Seventeen-year-old Alex Nay sat at a round table between his mother and a family friend at a memorial service, surrounded by paints and brushes, focusing on a small canvas rectangle.

Nay dipped a brush into various paints, transferred them onto a palette and swirled the colors together to form browns, oranges and reds for an autumn tree — something Nay hoped captures a feeling of transition.

He punctuated the sentiment by painting the words “change happens” in block lettering across the top of the painting.

“Change happens, even if you don't want it to,” Nay said earlier this month. “People die. I mean, it sucks. But I wanted that [painting] to serve as a reminder that his legacy is going to keep going … the things he did should resonate in other people so much that they continue his legacy.”

Nay was there that day to honor the life of family friend Joshua Livernois, 46, who died Oct. 11 in Gerlach. Livernois had used drugs, had recently been sober and most likely had a recurrence of drug use that turned fatal, though toxicology reports have not yet confirmed his cause of death.

Livernois was not just someone who used drugs. He worked to save lives through advocating for drug policy changes aimed at improving access to clean syringes and safer drug use practices. He served on the Nevada Behavioral Health Substance Abuse Prevention and Treatment Commission and, as his obituary noted, “he also clashed with bureaucrats who he believed did not share his sense of urgency about the public health crisis represented by the opioid epidemic.”

Livernois is not the first person Nay knows who has died from an overdose — a friend’s 19-year-old sister, a cousin’s child and the son of Nay’s mother’s friend also did. That is what inspired Nay to harness technology to do something about it in his community.

None of them were trying to die, Nay said, noting that many of them were using drugs unknowingly contaminated with fentanyl, a synthetic opioid 50 times stronger than heroin.

The deadly opioid crisis is more than just anecdotes. A 2022 state report indicates that almost 23 percent of adults reported using illicit or nonmedical prescription drugs (excluding cannabis) — the third highest rate in the country after West Virginia and the District of Columbia. The report also found that overdose deaths caused by opioids account for nearly 18.9 deaths per 100,000 people living in Nevada — lower than the national average of 24.7 but an almost 15 percent increase since 2011.

As a student in the medical academy at Reno’s Academy of Arts, Careers and Technology (AACT), Nay has instructors who served on emergency crews that responded to anywhere from eight to 10 overdoses within a 12-hour shift. Though law enforcement and public health organizations have internal systems allowing them to track reported overdoses and know when fentanyl-laced drugs are present in the community, Nay said everyday residents don’t have the same access to that information, which can lead to unnecessary overdoses and deaths.

Classroom discussions and interactions with loved ones surrounding the opioid crisis inspired Nay to use AACT’s required junior-year service learning project to create an app allowing Reno residents to report and track potentially dangerous batches of drugs and clusters of overdoses.

The app is called the Safety Outreach System, and allows residents to self-report overdoses and fentanyl presence in drugs. Nay said the Northern Nevada Harm Reduction Alliance, a community group that promotes a harm reduction strategy around use of recreational drugs, will manage the app and send out push notifications alerting residents when a batch of drugs contains fentanyl or if there is a high number of reported overdoses concentrated in an area. 

“[My instructor] would know when a bad batch hit Reno because there [would] just be a huge spike in these overdoses. And then it would slow down again,” Nay said. “That shouldn’t be happening. People shouldn’t be dying in the way that they are.”

‘What is happening on the ground now’

Lisa Lee, the vice president of the Northern Nevada Harm Reduction Alliance and Nay’s mom, said stigmas around drug use often prevent people struggling with addiction from seeking help. 

Lee has nearly two decades of experience working within the health care, public health, substance use and behavioral health realm, and is a peer recovery support specialist and supervisor. She has also struggled with addiction throughout her life, and credits harm reduction services for keeping her alive and able to have children.

“The fact that somebody cared about her enough to realize that she needed help is the reason that I’m here,” Nay said of his mother. “The reason that she’s still here.”

She said studies show that prohibiting and criminalizing drug use altogether doesn’t reduce illicit drug use and can create unsafe environments. States should try to regulate drug supplies similar to the regulation of alcohol or gambling, Lee said. 

Though there have been efforts seeking to decriminalize drugs outside of cannabis in the Legislature over the past decades, they have not been successful, with two significant exceptions — then-Gov. Brian Sandoval’s Good Samaritan Drug Overdose Act (SB459), a 2015 bill that allows health care providers to dispense opioid-counteracting drugs without criminal repercussions and a 2013 measure (SB410) establishing a program for the safe distribution and disposal of syringe needles and removing them from the drug paraphernalia category.

Through the alliance, Lee said volunteers pack kits with materials that allow people to test drugs for fentanyl — an important inclusion given rising psychostimulant use in the Mountain West region and that some test strips are not accurate at testing for the presence of fentanyl in those types of drugs.

The kits also contain literature and include items such as gloves, syringes, pads and injectable naloxone hydrochloride, a drug designed to rapidly reverse an opioid overdose.

The organization also includes opioid safety information in the kits and through the app, such as a toll-free phone number people can call if they are using drugs by themselves. It allows someone using drugs by themselves to have someone stay on the phone who can contact emergency medical services if something goes wrong.

“We have to keep people alive and able to make the best decisions possible, whether that is just testing their drugs, whether it’s using less frequently, whether it’s using in a different way, or whether it’s abstinence,” Lee said. “Harm reduction includes all of those goals. It’s not oppositional to abstinence; that is part of the continuum.”

Lee said Nevada’s system of addressing the opioid crisis is fragmented. 

The state has received hundreds of millions of dollars in settlements with major opioid companies, distributed under a formula to state and local governments. But within the umbrella of state government, there is not one person, agency or entity responsible for coordinating and following up on the response effort to the opioid crisis. 

Under Sandoval, the state had an accountability task force producing quarterly reports on implementing plans addressing the crisis, but neither subsequent governor has continued that effort.

Lee hopes the alliance can provide services and support on a more comprehensive basis than the state — saying it might have taken the state a year or two to get a similar project functional. In contrast, the organization took less than a year to get the app online. 

“The state apparatus isn’t nimble. So organizations like this that are community based are nimble,” Lee said. “We’re able to respond to what is happening on the ground now.”

But to become a nonprofit and to keep the app working, the organization needs sustainable funding to expand the app's reach and continue supplying test kits.

“We’re hoping people will trust us to keep each other safe,” Lee said. “People who use drugs have been keeping other people who use drugs safe since forever. And that’s really the beauty of harm reduction.”

Everyone working within the space or who loves someone who uses drugs is feeling cumulative grief, Lee said.

“It just leaves like this big hole in your heart,” Lee said. “Keep our people, keep family members at the Thanksgiving table. Keep them here. I’d rather have somebody who’s chaotically using drugs, a family member, here at that table than not here.”