VALUE & Precedent
Elimination of Overdose Deaths, HIV and Viral Hepatitis Through Syringe Services Program Expansion into Mail-based Delivery
The evidence for syringe service programs (SSPs) as a public health and public safety intervention is well-documented (CDC, 2019). Legalization of syringe service programs is taking place in the context of growing efforts to authorize supervised consumption facilities and decriminalize use of controlled substances on the local, state and federal level. With the American Rescue Plan Act of 2021 providing $30 million to support overdose prevention services including SSPs, it is an opportune time to expand SSP capacity and make significant progress on public health elimination goals.
Mail-Based Delivery Addresses Unmet Need in Populations Underserved by SSPs
As of August 2019, 39 U.S. states have legalized SSPs. Despite this progress, many people who use drugs (PWUD) live too far from an SSP and cannot afford to purchase syringes from online marketplaces such as Amazon. As more states legalize SSPs, the total number of SSPs will increase, but many low-income, rural communities remain unserved. Mail-based delivery addresses this unmet need.
National Recommendations for Mail-Based Distribution of Harm Reduction Services
In May 2020, the CDC issued guidance that SSPs be considered an essential service and that supplies are provided through mobile services, delivery, or mail-order services whenever possible. NASTAD SSP guidance recommends mail-based delivery as a method to reach rural audiences as well as to ensure safe continuity of services during COVID-19. In fall 2020, the states of Maine and Pennsylvania authorized SSPs to mail naloxone to combat the overdose crisis during COVID-19. Despite these actions, only 6% of 173 SSPs surveyed were providing mail-based services in 2020 (Glick et al., 2020).
NEXT Distro: Supporting SSP Expansion into Mail-Based Services
Founded in 2017, NEXT Distro operates as a hub-and-spoke SSP through the creation of a secure online platform for centralized screening, referrals, order fulfillment and data management, and decentralized mail-based distribution of harm reduction supplies via its 38 affiliate partners. NEXT Distro’s implementation model aligns with the CDC (2020) SSP technical package recommendations and is described in the American Journal of Public Health (Barnett et al., 2021; Yang et al., 2021), Journal of Urban Health (Hayes et al., 2021), Journal of Translational Research (Wegner et al., 2021) and RouteFifty.
Benefits of a NEXT Distro-Health Department Collaboration
Expand reach of SSPs to PWUD who may not otherwise engage in in-person SSP services or medical care
Achieve naloxone saturation metrics including reaching rural and remote communities across broad geographic areas
Build capacity of affiliate SSPs, including data collection and management training, operational support, and provision of bilingual health education and referral materials made by and for PWUD
Receive aggregate data to inform needs assessments, enhanced surveillance, and outbreak response strategies
Funding models
California: NEXT is funded by the State Department of Health through a CDC Opioid Data to Action grant to expand online and mail-based harm reduction. NEXT is the primary recipient of funds and sub-contracts with an in-state pre-existing harm reduction program. As part of this subcontract, four staff carry out strategy and mailings. Staff are members of the California program and all mail-based operations are supervised by NEXT.
Michigan: Foundation funding is directed to both an in-state syringe access provider to fund staff, and to NEXT to fund back-end administration, supervision, and technical assistance. This particular contracting process funds postage and supplies through NEXT but could be administered various ways.
What budget lines look like:
Personnel: This is largely based on the population and needs of the state as well as capacity and geographic distribution of pre-existing harm reduction organizations. For small to mid-size states we recommend 1 FTE- Shipping, supply inventory, supply packing (i.e., kits, supplies that need pre-packaging prior to shipping), 1 FTE- Participant communication and support including but not limited to, health insurance enrollment, testing and treatment services, supportive counseling, referrals, and other case coordination for mail-based participants
Supplies: Program supplies including but not limited to safer injection, hazardous waste disposal tools, and educational materials; mailing supplies including shipping boxes and bubble mailers
Postage: USPS the most economical option
Technology: Administration related to enrollment and ordering, data cleaning, data reporting, encryption systems maintenance; onboarding, training, capacity building, and technical assistance as needed, this is something NEXT can directly provide
Capacity Building & Technical Assistance: NEXT will work closely with an SSP in your state to build their policies and procedures, train staff, and provide ongoing program supervision and support
Other: Additional essential costs include computers, thermal printer, office supplies
NEXT Steps
In order to expand mail-based harm reduction services, state health departments are requested to authorize mail-based delivery of harm reduction services and fund training, technical assistance and staffing, and supplies at one existing SSP, in alignment with recommendations for SSP expansion (Pew, 2021).
Contact us to learn how we can support expansion of mail-based harm reduction services in your state.