(Management Case Study) Expanding Access to Harm Reduction Products with Automated Vending Machines

Purpose: Currently, the accessibility of harm reduction products and services are limited across the United States. This accessibility is limited by a combination of out of date drug and drug paraphernalia laws, politics, and societal stigma. Covid-19 has added yet another barrier, in many cases it has shut down the programs that previously found a way to reach this vulnerable population. This session will describe the creation and implementation of an automated harm reduction vending machine, attendees will leave the session with an understanding of how they can utilize this type of technology, to build similar machines in their own communities.

Methods: This single center, one year long pilot study was conducted via a partnership between the University of Cincinnati and Caracole, a local non-profit organization dedicated to HIV prevention and harm reduction services. The study began with the development and placement of a harm reduction vending machine in Cincinnati, OH. The vending machine is available 24 hours a day and contains harm reduction products such as injection kits, smoking kits, naloxone, pregnancy tests, sharps containers, band aids, and safer sex kits. When a patient approaches the machine for the first time, a phone number is listed which will connect them to a local harm reduction coordinator who will provide the client with a unique client ID number. This ID number provides them with access to the machine and registers them in our system. The coordinator will then assess the patient for what products and services they may require and record this non-identifiable information within an encrypted survey system. The harm reduction coordinator will offer and provide training regarding any of the products requested, they will additionally coordinate referrals and appointments for any services that the client requires, such as HIV testing, local housing programs, or treatment for opioid use disorder.

Results: During the first year of vending machine implementation (3/1/2021 - 3/1/2022) 508 unique clients registered and used the machine, of those clients, 47 (9%) had never utilized harm reduction products/services before. Most clients were between 25-44 years old, (25-34 years: 177, 35%) (34-44 years: 218, 43%). The majority of clients considered their race/ethnicity to be white (466, 92%) while (28, 6%) were Black/African American. While 6% is certainly not large enough to adequately represent the diversity of our community, it does represent an increase when compared to prior, in-person harm reduction services. The majority of patients identified as female (261, 51%). The most dispensed harm reduction product was naloxone, approximately 5,460 doses of naloxone were dispensed within the first year, this is 2.5 times the amount of naloxone doses dispensed at the next highest naloxone dispensing service in Hamilton County and additionally represents 77% of the total naloxone doses distributed throughout the county during that time period. In addition to the products dispensed, pregnancy tests dispensed from the machine detected 7 pregnancies, with 2 patients connected to pre-natal services. Lastly, 10 patients were connected to treatment programs for opioid use disorder and 15 were connected to local housing programs.

Conclusion: Ultimately, the development and implementation of an automated harm reduction vending machine dramatically increased the distribution of naloxone and other harm reduction products/services within Hamilton county within it's first year of existence. Within one year, the harm reduction vending machine became the largest distributor of naloxone within the county! Harm reduction vending machines are an effective way to increase the distribution of harm reduction supplies throughout communities.