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NEXT Distro

An online and mail order service provides access to harm reduction education and supplies including naloxone and syringes

Harm reduction materials such as naloxone and sterile syringes are critical in reducing opioid-related morbidity and mortality, but are unavailable in many communities. To help meet this need, in 2017 NEXT Distro initiated a confidential online and mail-order distribution system for naloxone, syringes, and other harm reduction materials, in particular those related to injection drug use. The program serves all 50 states and Puerto Rico, making harm reduction materials available free of charge to those requesting deliveries, whether individuals or organizations. State-level policies may affect which types of harm reduction materials are available. Due to its platform and anonymity, NEXT Distro may be especially effective in reaching certain populations, such as stigmatized groups and those in rural areas. 

The NEXT Distro website provides harm reduction education using an extensive library of resources, including information on using naloxone, HIV-AIDS, drug treatment, and family planning. It also provides links to state policies on drug use and harm reduction services, a page of many anti-stigma publications, and a social support guide to help users connect with peers in different stages of recovery. This innovative program is primarily funded through donations. 

NEXT Distro has been an especially important resource in naloxone distribution during the COVID-19 pandemic, and its impact has been documented in numerous news stories and several peer reviewed publications. As of November 2022, the program has delivered 96,000 naloxone shipments and 16,000 shipments for full-service supplies. Contact information for the executive director of the program, Jamie Favaro, is jamie@nextdistro.org. 

NEXT Harm Reduction provides an innovative platform for people who use drugs and others in the community to connect with low-barrier access to life-saving medication and supplies, information, and support. 

Continuum of Care
Harm Reduction
Type of Evidence
Peer-reviewed
Response Approach
COVID / Coronavirus related
Overdose prevention
Post-overdose response
Syringe service program / Needle exchange
Peer-reviewed Article
NEXT Harm Reduction: An Online, Mail-Based Naloxone Distribution and Harm-Reduction Program
Harm Reduction, By Mail: the Next Step in Promoting the Health of People Who Use Drugs
Expanding Mail-Based Distribution of Drug-Related Harm Reduction Supplies Amid COVID-19 and Beyond
Participants of a mail delivery syringe services program are underserved by other safe sources for sterile injection supplies
A free mailed naloxone program in Philadelphia amidst the COVID-19 pandemic
NEXT: description, rationale, and evaluation of a novel internet-based mail-delivered syringe service program
Related Resources
A Systematic Review of Community Opioid Overdose Prevention and Naloxone Distribution Programs
Legal Interventions to Reduce Overdose Mortality: Naloxone Access and Overdose Good Samaritan Laws
Opioid Safety: Focus on Furnishing Naloxone
Guide to Developing and Managing Overdose Prevention and Take-Home Naloxone Projects
Preventing Opioid Overdose Deaths with Take-Home Naloxone
Changing Course in the Overdose Crisis: Moving from Punishment to Harm Reduction and Health
A Systematic Review of Harm Reduction Strategies
Harm Reduction Coalition
North American Syringe Exchange Network (NASEN)
The Impact of COVID‑19 on Syringe Services Programs in the United States
Hayes2021_Article_HarmReductionByMailTheNextStep.pdf

Evidence of Program Effectiveness

"In the context of the opioid overdose crisis and ongoing HIV and hepatitis C epidemics, as well as active political opposition to local syringe access programs in many parts of the country, NEXT Harm Reduction provides an innovative platform for people who use drugs and others in their community to connect with low-barrier access to information, support, and life-saving medication and supplies." (Yang et al., 2021).

"...analysis of transaction data from NEXT suggests that their services are in high demand. For example, in just 2.5 years, NEXT has distributed over 600,000 sterile syringes to over 800 unique enrollees. Importantly, these services are being utilized by people with high needs, reaching high proportions of women, people living with HCV, and people who report no other access to sterile syringes. These data provide a compelling case that making mail-delivered services more widely available could have an important impact on the health of PWUD." (Hayes et al., 2021)

"Over the course of 42 months, 1,669 unique participants enrolled in NEXT. The program distributed 1,648,162 total syringes with a median of 79,449 syringes per month. Most participants ordered multiple times (61%); 31% had more 5 or more orders (upper range = 48 orders). The total number of syringes per month and total number of first-time syringe orders per month increased steadily over time, particularly after the onset of the COVID-19 pandemic...The online platform and mail-delivery model appears successful in reaching PWID at high risk for harms from IDU." (Hayes et al., 2024)