Harm reduction vending machines: An opportunity to bridge the resource access gap in non-urban communities

Overdose mortality in the U.S. remains high. Widespread availability of naloxone and other risk reduction materials can decrease fatal overdose risk and other drug use related harms, yet barriers to supply access remain. Harm reduction vending machines (HRVMs) may offer a solution, yet the intervention has not been scaled up within the US. In this study, we interview people who use drugs (PWUD) representing urban, suburban, and rural communities in the state of Maryland to examine naloxone access and attitudes towards HRVMs.

In-depth interviews (N = 22) were conducted with PWUD from high-density urban, suburban, and rural areas within Maryland between April and November 2023. Eligibility included being 18 or older, having used opioids in the past three months, and recently responding to an overdose with naloxone. Participants were asked about naloxone access and perspectives on HRVMs. Thematic analysis was engaged to characterize attitudes and examine differences by urbanicity.

Naloxone access differed among participants based upon urbanicity: those in suburban and rural settings reported access barriers, while those in the urban setting did not. Most participants were in favor of HRVMs, though some expressed concerns. Participants identified suggestions for HRVM contents, ideal placement, and oversight.

This study adds to the emerging literature on HRVM implementation within the US. We suggest intentional placement of HRVMs in Maryland, particularly within rural and suburban communities facing known harm reduction access barriers. Near universal support among participants suggests that HRVMs may be a highly feasible and acceptable intervention, particularly within areas of mixed urbanicity.