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To reduce stigma, Oneonta recovery center uses vending machine to distribute overdose-reversal drug

Narcan Vending Machine - FeatureWEB

An addiction recovery center in Otsego County has introduced the first naloxone vending machine in New York. Naloxone, also known as the brand name drug Narcan, can reverse opioid overdoses.

A month in, the center has seen a jump in the number of Narcan kits they distribute. Experts hope these vending machines will improve access to the lifesaving drug.

“Maybe they're afraid that they're going to be asked ‘Why? Why do you need Narcan?’”

Jesse Wilson is hanging out in the living room of The Turning Point, a recovery and community center in Oneonta. A naloxone vending machine was installed here about a month ago.

It’s just like a normal vending machine, but you don’t have to put any money in. And instead of snacks or beverages, it’s full of naloxone. It also contains overdose prevention kits with rescue breathing masks, and safe drug disposal bags.

“It's a novel idea, Narcan vending machines. So people are going to want to use it to say they grabbed it from the vending machine. But that's a good thing because it will bring awareness to it,” Wilson said.

Kyle LaFever is the program director for Friends of Recovery of Delaware and Otsego Counties, which runs the Turning Point. LaFever had heard about vending machines available in states like Michigan, and thought it would be a good fit for the recovery center.

“It's just really exciting to see the vending machine actually being used," LaFever said. "When somebody walks up to it and pushes the buttons and gets the medication and is able to go along their way.”

Before the vending machine, the center kept a basket full of naloxone at the front desk. LaFever started to notice that people were taking more when there was no one was sitting at the desk.

“Maybe they're afraid that they're going to be asked ‘Why? Why do you need Narcan? What are you going to do?'” You know, those accusatory questions,” LaFever said.

But with the vending machine, the center is distributing as much Narcan in a day as they used to in a week.

The machine is currently inside the center, which is only open during business hours. But LaFever plans to put it in a temperature-controlled enclosure outside, that would make it accessible at any time.

"Is it just decoration? Or is it really actually getting used?” 

Matt Costello is a program manager with Wayne State University Center for Behavioral Health and Justice in Michigan. Costello works with county jails and community centers to bring in naloxone vending machines. The machines are placed in visiting rooms, or in release areas, so people can access them on their way out of jail.

It’s the same program that inspired LaFever to install one in Oneonta.

Costello said the vending machines offer anonymity, helping to reduce the barriers that people who use drugs often face accessing naloxone.

“Again, this is a population that is already dealing with a lot of challenges... many of them stigma-based, shame-based,” Costello said.

He added that just having a vending machine doesn’t mean people will use it. That’s why experts are still trying to figure out the best ways to get naloxone to those who need it the most.

“How many cartons are we actually distributing, right? Again, because that's really what we want to notice. Like, it's great…[but] is it just decoration? Or is it really actually getting used?” Costello said.

Reducing stigma and providing anonymity are key, Costello said. But he pointed out vending machines should also be placed in areas that are accessible 24 hours a day.

“[It would be] nice if crises only happened from nine to five on Monday through Friday, right? We know in the real world, that just doesn't happen. So if you have a strategically placed machine, it offers the opportunity for ease of access,” Costello said.

He’s seen that access for himself; the program where he works in Michigan has placed 50 machines and distributed 19,000 kits of naloxone.

“There's not a naloxone silver bullet."

Naloxone is available at local overdose prevention programs, online and from pharmacies. But William Eggleston, a practicing pharmacist and assistant professor at Binghamton University, said vending machines could reach people who are afraid or ashamed to go to a pharmacy. They could also be helpful for people who live in "pharmacy deserts".

In his work as a pharmacist, Eggleston treats patients who have overdosed at Upstate University Hospital. He said ultimately, the best way to distribute naloxone successfully is to do it in a variety of ways.

“There's not a naloxone silver bullet. There's not a best way to do this, because everyone experiences drug use differently. There's not going to be one thing that gets Naloxone to everybody,” Eggleston said.

For naloxone to be truly accessible, Eggleston said larger policy changes need to happen.

He said the first step would be making naloxone an over-the-counter drug. Right now, naloxone is approved as a prescription-only drug by the Food and Drug Administration (FDA).

New York passed legislation in 2006 making it legal for "non-medical persons" to administer naloxone. And all 50 states have used workarounds to allow pharmacies to give naloxone to people without a prescription.

But Eggleston said many community organizations end up stuck in a legal gray area. They have to jump through more hoops to distribute naloxone.

If naloxone was classified as an over-the-counter medication, Eggleston said it would be much easier to make it available.

“There's really no reason it shouldn't be, because it's extremely safe, it's extremely effective, it's very easy to use,” Eggleston said. “And if that policy change were to happen, it could be in vending machines anywhere.”

The FDA has said it's open to approving naloxone as an over the counter drug. But in a statement to NPR last year, it blamed pharmaceutical companies for not applying for over-the-counter designation.

Naloxone vending machines have cropped up across the country in recent years. Programs exist in Indiana, Las Vegas, Philadelphia and Los Angeles, as well as other states and cities.

The naloxone vending machine at The Turning Point in Oneonta is the first of its kind in upstate New York. New York City plans to put similar machines in various locations.