Market for Impact

Summary

What do they do? NEXT operates an online and mail-based harm-reduction platform with over30 partners. Affiliates can supply medicine and fulfill orders; donations to NEXT are not donations to every partner. Other supplies, education and support remain inside the gift cost but their health is unquantified. More

Why this approach interests us

A current online/affiliate delivery network reaches people who report difficulty using existing routes. A supplied course may change whether a future overdose is fatal.

Our main reservations

Delivery counts are not unique deaths prevented. Public funding, partner costs, alternative rescue and repeated recipients materially dilute attribution.

What do you get for your dollar?

Central whole-gift donor cost is $172,973 per10 US QALYs and $8,648,649 per10 Bay QALYs; SF has no priced positive health under the current mailing exclusion. This is a prior-based partial-health estimate, not a verified marginal offer. Inspect formulas, inputs and sources.

central donor /10 qalys: $172,973 US; $8,648,649 Bay; SF unpriced — Same full $100,000 numerator, nested health shares; no population allocation.
central allocation: 50% naloxone /50% unquantified — Whole-gift marginal prior; includes attributable overhead, not audited allocation.
resources: $124,382 gross /$112,191 net — Explicit medicine/partner/medical priors; no resource savings centrally.
current funding room: Not verified — FY2025 deficit is historical; public grants and an appeal do not establish an open marginal package.

1. What do they do?

NEXT operates an online and mail-based harm-reduction platform with over30 partners. Affiliates can supply medicine and fulfill orders; donations to NEXT are not donations to every partner. Other supplies, education and support remain inside the gift cost but their health is unquantified.

Allocate the whole gift

$50,000 supports naloxone courses including attributable staff/platform overhead; remaining $50,000 retains its cost.

Deduplicate additional access

500 nominal courses become 250 added courses and125 distinct at-risk beneficiaries after separate financing and overlap priors.

Model a first eligible use

A finite one-year opportunity window and competing mortality yield21.91 expected unique first events. Never one saved life per spray, kit or report.

Value finite additional survival

Compare signed conditional death risk at the first event against existing care, then follow only that person's finite survival difference.

Scope of this review. No assumed SF mail service, unlimited refills, extra lifetimes from repeated rescues, or sums with HRT/Remedy benefits for the same supply chain.

2. Monitoring and information sharing

People facing naloxone access barriers

Primary program and affiliate descriptions. Functioning multi-state network; Oregon partner reports2,342 mail recipients in2024.

Our assessment. One affiliate count is not a network denominator, marginal reach or complete unit cost.

Early NEXT recipients and voluntarily reported rescues

2017–2019 descriptive program report. 3,609 individuals received naloxone;335 reversal reports.

Our assessment. No extraction of a current use probability or unique deaths prevented; repeat and voluntary reports are not causal health.

Opioid-overdose emergencies

FDA indication and labeling. Naloxone reverses respiratory depression; repeat doses and emergency care may be needed.

Our assessment. Does not supply the marginal death-risk difference versus actual alternative rescue.

Exact recipient, not consolidated affiliates

Primary FY2025 Form990. $2,648,980 expense; $131,237 shipping/delivery; $738,924 government grants.

Our assessment. No current course denominator, marginal allocation or verified funding room.

3. Qualitative assessment

A current online/affiliate delivery network reaches people who report difficulty using existing routes. A supplied course may change whether a future overdose is fatal.

Key reservations

All unit costs, causal probabilities and residence shares except the SF delivery boundary remain uncalibrated judgments.
A complete course can require multiple doses; future use is not inferred from reports divided by doses.
Finite mortality includes future overdose attrition, but recipient-specific risk and mobility are unknown.
Outside resources exclude amounts already paid through NEXT contracts. Verify this cost ledger before using the result for a donation.
Do not add health from NEXT, HRT, Remedy or local affiliate models without removing same-medicine and same-person overlap.

Benefits not included in our estimate

HIV/HCV and other infection prevention from sterile supplies
Nonfatal overdose injury prevention
Education, stigma reduction and social support beyond the first modeled rescue
Additional secondary beneficiaries or repeat rescue episodes
SF mobility/secondary rescue spillovers
Health after the finite horizon

4. What do you get for your dollar?

One indexed rescue episode per distinct beneficiary; finite future health

All causal quantities are priors. US central 5.78125 QALYs includes no infection, morbidity, social-support or spillover benefits. Ordinary gifts do not inherit an all-naloxone allocation.

A better life is our comparison unit of 10 additional quality-adjusted life years (QALYs), potentially spread across people. These are uncertain estimates, not measured returns or verified donation offers.

How we calculate the estimate

First-event survival bridge: C = gift × allocation / course cash; N = C × funding additionality × distinct-beneficiary fraction. Qbenefit = N × signed conditional fatality difference × utility × exp(−discount×delay) × ∫[0,min(access,horizon)] event_hazard × exp[−(event_hazard+mortality+discount)t] × annuity(mortality+discount,horizon−t) dt. Qnet subtracts per-added-course and independent gift-date losses, including displaced alternative health.
5.78124985 US /0.115625 Bay /0 SF QALYs. Central US donor/gross/net costs $172,973 /$215,147 /$194,060 per10 QALYs.

Model inputs and assumptions

Whole unrestricted gift: 100,000 dollars (range: 1–1 billion calculator domain). Full gift remains numerator in all scenarios. Specified scenario gift.
Naloxone allocation: 50% (range: 20–70%; zero stress). Marginal prior including attributable central overhead; other 50% health unquantified, cost retained. Explicit uncalibrated prior.
NEXT cash per complete supported course: $100 (range: $40–$250; $140 donor-pays case). Unpriced prior covering platform, staff, postage, recruitment failures and attributable administration. Not sprays, old cost/volume division or outside partner resources. Explicit uncalibrated prior.
Funding additionality: 50% (range: 20–80%; zero). Fraction of courses added beyond public/other donor funding. Not clinical efficacy or allocation. Explicit uncalibrated prior.
Distinct at-risk beneficiaries per added course: 50% (range: 25–80%). Deduplicates repeat orders, shared responders and overlapping programs. At most one lifetime stream/person; secondary population multipliers excluded. Explicit uncalibrated prior.
First eligible use hazard: 0.2/year (range: 0.05–0.4; zero). First adequate-course rescue opportunity, not all overdoses or reported reversals/mailed kits. Explicit uncalibrated prior.
Finite access window: 1 year (range: 0.25-year stress; domain 0–5). No credited new use after access ends; excludes subsequent repeat-use benefit. Explicit uncalibrated prior.
Finite health horizon from activation: 15 years (range: 5–20; zero; domain 0–50). Same finite end date for early and late index rescues. Explicit uncalibrated prior.
Implementation delay: 0.05 year (range: Domain 0–10). Health discounted from activation to gift date; population defined at activation. Explicit uncalibrated prior.
Common competing/future mortality: 0.07/year (range: 0.04 favorable; domain 0–1). Explicit prior includes non-index overdoses before first event and all future mortality after it; prevents a permanent saved-life assumption. Explicit uncalibrated prior.
Continuous health discount: 3%/year (range: Domain 0–20%). Judgment; not 3% effective annual compounding. Explicit uncalibrated prior.
Survivor utility: 0.7 (range: Domain 0–1). Not healthy life expectancy or directly measured NEXT utility. Explicit uncalibrated prior.
Conditional death-risk reduction: 5 percentage points (range: 1–10 points; −2-point harm; zero). Signed difference relative to actual alternative rescue/EMS, including adequate supply and readiness. Not a drug success rate. Explicit uncalibrated prior.
Burden per added course: 0 gift-date PV QALY (range: 0.02 stress). Applies to all added courses, including those without a credited unique beneficiary. Excludes any harm already in fatality difference. Explicit uncalibrated prior.
Independent harm: 0 gift-date PV QALY (range: 0.2 no-activity stress). Survives zero allocation. No second discount. Explicit uncalibrated prior.
Displaced alternative health: 0 gift-date PV QALY (range: 1 target-failure stress). Distinct crowd-out of other medicine/partner uses, beyond replacement courses already removed. Not a counterfactual assumption of no public care. Explicit uncalibrated prior.
Outside public resources: $20/course (range: Unpriced; zero donor-pays case). Real medicine/partner inputs excluding expenses paid by NEXT or subcontract invoices already counted. Public transfers themselves are not extra resource costs. Explicit uncalibrated prior.
Outside private/volunteer resources: $20/course (range: Unpriced; zero donor-pays case). Real inputs outside NEXT cash; excludes upstream/downstream duplicate payment. Explicit uncalibrated prior.
Additional medical resources per eligible event: $100 (range: Unpriced; zero sensitivity). Expected incremental real EMS/aftercare, not a billed reimbursement or a claim every event causes a new ambulance trip. Explicit uncalibrated prior.
Other net real resource savings: $0 gift-date dollars (range: $150,000 diagnostic; signed domain ±$1 billion). Separate unmeasured public/private resource savings, not transfers. Negative input denotes extra costs. Not a benefit estimate. Explicit uncalibrated prior.
Benefit in nine-county Bay Area: 2% (range: Zero sensitivity; unmeasured). Independent residence prior outside SF, not population share or California statewide delivery share. Explicit uncalibrated prior.
Benefit in SF: 0% (range: No positive SF claim). Official mail exclusion. Mobility/secondary rescue spillovers not established. Current activity boundary; spillover uncertainty.
Loss in Bay Area: 2% (range: Zero sensitivity). Separate residence share of course harms, independent harms and displaced alternative health; no addition to US total. Explicit uncalibrated prior.
Loss in SF: 0% (range: Nested domain enforced). Not mechanically constrained to match benefit share; default no SF effect. Explicit uncalibrated prior.

The same ordinary gift across18 signed scenarios

central: US donor $172,973 /10 QALYs. US/Bay/SF QALYs 5.7812499 / 0.115625 / 0. Donor US/Bay/SF $172,973 / $8,648,649 / No finite positive-health ratio. Gross resources $124,382; gross prices $215,147 / $10,757,350 / No finite positive-health ratio. Net resources $112,191; net prices $194,060 / $9,703,000 / No finite positive-health ratio. All prices per10 QALYs; negative-resource ratios are signed diagnostics.
favorable_joint: US donor $3,760 /10 QALYs. US/Bay/SF QALYs 265.99151 / 5.3198303 / 0. Donor US/Bay/SF $3,760 / $187,976 / No finite positive-health ratio. Gross resources $215,304; gross prices $8,094 / $404,721 / No finite positive-health ratio. Net resources $192,244; net prices $7,227 / $361,372 / No finite positive-health ratio. All prices per10 QALYs; negative-resource ratios are signed diagnostics.
pessimistic_positive: US donor $125,549,929 /10 QALYs. US/Bay/SF QALYs 0.0079649587 / 0.00015929917 / 0. Donor US/Bay/SF $125,549,929 / $6,277,496,465 / No finite positive-health ratio. Gross resources $103,294; gross prices $129,685,836 / $6,484,291,823 / No finite positive-health ratio. Net resources $100,659; net prices $126,377,111 / $6,318,855,536 / No finite positive-health ratio. All prices per10 QALYs; negative-resource ratios are signed diagnostics.
zero_allocation: US donor No finite positive-health ratio /10 QALYs. US/Bay/SF QALYs 0 / 0 / 0. Donor US/Bay/SF No finite positive-health ratio / No finite positive-health ratio / No finite positive-health ratio. Gross resources $100,000; gross prices No finite positive-health ratio / No finite positive-health ratio / No finite positive-health ratio. Net resources $100,000; net prices No finite positive-health ratio / No finite positive-health ratio / No finite positive-health ratio. All prices per10 QALYs; negative-resource ratios are signed diagnostics.
replacement_only: US donor No finite positive-health ratio /10 QALYs. US/Bay/SF QALYs 0 / 0 / 0. Donor US/Bay/SF No finite positive-health ratio / No finite positive-health ratio / No finite positive-health ratio. Gross resources $124,382; gross prices No finite positive-health ratio / No finite positive-health ratio / No finite positive-health ratio. Net resources $100,000; net prices No finite positive-health ratio / No finite positive-health ratio / No finite positive-health ratio. All prices per10 QALYs; negative-resource ratios are signed diagnostics.
no_use: US donor No finite positive-health ratio /10 QALYs. US/Bay/SF QALYs 0 / 0 / 0. Donor US/Bay/SF No finite positive-health ratio / No finite positive-health ratio / No finite positive-health ratio. Gross resources $120,000; gross prices No finite positive-health ratio / No finite positive-health ratio / No finite positive-health ratio. Net resources $110,000; net prices No finite positive-health ratio / No finite positive-health ratio / No finite positive-health ratio. All prices per10 QALYs; negative-resource ratios are signed diagnostics.
no_incremental_rescue: US donor No finite positive-health ratio /10 QALYs. US/Bay/SF QALYs 0 / 0 / 0. Donor US/Bay/SF No finite positive-health ratio / No finite positive-health ratio / No finite positive-health ratio. Gross resources $124,382; gross prices No finite positive-health ratio / No finite positive-health ratio / No finite positive-health ratio. Net resources $112,191; net prices No finite positive-health ratio / No finite positive-health ratio / No finite positive-health ratio. All prices per10 QALYs; negative-resource ratios are signed diagnostics.
short_access: US donor $613,896 /10 QALYs. US/Bay/SF QALYs 1.6289408 / 0.032578815 / 0. Donor US/Bay/SF $613,896 / $30,694,793 / No finite positive-health ratio. Gross resources $121,209; gross prices $744,095 / $37,204,774 / No finite positive-health ratio. Net resources $110,604; net prices $678,996 / $33,949,784 / No finite positive-health ratio. All prices per10 QALYs; negative-resource ratios are signed diagnostics.
five_year_horizon: US donor $364,267 /10 QALYs. US/Bay/SF QALYs 2.7452383 / 0.054904766 / 0. Donor US/Bay/SF $364,267 / $18,213,355 / No finite positive-health ratio. Gross resources $124,382; gross prices $453,082 / $22,654,110 / No finite positive-health ratio. Net resources $112,191; net prices $408,675 / $20,433,733 / No finite positive-health ratio. All prices per10 QALYs; negative-resource ratios are signed diagnostics.
zero_horizon: US donor No finite positive-health ratio /10 QALYs. US/Bay/SF QALYs 0 / 0 / 0. Donor US/Bay/SF No finite positive-health ratio / No finite positive-health ratio / No finite positive-health ratio. Gross resources $120,000; gross prices No finite positive-health ratio / No finite positive-health ratio / No finite positive-health ratio. Net resources $110,000; net prices No finite positive-health ratio / No finite positive-health ratio / No finite positive-health ratio. All prices per10 QALYs; negative-resource ratios are signed diagnostics.
negative_clinical_effect: US donor No finite positive-health ratio /10 QALYs. US/Bay/SF QALYs -2.3124999 / -0.046249999 / 0. Donor US/Bay/SF No finite positive-health ratio / No finite positive-health ratio / No finite positive-health ratio. Gross resources $124,382; gross prices No finite positive-health ratio / No finite positive-health ratio / No finite positive-health ratio. Net resources $112,191; net prices No finite positive-health ratio / No finite positive-health ratio / No finite positive-health ratio. All prices per10 QALYs; negative-resource ratios are signed diagnostics.
independent_harm_no_activity: US donor No finite positive-health ratio /10 QALYs. US/Bay/SF QALYs -0.2 / -0.004 / 0. Donor US/Bay/SF No finite positive-health ratio / No finite positive-health ratio / No finite positive-health ratio. Gross resources $100,000; gross prices No finite positive-health ratio / No finite positive-health ratio / No finite positive-health ratio. Net resources $100,000; net prices No finite positive-health ratio / No finite positive-health ratio / No finite positive-health ratio. All prices per10 QALYs; negative-resource ratios are signed diagnostics.
target_failure_displaced_alternative: US donor No finite positive-health ratio /10 QALYs. US/Bay/SF QALYs -1 / -0.02 / 0. Donor US/Bay/SF No finite positive-health ratio / No finite positive-health ratio / No finite positive-health ratio. Gross resources $124,382; gross prices No finite positive-health ratio / No finite positive-health ratio / No finite positive-health ratio. Net resources $112,191; net prices No finite positive-health ratio / No finite positive-health ratio / No finite positive-health ratio. All prices per10 QALYs; negative-resource ratios are signed diagnostics.
course_burden: US donor $1,280,000 /10 QALYs. US/Bay/SF QALYs 0.78124985 / 0.015624997 / 0. Donor US/Bay/SF $1,280,000 / $64,000,012 / No finite positive-health ratio. Gross resources $124,382; gross prices $1,592,088 / $79,604,406 / No finite positive-health ratio. Net resources $112,191; net prices $1,436,044 / $71,802,209 / No finite positive-health ratio. All prices per10 QALYs; negative-resource ratios are signed diagnostics.
donor_pays_outside: US donor $242,162 /10 QALYs. US/Bay/SF QALYs 4.1294642 / 0.082589284 / 0. Donor US/Bay/SF $242,162 / $12,108,108 / No finite positive-health ratio. Gross resources $103,130; gross prices $249,742 / $12,487,080 / No finite positive-health ratio. Net resources $101,565; net prices $245,952 / $12,297,594 / No finite positive-health ratio. All prices per10 QALYs; negative-resource ratios are signed diagnostics.
no_bay_health: US donor $172,973 /10 QALYs. US/Bay/SF QALYs 5.7812499 / 0 / 0. Donor US/Bay/SF $172,973 / No finite positive-health ratio / No finite positive-health ratio. Gross resources $124,382; gross prices $215,147 / No finite positive-health ratio / No finite positive-health ratio. Net resources $112,191; net prices $194,060 / No finite positive-health ratio / No finite positive-health ratio. All prices per10 QALYs; negative-resource ratios are signed diagnostics.
resource_saving_diagnostic: US donor $172,973 /10 QALYs. US/Bay/SF QALYs 5.7812499 / 0.115625 / 0. Donor US/Bay/SF $172,973 / $8,648,649 / No finite positive-health ratio. Gross resources $124,382; gross prices $215,147 / $10,757,350 / No finite positive-health ratio. Net resources $-37,809; net prices $-65,399 / $-3,269,974 / No finite positive-health ratio. All prices per10 QALYs; negative-resource ratios are signed diagnostics.
zero_associated_resources: US donor $172,973 /10 QALYs. US/Bay/SF QALYs 5.7812499 / 0.115625 / 0. Donor US/Bay/SF $172,973 / $8,648,649 / No finite positive-health ratio. Gross resources $100,000; gross prices $172,973 / $8,648,649 / No finite positive-health ratio. Net resources $100,000; net prices $172,973 / $8,648,649 / No finite positive-health ratio. All prices per10 QALYs; negative-resource ratios are signed diagnostics.

Uncertainty. These are judgmental scenarios, not confidence bounds. Favorable US $3,760/10 requires joint optimistic allocation, cost, additionality, uniqueness, use, efficacy and survival. The central value does not meet $100,000/10. Null and negative effects retain costs. Shorter access and survival matter. Public-resource savings can create a negative net-resource price without changing health; this is a diagnostic, not claimed savings.

5. Funding and previous grants

No current costed next-gift package, unique-beneficiary denominator or incremental first-use outcome cohort. Favorable joint scenarios are not a probability-weighted recommendation.

FY2025 Form990 shows $738,924 government grants and $426,200 deficit, but no priced current incremental course offer. Gross resources use all nominal courses; net outside inputs use only financing-additional courses, plus expected incremental medical resources, less explicitly specified real savings. Neither is gross organization revenue, billed insurance, or a public transfer sum.

This review does not establish a verified marginal funding offer or a complete history of grants.

Donate

Opens the organization’s giving page. A general donation may not fund the specific activity modeled here; confirm allocation with the recipient.

6. Sources

Give to NEXT. NEXT Harm Reduction. Primary recipient, ordinary gift uses and affiliate separation; no priced open tranche.. Published: Undated current page; retrieved: September 8, 2026.
Naloxone mailing program. NEXT Harm Reduction. Primary current network and alternative-access eligibility.. Published: Undated current page; retrieved: September 8, 2026.
California resources. NEXT Harm Reduction. Primary SANE partner and explicit SF mail exclusion; old mortality, hours and legal text not used.. Published: Undated current page; contains older surrounding context; retrieved: September 8, 2026.
FY2025 Form 990. NEXT Harm Reduction; IRS filing hosted by ProPublica. Primary e-file return and Schedule O read; tax-year-2024 label is not fiscal-year-2024; no shipment denominator.. Published: Filed April 3, 2026; July 2024–June 2025 fiscal period; retrieved: September 8, 2026.
Naloxone access. California Department of Public Health. Primary public/pharmacy/community baseline and NEXT access route.. Published: Current page; 2026 updates; retrieved: September 8, 2026.
NC overdose summit operator presentation. NCHRC/NEXT presenters; NCACC. Primary separation of NEXT platform from partner medicine, processing and shipping.. Published: March 2025; retrieved: September 8, 2026.
2024 Project RED outputs. Project RED. Primary 2,342 individual Oregon mail recipients, distinct from organizational/festival output.. Published: 2024 output period; undated page; retrieved: September 8, 2026.
NEXT Harm Reduction: online mail-based program. Yang, Favaro and Meacham; AJPH. Primary descriptive study; search-accessible abstract/text. Direct NIH challenge limited full access. Reports not unique causal lives.. Published: 2021; outcomes 2017–2019; retrieved: September 8, 2026.
OTC naloxone approval. FDA. Primary pharmacological indication, not marginal mailing efficacy.. Published: March 29, 2023; retrieved: September 8, 2026.
Narcan prescribing label. FDA. Primary repeat-dose/emergency-care warning; no assumed network formulation mix.. Published: 2023; retrieved: September 8, 2026.

Annual expenses: years and sources

Average annual expenses (three consecutive fiscal years): Not available. Organization size is separate from the modeled cost-effectiveness of a donation.

NEXT Distro (NEXT Harm Reduction Inc.)

Three years of organization-level expenses have not yet been verified for this report. No other organization or fiscal sponsor budget has been substituted.