being incarcerated, detox, or rehab that require abstaining from drug use—are at increased risk of an overdose.
Mixing Drugs:
- Research shows that most drug overdoses involve poly-drug use, the use of multiple drugs.
- Central nervous system (CNS) depressants such as alcohol, benzodiazepines, and opioids can increase someone’s risk of experiencing an overdose when mixed.
Drug Quality:
- The strength and purity of drugs purchased off the street and online are unknown.
- Unpredictable changes in drug quality, purity and strength may occur.
Previous Non-Fatal Overdose:
- Research shows that once someone has experienced a non-fatal overdose, they are at higher risk to experience another overdose in the future.
Using Alone:
- While using a substance alone is a not a risk factor for an overdose itself, it puts the person at a higher risk for a fatal overdose because there is no one there to respond if they lose consciousness, to call 911, to administer naloxone, or to help in any way.
How to Reduce Risk
- Be careful if you take a break or miss doses, use less, go slow
- Go slow/do a slow shot, make an overdose plan, have a phone on hand to call 911
- Assess for risk, carry naloxone
- Use with someone else, take turns; it's important to have someone to help
- If using alone, resources like Never Use Alone (877-696-1996) are available
- For those who are ready, medication assisted treatment (MAT) with methadone or buprenorphine
Use of any opioids can put someone at risk!
View an accessible version of the above graphic(PDF, 109KB)
Naloxone is a medication that reverses opioid overdoses by blocking opioid receptors, which prevents opioids from binding to them. It will have no impact if an overdose is not opioid related.
Naloxone is available in the form of a nasal spray, as well as an intramuscular injectable form. DDPHE distributes the intranasal spray naloxone under the brand name Narcan.
There are no negative side effects of using naloxone and no potential for misuse or dependence. However, naloxone may put a person dependent on opioids into withdrawal, which can be a very painful and uncomfortable experience.
As of March 2023, naloxone is available without a prescription from participating pharmacies and is often covered by medical insurance plans. Explore an interactive map of locations where you can find naloxone at
Stop the Clock Colorado
There is no cost, co-pay or prior authorization for Health First Colorado Recipients. Let the pharmacist know you are a Health First Colorado member.
Denver Resources
City & County of Denver residents have access to three syringe access/harm reduction providers within the city that provide a wide array of services that promote the health and wellness of people who use drugs, including naloxone.
If you are a person who uses drugs needing access to the services these program provide, please contact visit the programs below:
Additional naloxone distribution locations include:
Syringe and Medication Disposal
Denver Public Health & Environment (DDPHE) recently completed the installation of four sharps disposal kiosks to address the issue of discarded syringes in public spaces.
Find a kiosk & learn more
Syringe Access Programs
Syringe access programs (SAPs) are evidence-based interventions shown to reduce the transmission of HIV and hepatitis C (HCV) and do not increase drug use or crime. They meet people where they are to provide an array of services in a safe, anonymous setting. SAPs provide access to healthcare and treat people with dignity and respect, no matter where they are at.
View the 2023 Denver Syringe Access Program Needs Assessment
SAPs have many benefits including:
- creating opportunities to engage people who use substances and linking them to services,
- they are shown to be safe, effective, and cost-saving,
- they are associated with a 50 percent reduction in HIV and HCV incidence, and
- they provide a source of community connection through advisory groups, education classes, activities, community cleanups, and more.
Participants of SAPs are:
- more likely to safely dispose of needles,
- more likely to reduce or stop injecting, and
- five times more likely to access treatment for substance use.
Recent increases in fatal and non-fatal overdoses, and changing drug supply, have identified an additional need to promote the use of these programs to provide overdose education and naloxone to individuals who use substances but do not inject.
Programs provide a variety of services including:
- Access to sterile syringes and syringe disposal.
- Injection supplies such as cottons, cookers, waters, tourniquets, sharp containers and more.
- Overdose prevention education, including access to naloxone.
- Referrals to substance use treatment and resources for people who want to reduce or eliminate drug use in their life.
- Linkage to care and referrals to HIV and hepatitis C care.
- Harm reduction counseling and substance use education.
- Fentanyl Testing Strips.
- Wound care education.
- Other harm reduction supplies to reduce the impacts of drug use.
- Safer smoking and snorting supplies such as sterile pipes and multicolored straws to avoid sharing.
Currently, there are three syringe access programs in Denver.
- Access Point: A program of Colorado Health Network and provides services 4 days a week at 936 E 18th St. and provides mobile syringe access services throughout Denver | Walk-in Service Hours: Monday- Thursday 1-6 p.m. | 720-994-2403
- The Harm Reduction Action Center: Operates 5 days a week at 112 E. 8th Ave. and provides mobile syringe access services via street outreach 3 days a week. | Walk-in Service Hours: Monday- Friday 9 a.m.- 12 p.m. | 303-572-7800
- Lifepoint: A program of Vivent Health that provides mobile syringe access services throughout Denver four days a week (and at least one Saturday a month) | 720-385-6898
For People Who Use Alone
Because many individuals use substances when alone, there are resources available to ensure someone can respond to a potential overdose. Visit: neverusealone.com to receive anonymous support from a volunteer when you use your substances.
Wellness Winnie
What is Wellness Winnie?
- Wellness Winnie is a “fun size” RV, with scheduled travel route through Denver for the purpose of providing integrated behavioral health and support services.
- Wellness Winnie exists to empower all people in Denver to live their healthiest life and to increase equitable access to resources, helping the community to thrive.
- Wellness Winnie is staffed with mental health counselors and peer navigators. Through shared experiences, peer navigators are skilled to support recovery and mental well-being.
What does Wellness Winnie currently provide?
- Peer support and navigation
- Informal classes and presentations
- Sharps disposal
- Behavioral health screening and assessment
- Active referral to services such as: medical, legal, and social services
- Distribution of items such as: socks, gloves, toiletries, etc.
- Rehydration and cooling from the heat
- Warming from the cold
- Narcan distribution and overdose education
For more information about Wellness Winnie or to locate a stop near you, please visit our Wellness Winnie webpage.
Drug Checking Resources
Other harm reduction strategies include testing your substances for the presence of fentanyl or xylazine prior to use. Remember, no test is 100% accurate and user error can happen. Always try to follow the classic harm reduction tips: go slow, never use alone, and carry naloxone
Because drugs purchased on the street can contain unknown substances, it is important to test drugs before using them.
DanceSafe is an organization that promotes health and safety within the electronic music community. They provide a number of resources. They also offer fentanyl test strips for purchase.
UNC Street Drug Analysis Lab anonymously tests substances. Testing result data is available on their website.