Distributing Naloxone through Social Networks

A quick guide to engaging persons who use drugs to increase naloxone availability

Innovative Strategy

  • Naloxone distribution reduces fatal opioid-related overdoses.
  • People who use drugs have a long history of protecting each other and responding to overdoses to save community members’ lives.
  • Cash payments to people who use drugs for their time and involvement with the overdose prevention activities (naloxone distribution) in collaboration with a harm reduction program.
  • Provides services to people who may not be accessing existing harm reduction services or may not consider themselves at risk of opioid overdose.
  • Peer-to-peer models of training reinforce social support networks and successfully transfer skills.
  • Promotes peers as community leaders, who are in a unique position to connect people with supportive services.
  • Expands access to services during times the harm reduction program is not open.

Potential Benefits to Community

  • Supplies naloxone to people in high-risk areas and with limited access.
  • Cash compensation supports dignity and acknowledges the impact of people who use drugs in overdose prevention.
  • Increases the influence and autonomy of systematically marginalized groups over decisions that affect them.
  • Investing in our communities increases naloxone delivery to community members at the highest risk of overdose.
  • Outreach to populations includes:
    • People who do not access the OEND programs at a brick-and-mortar site (e.g., lack of access to transportation).
    • People who do not intentionally use opioids yet are at risk of being unwittingly exposed (e.g., people who use stimulants).
    • People not currently reached through street outreach (e.g., people who are living in homeless encampments, people using drugs at home).

Operational Considerations

  • Using this model, peers take naloxone and other harm reduction supplies back to their communities and distribute them. Peers operate in their own space and on their own schedules.
  • Program compensates designated peer distributors for their time and effort.
  • Strategy best housed within an overdose education and naloxone distribution (OEND) program, with a strong culture of harm reduction.
  • The program gives a cash stipend for weekly return of a data sheet indicating the number of naloxone kits distributed and supplies provided.
  • Peer recruits should be established OEND program participants, familiar with the neighborhood or the specific community you are trying to reach.
  • OEND programs must provide adequate support to peers and be aware not to overburden them because of limited resources.
  • Organizations should be prepared to navigate financial, policy or legal barriers.
    • Capacity to provide stipends in the form of cash to fairly compensate peers without stigmatizing constraints (e.g., lack of a bank account and/or identification to be able to cash a check).
    • Avoid disclosure of a social security number or criminal offender record information.

Evaluation metrics

  • Track the following information to help measure success of the program:
    • Number of kits distributed on a weekly basis.
    • General descriptions of where distribution occurred.
    • Observed insights from peers regarding successes, challenges, and ideas to expand distribution.

Estimated cost to implement

  • Compensation for $25 per peer, per week.
  • Naloxone kits (check with your local pharmacy or health dept for cost).
  • Supplies are provided by the OEND program.
  • Cost of OEND program staff to recruit peers and oversee program.
  • Total estimated program cost for 15 months of services: $3,000 - $4,000.

Acknowledgements

We wish to express our thanks to all community partners who have implemented these programs during the HEALing Communities Study. Key insights from these partners were crucial in the development of these resources that will be important tools for programs looking to build on the successes of these strategies to reduce fatal overdoses.

Read our latest publication on stipends for peer distributors

Lewis, N.M., Smeltzer, R.P., Baker, T.J., Sahovey, A.C., Baez, J., Hensel, E., Poole, B., Stewart, C., Cogan, A.G., Bullard, M., Taylor, J.L. Feasibility of paying people who use drugs cash to distribute naloxone within their networks. Harm Reduction Journal. 2024 Feb 16;21(1):42. doi:10.1186/s12954-024-00947-6.