Harm reduction vending machines in New York State expand access to overdose treatment and drug test strips, UB studies confirm

BUFFALO, N.Y. – Two studies led by an opioid treatment program run by the University at Buffalo and UBMD Emergency Medicine have found that harm reduction vending machines installed across New York State are well utilized and provide critical, lifesaving services to high-risk individuals who might not otherwise have access.

The studies, published late last year, evaluate the performance of the 15 harm reduction vending machines installed throughout New York State by the MATTERS Network, based at UBMD Emergency Medicine and UB.

MATTERS (Medication for Addiction Treatment and Electronic Referrals) now operates 30 harm reduction vending machines in New York State and will be rolling out similar machines in New Jersey this year.

‘Available 24 hours a day, no questions asked’

“These studies underscore that the harm reduction vending machines that we operate throughout the state of New York and which are available to the public, 24 hours a day, no questions asked, are an effective use of resources in mitigating opioid use disorder,” says Joshua J. Lynch, DO, clinical professor of emergency and addiction medicine, and family medicine, in the Jacobs School of Medicine and Biomedical Sciences at UB and founder of the MATTERS Network.

The paper, “Evaluating Community-based Harm Reduction Vending Machine Utilization in New York State” in the Journal of Addiction Medicine reports that over a 14-month period, 15 harm reduction vending machines in the state dispensed more than 13,655 supplies including an average each month of 529 naloxone kits, 245 fentanyl test strip packages and 169 xylazine test strip packages.

Nearly half of all items were dispensed outside of regular business hours, which Lynch says underscores the importance of having these machines accessible 24 hours a day.

While European nations have made harm reduction vending machines widely available for decades, they are a relatively recent phenomenon in the U.S.

In another study, “Implementing Harm Reduction Vending Machines to Reduce Opioid Overdose Risk: Description of a Centralized Implementation Model, Pros, Cons, and Lessons Learned,” published in the Journal of Public Health Management and Practice, the UB researchers describe how in 2022, MATTERS first began to make harm reduction supplies, such as overdose drugs and drug test strips, available for free by mail to anyone in New York State.

From mail order to vending machines

“But there are situations where mail-based distribution may not be desired,” Lynch says, adding that high-risk individuals are also likely to want to avoid in-person interactions in a retail setting. By 2023, it became clear to MATTERS that harm reduction vending machines could reach many more people throughout New York State who could access supplies anonymously. And because MATTERS’ focus was statewide, officials decided that the best approach would be to partner with local agencies that could serve as the on-the-ground experts that would manage the machines with a local perspective.

The paper describes how, after initiating contact with local agencies, MATTERS, with the support of the New York State Office of Addiction Services and Supports (OASAS), which funded the machines, collaborated with the local managing organizations and deferred to them for their knowledge of the local landscape.

To reduce administrative burden, MATTERS also serves as a liaison between the machine manufacturer and the managing organization. MATTERS leads the comprehensive on-boarding process and also provides opportunities for participating organizations to share experiences and lessons learned.

The paper notes that while there have been limited studies of the efficacy of these machines in the U.S., some have noted that locating these machines inside buildings when they are accessible only during business hours, or require registration, can work to deter the very individuals that the machines were established to serve.

In order to make placement as successful as possible, MATTERS aims to install the machines in a variety of high-traffic, public areas.

“The data in our studies show that these machines were accessed at all hours of the day and night,” Lynch says. “Locating them outdoors without having to register or create an account to access supplies allows for a low-barrier approach.” 

With feedback from partners and individuals who use the machines, MATTERS continues to expand and optimize its vending machine program. Lynch adds that since grant funding has made the program possible, continual evaluation is a critical piece.

Asked if there is any way to know if individuals who have taken advantage of harm reduction programs are more receptive to eventually seeking treatment, Lynch says they haven’t collected user-level data at this point. 

“The balance between keeping the machines low-barrier, so not collecting names or identifying data, makes this challenging,” he says. “There’s no way to link vending machine users to patients that are eventually linked to treatment. But we are exploring ways to query those who are referred to treatment to find out if they have ever used the vending machines or other harm reduction services.”

Matthew Thomas, PhD, senior research scientist in the Department of Family Medicine, is first author in the Journal of Addiction Medicine paper, and Bonnie M. Vest, PhD, research associate professor in the department, is first author on the Journal of Public Health Practice and Management paper.

Other co-authors are Brian M. Clemency, DO, professor and vice chair; Orian B. Painter; and Hilary Kirk, all of the Department of Emergency Medicine; Meghan K. Chambers of the Department of Family Medicine; and Shelby Arena and Mia Dickinson of MATTERS.

The work was funded by OASAS and by MATTERS.