Gov. DeWine preserves naloxone access during covid-19 
Ohio Department of Health supplies overdose-reversing drug to HRO online program

In March, Harm Reduction Ohio (HRO) distributed 1,766 naloxone kits, a record for us, the state’s only licensed lay distributor of naloxone.

A large share of this record number was in support of Ohio’s “shelter in place” response to prevent the spread of the covid-19 virus. In recent days, half the web traffic flowing to our online naloxone ordering service has come directly from a link posted on the Ohio Department of Health web site.

The Ohio Department of Health (ODH) is providing HRO all the Narcan needed for our online service to keep naloxone access alive statewide during the coronavirus scale. HRO offers a big “thank you!” to ODH for providing the Narcan, believing in the ability to our online program to handle this important statewide mission and — most of all — for caring about the health and well-being of people who use drugs.


Online naloxone distribution

Harm Reduction Ohio’s online service lets people choose between Narcan nasal spray and intramuscular naloxone (injected into a large muscle). (Both are free to the requester, and both are equally effective when used in a bio-equivalent dose.) In March, 68% of naloxone kits we gave out were Narcan; 32% were IM naloxone.

Also in March, 90% of the kits were given out through our online service; 10% were given out through our statewide network of about 40 trained lay distributors. In the January and February, our lay distribution network and our online service each provided out about half of the total naloxone we distributed.

This may be an example of how covid-19 causes lasting change. Our lay distribution network has had to scale back because of the need for social isolation to prevent the virus from spreading. (It will return to full force later this year!) In fact, we expect it to grow.) But the privacy and convenience of ordering via a phone or a laptop will likely push an increasing share of naloxone orders online. Harm Reduction Ohio expects to be the of our niche of naloxone and harm reduction supplies in Ohio: Like, online ordering is of greatest benefit to people living in Ohio’s small cities and rural areas where naloxone access is limited or almost non-existent.

Online innovator NEXT Distro

HRO’s other partner in this venture is NEXT Distro, a New York City-based non-profit that handles the technology of processing online orders and asking the questions required by the Ohio Department of Health. NEXT Distro, founded by harm reduction visionary Jamie Favarro, build an organization that supports online distribution programs across the country. HRO is just the Ohio affiliate of a nationwide effort.

NEXT Distro founder Jamie Favaro

Harm Reduction Ohio took its first order on February 14, 2019. It was the only order we had all week! Our second order came on February 20, 2019, our third on February 26, 2019. NEXT Distro paid our postage at times when Harm Reduction Ohio couldn’t afford it.

Today, just one year later, we’re averaging 46.6 online orders per day and will furnish at least 15,000 naloxone kits (probably closer to 25,000 kits) in Ohio this year. We have improved the efficiency of online distribution enormously thanks to Jamie Favarro and employees and volunteers Allison Loeber, Carole Robinson, Ajeeta Jandkami, Jenny Nath, Chris Hopkins and others.

Every order received before 4 p.m. yesterday was mailed yesterday, delivered to the post office in Mansfield, Ohio, before it closed at 5:30 p.m., by naloxone distribution specialist Allison Loeber. Some people who ordered Narcan online Friday afternoon will get it in the mail Saturday morning. All 67 orders should be in mailboxes by Monday, if the postal service can meet its delivering goals during these tough times.

HRO’s postal receipt for Friday, April 3rd: 67 first-class envelopes sending naloxone to 52 Ohio cities and towns, plus three boxes of naloxone for lay distributors to hand out personally.

Reversing overdoses in large numbers

Another exciting thing about online ordering is that makes it easier for naloxone to reach the stigmatized, criminalized, hard-to-reach audience of people who are at risk of overdose death: people who use drugs.

In March, 110 of our orders were placed by people who needed naloxone because the previous kit was actually used to reverse an overdose. Harm Reduction Ohio, as a non-governmental organization, has the trust of those who use illegal drugs in Ohio. We are proud to serve people who use drugs, as well as their family, friends and co-workers who may be called on to reverse an overdose.

Demographics skew

All is not rosy with online distribution, though. With online distribution, your customers choose you, not the other way around.

In March, only 2.6% of naloxone orders were placed by people who identified themselves as black or African American. By contrast, the Census Bureau reports 13% of Ohio residents are black. This is especially disturbing because, in Ohio, for the first time in many years, black residents had higher overdose death rates than white residents in 2019. (Harm Reduction Ohio reported this exclusively here.)

When HRO can influence the population receiving naloxone, the racial imbalance declines. As a group, our lay distributors provide naloxone to a population that represents Ohio almost exactly. Why? Because we have lay distributors — and seek lay distributors — who work in diverse communities.

In the past, HRO has slightly reduced the racial imbalance in online distribution by advertising our online naloxone service to predominantly black audiences, such as people living in predominantly black zip codes. However, this has made less of a difference than we hoped. (Harm Reduction Ohio recently received a $10,000 per month Google ad grant, which we hope to use to promote naloxone availability in predominantly black zip codes. However, our first Google ad was rejected because Google disapproved advertising access to naloxone, a prescription drug.)

The other enormous demographic skew in online ordering is toward women. In March, 69.0% of orders were placed by women, 27.3% by men and 3.7% by people who identified themselves as gender non-confirming. This tilt is disturbing because most people who die over drug overdoses in Ohio are men.

What causes this naloxone gender gap? The difference seems to reflect an empathy gap. In public policy and perhaps human affairs, women tend to be kinder, more empathetic and less judgmental than men — in other words, more open to harm reduction.  Go to a typical harm reduction event, and it will be 80% women. So men are the ones who benefit most from the practice of harm reduction (and access to naloxone) but women are the ones disproportionately making it work for men.

Online orders during the pandemic

The demographic bias in who’s getting naloxone is an important problem to be worked on. But, for now. during the covid-19 pandemic, it’s time to celebrate the huge increase in naloxone available in Ohio.

Since March 16, HRO’s online service has averaged 46.8 orders per day. The number of kits provided is somewhat higher than that because some people need more than one kit. (Order here.) We’ve reached nearly all of Ohio’s 88 counties, especially southern Ohio counties, such as Scioto and Pike, that have the highest overdose death rates in the state.

Thank you, Ohio, especially Gov. Mike DeWine and ODH Director Amy Acton, M.D., for helping get naloxone where it needs to be during an emergency.

— By Dennis Cauchon, President, Harm Reduction Ohio


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