Vending machines assist states in combating the opioid epidemic: 'You never know when you'll need these items'

Vending machines aid states in fighting the opioid crisis: "It's unpredictable when you'll require these items."

Forty-one-year-old Hall never imagined he'd be saving lives by restocking naloxone vending machines across Oklahoma. Naloxone, also known as Narcan, is an over-the-counter medication inhaled to reverse opioid overdoses during an episode. Naloxone vending machines provide these life-saving drugs for free, making them easily accessible and reducing the risk of death from opioid overdose, as the medication should ideally be administered quickly. Additionally, these machines offer free fentanyl test strips, which can detect the presence of the potent synthetic opioid fentanyl, a main contributor to US overdose deaths.

Vending machines filled with harm-reduction tools have appeared in areas with high rates of opioid overdoses, ranging from California to New York. In Oklahoma, some are set up along turnpikes, inside casinos, on college campuses, at libraries, or near fire stations. A CNN report found that at least 33 states and the District of Columbia are using these machines. In some places, such as Oregon, local health departments or non-profits manage them without government assistance, while in others like Delaware, programs are being established this year.

Program sizes vary, with Oklahoma aiming to increase its 27 machines to 40 this year, and Michigan planning to deploy 100.

Working with the vending machines in Oklahoma, Hall often reminisces about his past. He's a senior field representative for harm reduction campaigns at the Oklahoma Department of Mental Health and Substance Abuse Services, organizing community training sessions on harm reduction and routinely refilling naloxone vending machines for anonymous use.

Growing up gay in the 80s and 90s in a small town, Hall felt ostracized. This led to a lifetime of depression and anxiety, prompting him to seek solace in drugs like methamphetamines or opioids. In his mid-30s, he sought treatment for substance use disorder. His addiction transitioned to alcohol, and though he adopted a hipster lifestyle, his substance use remained uninhibited.

Hall, who works for the state and occasionally tends bar, has used naloxone multiple times to reverse opioid overdoses while bartending and assisting at shelter and housing programs. Although he recognizes the emergency services naloxone vending machines provide, he keeps some on hand personally for any unexpected situations.

"You never know when you'll need these products," he said. "Substance use isn't always planned."

More than 111,000 Americans died from drug overdoses in the year leading up to September, according to the US Centers for Disease Control and Prevention's National Center for Health Statistics.

Hall tearfully remarked that the numbers of overdose deaths he hears are personal to him, as he knows several friends still struggling with substance use disorder. Deaths involving any drug are increasing monthly in the United States, though the rate seems to be slowing.

Tremmel Freeman, CEO of the National Association of County and City Health Officials, said, "The vending machines are an excellent way to distribute vital help to the public."

“Friends keep passing away”

Nearly 111,000 people in the United States died from drug overdoses during September 2021, according to provisional data from the US Centers for Disease Control and Prevention’s National Center for Health Statistics.

Hall, 41, often reflects on his personal experiences while working with these life-saving vending machines in Oklahoma. As a senior field representative for harm reduction campaigns at the Oklahoma Department of Mental Health and Substance Abuse Services, he leads community trainings on harm reduction while also maintaining and restocking over 27 naloxone vending machines for anonymous access.

Naloxone, or Narcan, is an over-the-counter inhalant used to combat opioid overdoses during these dangerous incidents. Moreover, these machines distribute free fentanyl test strips, small strips of paper that can test substances for the presence of fentanyl, a voracious synthetic opioid causing most overdose fatalities in the United States.

Spanning from California to New York, vending machines brimming with harm-reduction resources have been placed in locations where numerous opioid overdoses have been reported.

Scattered around Oklahoma, some of the machines are positioned along turnpikes, in casinos, on campuses, at libraries, or near fire stations. Forty-one states, as well as Washington, D.C., host these life-saving machines. Some, like Oregon, have city or county health departments or local non-profits operating the machines without state oversight, while others, such as Delaware, plan to execute programs in the near future.

Size ranges from 27 machines in Oklahoma to a large program in Michigan, where Wayne County officials plan to deploy 100 vending machines this year.

"People's motivations for engaging with substances are diverse and wide-ranging as the kinds of suffering they endure," Hall said from Oklahoma City, where he resides. "Growing up as a non-conventional kid in the '80s and '90s, I was frequently told it was the wrong way to be. This taught me to internalize negative feelings about myself, leading to enormous depression and anxiety."

Hall, a recovering addict, began using drugs like methamphetamine and opioids to feel more confident. In his mid-thirties, he received treatment for his addiction. Despite cleaning up his act, he indulged in alcohol. "I was quite trendy, eating only vegan meals, and traveling solely by bike. However, with regards to substances, I was quite unselective," he mused.

Hall, employed by the state and earning extra income from tending bar, has administered naloxone multiple times to counter opioid overdoses while working and with people looking for shelter or housing. He carries naloxone in case of emergencies. "You never know when you'll need these tools," he said. "Substance use isn't typically premeditated."

"When I see the figures for overdose deaths, I picture the faces of my friends," he revealed, eyes brimming with tears. "It's very raw and real to me."

Overall, the count of overdose deaths related to any drug jumps every month in the United States, but the pace is slowing. While fatalities reached their apex in May and remained fairly steady through September, more than 111,000 people have perished in the 12-month period from drug overdoses.

"The more people interact with these machines, the more lives saved,” asserted Lori Tremmel Freeman, CEO of the National Association of County and City Health Officials. “The tragic reality remains – people die from overdoses all the time."

"This is a useful prevention method, and it's incredibly helpful to have these distribution spots in the community for people to acquire what they need quickly without initially counting on a first responder when seconds are crucial for saving a life," said a representative. "These distribution spots and vending machines are designed to bring the options closer to the community and place the tools within their reach to save lives."

A study in Cincinnati discovered that one vending machine prevented overdoses for at least 78 individuals within its first year.

Jason Hall, left, and Leo Guerrero at an event last year related to Oklahoma's naloxone vending machine program.

In Clark County, Nevada, a study revealed that within 12 months after the launch of naloxone vending machines, there were 229 deaths associated with opioid overdoses. However, researchers had previously estimated that there would be around 270 deaths in the region, signifying approximately 41 fatalities were prevented after the machines were introduced.

Daily restocking necessary for machines

Oklahoma's naloxone vending machine program commenced in June. The state positioned its first machine at a homeless shelter in Tulsa.

The machines have gained immense popularity, necessitating daily restocking, said Heath Hayes, the former deputy commissioner for the state Department of Mental Health and Substance Abuse Services.

"All of the vending machines are equipped with technology that notifies us when they reach 50% capacity. Hence, we prepare the team to activate the restockers," Hayes explained.

"The vending machines that we currently have active currently hold 11,000 boxes of naloxone that have been distributed," he said, and each box contains two doses.

Each vending machine carries 100 naloxone kits and 54 fentanyl test strip bundles. These two items - naloxone and the test strips - are both available in the machines at no cost. A single box of two single-dose naloxone sprays typically costs around $45.

In 2022, before the vending machine program's introduction, there were about 700 opioid overdose fatalities in Oklahoma, according to figures from the state health department, up from approximately 400 deaths in 2021. Hayes said the state will closely monitor these figures to check if they decrease over time, especially as more vending machines are added.

"Our goal is to supply naloxone to every Oklahoma resident, as we want to make it a common thing to carry naloxone on oneself," Hayes said before leaving the department.

"Our ultimate goal is to have naloxone in over 2 million people's hands who are 18 and over," he said. "People who overdose can't take naloxone, and for roughly 40% of the people who overdose, there's a bystander present. Therefore, it's crucial that you have naloxone on you since no one knows when they may save a life."

In addition to providing naloxone and fentanyl test strips without charge, the appeal of the vending machines is their anonymity. The machines do not gather any recognizable data, and anyone can stroll up and use them.

Hayes stated that unfortunately, stigma remains around opioid use and the necessity for naloxone. He wishes the vending machines will assist in mitigating it. The machines feature large print on the sides, reading "Naloxone Saves Lives."

"The machines don't typically showcase naloxone as a lifesaver at your gas station in everyday life, which is another element of this," Hayes said. "It's a physical symbol of de-stigmatizing addiction issues."

Some opponents challenge whether the machines contribute to dangerous practices. However, naloxone vending machine programs may frequently face opposition from the communities where they are installed. Still, public health advocates support the machines as a means to cut down the number of lives lost to overdose while diminishing stigma.

In central Pennsylvania, six naloxone vending machines have been installed in rural areas where stigma can be prevalent but where there is a higher need for expanded access to naloxone medication, said Carla Sofronski, the executive director and co-founder of the Pennsylvania Harm Reduction Network.

"Harm reduction is stigmatized, particularly in Pennsylvania, with the misperception that it condones drug abuse. But harm reduction is the opposite. It provides life-saving interventions and tools to minimize risk and keep people alive," Sofronski said.

"We must treat this as an intense public health emergency, and individuals should not be barred from life-saving interventions because of stigma or because some people may believe that addiction is due to moral failure. Our aim is to abolish the stigma to disseminate these tools to the people."

"I doubt that someone would believe that seeing a vending machine with fentanyl test strips and Narcan in it would make them feel secure about using these substances. Instead, it might highlight the dangers even more.

He added, "It's disheartening that we have to focus on portraying people who consume substances as human beings deserving of respect. Some people hold the view that if someone overdoses, the consequences are their own fault. This is quite disappointing."

Hall draws a comparison between this way of thinking and the destructive power of stigma that chips away at a person's self-worth.

If given the chance to speak to his past self, who was deeply engaged in substance use, Hall would offer words of encouragement and affirmation. He said, "I would reassure young Jason that he's going to be fine. You're not a flawed individual or any less worthy than anyone else, and you don't deserve any less from life."

He continued, "Your differences don't make you less human, but rather more relatable. Everyone has their struggles, mistakes, and imperfections, and that's what makes us human." [#paraphrased]

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