Five overdose emergencies. Less than 24 hours.
On October 27, Public Health Madison & Dane County issued an alert about at least five emergency-service incidents involving overdoses the day before. Several calls involved reported cocaine use, yet the symptoms were consistent with opioids. The cause of the spike remained unknown. The alert did not report whether anyone died.
Those are the only facts in front of us; they’re frightening.
And I am fucking furious.
Because nothing happens in a vacuum. People encounter an unpredictable drug supply inside a community that makes decisions about whether they can get information, supplies, shelter, care, and interact with somebody they trust. Every one of those decisions shapes the protection available when something goes wrong.
Madison needs to stop discussing an overdose alert as though the only relevant events happened in the few hours before the ambulance arrived.
There’s a history here. There are decisions here. There are also familiar names attached to them.
And before anybody starts pretending harm reduction is some strange, radical concept, let me ask you something.
Did you put on your seat belt today?
Your car has seat belts, airbags, crumple zones, and anti-lock brakes. We build layers of protection into driving because moving human bodies down the road at high speeds carries risk. People make mistakes. Some people speed. Some people drive recklessly. Even the most careful Subaru drivers encounter danger they didn’t create.
Does buckling your seat belt suddenly give you the urge to run a stop sign? Does an airbag make you feel like you have permission to drive drunk? Of course not. We enforce traffic laws and build safer vehicles at the same time. We understand that preventing injury is a responsibility, including when somebody has made a bad decision.
Nobody insists that a driver prove moral worthiness before an airbag deploys.
The same damn logic applies to unregulated substances. People use them. Their contents can be uncertain. The risks can be deadly. We have a responsibility to reduce those risks, and doing so does not require approving of somebody’s drug use.
A person’s survival should never depend on whether you approve of their behavior.
Now let’s look at what happened here.
Wisconsin Watch documented a revealing sequence in March: a reporter asked City Attorney Michael Haas about the legality of PHMDC’s smoking-supply program; the inquiry reached public health staff; the following day, a supervisor directed the removal of smoking supplies from an internal tracking system. By the end of that week, the supplies had disappeared from the department’s website. Related correspondence was withheld under attorney-client privilege. The program ended amid concerns about Wisconsin’s paraphernalia law.
Haas and PHMDC owe this community a public explanation of the legal advice that informed that retreat, the alternatives they considered, and what they did to preserve access. Legal obstacles require work. People whose health depends on a service deserve more than its disappearance and an explanation they cannot examine.
I have no patience for a version of leadership that can locate every reason a service might be difficult to provide and cannot produce an equally urgent plan for the people losing it.
Especially when the department had already documented whom that service was reaching.
PHMDC’s 2024 annual report said visits among Black people had tripled since safer smoking supplies were introduced.
Read that again. Tripled.
A supply that somebody actually needed gave them a reason to walk through the door. That encounter also created opportunities for naloxone, information, referrals, and another conversation with somebody who might help. PHMDC’s own overdose report described how expanding beyond injection supplies increased participation and broadened the people its program reached.
Taking away that point of contact puts those relationships at risk. A person who stops coming through the door does not stop needing help. They just become easier for an institution to lose sight of.
And then there was the proposed harm reduction drop-in center.
Sabrina Madison was a leading public opponent of the proposal. She said at the time she wasn’t opposed to harm reduction as a strategy, but the specific proposal didn’t pass muster. CAYA eventually withdrew after problems with its application became public, and the Board of Health rejected the contract. Those facts matter. So does what officials owed the people who were supposed to receive services.
In February, Sabrina explained that approximately $2.4 million over three years remained available. She endorsed a comprehensive needs assessment and a new approach. Fine. Another study. Officials should now be able to show this community what replaced that proposal, when people can walk through the door, and who will be responsible for delivering it.
The need survived the proposal.
You don’t get to stop a project, invoke the people it was supposed to serve, and then treat their continued need like somebody else’s unfinished business.
And about that needs assessment: my team and I went out and did that work.
Through Satori House Recovery, Lacee Blair, Joe Galey, and I spoke with people in outreach settings, including encampments and outside buprenorphine clinics. Our Community Needs & Service Gaps Survey included 84 eligible respondents. This was a targeted outreach sample, so its percentages describe the people we reached, not everyone who uses drugs in Dane County.
Their answers were clear. Thirty-nine of 83 respondents said recent changes to Public Health services had reduced their access to harm reduction supplies or support. Among the 38 who answered the follow-up, 34 identified safer smoking supplies as harder to obtain. Separately, 44 of 78 respondents who rated access to smoking supplies they needed reported difficulty getting them.
The question about Public Health changes did not isolate one policy, so those findings cannot establish the effect of the smoking-supply decision alone. They do establish that people we reached were reporting a serious access problem.
We also asked whether people would use services brought to where they stayed or spent time. Seventy-four of 81 said yes.
People told us what they needed. People told us how to reach them.
Among the 25 Black men in our sample, 21 were staying in a shelter or outside. Twenty-two said housing assistance was difficult to access. Twenty-four said they would use mobile services. These are small-sample findings, but every number represents somebody whose answer deserves to matter.
And the broader racial disparity was already in the county’s own data. PHMDC’s July 2025 report found that the overdose death rate among Black residents was approximately four times the countywide rate and that the sharp increase over the preceding decade was driven primarily by deaths among Black men.
How many times do Black men have to appear in a disparity report before our survival becomes an operational priority?
I sent the Satori findings and our companion report to dozens of officials, through individual offices and elected-body distribution lists: city leadership, county leadership, alders, supervisors, and public health. On October 2, I followed up with County Executive Melissa Agard’s office and asked specific questions about housing, mobile outreach, and the needs of Black men documented in the assessment.
The warning was sent. The findings were available. The questions were specific.
I am still waiting to see a response commensurate with what people told us. A response people can actually use. A service they can reach. A commitment with funding, a responsible person, and a date. Hell, in most cases I’m still waiting on a response to my email.
Then there’s drug checking, which my organization tried to bring to this community in a comprehensive, accessible form. When I sought District Attorney Ismael Ozanne’s engagement on the legal barriers facing that work, the engagement we needed never materialized. That’s my firsthand experience trying to build this service.
For anyone unfamiliar with it, drug checking analyzes a small sample of a substance so somebody can learn more about what it contains. A comprehensive program combines tools. Fentanyl and xylazine strips look for particular substances. An FTIR instrument uses infrared light to help identify major components in a sample. More sensitive laboratory testing can investigate or confirm findings. Trained workers explain the results and their limits. FTIR can miss potent substances present in small amounts, and no result certifies that a drug or an entire batch is safe.
But the information can still matter enormously. Someone may decide not to use a sample, change their plans, or take additional precautions. Across submitted samples, a program can also identify concerning patterns and help inform community warnings, while recognizing that those samples do not represent the entire local supply. Drug checking adds an opportunity to learn about danger before another emergency occurs. It belongs alongside naloxone, trusted outreach, treatment access, and practical support. People deserve more information than a seller’s assurance and a warning issued after somebody else has overdosed. Still, in Dane County, our officials would rather the medical examiner be the first person who knows what’s in the unregulated drug supply.
Read today’s alert again: reported cocaine use, symptoms consistent with opioids, uncertainty about what is driving the spike.
That’s exactly the kind of uncertainty community drug checking is designed to help investigate. It doesn’t guarantee prevention of these incidents. But it does give people and responders another source of information in a situation where information itself matters.
Ozanne owes this community an answer about why cooperation with his office was withheld. Haas owes an explanation of the legal posture surrounding the service retreat. PHMDC owes an account of what happened to access after supplies were withdrawn. Sabrina and the other officials who opposed the center owe an account of what they delivered for the people left waiting.
Those are reasonable demands. The fact that I am angry while making them does not make them less reasonable.
And yes, I see a connection to the independent police monitor fight.
Sabrina Madison was one of seven sponsors of the resolution that terminated Meeka Glass’s interim appointment, and one of 14 who voted for it. The council passed it after the Police Civilian Oversight Board had publicly reported that Glass performed at a high level across its evaluation categories.
I see the same failure of leadership across these fights: community protection becomes negotiable, institutional comfort becomes urgent, and the people demanding accountability are expected to wait patiently for whatever remains.
Independent oversight and harm reduction both require a willingness to hear people whom institutions find inconvenient. People who use drugs. People who are unhoused. People who have been harmed by police. Black men who keep being counted in reports while struggling to get their needs counted in decisions.
Leadership should be judged by what happens to those people when the meeting ends.
There are public workers and community providers doing valuable work. The county announced additional harm reduction vending machines in Sun Prairie and Stoughton this month. Naloxone access is great, and those efforts deserve support. Would you like a cookie?
Now, can I get a response from the officials responsible for explaining the gaps documented here? Every single withdrawn protection demands scrutiny.
I cannot assign the overdoses in this alert to a particular official or policy. Political responsibility does not disappear because causation is complicated. We can examine who opposed a service, who ended a program, who failed to engage, what warnings reached them, and what they delivered afterward.
So publish the plan for comprehensive community drug checking. Explain how safer smoking access will be addressed and what changes to state law you are pursuing. Account for the money set aside for the center. Put mobile and peer-led services where people told us they would use them. Track whether Black residents are being reached. Give the public names, budgets, and deadlines.
And answer the people who already did the work of telling you what is wrong.
I’m tired of watching this community praise the dignity of people in the abstract while making their survival so fucking difficult in practice. I’m tired of reports that describe the same suffering more fluently than our government responds to it.
Somewhere in all those meetings, somebody needed to ask what the person outside was supposed to do while everybody inside kept talking.
Those people still need answers.
Madison understands seat belts. Madison understands airbags. Madison understands that a dangerous world requires layers of protection.
The question is whose life we consider worth the trouble.
You were warned. Now show us what you are going to do.
