NEXT Distro - Missouri Order Form  

Please note that orders are shipped on Monday and Tuesday. Orders placed Tuesday afternoon may not ship until the following Monday.

Sign in to Google to save your progress. Learn more
What is your handle? *
The handle is the 'username' you choose when you originally enrolled with our program. If you do not remember your handle we will not be able to match this order with your name and address. Please reach out to Dan if you can not remember it at (646) 389-0752‬.
Type only the street number of your address so we can confirm we are shipping to the correct address. If your package is not going to the same address we have on file for you, please call / text us at (646) 389-0752‬  and write "different address" below.
*****Do not enter your complete address here if you have not yet submitted your address to us. Please send it to us via text/email.
*
For example, if your address is 123 Brown Street, write "123"
SYRINGES ARE LIMITED TO 200 PER ORDER (20 BAGS)
You may place an order once every 30 days.
What size syringes do you want us to send you? *
Note: you may receive syringes that are Aimsco brand syringes instead of Easy Touch depending on what's in stock. You will still get the correct gauge, volume, and length you ordered.
Required
Syringes come in a bag of 10.
How many bags of 10 syringes do you need TOTAL?
*
Reminder: You can place an order every 30 days. Think about what you need for the next 4-5 weeks.

20 bags maximum per order
If you chose more than one syringe size, how many bags of syringes of each size should we send?
For example, if you need 10 bags of syringes total but a few different sizes, let us know how many bags of each type you need.
Sharps Containers - Quart Size
Please see safeneedledisposal.org for information about how to best dispose of used syringes if you do not have a sharps containers. You can dispose of used syringes in plastic containers (thick walled) such as detergent bottles. Tape the container shut and label "SHARPS" and dispose of in your household garbage. Do not put in recycling.
Captionless Image
2 Gallon / Large Sharps Containers
Please see safeneedledisposal.org for information about how to best dispose of used syringes if you do not have a sharps containers. You can dispose of used syringes in plastic containers (thick walled) such as detergent bottles. Tape the container shut and label "SHARPS" and dispose of in your household garbage. Do not put in recycling.
Captionless Image
Fentanyl Test Strips
Fentanyl test strips can be used to test drugs for trace amounts of fentanyl.
1 red line = positive, 2 red lines = negative.

Can be ordered in quantities 5/10/20
Captionless Image
Xylazine Test Strips
Xylazine test strips can be used to test opiates for the presence of xylazine. Please only order these if you intend to use them for testing opiates such as heroin or fentanyl.

Learn more at: nextdistro.org/xylazine
Captionless Image
Benzodiazepine Test Strips
Benzodiazepine (Benzo) test strips can be used to test a substance for the presence of a benzo. Please note that these tests detect whether or not a benzodiazepine is present, but not how much or which type of benzo.
Captionless Image
Tourniquet
A tourniquet will restrict blood flow and cause the vein to bulge, making it more accessible for injection.
Captionless Image
Cookers  
Captionless Image
Alcohol Prep Pads  
Alcohol pads are used to clean an injection site prior to injection to remove bacteria and germs that could be pushed into the skin during the injection process. Do not use an alcohol pad post-injection, it will prevent blood from clotting.

Alcohol pads come in boxes of 100, how many boxes would you like?
Captionless Image
BZK Wipes
BZK is short for benzalkonium chloride, an antiseptic for cleaning hands and other body parts when soap and water is not available. They can be also be used to cleanse broken skin and wounds. Can order (50/100/150/200 individual packets)
Captionless Image
Bag of Cottons  
Cottons are used to filter impurities in the drug mix when pulling it into the syringe. Best practice is to use one new/clean cotton each time. Cottons come in a pillow pack with between 80-100 cottons in each bag.
Captionless Image
Addipak Sterile Respiratory Therapy Solution (3mL vial)
Sterile water, for mixing with injection drugs, can be used to clean wounds if potable tap water or sodium chloride solution is not available.

Can be ordered in quantities of 5/10/15/20
Captionless Image
Drink Powder - For Hydration
Add this powder to water and drink to quickly hydrate yourself, this helps make veins easier to locate. 
*Please note that the brand of drink powder may vary*
Captionless Image
Straight Pipes / Stems
Our ability to stock this item is inconsistent. We may not be able to include this in your order.  (1/2/3/4)
Captionless Image
Bulb Pipes
Our ability to stock this item is inconsistent. We may not be able to include this in your order. (1/2/3/4)
Captionless Image
Foil
Used for smoking, can me made into a pipe. 
Captionless Image
How to make a foil pipe
Wound Care
Adhesive Bandages
3/4 inch by 3 inch size, tan color.

Adhesive bandages come in boxes of 100, how many boxes would you like?
Captionless Image
Triple Antibiotic Ointment
Each box contains 25 individual packets of ointment
Captionless Image
Overdose Prevention
IM Naloxone Kit
Up to 10 kits can be ordered.
Captionless Image
Narcan-brand Naloxone Nasal Spray
*OUT OF STOCK*  We expect to have this back in stock soon.
Captionless Image
CPR Shield
A single use only physical barrier for mouth-to-mouth resuscitation
Captionless Image
Since you last received a package from NEXT, have you used naloxone/Narcan in an overdose incident? If so, please tell us about the incident(s) below.
Details such as the age, gender, and race/ethnicity of the person or people that overdosed is helpful for our program, but not required.
Safer Sex Supplies
Condoms
We apologize, we don't have a choice of brands. We will send you what we have available. Some condoms we have are flavored. If you do not want flavored or you need non-latex please mention that in a comment at the end of this form.
Captionless Image
XL Condoms [depending on availability]
Not always in stock - we will ship them if we have them.
*OUT OF STOCK* Internal Condoms
Captionless Image
Dental Dams
Used for protection during oral sex.
Captionless Image
Water-Based Lube
Can be ordered in amounts of 4/8/12/16 individual packets.
Captionless Image
Emergency Contraceptive
1.5mg levonorgestrel tablet - reduces chance of pregnancy after unprotected sex.
* may be less effective for people who weigh 165lbs or more.

If you need support to end a pregnancy or are interested in support for a wanted pregnancy as a person who uses drugs, we’re here to support you. Check out the Sexual & Reproductive Health and Parenting sections of nextdistro.org/resources and reach out to us at nextdistro@pm.me if you have any questions or need additional resources.
Captionless Image
Clear selection
Other Supplies
KN95 Masks
Captionless Image
Do you need something that isn't mentioned here? We have a limited amount of supplies.
How would you like tracking information for this order sent to you? *
If you choose the email or Pirate Ship option, make sure we know your email. If you choose the text option, make sure we know your phone number. Pirate Ship is the fastest method to get tracking info for your order.
Do you have any questions about harm reduction, safer injection, or anything else?
NEXT will not resend packages that have been lost or stolen. USPS.com provides a tracking notification option which can alert you to shipment updates via email or text. Simply enter your tracking number into Google or USPS.com and choose "Text & Email Updates". We strongly urge you to sign up for these notifications regardless of concern around package security. *
Required
You can place a NEXT Distro supply order at most every 30 days. Please confirm that you understand our ordering policy. *
Required
Is there anything else you want us to know before you 'check out'?
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Next Harm Reduction. Report Abuse