our method - step one: triaging Opioid response opportunities

The logical first step to saving as many lives as possible, as quickly as possible, is to get the intervention that works fastest to the the people who are most likely to die. This means getting naloxone to opioid-dependent individuals through the service providers they regularly use. 

In practice, harm reduction organizations, particularly syringe-exchange programs (SEPs), tend to be the only organizations in opioid-impacted communities that actively seek out ongoing and constructive relationships with people who use drugs, recent overdose survivors, and others at highest risk for fatal overdose. 

SEP-facilitated naloxone distribution presents itself as the first step of a justice-based national opioid response on the basis of logical deduction and empirical evidence.

  • Naloxone is an emergency medication that safely reverses otherwise fatal overdoses. No intervention (education, recovery support, housing) works faster to avert fatality, and with higher probability of success.

  • The person most likely to be first on the scene of a potentially fatal overdose, and thus the real “1st responder” capable of providing life-saving assistance, is another person who uses drugs.[1]

  • SEP-facilitated naloxone distribution is extremely effective at reducing opiate-related fatality, with reported overdose reversal rates of 1 per every 5-to-10 doses distributed.[2] [3]

  • Contrary to intuition, there is no evidence that the net effect of increasing naloxone distribution is greater risk-seeking behavior by people who use drugs (i.e. “moral hazard,” or “enabling”).[4]

  • Given its ability to rapidly save lives, naloxone distribution is an extraordinarily inexpensive public health intervention. Narcan costs $125 retail if you buy it at a pharmacy. Intramuscular (IM) naloxone can be bought for 1/5th of that price, or less. Unfunded opportunities to save a life for that little money are difficult to find outside of the developing world, let alone in the United States. For perspective, as of 2014, Medicare spent an average of +$34,000 per patient on end-of-life care.[5]

  • Despite the demonstrated life-saving potential and cost-effectiveness of SEP-facilitated naloxone distribution, it is severely underfunded. Government-sourced funding for naloxone distribution overwhelming goes to law enforcement, traditional 1st responders, and other groups through whom naloxone distribution is more culturally palatable, but far less effective.

our method - step two: triaging naloxone distribution opportunities

OCRF provides funding for purchase of naloxone to organizations especially well-positioned to reduce opiate-related fatality through distribution of incremental naloxone supply.

OCRF prioritizes naloxone distribution funding opportunities on the basis an analysis that includes…

1.       Can the organization distribute naloxone directly to people who have a high probability of being in the presence of an overdose?—for example, people who use drugs, people who detoxed in prison/jail and are now being released, OD victims revived by EMS, and people with <6m of recovery being released from supervised treatment settings.

2.       Does the organization serve a large volume of clients with unmet need for naloxone?

3.       Is the organization operationally ready to distribute incremental naloxone without delay?

4.       Can the organization purchase naloxone at a price-per-dose that will allow OCRF funding to extend naloxone distribution as far as possible?

5.       Are there sufficient, or at least substantial, alternative sources of naloxone supply or naloxone funding in the community?

Ideally, OCRF will operate as a source of “bridge funding” to carry organizations from the initial scale-up of naloxone distribution efforts, to the acquisition of a more permanent and proprietary source of naloxone distribution funding from within their own jurisdiction or community.