Washington DC – It was a hot summer day in July when Shekita McBroom received a call from her local hair salon.
The stylist on the other end of the line was in dire need of refills of naloxone, a drug used to prevent an overdose, rather than hair dye or shampoo.
Naloxone, commonly known by its brand name Narcan, is a life-saving drug often used as a nasal spray to control symptoms caused by opioid ingestion.
But it was no surprise to McBroom, a Washington, D.C., community activist who advocates for overdose prevention, that the hair salon was supplying the drug in its backroom. Instead, she would like to see naloxone made more widely available, including in vending machines.
“I try to provide people with more supplies because they don't necessarily know where to find more supplies,” she told Al Jazeera. But she thinks vending machines are a convenient solution. Without vending machines, it's a quick and easy way to provide emergency medical care at any time of the day in areas with limited service.
A growing number of communities in the United States are adopting that approach. In 2023, there will be a boom in vending machines dispensing free overdose reversal drugs, as well as fentanyl test strips, clean needles, and other “harm reduction” items.
US adopts this approach 'later than everyone else'
Washington, D.C., is one of several cities to launch vending machine programs this year. There are currently seven vending machines, managed by two local community health organizations.
Four of those machines are overseen by Family Medical Counseling Services, Inc., which dispensed 204 packages of Narcan between October and November. That means, on average, he delivered about three boxes of two-dose Narcan to people in need each day.
Angela Wood, the group's chief operating officer, said: “We're amazed at the amount of activity the machine actually gets.”
He noted that vending machines do not require users to submit any personal information or even interact with a real person, reducing the potential for bias.
“This is a way for people to access these products in their own time, in their own way, without having to fully participate in the program,” she told Al Jazeera.
Chicago similarly introduced a pilot program for naloxone vending machines in November, and New York City opened its first vending machine in Brooklyn in June.
Progress was also made at the state level. West Virginia, Wisconsin, Vermont, Missouri, Kansas and Connecticut all announced or approved vending machines this year.
Even tribal governments have adopted this strategy. In April, the Para Band of Mission Indians installed what it said was the first naloxone vending machine on tribal land in the United States. Four months later, the Tulalip Reservation in Washington state had its own machine installed.
The uptake of vending machines has been dramatic, said Rebecca Stewart, an assistant professor at the Penn Center for Mental Health who studies substance abuse treatment.
“They're really popping up all over the country,” she said.
This trend started in the United States just five years ago in 2017 with Nevada's vending machine program. But, as Stewart pointed out, similar programs have existed for years in Europe, Australia and even Puerto Rico.
“The United States is in some ways behind everyone else in this regard,” she said. “When it comes to harm-reduction vending machines, they have been introduced around the world for decades, so we are only just beginning to see them in the United States.”
Escaping the “moral hazard” debate
One of the biggest obstacles to vending machine adoption has traditionally been public opinion.
Stewart said many Americans, including politicians and policymakers, are concerned that vending machines encourage drug use by making it safer. She calls this the “moral hazard” argument.
Officials reiterated that idea this year. Kentucky installed its first naloxone vending machines in 2022, but some local politicians remain opposed to expanding it to neighboring counties.
“Basically, instead of helping people who have drug problems get off drugs, we're trying to get them off drugs,” Nelson County Judge and Executive Tim Hutchins told television news station WHAS11 in February. It's about promoting and enabling.”
Still, overdose deaths continue to rise in the United States. From 2021 onwards, more than 100,000 people will die from drug overdose each year, double the number recorded in 2015.
The majority of these overdose deaths are linked to opioids, and experts blame the rise of synthetic substances like fentanyl for the spike in deaths.
Ryan Hampton, an activist and organizer focused on addiction, sees the proliferation of vending machines as evidence of an impending opioid crisis.
He worries that the United States continues to ignore “harm reduction” strategies as a means to reduce mortality rates. The term “harm reduction” is widely used to refer to methods that help prevent overdoses and other ramifications of drug use, such as the transmission of disease through sharing needles.
“For too long, harm reduction has been a stigmatized strategy,” Hampton said.
Instead, he explained, the U.S. is investing more in a “prevention/intervention” model that deters drug use in the first place. As a result, there are few resources devoted to preventing overdoses and other drug-related harms, he added.
“What is being invested in never meets the demand for services or the scale of what is currently needed,” he said.
“Given the supply of toxic drugs we face, the mechanism has to be to bring harm reduction into every setting possible, whether it's in vending machines or in community health care settings.”
Stewart has noticed a shift away from the perception that naloxone is a “facilitator” of opioid use.
Rather, her study, which focused on Philadelphia, found that local residents were open to the prospect of drugs to reverse overdoses being easily available in vending machines.
“One of the things we found from talking to these various stakeholders is that Narcan is widely accepted,” she added. “And I feel like this is a very promising finding because I don't think Narcan was widely accepted five years ago.”
Although technology is low, access is high
However, vending machines themselves are not a silver bullet. Navaln Dasgupta, a senior scientist at the University of North Carolina at Chapel Hill Injury Prevention Research Center, said they also need to pay attention to how they are deployed.
Dasgupta, co-founder of Remedy Alliance/For the People, an organization that aims to make naloxone more easily available, said he sees unnecessary requirements being placed on how vending machines can be used. He said he had seen it.
For example, some jurisdictions require machines to be refrigerated. But Professor Dasgupta said the requirement was a costly “commercial misdirection” and unnecessary for naloxone storage.
“A better version of the vending machine paradigm is to adopt low technology [and] It will improve access,” Dasgupta told Al Jazeera.
He believes community input is key to designing programs that reach those with the greatest need. He pointed to a startup company in Michigan that is using old newsstands on the city's streets to distribute naloxone.
“With 100,000 people dying from overdose a year, I think something must be going wrong,” Dasgupta said. “It's time to think about new solutions. And vending machines are part of the next generation of new solutions.”
Other changes are also underway to make naloxone more easily available across the United States.
In March, the federal Food and Drug Administration (FDA) approved the first naloxone nasal spray for use without a prescription, paving the way for drugstores, corner markets, and gas stations to stock the product for over-the-counter use. .
personal battle
Back in Washington, D.C., McBroom, a community advocate, noticed an empty vending machine at her friend Lashawn Love's hair salon.
Where snacks were once sold, McBroom envisioned naloxone and other “harm reduction” items stocked on vending machine shelves, available to anyone who needed them.
And the need is great in Washington, DC. There will be 448 opioid-related overdose deaths in the city in 2022, making it one of the highest death rates per capita in the country.
Love, the salon owner, said she keeps a cardboard box filled with Narcan on hand just in case.
“Usually I put one here at the station and then another one at the front door,” she told Al Jazeera. This will allow neighboring residents to access the site with peace of mind.
“They'll knock on the door and say, 'Sean, do you have Narcan?'” Even the paramedics asked me for it. ”Requests from the community come in weekly, if not daily, Love added.
For McBroom, the fight to prevent overdoses is personal. Her own daughter Jayla died in 2021 at the age of 17 from a fentanyl overdose.
She would like to see more vending machines integrated into communities for maximum impact.
“The person who needs Narcan could be your family member,” she said. “Wouldn’t it have been nice if they had access to something that could ultimately save their lives?”
