A new harm reduction clinic funded by money from a settlement with opioid manufacturers and proposed for Madison’s East Side has prompted pushback from Common Council members and others who allege a flawed approval process, inadequate planning and a conflict of interest, as the County Board Supervisor who chairs the subcommittee in charge of the funding works for the organization recommended for the contract.
Advocates, on the other hand, say the process was transparent and no additional planning is required.
The Dane County Board of Health is scheduled to consider and vote on the proposal Wednesday.
The proposal & process
Created in 2024, the Opioid Settlement Subcommittee recommends how the County Board should allocate funds received through a variety of court case settlements with pharmaceutical manufacturers, who have been paying billions of dollars to local governments to mitigate the harmful effects of their drugs. Rick Rose, who chairs the subcommittee, told Madison365 that to date, the subcommittee has made recommendations on about $10 million.
Last fall, the subcommittee recommended the County Board allocate about $2.5 million to Public Health Madison & Dane County (PHMDC) to create a harm reduction drop-in center “that acts as a nonjudgmental community hub offering a safe environment and trauma-informed services that meets people where they are, reduces immediate health risks, and helps individuals connect to care and long-term support,” according to the request for proposals (RFP). The $2.5 million would fund the center for three years.
Four local nonprofit organizations submitted proposals: Anesis Foundation, Tellurian Behavioral Health, Urban Triage and CAYA Clinic, and the proposals were scored by nine social service professionals. CAYA Clinic was awarded the contract.
CAYA Clinic
Skye Boughman founded CAYA Clinic – CAYA stands for Come As You Are – in 2023 after 20 years in the substance abuse therapy business. More than 20 therapists offer counselling and therapy to people dealing with addiction and in recovery. Boughman said in an interview that she has always taken a harm-reduction approach, as opposed to abstinence. At their clinic on Hayes Road, they offer a syringe service program, free lunch, laundry, and a space to hang out during the day. Boughman said about 500 people who are not therapy clients made use of those harm reduction services in the past year.
“People come and spend their days with us because there isn’t anywhere else for them to go,” Boughman said. “Unhoused people, people who are using drugs but live with family that are not okay with that. People who use drugs are shunned in our society. So giving them a place where they can actually build community and feel safe is really important.”
That was the idea behind their proposal to place a harm reduction drop-in center at 1765 Thierer Road.
The RFP did not ask to specify a location, and CAYA’s proposal was the only one to propose creating a drop-in center at a dedicated location. Anesis Foundation and Tellurian Behavioral Health both proposed housing the center at existing facilities that they operate.
Boughman said she chose the location with the help of a realtor friend because it is on a bus rapid transit line and is in a neighborhood where the target population already is.
“I’ve been studying the hot spot maps since before there were hot spot maps,” Boughman said. “I used to be the one that called EMS and MPD to get where the fatal overdoses were occurring before we had a system to track them. … That area on Theirer Road is … a hot spot, and it is where the community that we serve is.”
Boughman said the proposed harm reduction center would be open from noon to 6 pm, Monday through Friday, and accommodate 20 people per day. It would offer SSP, laundry, showers, and food, as well as case management and other services. It would be staffed by a program manager, a case manager, and peer support specialists provided by subcontractors, including OutReach LGBTQ+ Community Center and the African American Opioid Coalition.
The controversy
Madison Alder Sabrina Madison, who represents the neighborhood where the proposed center would go, said the proposal sounds more like a day shelter for unhoused people – which, she said, would require additional planning, especially as relates to additional needs for police and emergency medical services that often accompany such facilities.
“I wouldn’t call it a day shelter,” said CAYA operations director Kathy Holt.
But the city of Madison might.
“Everything I’ve seen thus far points to this being classified as a ‘daytime shelter’ under the zoning code,” City of Madison Zoning Administrator Katy Bannon wrote in an email to Alder Madison, noting that she had only seen a floor plan and was still waiting for more information on proposed use and capacity. If classified as a daytime shelter, it would require Plan Commission approval.
“No one assessed the current calls for service or the potential increase in service. There was no impact study. There were no measurements,” Madison said. ““Every day shelter in the city has a security plan. MPD is included in setting that up. That happens proactively. It does not happen reactively … You can either do something, or you can do it right the first time. This feels like doing something and worrying about the consequences later.”
Boughman said fears of an increase in police and EMS calls are unfounded, noting that evidence from other cities shows that harm reduction centers actually decrease such calls.
“When I read these concerns about overdose and EMS and crime, that is exactly why we need to be there,” Boughman said. “This will reduce those. It’s not going to make it worse.”
Madison Alder Derek Fields, who represents an adjacent district, said he would like to see more evidence.
“I’ve seen their assertion that research suggests (a harm reduction center) reduces crime. I haven’t seen more than that yet,” he said. “That’s kind of a tough ask for us to just trust.”
Boughman also said CAYA works to create an environment of trust and community, where clients will hold each other accountable.
“The people that felt safe here and really began to trust us started to self-manage the population,” she said.
Madison is skeptical.
“Let’s just say they can keep it at 20 (people in the center), but there are five more people who want to come in for whatever reason. Who manages the extra five?” she asked.
“I don’t live in a world where we don’t plan for challenges. No matter how good your intentions are, challenges will happen,” Madison said. “Saying, ‘It’ll be fine because we’ll hire the right people and create a good culture’ feels really naive when you’re talking about scaling up in a corridor that already has high calls for service … They don’t actually know how many people will use the space, and that’s the problem.”
Madison is also skeptical of the process, as no City of Madison alders were consulted.
Further, Rose, who chairs the Opioid Settlement Subcommittee, has worked at CAYA part-time since last summer, which is a red flag for Madison.
Boughman said Rose, whom she calls “one of my best friends,” has been helping with administrative and receptionist duties in place of CAYA’s regular administrative assistant, who had to take a medical leave. Rose said he was not involved in creating CAYA’s proposal, did not advise CAYA leadership on their proposal and was not involved in scoring the proposals.
Boughman said she disclosed Rose’s employment at CAYA to PHMDC and consulted the county’s Corporation Counsel, who advised there was no conflict.
“Public Health is by here all the time,” Boughman said. “They knew that Rick works here the whole time. It’s certainly not something that was a secret.”
A PHMDC spokesperson, however, said Rose’s employment was not disclosed to PHMDC until staff asked CAYA for a list of employees.
Madison also noted that CAYA’s proposal states that the organization is “led by people with lived experience and BIPOC leaders who understand their community,” but CAYA’s staff is entirely white.
The RFP did not specify that proposals would be scored on cultural competency or staff diversity, but all involved agree that Black men are most susceptible to the harms associated with opiates; Boughman estimates that about one in four of CAYA’s current clients are Black or Latino. Some of the other proposals touted more specific information about staff diversity; Anesis Foundation, for example, noted that “Across nearly 70 employees, 50% identify as Black, 27% Latine, 17% Asian, 5% White, and 1% Indigenous.”
Boughman initially said she didn’t remember including in the proposal that CAYA is led by BIPOC people, and later speculated that she made an error while editing the proposal down to the 550-word limit. She said she “deeply apologize(s)” for including that.
“I’m not against CAYA”
Boughman said she’s dispirited by the pushback.
“There is always an additional level of scrutiny for any services for people who use drugs, and this process has made it very clear that Madison is not above that,” she said. “People are very okay with discriminating against people who use drugs, and it breaks my heart.”
Madison rejected that characterization of her opposition.
“I have never been anti–drug user. That would mean I’m anti my own family. That’s absurd,” she said. “It feels like an easy way to pivot away from a real discussion and try to make me out to be a villain — to say I’m anti–drug user — instead of doing the work that needs to be done.”
She said she’s not opposed to CAYA as a service provider, with more planning and a more transparent process.
“I’m not against CAYA. I’m against the process that led to CAYA being funded,” she said. “What I’m amenable to is a new RFP process, one that includes impact planning, includes alders, and removes potential conflicts of interest.”
What’s next
The proposal was initially scheduled for a vote at the Board of Health’s December meeting, but Madison’s concerns led to the board tabling it until their January 14 meeting.
“I appreciate that the Board of Health agreed to slow this down,” Fields said. “That’s given us time to ask questions and study the issue a little more.”
Rose, on the other hand, expressed frustration with the delay.
“If we want to fix the process, let’s do it. But we can’t keep delaying action while people continue to die,” he said.
The January 14 meeting in person with no hybrid option, something Madison has asked the board to change, as she said several people who would like to attend could only do so virtually.
Madison said ultimately the next steps don’t have to be acrimonious.
“This doesn’t have to be done in conflict. It can be done in partnership, if the process is right,” she said.
