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Amid rising overdoses and encampment sweeps, a quiet public health strategy gains ground
Just after dawn, a van pulls up beneath a freeway overpass in West Oakland. Inside, staff with the HIV Education and Prevention Project of Alameda County, or HEPPAC, prepare for the morning’s work. They are part of a mobile harm reduction team distributing clean syringes, fentanyl test strips, and naloxone, the overdose-reversing medication better known as Narcan.
Scenes like this rarely make headlines. But to public health experts and outreach workers, they represent one of the most effective responses to the intertwined crises of opioid use and homelessness: meeting people where they are, with dignity rather than discipline.
“Bringing the services right to where the people are at, that’s what our bread and butter is,” said Braunz Courtney, executive director of HEPPAC to ‘The Street Spirit.’
When the Supreme Court case Grants Pass v. Johnson raised the question of whether cities can punish people for sleeping outside, the underlying assumption was that punishment deters homelessness. But in Alameda County, a growing number of public health and housing programs are offering a counter-narrative to punishment: one rooted in care, not criminalization.
At the center of this effort is the Overdose Prevention Education and Naloxone Distribution (OPEND) project operated by HEPPAC and funded through Alameda County’s voter-approved Measure A. The program trains outreach workers, case managers, and housed community members in overdose prevention.
Since its launch, OPEND has trained more than 500 people and 47 organizations. According to HEPPAC, at least 137 overdoses have been reversed using OPEND-distributed Narcan, nearly 70 percent of which involved unhoused individuals.
Alameda County has also leaned into a “Housing First” strategy, converting motels and unused buildings into supportive housing with wraparound services like mental health counseling, addiction treatment, and job placement. Residents aren’t required to be sober before moving in, a critical departure from traditional shelters, which often exclude those actively using drugs.
One such site, OakDays, operated by Cardea Health and Five Keys, has delivered striking results: a 78 percent drop in emergency department visits and hospital admissions, and an estimated $3.5 million in savings within its first six months.
“We’ve successfully housed many of those folks who had cycled previously, out of the hospital, to the street, to a nursing home, to jail, back to a hospital,” said Catherine Hayes, a nurse practitioner and cofounder of Cardea Health, in an interview with KQED.
For Vera Salido, one of OakDays’ residents, the impact has been life-altering. “My physical and mental health are so much better,” she said to KQED. “This place is like Disneyland. It’s just a huge difference. Feeling safe when you close your eyes is a big, big deal. I never felt safe on the streets.”
Grassroots groups are also stepping in to fill critical gaps. Punks with Lunch, a mutual aid group, and HEPPAC’s mobile units provide daily outreach across encampments, offering supplies, information, and what many describe as something rarer: consistent human connection.
These interventions, long supported by public health literature, have growing clinical backing. “Harm reduction and treatment are like part and parcel of each other,” said Dr. Ayesha Appa, an assistant professor of medicine at the University of California, San Francisco, to KQED. She said that for one of her patients, “having relationships with people who are offering safer-use supplies allowed him to feel valued and then think, ‘I’m worth something. I can do this.’”
Despite such evidence, programs like OPEND and OakDays remain exceptions, not the rule. Many parts of Alameda County still funnel unhoused residents into abstinence-only shelters, many of which are underfunded and operate with rigid requirements. Miss a rule, and you’re out. Use drugs, and you’re banned.
Hospitals, too, discharge overdose patients back onto the street with minimal follow-up. For many, the result is a revolving door: from encampment to ER and back again. For people on the streets, the difference between criminalization and care is often a matter of life or death.
The evidence is clear: Housing-first programs, harm reduction outreach, and peer-led care not only save lives, but also cost less in the long term than repeated incarceration or emergency response.
Most city budgets, including Oakland’s, still devote far more to police enforcement and encampment sweeps than to prevention and treatment. If we know what works, why do we keep investing in what doesn’t?
This article was written as part of a program to educate youth and others about Alameda County’s opioid crisis, prevention and treatment options. The program is funded by the Alameda County Behavioral Health Department and the grant is administered by Three Valleys Community Foundation.
