Vending machines stocked with needles and Narcan to curb overdose deaths

North Adams is a center of modern art, a haven for stressed New Yorkers, and a fall foliage destination. Many visitors will drive right past a special vending machine. It provides clean syringes, pipes for smoking crack or methamphetamine, Narcan to reverse opioid overdoses, condoms and more.

The machine, painted with colorful triangles, sits just outside the entrance to Berkshire Harm Reduction, a clinic where employees hand out the same supplies Monday through Friday from 8 a.m. to 4:30 p.m. But drug use continues, even outside office hours. weekends. Some customers call the machine a potential life saver.

“I don’t shoot that much,” Brian said. “But someone 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 this, you know. ”

Brian said he would try cleaning needles with bleach to avoid exposure to hepatitis C, a virus that can 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 machine, Brian can now get clean needles or pipes when he needs them and no longer have to worry about contracting 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 he can find wound care kits to treat the skin lesions that is more common with xylazinean animal tranquilizer found in the drug stash.

Overdoses claim about 100,000 lives in the US each year, as do deaths decreased nationally over the past year and inside Massachusetts. Rates remain higher than before the COVID pandemic, leaving many communities looking for solutions to address these and other impacts of an increasingly toxic drug supply.

Replacing 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, rather than condemnation.

Harm reduction practitioners often provide resources aimed at saving lives and reducing the spread of disease, and they treat medical conditions to keep clients healthy regardless of whether they are willing to stop using drugs.

The first vending machine in the continental US, like the one in North Adams, made by the company IDS Vending, popped up 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 fueling interest in the machines.

Harm reduction vending machines can be customized to the items each program wants to distribute, and can be kept cool or heated to store medications like Narcan. (Martha Bebinger/WBUR)

The Massachusetts Department of Public Health bought 14 of the machines last year, at a cost of about $15,000 each. The outdoor models are more expensive than machines that are placed indoors.

The only device used in the state so far is that of Berkshire Harm Reduction. The machines, like harm reduction programs, face resistance.

Critics claim that giving people needles or pipes enables or encourages drug use. In some communities, residents and business owners are concerned about increased needle waste and drug use in public. Officials in Oklahoma recently ended a vending machine program, stating: costs were too high and the results were not as positive as they had hoped.

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

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

Sara Whaley, an opioid policy researcher at the Johns Hopkins Bloomberg School of Public Health, is among those in favor encouraging communities to think using opioid settlement funds to purchase harm reduction machines, arguing that research shows the benefits outweigh the harm.

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

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

Whaley points out one study conducted in southern Nevada, which suggested Narcan was in vending machines, contributed to a 15% reduction in overdose deaths in its first year of use. In Cincinnati, research found 24/7 access to supplies was associated with slower spread of HIV.

A report on Harm Reduction Vending Machines, prepared for the federal Centers for Disease Control and Prevention, found that the vending machines are a cost-effective way to expand access to Narcan, needles, pipes and first aid supplies and attract people previously unwilling to enter to establish a harm reduction agency.

“A vending machine can almost be a first step,” says Caroline Davidson, director of practice improvement and consulting at the National Council on Wellbeing, which conducted the CDC-funded report. “This is a great, accessible way to get services to people.”

What’s included in a harm reduction machine varies from state to state. Colleges and Universities Install “well-being” models with Narcan, emergency contraception, condoms and other safe sex supplies.

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

“We are in a sad situation as a country,” he said. “We are losing thousands and thousands of lives, so if we want creativity and thinking outside the norm, that has to be on the table.”

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

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

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

“People need to come in and contact us again and reactivate their code,” DeJesus said, “so we can talk about what substances they’re using, what supplies they’re getting, and how they’re doing in general. ”

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

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

“I don’t want it to break,” Brian said, “because it’s come in handy a few times just for myself.”