UPDATE: This article was edited on April 16, 2026

A proposed harm reduction center in Madison, an effort that was initially intended to help address the opioid crisis, has instead exposed deep fractures in public trust, accountability, and equity in local public health systems.

Backed by approximately $2.4 million in opioid settlement funds, the plan aimed to establish a drop-in center offering services like syringe exchange, overdose prevention, and connections to care. Public Health Madison & Dane County selected CAYA Clinic, a local provider focused on substance use counseling, to operate the site.

But in January, it was discovered that CAYA included a number of false claims in their proposal, including that the organization was led by BIPOC leadership when, in reality, its staff was entirely white. In the initial summary of the organization’s history, the proposal claimed that CAYA was: “Founded on September 4, 2023, by harm reduction practitioners Lara Skye Boughman, Rene Livingston-De Tienne, and Kathy Holt.”

However, according to Rene Livingston De-Tienne’s spouse, Dannee Livingston De-Tienne, Rene, a Black leader and former harm reduction advocate who passed away in 2025, had not been a founding member of the organization. In fact, in a widely shared response, Dannee reflected that she was a: “part-time and short-term employee [who] played a big role in launching and championing the clinic.”

Dannee’s response essay goes on to say that Rene: “Served on Dane County’s Opioid Settlement Committee, and spent countless hours leading the recommendations of the drop-in center. In a further attempt to claim unearned proximity to Blackness, CAYA also proposed naming the drop-in center after her. That turned my wife’s name into a token.”

The essay, framed as, “a white person calling white people in,” challenges white-led organizations to move beyond performative gestures toward real accountability. Livingston-De Tienne writes about how systems that sideline Black leadership in life can continue to do harm in death. The misuse of Rene’s name, they argue, is emblematic of a broader pattern in which institutions claim proximity to communities of color without doing the sustained, relational work required to earn trust.

Founder Skye Boughman attributed the proposal’s language in part to rushed editing and the use of artificial intelligence tools, but emphasized that the organization took “full accountability” for the error and amended the proposal language. The organization released a statement to the media stating that they: “Understand that moving forward with the current process could increase mistrust and cause harm to the community we are committed to serving. We hold ourselves to the same standard of accountability and making amends that we ask of others in our community. After thoughtful reflection and community collaboration, CAYA Clinic respectfully stands with Anesis in encouraging the Board of Health to reissue the Harm reduction Drop in RFP. We believe that restarting the process is the only fair path forward, and we are committed to supporting a process that is fair, transparent, and centered on community trust and equity.”

Many felt that this statement represented a withdrawal of CAYA’s proposal from the consideration process, and several local news organizations reported it as such. However, after clarifying the statement with officials at Public Health Madison & Dane County, Alder Sabrina Madison confirmed that CAYA had not, in fact, withdrawn their application, but had merely supported the idea of restarting the process for all applicants.

Further reporting revealed that CAYA’s proposal also overstated or mischaracterized partnerships with several community organizations, some of which said they had no knowledge of being listed. There have also been allegations claiming unfairness in the assessment process in which each clinic that submitted a proposal was scored. The concern was that CAYA’s scores were unfairly inflated due to both the false claims as well as the involvement of CAYA-associated representatives during the assessment design process. These revelations compounded concerns about transparency and due diligence in the selection process.

The Dane County Board of Health did not reissue the request for proposals (RFP) after CAYA confirmed they were not withdrawing, and they voted on the project proposals in early February. Ultimately, the board unanimously rejected CAYA’s proposal, electing to halt the proposal process entirely citing a breakdown in public trust and the need for a more community-centered approach.

But the fallout extends beyond a single organization or contract. For many advocates, the controversy underscores longstanding inequities in how public health initiatives are developed and who gets to lead them.

Harm reduction, at its core, is a community-driven model rooted in dignity, trust, and cultural competency. Critics argue that the CAYA proposal failed to meaningfully engage the communities most impacted by substance use. In particular, Black and Indigenous male residents are disproportionately affected by opioid-related harms in Dane County and nationally. The inclusion of BIPOC leadership in the proposal, even if unintended, highlights how essential that representation is and how damaging its absence can be when misrepresented.

The controversy has also raised broader questions about process. From alleged conflicts of interest to a lack of coordination with city officials, critics say the rushed rollout prioritized expediency over accountability. As Chritina Liefring noted in an article for Tone Madison, Madison’s reputation as a progressive city is increasingly at odds with how it treats its most vulnerable residents.

This story underscores what is at stake in Madison’s harm reduction debate: whose voices are centered, whose labor is recognized, and whose lives are treated with dignity. For many advocates, honoring that legacy means ensuring that future efforts are led by those most impacted, not merely referenced in proposals.

Meanwhile, the need for harm reduction services has not gone away. If anything, the delay in allocating funds means that people who use drugs, many of whom already face stigma, housing instability, and limited access to care, will continue to navigate those risks without additional support.

However, public health leaders have signaled interest in restarting the process with a stronger emphasis on transparency, community input, and culturally competent care. Advocates say that means centering people with lived experience, partnering authentically with grassroots organizations, and rebuilding trust from the ground up.

In a moment shaped by both urgency and missteps, Madison faces the question of whether it will fund harm reduction, and whether it can do so in a way that truly reflects the values it claims to uphold.