Narcan vending machines help communities save fentanyl users’ lives
Vending machines around the country dispense naloxone, also known as Narcan, an overdose reversal medication that paramedics and emergency room doctors have administered for years to save lives. Photo by Roastedbeanz1/Wikimedia Commons
New vending machines have been cropping up around the country as innovative public health tools to combat overdose deaths from fentanyl — a potent synthetic opioid, or painkiller, that can be extremely addictive.
The vending machines dispense naloxone, also known as Narcan, an overdose reversal medication that first responders have administered for years to save lives.
The machines do this at no cost to the users and without requiring a prescription, providing vital access for high-risk individuals who want to keep their addiction private, experts say.
Many of these machines are funded through health departments or local governments and supported by federal and private grants.
“Stigma surrounding drug use can be a significant barrier for people accessing services and overdose prevention resources,” said Sean Allen, an associate professor in the Department of Health, Behavior and Society at the Johns Hopkins Bloomberg School of Public Health in Baltimore.
“Misconceptions about substance use and negative stereotypes can prevent people from seeking help,” he said.
In addition to naloxone, public health vending machines often contain a variety of supplies, such as sterile injection equipment, condoms, first-aid kits and pregnancy tests, Allen said.
“Amid the ongoing addiction and overdose crisis, public health vending machines are an important evidence-based tool for communities to consider,” he said, while cautioning that “there is no silver bullet” to preventing deaths related to substance abuse.
Naloxone in nasal and injectable forms, obtained from one public health vending machine outside the HIV/AIDS nonprofit organization Caracole in Hamilton County, Ohio, led to the reversal of more than 3,000 overdoses since February 2021, said Daniel Arendt, an assistant professor of pharmacy practice and administrative sciences at the University of Cincinnati’s James L. Winkle College of Pharmacy.
“We also ask users about their experiences using the materials,” said Arendt, who has tracked this data. “For instance, many of our users take fentanyl test strips, and about 50% of the time, when fentanyl is detected, users either lower their dose or discard the substance.”
According to his research, the machines’ success depends largely on location. Placement in high-traffic areas, hours of operation, if indoors, and the variety of products play a role, as well as accessibility on foot or via public transport, he said.
Raising awareness is equally important, Arendt noted. “We have also seen usage grow overtime as people in the community begin to trust the machine more and recognize that it isn’t a trap set up by police or something,” he said.
“That increased relationship with the community itself and building that trust is instrumental in having a successful program.”
One recent public health vending machine rollout came in Wayne County, situated along the Detroit River in Michigan. It has recorded the most overdose fatalities of any county in the state, with 4 out of 5 deaths driven by fentanyl, said Dr. Avani Sheth, chief medical officer at county’s Department of Health, Human & Veterans Services.
Plans exist to deploy 100 public health vending machines throughout the county’s 43 municipalities in a variety of locations that include local government sites, civic centers, libraries, churches, substance use treatment providers, marijuana retailers, housing and social services organizations, Sheth said.
“We are in the early phase of rollout, with placement of 26 machines and newsstand-style devices,” she said of the dispensers, which also contain test strips for fentanyl and xylazine, a sedative commonly used by veterinarians and increasingly linked to overdoses.
Since Sept. 1, the machines have distributed more than 1,000 naloxone nasal spray kits and more than 500 test strip packets, she said.
The public health vending machines have been branded “Well Wayne Stations.” Expenses are covered by national opioid settlement funds and support from the American Rescue Plan Act, with costs estimated at $3.6 million over four years, Sheth said.
“As with many challenging public health issues, this is not meant to be a panacea solution,” she said.
“The overdose crisis is complex, unique to each community, with many interconnected factors like mental health, trauma, unmet social needs and a contaminated, dangerous drug supply. It necessitates a combination of strategies that work in concert to maximize impact, with this intervention being an essential component.”
Since the 2017 launch of vending machines to dispense free naloxone and test strips, an increase in reversed overdoses has occurred through Trac-B Exchange, a Las Vegas-based harm-reduction project under the nonprofit organization Impact Exchange, said Rick Reich, the executive director.
Twelve vending machines are in use, mainly in Las Vegas and Reno, and also one in a rural area. Another 15 are scheduled to be installed, Reich said.
Anyone at least 18 years old and with an ID can sign up for a vending machine card at the center or online. Participants receive a pin number for accessing injectable or nasal naloxone, pregnancy tests, safe sex kits, hygiene kits, first-aid kits and sharps containers, he said.
“In general, vending machines, don’t discriminate or judge — they just spit the product you select to the hopper for you to pick up,” Reich said, adding that “a lot has to do with the privacy the vending machines afford.”
The feedback has generally been positive, with complaints arising when machines have been emptied of products that people want. The center can’t restock them quickly enough sometimes due to high demand, he said.
Since 2023, more than 6,000 naloxone kits have been dispensed via vending machines through the County of San Diego Health and Human Services Agency, according to its communications specialist, Anita Lightfoot.
“Research has shown that opioid overdose death rates are reduced in communities where naloxone is distributed,” Lightfoot said. “Naloxone vending machines are an innovative way to increase access to this life-saving medicine.”
She added that “our goal is to saturate the community with naloxone, especially among those who are at high risk of witnessing or experiencing an overdose. These vending machines are a key element in this effort.”
Overdoses from opioids, including fentanyl, are common in hospital emergency departments, “and naloxone is the treatment of choice,” said Dr. Robert Frolichstein, president of the American Academy of Emergency Medicine and a practicing physician in San Antonio.
“It is very effective,” Frolichstein said. “When a patient overdoses on opioids, it takes away their respiratory drive — need to breathe. Naloxone reverses this and they begin breathing on their own.”