Harm Reduction Vending Machines: What are they and do they work?
By: Molly Reid, Sara Whaley, Sean T. Allen
Harm reduction vending machines are an evidence-based strategy to provide essential harm reduction supplies to people who use drugs. Harm reduction vending machines are similar to drink or snack vending machines, but may be stocked with supplies such as naloxone, sterile injection equipment, condoms, sharps containers, first aid kits, and pregnancy tests. Harm reduction vending machine implementation has been associated with reductions in syringe sharing and overdose mortality (Allen et al., 2022; McDonald, 2009; Obadia et al., 1999, Arendt, 2023). Amid the ongoing addiction and overdose crisis, harm reduction vending machines are an important evidence-based tool for communities to consider.
As jurisdictions explore opportunities to invest in opioid settlement funds, The Principles for the Use of Funds from the Opioid Litigation encourages jurisdictions to invest in strategies that expand access to lifesaving resources and services. With opioid overdose fatalities on the rise, harm reduction vending machines can expand access to the opioid overdose reversal medication naloxone and reduce overdose morbidity and mortality (Allen et al., 2022; Arendt, 2023).
Harm reduction vending machines have existed internationally for a number of years, starting with Denmark in 1987 and other locations in Europe and Australia quickly following suit (Shirley-Beavan, 2019). The United States has been slow to adopt them, however. In 2009, a non-profit community organization launched the first harm reduction vending machines in the United States in San Juan, Puerto Rico (Punto Fijo – Iniciativa Comunitaria, 2022). In 2017, harm reduction vending machines were implemented in Clark County, Nevada (Allen et al., 2022). Since then, nonprofits and public health organizations across the country have begun to establish vending machines to complement syringe services programs and expand access to much-needed harm reduction supplies.
Do they work?
Since their introduction in the late 1980’s, harm reduction vending machines have been shown to improve access to sterile syringes and other equipment (Arendt, 2023; Islam, Wodak, et al., 2008; Otiashvili et al., 2019), and reduce syringe sharing (McDonald, 2009; Obadia et al., 1999). More recent evidence suggests that including supplies to reverse opioid overdose may expand their public health reach. The implementation of naloxone dispensation at harm reduction vending machines in Clark County, NV was associated with a 15% reduction in overdose fatalities in the first year (Allen et al., 2022). In contrast to a statewide 5% increase in fatal opioid overdoses, in Hamilton County, Ohio, fatal overdoses decreased by 10% in the first year following the introduction of vending machines stocked with naloxone (Arendt, 2023). Some studies also suggest that they can improve access to harm reduction resources for hard-to-reach people who use drugs, including younger people (Islam & Conigrave, 2007), people newer to drug use (Islam, Stern, et al., 2008; Obadia et al., 1999; Otiashvili et al., 2019; Stark et al., 1994), persons who use drugs less frequently (Dodding & Gaughwin, 1995), and persons with poor linkage to social services (Islam, Stern, et al., 2008). A scoping review of studies of harm reduction vending machines found consistent high levels of acceptability and feasibility among people who use drugs and syringe services program staff (Russell et al., 2023). Studies have demonstrated that implementation is not associated with adverse events or syringe litter (Islam, Stern, et al., 2008; Islam, Wodak, et al., 2008; McDonald, 2009).
Considering investing in vending machines?
Here are some ways settlement funds can be used to support this intervention:
- Invest in infrastructure: Harm reduction vending machines are an evidence-based strategy to expand harm reduction efforts to serve diverse populations of people who use drugs. Vending machines can extend the accessible hours and reach of harm reduction services (Islam, Stern, et al., 2008; Islam, Wodak, et al., 2008).
- Supplies to stock them: Most of the literature on harm reduction vending machines describes inventory of sterile syringes, syringe disposal containers, and naloxone nasal spray (Russell et al., 2023). However, vending machines operators have identified there is ample potential to offer tailored supplies for diverse local populations of people who use drugs (Deimel et al., 2020), including fentanyl test strips, medication lock boxes, HIV take-home test kits, educational materials for overdose prevention and safer injection practices, and condoms.
- Research and Evaluation: Current evidence for harm reduction vending machines supports their expansion, but further research is needed to optimize how they are implemented in diverse contexts across the United States. This work could substantially build on existing harm reduction vending machine evidence.
You’re not alone – The Wisconsin Department of Health Services elected to allocate a portion of their opioid settlement funds towards harm reduction vending machines in 2022, with the first machine already in operation in Milwaukee County by 2023.
Allen, S. T., O’Rourke, A., Johnson, J. A., Cheatom, C., Zhang, Y., Delise, B., Watkins, K., Reich, K., Reich, R., & Lockett, C. (2022). Evaluating the impact of naloxone dispensation at public health vending machines in Clark County, Nevada. Annals of Medicine, 54(1), 2692–2700. https://doi.org/10.1080/07853890.2022.2121418
Arendt, D. (2023). Expanding the accessibility of harm reduction services in the United States: Measuring the impact of an automated harm reduction dispensing machine. Journal of the American Pharmacists Association, 63(1), 309–316. https://doi.org/10.1016/j.japh.2022.10.027
Deimel, D., Felix, O., Stöver, H. J., & Bock, C. (2020). Harm reduction 24/7: Evaluation of the vending machine program for drug users in North Rhine-Westphalia, Germany. Heroin Addiction and Related Clinical Problems, 22(4), 29–38.https://fra-uas.hessenfis.de/converis/portal/detail/Publication/11730364?auxfun=&lang=en_US
Dodding, J., & Gaughwin, M. (1995). The syringe in the machine. Australian Journal of Public Health, 19(4), 406–409. https://doi.org/10.1111/j.1753-6405.1995.tb00395.x
Islam, M., & Conigrave, K. M. (2007). Assessing the role of syringe dispensing machines and mobile van outlets in reaching hard-to-reach and high-risk groups of injecting drug users (IDUs): A review. Harm Reduction Journal, 4(1), 14. https://doi.org/10.1186/1477-7517-4-14
Islam, M., Stern, T., Conigrave, K. M., & Wodak, A. (2008). Client satisfaction and risk behaviours of the users of syringe dispensing machines: A pilot study. Drug and Alcohol Review, 27(1), 13–19. https://doi.org/10.1080/09595230701711199
Islam, M., Wodak, A., & Conigrave, K. M. (2008). The effectiveness and safety of syringe vending machines as a component of needle syringe programmes in community settings. International Journal of Drug Policy, 19(6), 436–441. https://doi.org/10.1016/j.drugpo.2007.07.006
McDonald, D. (2009). The evaluation of a trial of syringe vending machines in Canberra, Australia. The International Journal on Drug Policy, 20(4), 336–339. https://doi.org/10.1016/j.drugpo.2008.06.004
Obadia, Y., Feroni, I., Perrin, V., Vlahov, D., & Moatti, J. P. (1999). Syringe vending machines for injection drug users: An experiment in Marseille, France. American Journal of Public Health, 89(12), 1852–1854. https://doi.org/10.2105/ajph.89.12.1852
Otiashvili, D., Kirtadze, I., Vardanashvili, I., Tabatadze, M., & Ober, A. J. (2019). Perceived acceptability of and willingness to use syringe vending machines: Results of a cross-sectional survey of out-of-service people who inject drugs in Tbilisi, Georgia. Harm Reduction Journal, 16(1), 21. https://doi.org/10.1186/s12954-019-0292-8
Punto Fijo – Iniciativa Comunitaria. (2022). https://www.iniciativacomunitaria.org/punto-fijo/?lang=en
Russell, E., Johnson, J., Kosinski, Z., Kaplan, C., Barnes, N., Allen, S., & Haroz, E. (2023). A scoping review of implementation considerations for harm reduction vending machines. Harm Reduction Journal, 20(1), 33. https://doi.org/10.1186/s12954-023-00765-2
Shirley-Beavan, S. (2019). The State of Harm Reduction in Western Europe, 2018. Harm Reduction International. https://www.bag.admin.ch/dam/bag/de/dokumente/npp/forschungsberichte/forschungsberichte_drogen/The%20State%20of%20Harm%20Reduction%20in%20Western%20Europe%202018.%20Harm%20Reduction%20International,%20London.pdf.download.pdf/HRI_WesternEuropeGlobalState_Feb2019_Final.pdf
Stark, K., Leicht, A., & Müller, R. (1994). Characteristics of users of syringe vending machines in Berlin. Sozial- Und Praventivmedizin, 39(4), 209–216. https://doi.org/10.1007/BF01309220
About the Authors
Dr. Molly Reid is a postdoctoral fellow at Johns Hopkins University in the Drug Dependence Epidemiology Training Program. She graduated with a PhD in Epidemiology in Spring 2023 from the University of Washington, focusing on polysubstance use and harm reduction.
Dr. Sean Allen is an Assistant Professor at the Johns Hopkins Bloomberg School of Public Health. His research focuses on addiction and overdose.