Filling vending machines with needles and Narcan to reduce overdose deaths

North Adams is a center for contemporary art, a haven for stressed-out New Yorkers, and a place to spy fall leaves. Many visitors drive past the unusual vending machine. He distributes clean syringes, pipes for smoking crack or meth, Narcan to prevent opioid overdoses, condoms and more.

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

“I don’t shoot that much,” Brian said. “But somebody will give me something, and if it’s late at night, I don’t want to use their 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 name because he purchases and uses illegal drugs.

Thanks to the vending machine, Brian can now get clean needles or tubes when he needs them, and he no longer has to worry about contracting an infectious disease. He can also get test strips to check for the presence of the powerful opioid fentanyl, which has been linked to overdoses in hundreds of thousands in the United States. He can also find wound care kits to treat skin lesions that becoming more common with xylazineanimal tranquilizer found in drug stockpiles.

Overdoses claim nearly 100,000 lives each year in the United States, even as the number of deaths fell over the past year across the country and in Massachusetts. Rates remain higher than pre-COVID levels, leaving many communities looking for solutions to address this and other consequences 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. This is a response that offers compassion rather than judgment.

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

The first vending machine in the continental United States, like the machine in North Adams, created by IDS Vending, appeared in Nevada in 2017. Since then, company officials said they have sold hundreds of machines in at least 35 states. They believe the pandemic and the availability of federal grants to address the opioid crisis have contributed to increased interest in the machines.

Harm reduction vending machines can be tailored to the items each program wants to distribute and kept cool or heated to preserve medications such as Narcan. (Martha Bebinger/WBUR)

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

The only device currently in use in the state is the Berkshire Harm Reduction device. Machines, like harm reduction programs, face resistance.

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

But many public health experts say vending machines do help, and fears about them are largely unfounded. Washington State Patrol Chief Jon Baptiste, who co-chairs the International Association of Chiefs of Police’s Narcotics and Dangerous Drugs Committee, questions the idea that providing safe products in vending machines encourages drug use.

“The people who come to these machines have already made up their minds, or they are already using drugs,” he said. “So I don’t see how that’s encouraging.”

Sarah Whaley, an opioid policy researcher at the Johns Hopkins Bloomberg School of Public Health, is among the supporters. encouraging communities to consider using opioid compensation funds to purchase harm reduction vending machines, research shows the pros outweigh any cons.

“There is no increase in crime, there is no increase in loitering, there are no, I think, any general issues that people are concerned about,” she said.

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

Whaley points to study A study in southern Nevada found that Narcan in vending machines was associated with a 15% reduction in overdose deaths in its first year. In Cincinnati, research found 24-hour access to supplies has been associated with slowing the spread of HIV.

A report on Harm Reduction Vending Machines prepared for the federal Centers for Disease Control and Prevention found that these machines are a cost-effective way to increase access to Narcan, needles, tubes and first aid supplies, as well as attract people who were previously reluctant to enter a harm reduction cabinet harm.

“A vending machine could be almost a first step,” said Caroline Davidson, director of practice improvement and consulting for the National Wellness Council, which produced the CDC-funded report. “It’s a great low-barrier way for people to get services.”

The contents of a harm reduction vending machine vary from state to state. Colleges and universities establish “wellnessModels with Narcan, emergency contraception, condoms and other safe sex products.

Cars filled with drug paraphernalia, such as pipes and syringes, are much less common. Drug paraphernalia is illegal in 11 states, and some other communities do not allow drug distribution through vending machines. Baptiste is undecided on what to propose, but said communities should consider using vending machines.

“We are in a sad situation as a country,” he said. “We are losing thousands and thousands of lives, so creativity and out-of-the-box thinking have to be on the agenda.”

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

“You often hear people say, ‘Why give them Narcan?’ You have to let them die,” Bailey said. “It’s just ignorance, people who don’t care or don’t have a loved one affected. Any time you have the opportunity to save a life, that’s the whole point.”

When Berkshire Harm Reduction installed its machine, some employees worried they would lose touch with customers. Sarah DeJesus, the program manager, found a compromise. She turns off the machine when the office is open. Clients wishing to access drug paraphernalia must periodically register with the clinic.

“People should 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 has set individual limits on items such as tubes and needles, and clients must register to receive these items. But anyone can get Narcan, fentanyl test strips and condoms from a machine for free, without registration.

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

“I don’t want it to go bad,” Brian said, “because I’ve used it a lot of times.”