Crisis Response Podcast Episode 8 Opioid Overdoses in Vancouver Brave Co-Op

Episode #8: Opioid Overdoses in Vancouver | Brave Co-Op

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Episode Transcript

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Jason: Hello Gordon, welcome to the Crisis Response Podcast, it’s a real pleasure to have you, where are talking to you from today?

Gordon: I am in Vancouver, Canada.

Jason: So tell us about Brave Co-Op. What does Brave do and how did you get started?

Gordon: So Brave is the Brave Technology Co-Op for long, and we’re focused on overdose detection. So that moment when somebody who’s using drugs is most at risk of having an overdose, when they’re actually consuming, we have a couple of different tools that will be connected to them so that if they do overdose, we can get help to them immediately.

Jason: That sounds like some truly lifesaving technology. How did you come to decide to start Brave and get involved in this type of response?

Gordon: I was living in the Caribbean and noticed that the 911 response, not actually 911, but the emergency response there wasn’t functioning at a hundred percent, and I discovered as I was looking for options to improve that, that their carousel was not unique in having this issue.

So then in the course of trying to find ways to activate community response, I was looking at the number of different issues that were sort of falling through the gaps as it were. And around that same time we moved to Vancouver. This was 2016, and that was when fentanyl was really ramping up in the drug supply here in Vancouver and the numbers of overdoses were reaching then record numbers. As I asked questions about what tools that could activate community response for emergency or life-threatening situations would be best, people responded saying that the most pressing concern here and pretty much across the country and across North America was to activate some kind of overdose response.

Jason: So then you dove right in?

Gordon: I started talking to drug users and saying, you know, we have this idea that technology could be of use. I took a bit of a step back from the ideas that I had around what the solution might look like, well I did that after a bit of a learning curve, I wasn’t smart enough to do that immediately, but I asked these people what could tech do, and did they think it had a place?

And what I learned and what people who use drugs hammered into me was that most folks who are using alone are really, really likely to die if they overdose. And furthermore, very unlikely to have a friend who finds them call 911. If they find them, they may call, but they would like to call for community help first and foremost. And while the numbers have changed over time, at one point in time it was as high as 85% of overdoses were being responded to by non-EMS personnel, non-emergency service personnel.

So then the mission became to develop and design tools with the people who would use them so that if you use alone and you overdose that somebody will know about it and then Brave will take care of the bit where we connect that to some kind of response, both community response and emergency response.

Jason: What tools did this lead you to develop after doing some really immersive hands-on research and development?

Gordon: We’re lucky in Vancouver that we have legally sanctioned and supervised consumption sites. They take a lot of different forms, but there’s a lot of places here where people who are consuming illicit drugs like heroin, and almost anyone can go and be observed and be in a safe place where peers, volunteers, nurses, a whole swath of people will be there to look after them. Not just if they overdose but including if they were to overdose.

We tried to just take that model because we know it works and we know that the community is familiar with it and just replicate that in the form of an app. So the app is really remote supervised consumption. Somebody gets on a call with another human being, they tell them what they’re consuming, they tell them what they expect their experience to be, and together those two humans figure out what the rescue plan is going to be for that person if they become at risk of an overdose. They enter that information into their phone on their side, and we don’t see that, it remains confidential and private to them unless and until they become unresponsive, at which point our side of things or the supporter will send a ping through to their and say, “please release that information to me.” If there’s nobody to stop that from happening on their side, like if they are alerted that the information’s going to be released and they don’t cancel that release, then we see where they are, if they are comfortable with 911 response or they only want a community response, and we immediately initiate that rescue.

Jason: I can imagine that in the United States and even too in Canada you experience some pushback. Can you talk about what kind of pushback you get and how you respond to it?

Gordon: Yes, so you’re spot on. A lot of pushbacks, and not just in the States, even here in Vancouver, which some people call the harm reduction capital of North America, people here have concerns and they’re legitimate concerns, right? I get that.

So might somebody use the app who might have otherwise used a safer alternative and now you’ve got greater risk of overdose if something goes wrong? And as you know from your work in this space, Jason, like things can go wrong with technology. Human error is huge, but technological errors exist as well.

So a phone battery might die. A connection might fail at the exact moment when you’re trying to send information across the technological line. And as you know, most of our work after building the initial thing is trying to ensure that none of that happens to the extent that it’s within our control. That everything that could go wrong does not go wrong, that we have alerts when things start to go wrong so that we can mitigate against those, et cetera, et cetera.

So some of the concerns that people had were on that caliber, you know, why we would want to move forward with something that is a remote service when there is a real service. And of course the answer to that is that not everybody has access to the real service, right? So even in a place like Vancouver, which has dozens of supervised consumption spaces, those are not accessible to everybody. Furthermore, if it’s three o’clock in the morning there’s only one or two that you could use.

You know, if it’s lashing down rain and it’s three blocks to get to the nearest location, three blocks sound really close when you don’t have a single supervised and legally sanctioned consumption space in your entire country, but that’s really far if it’s lashing rain and you’ve got your drugs and what you want to do is actually just settle in and consume them and get on with your life.

Those arguments pretty much disappeared after Covid because, A) the number of overdoses went flying through the roof. But also B) because the concept of remote telehealth just became suddenly completely okay with everybody, including health authorities.

Then, on the more philosophical objections to what we’re doing, those tend to not actually reach us to be honest. We are somewhat sheltered from that due to the nature of the work that we’re doing. We don’t hear a lot from people who think that tools like this or the existing physical infrastructure around supervised consumption might be inappropriate or might be enabling or might increase the number of drug users in your community or something along those lines.

Furthermore, you know, the reality of technology and a tool like this where it can be used by people from the safety and privacy of their own homes means that we don’t actually trigger a lot of those concerns. Which is not to say that we think we’re better, but folks are strangely more comfortable with the idea of a technological solution, which is less in the face of constituents and not as politically or philosophically difficult for people to handle or understand why it might be useful to their community.

Jason: So that’s a really interesting take on “not in my backyard.” If they know it’s happening in their backyard, they could be opposed to it, but if they don’t know that it’s happening in their backyard, then no harm no foul.

Gordon: Or almost have plausible deniability, in a sense. Like they can have some kind of defense against it.

Jason: Wow, yeah, I had never considered that. So when you and I first met, it was back when the FDA had put out that contest, or challenge, to find innovative mobile technologies to alert bystanders when someone had witnessed an opioid overdose. I think it was in 2016?

Gordon: Yes, 2016 or 2017.

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Jason: We were talking about the problem of unwitnessed overdoses, right? Because witnessed overdoses versus unwitnessed overdoses have different solutions for actually detecting and reporting the overdose.

A witnessed overdose is convincing people that they need to send for help if they don’t have naloxone with them. But if it’s an unwitnessed overdose, there’s nobody there to send for help. So how do you do it? And we were talking about a number of solutions you had initially been working on that, as I remember, and correct me if I’m wrong, ran into significant challenges. Is that correct?

Gordon: Yes. So we developed an MVP, a minimum viable product, of something that would call out for help. Everybody loved the idea, so we felt we had sort of community buy in and that it was the right thing to do.

We could see this problem with the fact a bystander would typically discover an overdose. And we knew as well that the community was very frustrated at the number of overdoses and feeling powerless to do something about it. So these bystanders, let’s call them civilians, would come across an overdose and have no idea what to do, when on the other hand there are people literally just around the corner that are trained, that have naloxone with them, and who don’t need to wait for the ambulance to get there in order to deliver that first response.

So we thought it would be great to have this app to connect the users to the proper responders with the naloxone. We developed this MVP, and we rolled it out in Vancouver. And that was when we realized our mistake, which made total sense in hindsight. See, Vancouver in 2017 was probably the greatest density of naloxone in North America, possibly the world at the time. The CDC, so the British Columbia CDC had engaged in this phenomenally successful take home naloxone program which they’ve calculated must have saved thousands and thousands of lives. They just blanketed the province with naloxone and that was sort of primarily here in Vancouver, in the city.

So that made the city the least likely place for anybody to actually need to have an app to summon for help. If we had gone somewhere more rural, if we had gone to places where naloxone really was more like gold dust and was hard to get hold of and only a few people had it, then they might have had a need for this first version of our app.

If we had gone to a place like that, we likely would’ve seen it catch on more. But just to remind you what I said earlier, the sort of cost benefit of that, while it is a pity that we didn’t learn that lesson and know that there was a place and time for those solutions, it did mean that we learned this other lesson that really, we want to target people who are using alone.

That’s anywhere between 80 to 95% of overdose deaths are people who are alone at the time that they used. So the understanding we came to as a result of that failure that we really needed to serve those folks more specifically, yeah that was priceless.

Jason: Right. So that’s when you double down or really focus your energies on the virtual safe consumption sites.

Gordon: Exactly.

Jason: And so you develop this button, right? If you want to talk a little bit more about that, especially where you first rolled it out, and the fact I remember that you had gotten a real early vote of confidence on it, could you talk about how that all played out?

Gordon: So after we developed the app, we were talking with a few dozen different community groups here in Vancouver. Drug user unions and other people who we thought should have an input into what was happening next. And one of the groups we met with was associated with one of the supportive housing operators here in Vancouver.

So it was about 12 people that would meet regularly and we came, and we said, here’s this app that we’ve worked on, what do you think? And we told them who we’d worked with so far and they said, “yes, it’s super cool, we love it.” And this was our virtual supervised consumption app, which is still the existing app that we now have live.

They did say though that for those living in supportive housing, it’s probably not going to work very well. They said they live in older buildings, they’re really small rooms, which meant finding them might be hard. The doors are usually locked so you can’t get access. You’d need to be connected to our front desk. And that while they had phones, they didn’t necessarily have the same phone all the time, and not usually the latest phone so the app might not be compatible or the data or WIFI might not be strong enough to maintain a voice call for the length of time that’s needed.

So we worked with them for a while on an alternative, and that was the button that you mentioned. So at the time, a Bluetooth connected button that would connect to a sort of WIFI and internet connected hub that we built so that anybody could push a button in their room, and it would send a text message to the staff at the front desk. Staff would then know to go and check on that person, so again it’s virtual supervision.

It’s not an overdose button, right? In case some folks don’t know, you don’t have time when you overdose to push a button or make a call or do any of those things. It is possible but that’s maybe 2% of overdoses where you’d feel it coming on and it would be slow and gradual enough for you to take some kind of action.

So the idea is similar to putting on a seatbelt. You need to put on your seatbelt before you start driving and you need to push your button or make your call in the app before you start using the drugs that would put you at risk of an overdose. We had a lot of cynicism, both internally and from a lot of folks in the community about the likelihood of people using this during the pilot that we rolled out. But we met with tenants, and they were super excited about it. We met with building staff, they were also excited, though they did have some legitimate concerns of buttons being pushed 25 times in an hour.

So we rolled it out in a small SRO here in Vancouver, and in the first 11 days buttons were pushed over a hundred times by those residents. There were three overdoses that happened in that space of time, and as well as that, there were a number of incidents of safety concerns where people just had somebody else in their room or they could hear something happening in the room next door and they wanted to make sure somebody came up and checked on them, helped them or helped their neighbor. All of which had everybody astounded by the engagement levels, us and the staff, and sort of the nurses and other folks at the health authority and the city that we’d been speaking to.

Then it was shortly after that that we applied for this Ohio competition. The Ohio Opioid Technology Challenge, which came with a huge chunk of money as prize, and I think was a very smart way for Ohio to sponsor innovation through federal money and grant money that had been allocated towards the opioid crisis. They took what was maybe 10% of their budget that they had for one year, and they just said, we’ll turn this into a competition. And they got a huge response and really great innovative solutions came out of that and we were honestly quite shocked to win the challenge two years in a row.

The challenge had three phases to it, and we won the second phase and then we won the final phase as well. We were the only harm reduction organization that participated in the challenge, and we were the only non-American organization as well. It was open internationally, but we were the only non-American participant.

Jason: I hadn’t heard that part before. You were the only harm reduction organization that participated? Any clues as to why? You would think that it would be almost entirely harm reduction organizations applying?

Gordon: I think it was that that year was the first that the US Federal government was using the words harm reduction in its opioid strategy plan, or maybe it’s called the overdose strategic plan.

I think in 2017 and 2018 when they launched the competition, I think the primary cultural understanding of what the opioid epidemic was, was very much that it’s an opioid epidemic, not an overdose epidemic. And the second part of that was the understanding was it’s primarily due to over prescription.

Canada had not had the same experience as the US, in that sense. We had a very different understanding, and Vancouver was a bit of a canary in the coal mine in terms of understanding that fentanyl had completely changed the drug supply. A lot of this is because of harm reduction because there’s very active drug testing here and has been for quite a while, so when the change in the supply happened, people saw it and knew what was happening. So they weren’t questioning why is there an increase in overdose, but they understood that largely this was due to a change in the drug supply. Whereas for the rest of North America, a lot of the US and for sure some parts of Canada, it took a lot longer for that realization to settle in for it to be now-a-days very common knowledge for everybody in the states to talk about this as an overdose epidemic rather than an opioid epidemic, and harm reduction is just now sort of reaching the mainstream.

Jason: Interesting. So you win the competition two years in a row in Ohio, and what does that lead to for Brave?

Gordon: That was our bread and butter, that was our meat and potatoes. Everything for the last three to four years, we’ve lived off that money we won for as long as we could, which allowed us to develop the buttons and improve them. Things like we are no longer using Bluetooth and WIFI, but now using cellular and LoRaWan which means low range wide area network. Those are both technologies that are more appropriate for the kinds of buildings we’re going into. We also now have one or two routers per block rather than what would probably be more like 20 to 50 routers per block, which is exciting. And the cellular connectivity means we don’t have to mess with our clients WIFI or get access to their credentials or they don’t have to set up extra special networks just for us to operate on.

That win and the money from it also meant we could develop another solution, which is our stillness sensor, which is primarily used in public restrooms. That combines a door sensor plus a motion sensor powered by Doppler Radio Radar to determine if somebody is in the bathroom, first of all, and then if they’re in the bathroom if they’re still moving or not. If anybody stops moving, we send an alert out to get someone to come check on them.

Jason: Wow, that sounds like it could be really useful and in high demand by – and this isn’t a joke – by fast food chains. When I was working as a medic, I remember when we got called to a Carl’s Jr bathroom, we knew exactly what it was for. So who is part of the demand for these? Where are you getting these sensors out to?

Gordon: Currently we’re primarily going into community organizations, so people that have sort of a retail presence on Main Street, serving folks who they know are at risk of overdose. They are people who already want to check on the bathrooms regularly, or if they see that somebody’s been in there for 10 or 12 minutes, they’re getting antsy and they want to make sure that everybody’s okay. But these are very much the early adopters, right. We don’t even need to sell this to them in any meaningful sense of the word, they react similar to how you did, “oh my gosh, I didn’t know this existed, it’s amazing, how can we get it?”

The conversations with fast food and so on are taking longer to have for a lot of the reasons that you mentioned when you asked about pushback. It’s hard for these places to admit that their coffee shop or fast-food location is a central place for drug use to take place.

And just in case this is confusing for folks, the reason why people who use drugs want to use in a bathroom is because it’s private. And it means they can take their time and not be disturbed. If you’re using on the street, there’s always a chance that somebody will steal your drugs, steal your other stuff if you happen to nod off for a minute or two. Whereas the bathroom is well lit, it means they can go slow which is something that will help them avoid other comorbidities or other sorts of injuries, and it’s just much nicer. So it’s no judgement on anybody that they want to use in your bathroom, it just means you have a nice place. But that is hard for folks to admit that and take a step that would maybe be seen as inappropriate by some of their constituents or customers.

Jason: What about homeless shelters, I would assume those might be in high demand for a product like this?

Gordon: Yes, so any homeless shelter or temporary housing, if they have a shared bathroom then it’s perfect for them. And they are another type of location that is already concerned about this, already trying to take steps to ensure that their people are safe in their space, including in their washrooms. So this sensor is to them just like we’ve taken a burden off of them, now they only have to go check when there is an alert instead of feeling like they have to grow a third eye out the back of their head to see what’s happening in the bathroom at all times.

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Jason: That’s one of those solutions where it’s like right under your nose, you know. That’s fantastic. I want to switch gears a bit, you are Brave Technology Co-op. What is a co-op?

Gordon: Yes, a question many ask, including the tax authorities. A co-op, or cooperative, is an incorporated entity, so we’re a legal person or have legal personhood and limited liability. So it’s those things, but instead of shareholders like a corporation would have, we have members.

And the members are similar to the citizens of a country. As a citizen of anywhere, you don’t own that country, you’re just a member who participates in the governance of and the wealth of your country, and members of a co-op are similar. Different co-ops have different structures for who their members are or what entitles you to become a member. At Brave we have three different kinds of members, so you can become a member if you work at Brave, so for instance I’m a member by virtue of that. Then you can become a member if you invest money in Brave, so we have a few of those, not a lot. And then anybody who uses our technology can also become a member.

So you can probably figure out right away that the end user member numbers are going to vastly outnumber the people who work here and the people who invest in Brave, and that is very intentional. The idea is that they will have a much greater voting block than anybody else and will therefore be able to control the direction of the company if we were to sort of go off the rails.

This is meant to achieve two things. We look at being a cooperative as an act of social justice, we are handing over control to the people that we claim we’re trying to serve, and then they have the ability to hold us accountable. It also means that any financial surplus that we do make will be shared between those three groups as well. Some co-ops use the word surplus instead of profit, and on the one hand it’s just words, but I do like it because it speaks to the fact that cooperatives are generally not out to make money.

We’re not a not-for-profit, but to call us a for-profit entity would also be not quite accurate or true. We want to survive financially, certainly. We want to be financially sustainable, and we want to succeed in our mission and achieve impact. But any money that happens to be made on top of that is surplus and is really like the cup flowing over and bunch of that, a third of that will get clawed back to the co-op to enable it to grow, and the rest would be shared between all the members.

Jason: How did you come to the decision, I know you briefly touched on this, but clearly there were a lot of deliberations that had to go on before you decided we’re going to be a co-op, what was that like and when did that happen?

Gordon: I’ve had businesses before, not too big or anything, but I’ve had limited liability and other regular structured businesses. They always seem kind of broken to me. I’ve had some experience in the startup field as well, and they seemed weird too, those structures and the conversations that would inevitably happen about who is getting what and whether shares should be increased to one person or another.

One of those that I worked with had a really generous founder, who just kind of shared things much in the same way as would happen if it had been a co-op. It wasn’t, but it was his way of doing work and sort of being in the world, and I wanted to kind of emulate that and ensure that the people who really contributed in one way or another to the success of the co-op or the enterprise would be rewarded for that and would have some control over that.

I was fascinated by cryptocurrencies, and when I was thinking about this and could see that they were building in ways for people to participate in the growth and to have it be repaid automatically. And I mentioned all of this to a friend, about what I was thinking, what I was trying to build, that I wanted something fair, and that I had in mind something with crypto and something with nonprofit holding companies and different shareholder rights and things. And he said, “I think you’re describing a cooperative.” And I said, “what are you talking about?” The only co-ops I had heard of were sort of the corner store in the UK that those are usually co-ops, and here in North America there was REI, the outdoor gear shop.

So I looked into what this was and the things I read were very aligned with what I was thinking. It took me a while to really digest how transformative a cooperative could be, or more to the point how transformative an economy which embraced cooperatives could be at the large scale. A lot of us would argue that it’s kind of what the world needs right now.

The decision then to continue on as a co-op, as we got greater direction and clarity on our vision of what Brave was going to be, it made even more sense. To ensure that we were returning any power and trust that was being given to us by the people who use drugs, by those that serve those people on the front lines, that we could return that power and trust back to them in the form of giving them democratic voting rights within the co-op and the financial surplus if and when those happened.

Jason: So how many members are there in Brave Co-op?

Gordon: We are just over 50 at the moment. But we have a backlog of about a hundred that we need to process and get into the co-op. As I’m sure you are familiar with, we have a whole bunch of governance stuff that we need to catch up on and it sadly never makes it to the top of the priority list and piles up over time.

Jason: Yes, I can understand that. How many programs or how many locations are you active in?

Gordon: Good question, I think we have 65 sites with the sensors right now, we have around 550 rooms with buttons, and we have about 5000 folks who’ve used the app at one time or another.

All of those numbers except for the app will be growing by about 2x over the next couple of months as we have a backlog of orders to fulfill. Nothing horrendous, but we are subjected to the supply chain issues that everyone is right now. A lot of our technology comes from far across the seas and it’s a bit of a process to get them here. So we will be in well over a thousand rooms by the end of the year, and likely well over 200 bathrooms by the end of the year as well. And those sites are all catching overdoses every week.

It’s exciting, but it’s also depressing. It’s, you know, doing this work is often, sort of, I don’t quite know what the word is, but you often are feeling joy at things that are not joyful in the sense that you’re catching an overdose and reviving that person, which is wonderful, but you still feel that the other side of that, which is the sadness that it has happened in the first place.

Jason: That’s absolutely right. I find myself saying that all the time when we have programs, especially new programs launching, and it’s like very gratifying to be part of the solution but it’s also very depressing because you begin to really see how big of a problem it all is, right?

One of the organizations that we support is called SafeNest in Las Vegas, they deal with domestic violence, and it is very gratifying to be able to support them in what is such an awesome mission, but then to learn about the scale of the domestic violence problem is really depressing. So I totally get what you’re saying.

So in the near term, what’s the two to three year goal for Brave?

Gordon: With the devices, we’re hoping that within the next six months or so that we’re putting up an e-commerce site and we’re doing things like that to get the word out about the work that we are doing and what’s available.

So I would hope that by the 18 to 24 month mark, anybody who really needs this in their site, in their location, in their shelter, in their community center, that group of customers that we are trying to serve, that they would just know about us and would be able to go to a site and purchase immediately.

At the moment everything is still quite labor intensive in terms of me having conversations with folks and walking them, holding their hand through the discovery process so they fully understand what it would look like in their building, et cetera. So we want to convert that to videos and just documentation so they understand that intuitively very quickly and can quickly come to a decision as to whether it’s a good fit and then go and find the money to do it.

Our pricing strategy is to make our stuff as cheap as possible so that it can get out to as many people as possible as quickly as possible. So we really do want to be ubiquitous in the greatest sense. If this fits with people’s philosophy and their approach and their culture, then there’s no reason for this not to be there helping them sort of fight the overdose epidemic on their own doorstep.

Jason: So right now you are working with individual locations, right. You’re working with housing, you’re working with homeless shelters. Is there an end state, like an ideal partner that you’re working towards. I’m specifically thinking about municipalities, right. Is that the goal? To be signing agreements with entire communities or do you see yourself staying at the end user level?

Gordon: So there’s very much three of us involved in almost all of these conversations. It’s us working here, and it’s the end user or end client let’s say, and then their funder is the third and I’d say maybe 25% of the time we don’t know who that funder is. Sometimes it’s visible, some donor or philanthropist, but most of the time we know that it’s some kind of governmental body or pseudo governmental body or something along those lines.

The ideal situation is for those folks to offer the funding and backing and potentially training and sort of onboarding for our systems to not just the one end user that we’re talking to but to everybody within their circle.

So an example would be the city of San Francisco, where we do have some buttons and sensors deployed. They might decide to let every supportive housing operator in the city have access to our tools and they would pay for it, or they would provide them with the money to be able to pay for these tools.

So it’s honestly not feasible for us to do it any other way, and those are the more interesting conversations that we’re starting to have with some city, county, and state bodies around the US.

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Jason: What types of problems or issues do you see in the United States that you don’t see in Canada, or vice versa? I think a lot of people in the US don’t fully understand the differences, particularly when it comes to public health between Canada and the United States. And of course with the United States, we’re 50 states with a spectrum of attitudes and behaviors and beliefs on this topic. I’m wondering if you could maybe talk about a few of the bigger differences that you see between working in Canada and working in the United States?

Gordon: I think it’s mostly what you just said. It’s such a spectrum in the US, and in Canada it’s still a spectrum, you know each province does things differently, but the federal approach is public health across the board. Harm reduction is the official policy of Canada and has been for I think 12 or 13 years now. And it’s called the Vancouver Model. So that part is relatively easy, you can at least appeal to that in Canada.

But in the States, for instance there are places in the US, lots of them even, where it’s still illegal to have Naloxone on you, because it’s still considered drug paraphernalia. The FDA just this week changed their requirements around mass prescription of Naloxone or mass distribution of Naloxone so that harm reduction organizations can do a whole bunch of things that they haven’t been able to do for the past, you know ever, which is great. But things like that are obviously huge, huge barriers, and are unlikely to change in the near future.

So when I was at this event, the National Harm Reduction Coalition had an event in New Orleans in 2018, and the saddest thing to me about the conversations I had was that when I was talking to, for example, some groups from North Carolina, they were bemoaning the fact that their syringe service program had just been shut down. They were going to have to find a way to work around the new sort of legal requirements or restrictions. So that was their next thing was they wanted to get back to where they were. Then Philadelphia, on the other hand, was working really hard to get a legally sanctioned, supervised injection site opened and operational in Philly.

Meanwhile, in Canada, we are starting to talk about what we call safe supply here. So a more open ability for medical grade opioids and other drugs for folks to use so that they’re not using the illicit street supply, which we know is going to be tainted.

So everybody is sort of thinking about that next thing that may be the silver bullet and looking forward to that and aspiring to that, but then we would talk to somebody who had 25 syringe service programs get shut down and realize, oh you haven’t been so lucky.

Sometimes it can seem like Vancouver has all the answers, but I promise you we don’t. Or that we have all the services and we definitely do not. Everything is still a struggle. Both here and everywhere. Everybody’s still struggling. And this will possibly sound radical to some folks, but until the war on drugs is ended – and the new President of Columbia gave a very interesting speech recently about the need to end the war on drugs otherwise it’s going to kill so many more Americans and so many more people in Latin America. We believe that same thing, but we know that isn’t going to change any time in the near future.

So in the meantime, everybody’s going to be struggling with different things at different times, which makes it hard to unify folks as well, because everybody seems from a distance to be asking for different things, which makes sense because everybody is in a different place right now.

Jason: Absolutely. And I thank you for making that point which I think is important too, Canada is not a monolith in terms of their approach, and they certainly have a spectrum as well. I think that they have a socialized healthcare system which certainly separates them from the United States, though clearly in the United States we have aspects of our healthcare system that are very much in line with the socialized healthcare. But that’s not for this discussion.

For other organizations that are looking to get involved in community response or that are already involved in community response. I’m wondering if you have any lessons learned, or changes in course you made, or advocates you thought you’d have that you didn’t. Anything like that worth sharing with those just getting started.

Gordon: The one big lesson that we’ve learned is most of the people that we are trying to serve, and help are severely under-resourced. So a lot of the conversations that we have are to a certain extent really aspirational on their part. They see what we’re doing, they know that it would serve their community, and they want the outcomes.

They see that it could happen if this were fully operational and up and running and working at a hundred percent engagement from their community. But to get from nothing to one hundred percent, there’s no technology that can do that. There is very little Brave can do to get your community one hundred percent engaged. We can make videos to explain things, we can do all this marketing, but the really heavy lifting is going to be done on the ground with the frontline workers, and it’s just a lot. So sometimes out of a sense of optimism and just hope and not wanting to feel that everything is hopeless people don’t see the amount of work that will need to go into it at the time they are considering implementing these tools.

Jason: Makes sense. Could you share any lessons learned about technology development? We find a lot of organizations aspire to create their own technology solutions and that’s what we did, and that’s what you are doing. I’m wondering if you have any suggestions for the companies who know what they want to do but have to make the software or hardware to do it?

Gordon: Yes, so we built our app about three times before we settled on the right one. So it’s expensive, and you know, I don’t know if there’s a figure, but it’s probably going to be five to ten times more expensive than whatever you’ve been told it’s going to cost you.

And that’s just the money, that’s not the blood and the sweat and the tears and the hair pulling from frustration. I think, you know, it’s hard because when you have a vision for something, it’s really hard to see that the things that are already out there in the world are 80% of what it is that you’re looking for, but that’s usually the case.

I actually wish that we’d started with a phone line. So there’s a phone line in the States called Never Use Alone. There’s a phone line here in Canada called the National Overdose Response Service, which we launched in partnership with some groups in Ontario. But that would’ve been a great way for us to learn a bunch about the app and what needed to go into it and what would be beneficial and to differentiate between what people told us was important and what was actually important. But we didn’t think of that, like literally didn’t think of that up front.

I thought of WhatsApp groups, and I thought of other things like that, which we did try and didn’t work, but a phone line would’ve worked. So anyway that you can test your hypotheses without building an app or a website or something more complicated, try that first. I know that is free advice that is hard to take seriously if you are creatively inclined or you just have a vision and passion and doing something like a phone line to start isn’t sexy, but it may help you avoid that 5x or 10x cost before you even get to the thing that you dreamed about and something you can put out into the publics hands.

Jason: I agree with everything you just said, and honestly, 5x to 10x what you expect it to cost just for the beta version, right. Just to get that MVP usable. Then all the continuous improvements on top of that and so on.

Well Gordon, it’s always great catching up with you. Is there anything else you’d like to share about Brave that we didn’t get to or for aspiring organizations that hope to follow in your footsteps, some final advice?

Gordon: Just to offer myself as a resource. I do actually love chatting with other folks who are founders in the same or adjacent industries, and anyone who loves humans and our planet and wants to keep us going and show some kindness to the world, I’m more than happy to have a chat. [email protected] is my email address, and I’m all over the internet, I’m not hard to find.

But yeah, we need more of us, we need to collaborate more and sometimes collaboration is just a conversation and sharing stuff and we’re very open and transparent with all of our stuff.

Jason: No doubt about that, you have been a consistent and constant source of assistance and inspiration for many years, so I really appreciate that and all your time today and hopefully folks will reach out to you.

Gordon: Likewise, Jason, as I hope you know. Thanks for having me.

To learn more about Brave, visit their website here. 

To get in touch with Gordon directly, email [email protected]

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Beacon emergency dispatch is a cloud-based, do-it-yourself platform for emergency services that alerts, coordinates and tracks prehospital personnel using any mobile phone, with or without internet.

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