Washington, DC – It was a hot summer day in July when Shekita McBroom received a phone call from a local hair salon.
The stylist on the other end of the line urgently needed a resupply — not of hair dye or shampoo, but of the overdose-reversal drug naloxone.
Commonly known by the brand name Narcan, naloxone is a life-saving medication, often taken as a nasal spray to counteract the symptoms of opioid consumption.
That a hair salon had a backroom supply of the drug came as no surprise, though, to McBroom, a community advocate in Washington, DC, who campaigns to prevent overdoses. If anything, she would like to see naloxone available more widely — including through vending machines.
“I try to connect people with more supply because they don’t always know where to find it,” she told Al Jazeera. But with vending machines, she sees a convenient solution: a quick and easy way to dispense emergency care at all hours of the day, in neighbourhoods where services might otherwise be limited.
More and more communities in the United States are adopting that approach. In 2023, there has been a boom in vending machines dispensing overdose reversal drugs for free — as well as fentanyl testing strips, clean needles and other “harm reduction” items.
US ‘behind everyone’ in adopting method
Washington, DC, was among several cities to launch a vending machine programme this year. It currently has seven vending machines overseen by two local community health organisations.
Four of those machines, overseen by the Family and Medical Counseling Service Inc, dispensed 204 packages of Narcan from October to November. That meant, on an average day, about three boxes of Narcan, each containing two doses, made their way to those in need.
“We’ve been surprised at the amount of activity that the machines actually can get,” said Angela Wood, the group’s chief operating officer.
She pointed out that the vending machines do not require users to produce any personal information — or even interact with a real person, thereby reducing the potential for stigma.
“It’s a way for people to gain access to these products in their own time, in their own way, without having to fully engage with a programme,” she told Al Jazeera.
Chicago likewise introduced a pilot programme for naloxone vending machines in November, and New York City opened its first machine in Brooklyn in June.
There were also advances on the state level. West Virginia, Wisconsin, Vermont, Missouri, Kansas and Connecticut all either unveiled or approved deployments of the vending machines this year.
Even tribal governments have embraced the strategy. In April, the Pala Band of Mission Indians installed what it described as the first naloxone vending machine on tribal land in the US. Four months later, the Tulalip reservation in Washington state set up its own machine.
The spread of the vending machines has been dramatic, according to Rebecca Stewart, an assistant professor at the Penn Center for Mental Health who studies substance abuse treatment.
“They’re really popping up all over the country,” she said.
The trend began in the US only five years ago, in 2017, with a vending machine programme in Nevada. But as Stewart pointed out, similar programmes had already existed for years in Europe, Australia and even Puerto Rico.
“The United States is sort of behind everyone in this aspect,” she said. “In terms of harm reduction vending machines, these have been implemented for decades all over the world. And so these implementations in the United States are just beginning.”
Escaping the ‘moral hazard’ argument
One of the biggest hurdles to adopting the vending machines has traditionally been public opinion.
Stewart said many Americans — including politicians and policymakers — feared that the vending machines would encourage drug use by making the practice safer. She calls it the “moral hazard” argument.
Even this year, officials echoed that line of thinking. Kentucky installed its first naloxone vending machine in 2022, but some local politicians remain opposed to their expansion into neighbouring counties.
“You’re basically promoting and enabling the people that’s got the problem with the drugs instead of maybe trying to help them get off the drugs,” Nelson County Judge-Executive Tim Hutchins told the TV news station WHAS11 in February.
The majority of those overdose deaths have been linked to opioids, with experts blaming the emergence of synthetics like fentanyl for sending the death toll skyrocketing.
Ryan Hampton, an activist and organiser who focuses on addiction, sees the increase in vending machines as evidence of the immediacy of the opioid crisis.
He fears the US continues to overlook “harm reduction” strategies as a tool to bring the death rate down. The term “harm reduction” is used broadly to describe methods that can help prevent overdoses or other knock-on effects of drug use, like disease transmission through needle sharing.
“For too long, harm reduction has been a stigmatised strategy,” Hampton said.
Instead, he explained that the US has invested more in a “prevention/interdiction” model that discourages drug use in the first place. The result, he added, has been few resources dedicated to stopping overdoses and other drug-related harms.
“What is being invested by no means meets the demand for the services or the scale for what’s needed right now,” he said.
“With the toxic drug supply that we’re faced with, harm reduction has to be a mechanism that we deploy in every setting that we can, whether that be in vending machines or community care settings.”
For her part, Stewart has noticed a shift away from perceptions that naloxone is an “enabler” for opioid use.
Rather, her research, which focused on Philadelphia, found that community members were open to the prospect of overdose-reversal medications being readily available in vending machines.
“One of the things we found from talking to these different stakeholders is that Narcan was universally accepted,” she added. “And I feel like this is a really promising finding because I don’t think Narcan was universally accepted five years ago.”
Lower tech, higher access
But the vending machines themselves are no silver bullet. Attention must also be paid to how they are deployed, said Nabarun Dasgupta, a senior scientist at the University of North Carolina at Chapel Hill’s Injury Prevention Research Center.
As the co-founder of Remedy Alliance/For the People, an organisation that seeks to make naloxone more easily available, Dasgupta said he has seen unnecessary requirements be tacked onto how the vending machines are used.
For example, several jurisdictions have required the machines to be refrigerated. But Dasgupta called that requirement a costly “commercial misdirection”, unnecessary for naloxone’s storage.
“The better version of the vending machine paradigm is to go with lower tech [and] higher access,” Dasgupta told Al Jazeera.
He believes community input is key to designing programmes that reach the people whose needs are greatest. One start-up, he pointed out, is using old newspaper stands on city streets to distribute naloxone in Michigan.
“I think, with 100,000 people a year dying of overdose, something isn’t working,” Dasgupta said. “It’s time for new solutions. And the vending machines are part of a generation of new solutions.”
Other changes are also under way to make naloxone more easily accessible across the US.
In March, the federal Food and Drug Administration (FDA) approved the first naloxone nasal spray for use without a prescription, which paved the way for drug stores, corner markets and gas stations to stock the product for over-the-counter use.
A personal battle
Back in Washington, DC, community advocate McBroom found herself eyeing an empty vending machine in the hair salon of her friend, LaShaun Love.
Where once there had been snacks for sale, McBroom imagined rows of naloxone and other “harm reduction” items on the vending machine’s shelves, ready for anyone who might need them.
And the need is great in Washington, DC. The city saw 448 opioid-related overdose deaths in 2022, giving it one of the highest per-capita rates in the country.
Love, the salon’s owner, revealed she kept a cardboard box full of Narcan on hand, just in case.
“Normally, I keep one right here on my station and then another right up at the front,” she told Al Jazeera. That way, neighbourhood residents can have easy access.
“They’ll knock on the door and say, ‘Miss Shaun, you got any Narcan?’ Even ambulance workers have asked me for it.” Requests from the community come weekly, if not daily, Love added.
For McBroom, the fight to prevent overdoses is personal. Her own daughter Jayla died in 2021 at age 17, following a fentanyl overdose.
She hopes to see more vending machines integrated into the community, where they can have the greatest impact.
“The person who needs Narcan could be your family,” she said. “Wouldn’t you rather they were able to have access to something that could ultimately save their life?”