Punch a code into the safer drug-use vending machine, and get free Narcan. Or get safer smoking products, fentanyl test strips, or other things that help keep you out of harm’s way.
Nearly 600 overdoses have been turned around with naloxone products from this machine in Northside. Cold Heading Equipment
Nearly 13,000 safer drug use and healthcare items, from safer-smoking pipes to personal protective equipment, have been dispensed from the vending machine outside Caracole since it opened in 2021.
Caracole, the Cincinnati region’s nonprofit devoted to fight against HIV and AIDS, operates the harm reduction vending machine. It tracks the machine's customer base and product dispensing. A report from March 1, 2021, to Sept. 30 this year shows an "overwhelming" response to the strategy, said Caracole CEO Linda Seiter.
"We have provided life-saving supplies for persons who use drugs 24 hours a day, seven days a week,” Seiter said.
The safer-use machine was only the second of its kind in the country when it became available to people who use drugs, with the first harm-reduction vending program in Las Vegas. Since then, the Cincinnati-based machine has reached more than 800 individuals, and it has become an avenue for harm reduction help for a client base that isn’t always reached by such efforts: people who smoke, rather than inject, drugs. And that can include recreational drug users.
Harm reduction is the effort to give people who use drugs practical ways to minimize their health risks in a nonjudgmental manner. Syringe exchanges, which provide sterile needles to drug users to reduce the chances of getting HIV or hepatitis C and containers for used syringes for safe disposal, are among those strategies.
The region's vending machine is a model strategy in the country for fighting overdoses and overdose deaths while helping those who use drugs stay healthy in other ways. Caracole’s prevention team has had 57 meetings with individuals from communities across the country how to do it since the machine's inception.
"We can share everything," said Suzanne Bachmeyer, Caracole's prevention director.
She’s talked to New York City and Philadelphia health departments, Circle Health in Cleveland, Franklin County Public Health in Columbus among dozens of other community-based harm reduction groups and health officials.
Throughout Ohio and the country, vending machines are becoming a sought-after way to prevent harm and death from drug use. In Kentucky's Hardin County, a vending machine stocked with Narcan that opened to the public early in October ran out of the opioid overdose antidote in less than two days.
In central Ohio, the Franklin County commissioners and Columbus Public Health are partnering in a prevention vending pilot program as part of a comprehensive strategy to reduce overdose deaths and prevent other drug-use health risks. The county plans to host two prevention vending machines in the 43223 ZIP code, an area that consistently has experienced a high number of fatal overdoses, officials said. The machines could be up by the spring of 2023.
Residents of Brown County, Ohio have access to a harm-reduction vending machine outside the Brown County Mental Health and Addiction Services offices in Georgetown, said Deanna Vietze, the agency's executive director, "making these items available 24 hours a day 7 days a week."
The operation at Caracole works this way: There’s a phone number on the machine for people to call (or they can walk into Caracole if it’s open). They’re given a code that’s good for 90 days of accessing the machine for up to one item per week. Those registered are asked to answer a few questions that don’t jeopardize anonymity. If they’d like to continue to use the vending machine after that 90 days, they can reregister for another three months.
The registration gives Caracole prevention staff a chance to collect a few demographics of their users, get feedback from clients, and further engage them if it makes sense to do so. As a result, Caracole has provided education about HIV, hepatitis C and referrals, when requested, for medical care to those registered, Seiter said.
Client feedback includes these details:
One of the most engaged client bases has been people who smoke drugs, primarily cocaine and methamphetamine, Seiter said. The machine is stocked with two types of safer-smoking kits. Records show that 4,183 of the kits have been dispensed, which is almost a third of all items dispensed.
And that has encouraged the Caracole prevention staff, because people who smoke, and especially recreational drug users, don't commonly go to safe syringes sites, which offer other safer-use items, Bachmeyer said.
"The population of people who don’t use opioids … doesn’t get a lot of outreach," she said. "It is a really low to no-barrier way to access supplies."
What's particularly important with the kits now, as fentanyl overdose deaths pummel the nation, is that the safer-smoking kits provide Narcan and fentanyl test strips. Fentanyl and its analogs have been found in meth and cocaine, and the test strips let this population know if their supply is tainted.
The demand among Caracole's vending customers is also high for the vending machine's safe needle disposal containers, Seiter said. More than 1,000 of these sharps containers have been dispensed.
She said that's encouraging: Having the containers for used syringes and bringing those syringes back to exchanges for sterile ones limits the spread of infectious diseases in the general community ‒ because people aren't haphazardly dropping used syringes.
The machine doesn't provide sterile syringes, although Caracole is among several safe syringe sites in Hamilton County. It does have safer-injection kits that contain cotton, alcohol pads, cookers, or metal containers for mixing water with powder drugs and heating the solution, tourniquets and education.
The startup funding for both Caracole's and Brown County's vending machines came from grants from Interact for Health in Kenwood, a nonprofit health agency that helps provide health equity strategies, grants and education in 20 Greater Cincinnati counties. Brown County's grant was for $20,000; Caracole's was $50,000, Interact records show. The grants have run out.
Brown County also used state opioid response grant funds through its Regional Harm Reduction Collaborative to help with its costs, Vietze said. She added that the county will continue operating the vending machine and it's possible that state opioid and stimulant response money will help fund it. Daryl Hams, project director for the harm reduction collaborative, said that based on use of the machine for six months, the annual budget for the machine's contents is about $15,000.
Caracole officials said its vending machine budget is about $60,000 annually. That doesn't include staffing, electricity and other operations costs, said spokesperson Tricia Bath. Area organizations have been donating supplies. One example: Talbert House, one of the region's primary distributors of Narcan, has provided the antidote to the vending operation.
Bath said Caracole is looking for additional funding for the vending machine operation. Bottom line, officials said, the machine will stay.
“We did not anticipate the overwhelming response to our machine," Seiter said, adding that the strategy has helped people feel "empowered" to take control of their health.
Threading Machine "That’s the core of what we do," she said, "and we’re committed to continuing it.”