Since the overdose crisis began, overdose lives have exceeded one million, with opioids accounting for 72% of these deaths. In 2023, the FDA approved Naloxone (brand Narcan) for over-the-counter purchases in pharmacies without prescriptions. This marks a key advancement in expanding life-saving opioid overdose reversal drugs. Naloxone is available in the form of a user-friendly nasal spray, which has equipped people with emergency tools to reverse opioid overdose and potentially save lives.
Despite over-the-counter medications in pharmacies, various obstacles to accessing naloxone remain. One challenge is the inconsistency of naloxone. A multinational study found that naloxone is often locked or placed in difficult locations in pharmacies across the country. Although these pharmacies may technically have stocks and have naloxone available, they have been working hard to make it easy to use. After all, if people can’t find and buy quickly and easily, its usability doesn’t make much sense. Another challenge is the inability to access pharmacies in the first place, especially in rural areas. This geographical barrier makes it more difficult for people who get naloxone.
Cost remains another important obstacle. The package for a package of two-plate Narcan is about $57, which can be a huge obstacle, especially for those without insurance, and for a large percentage of those who use drugs that live below the federal poverty line. Coupled with the barriers to social stigma, negative perceptions surrounding substance use and addiction often prevent people from going to pharmacies to buy naloxone.
Given the life-saving potential of naloxone and its availability, it is crucial to make sure that anyone who wishes to have it can easily get it. Next Distro is one of the early efforts of a nonprofit organization to reduce national hazards to address the above barriers. Through their online mail-based naloxone delivery program, they provide free hazard reduction resources directly to people’s doorsteps. This approach effectively overcomes obstacles such as cost, limited accessibility, geographical challenges, and stigma associated with the purchase of naloxone. This proved particularly valuable during the pandemic, when additional barriers made it more challenging to get the supply in person.
However, the effectiveness of the program and other mail-based naloxone distribution programs can be greatly improved through active promotions and funding from county, municipal or state and health departments. Since residents often rely on government health websites to find resources like naloxone, it is important for these sites to highlight information about the mail-based naloxone issuance programs available in the state. Delaware provides an example of a model. A simple Google search for “Delaware Order Naloxone Online” guides users heldisherede.com, a website established by the Delaware Department of Public Health, through which Delaware residents can find information on how to order Naloxone online. Other states, such as California and Michigan, have implemented comparable measures as Google searches for “California Order Naloxone Online” and “Michigan Order Naloxone Online” that will bring users to their respective health department pages where they can access information about email-based naloxone.
However, it is important to note that promoting this resource through government health websites alone is not enough. These costs are added as processing orders and shipping supplies increase expenses, otherwise the naloxone distribution will also increase costs, so there are additional costs. Therefore, it would be beneficial for local agencies not only to promote but also allocate funds to support these email-based programs. In New York, for example, the Office of Addiction Services and Support is leveraging opioid settlement funds to support its email-based naloxone delivery program and working with New York affairs.
Opioid and Settlement Funds provide crucial opportunities for state or municipal funding behind mail-based delivery of naloxone that can help expand the impact of these programs. Furthermore, existing organizations like the next release already have a strong infrastructure and extensive experience in mail-based naloxone distribution, so by working with these organizations, municipalities can effectively scale their efforts. The system is already available; it will require additional support from state and local governments to maximize its influence.
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Suhanee Mitragotri is an undergraduate at Harvard University, a middle school that studies neuroscience, which is global health and wellness policy. She is also the co-founder of the Naloxone Education Program, which aims to expand opioid and naloxone education to youth. She has written about topics related to the opioid crisis, harm reduction and drug policy and has published articles in a variety of journals and magazines, including the Lancet Regional Health America, Addiction, Frontiers in Health Affairs, The Boston Globe and New Scientist.
Kevan Shah of MSM MSC is a MD candidate at Rowan University’s Cooper School of Medicine. He is the founder and executive director of End overdose, aiming to train and equip individuals to prevent opioid overdose.
Dr. Avik Chatterjee is an assistant professor at Boston University’s Chobanian and Avedisian School of Medicine, and a primary care and addiction medicine physician trained through several shelter-based clinics at the Boston Healthcare Homelessness Program. His areas of clinical and research interests include innovative treatment models for opioid use disorders in marginalized populations, and interventions on social determinants of health, such as food insecurity. He has additional interest in racism and health care, especially his performance in medical education and training.
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