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Stocking vending machines with needles and Narcan to reduce overdose deaths

Online Niel October 29, 2024

North Adams is a center for modern art, a haven for stressed-out New Yorkers, and a destination for fall foliage. Many visitors will drive right by an unusual vending machine. Dispense clean syringes, pipes for smoking crack or meth, Narcan to reverse opioid overdoses, condoms and more.

The device, spray-painted with colored triangles, sits just outside the entrance to Berkshire Harm Reduction, a clinic where staff members hand out the same items Monday through Friday, 8 a.m. to 4:30 p.m. But drug use continues after hours. weekends. Some customers call the vending machine a potential lifesaver.

“I don’t shoot that much,” Brian said. “But somebody’s going to give me something and if it’s late at night, I don’t want to use the needle, but I really want to do it, you know. “

Brian said he would try to clean the needles with bleach to avoid exposing himself to hepatitis C, a virus that can be spread through intravenous drug use. WBUR and NPR agreed to identify Brian by his first name because he buys and uses illegal drugs.

With the dispenser, Brian can now get clean needles or pipes when he needs them and no longer has to worry about catching an infectious disease. He can also get test strips to check for the powerful opioid fentanyl, which has been linked to hundreds of thousands of overdoses in the US, and find wound care kits to treat skin lesions that are becoming more common with xylazinean animal tranquilizer found in the drug supply.

Overdoses claim about 100,000 lives each year in the U.S., even though the number of deaths has decreased in the last year nationally and in Massachusetts. Rates remain higher than before the COVID pandemic, leaving many communities searching for solutions to address this and other effects of an increasingly toxic drug supply.

Replacing potato chips and candy with needles and Narcan is a relatively new strategy in an approach known as “harm reduction.” It is a response that offers compassion instead of condemnation.

Harm reduction practitioners often provide supplies aimed at saving lives and reducing the spread of disease and treat medical conditions to keep clients healthy, whether or not they are ready to stop using drugs.

The first vending machine in the continental U.S. like the one in North Adams, made by IDS Vending, appeared in Nevada in 2017. Since then, company officials said they have sold hundreds, in at least 35 states. They credit the pandemic and the availability of federal grants to address the opioid crisis for helping fuel interest in the devices.

Harm reduction vending machines can be tailored for the items each program wants to dispense and can be kept cold or heated to hold medications like Narcan. (Martha Bebinger/WBUR)

The Massachusetts Department of Public Health purchased 14 vending machines last year at a cost of about $15,000 each. Outdoor models are more expensive than indoor cars.

The only device used in the state so far is the one from Berkshire Harm Reduction. Machines, like risk reduction programs, face resistance.

Critics argue that providing people with needles or pipes enables or encourages drug use. In some communities, residents and business owners are concerned about increased needle litter and more public drug use. Oklahoma officials recently ended a vending machine program saying that the costs were too high and the results are not as positive as they had hoped.

But many public health experts say the vending machines help and fears about them are largely unfounded. Washington State Patrol Chief John Batiste, who co-chairs the Narcotics and Dangerous Drugs Committee for the International Association of Chiefs of Police, questions the idea that providing safe supplies in a vending machine encourages drug use.

“People who come to these machines have already made the decision or are already using drugs,” he said. “So I don’t see how encouraging it is.”

Sara Whaley, an opioid researcher at the Johns Hopkins Bloomberg School of Public Health, is among the advocates urging communities to consider using opioid settlement funds to buy harm reduction machines, arguing that research shows the pros outweigh any cons.

“There’s no increase in crime, no increase in loitering, none of the, I think, general concerns that people have,” she said.

The vending machine outside Berkshire Harm Reduction in North Adams, Massachusetts. (Martha Bebinger/WBUR)

Whaley points to a study conducted in southern Nevada, which suggested that Narcan in vending machines contributed to a 15% reduction in overdose deaths in the first year of operation. In Cincinnati, research found 24/7 access to supplies has been associated with a slower spread of HIV.

A report on Harm Reduction Vending Machines prepared for the federal Centers for Disease Control and Prevention found that the machines are a cost-effective way to expand access to Narcan, needles, tubing and first aid supplies and attract people who were not willing to enter before. a risk reduction office.

“A vending machine can almost be a first step,” said Caroline Davidson, director of practice improvement and consulting at the National Wellness Council, which conducted the CDC-funded report. “These are a great way to get services to people.”

What’s in an automatic risk reduction varies from state to state. Colleges and universities install “welfare” models with Narcan, emergency contraception, condoms and other safe-sex supplies.

Devices stocked with drug paraphernalia, such as pipes and syringes, are much less common. Drug paraphernalia is prohibited in 11 states, and some other communities do not allow dispensing through vending machines. Batiste isn’t taking a position on what to offer, but said communities should consider the vending machine option.

“We are in a sad state as a country,” he said. “We’re losing thousands and thousands of lives, so for creativity and thinking outside the box, it has to be on the table.”

Acting North Adams Police Chief Mark Bailey has called for support for the machines, but is realistic about opposition, even to naloxone — the opioid reversal drug, also known by the brand name Narcan.

“A lot of times you hear people say, ‘Why are you giving them Narcan?’ You should let them die,” Bailey said. “It’s just about ignorance, people who don’t care or don’t have a loved one who has suffered. Anytime you have the ability to save a life, that’s the goal.”

When Berkshire Harm Reduction installed its machine, some staff members worried about losing touch with customers. Sarah DeJesus, program manager, found a compromise. Turn off the device when the desk is open. Clients who want access to drug supplies must check in periodically with the clinic.

“People have to come in and reconnect with us and reactivate their code,” DeJesus said, “so we can talk about what substances they’re using, what supplies they’re getting and generally how they’re doing. “

Berkshire Harm Reduction staff have set individual limits on supplies such as pipes and needles, and customers must register to receive these items. But anyone can get Narcan, fentanyl test strips and condoms from the machine for free without registering.

DeJesus and her team installed the machine after years of customers asking for extended hours. Brian and others said they were grateful for that. A few weeks ago when Brian saw a guy sticking his arm through the machine opening trying to shake out clean needles, Brian entered his own code and gave the guy a pack of needles to stop him.

“I don’t want it to go bad,” Brian said, “because it’s only worked for me a few times.”