Optimizing Naloxone Access Through Group Purchasing
While OTC naloxone represents an exciting shift in the visibility of naloxone, a relatively small proportion of the medication is accessed through retail pharmacies. As such, lawmakers and regulators alike need to continue examining ways to improve access — and thus community saturation — through community based harm reduction organizations that rely on bulk purchasing and distribution.
In order to improve access and facilitate uptake, we need a diversity of naloxone products to be available through community based organizations as people have nuanced needs and preferences. To facilitate this, we need more competition among intranasal products to drive the prices down; and states that are acting as group purchasers should really work closely with organizations on the ground to make sure they’re supplying a mix of injectable and intranasal products to meet people’s preferences while also stretching limited budgets as efficiently as possible.
We cannot forget about improving access to injectable naloxone. States should continue to assess and improve naloxone access laws to ensure community organizations are able to procure and distribute injectable naloxone without barriers such as needing a commercial address, as this formulation is preferred by many people who use drugs and is significantly less expensive than intranasal formulations. In addition, the federal government should consider pathways to removing prescription barriers to injectable naloxone that is distributed by harm reduction organizations — this might take the form of a novel pathway through the FDA or a nationwide standing order.
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As the United States continues to grapple with the ongoing overdose crisis, it is increasingly important that policymakers look to effective harm reduction tools that can save lives right now.
Last year, the United States saw more than 100,000 overdose deaths—the majority of which involved synthetic opioids such as fentanyl. Many of those deaths could have been prevented if the people most likely to experience or witness an overdose—people who use drugs—had better access to the overdose reversal medication naloxone.
Harm reduction organizations have been key distributors of naloxone since the mid-1990s, despite considerable barriers related to cost and naloxone’s prescription status. Grassroots buyers clubs emerged to help overcome these challenges, and even as they have evolved over the past decade, group purchasing remains a cornerstone of naloxone procurement for harm reduction organizations. Nonetheless, most legislative and regulatory efforts, while well intentioned, have overlooked this aspect of naloxone access, leaving much room for improvement.
In this paper, we integrate a review of the scientific literature with findings from a survey of harm reduction organizations and interviews with several individuals familiar with harm reduction and naloxone group purchasing to describe the emergence of naloxone group purchasing, explain its role in facilitating naloxone access, and discuss how policy can improve this important resource.