DAP Health adds harm reduction vending machine at Hunters, reflects on program

A free vending machine stocked with an overdose reversing spray, STI test kits and fentanyl and "party drug" test strips is now available at Hunters Palm Springs.

As part of local nonprofit DAP Health's harm reduction program, which launched last year, officials say the vending machine is another way they hope to lower overdose and infection rates locally and reduce stigma associated with drug use. Cities across the United States, such as San Francisco, New York City and Washington, D.C., have also installed similar vending machines.

DAP Health is one of three state-certified Syringe Services Programs in Riverside County, among more than 60 across California.

The vending machine comes during a crisis point in the country and county when overdose rates, especially those related to the synthetic opioid fentanyl, continue to increase. Approved by the U.S. Food and Drug Administration for medical use, fentanyl is also used and distributed illegally and found in other drugs, including heroin, cocaine, methamphetamine and MDMA. It takes little to produce a high, which makes it a cheap option for illegal distributors, but it also comes with severe risks: It only takes about 2 milligrams of fentanyl to be potentially lethal.

Overdose death rates continue to increase annually in Riverside County. Fentanyl-involved overdose deaths have jumped from two in 2016 to 519 in 2022. So far in 2023 (data from January to May), there have been 209 fentanyl-related deaths in the county, including 55 in the Coachella Valley.

DAP Health's harm reduction program has had its successes addressing the drug crisis locally, the organization reported, but it has also faced criticism from some.

Anonymous vending machine

You won't find soft drinks or candy in the new vending machine added at Hunters Palm Springs. Instead, free lifesaving items are just a few taps away.

The pink and yellow vending machine, located near the women's restroom, has male and female caricatures on it with speech bubbles that read "Harm reduction saves lives." On the frontside is a touch screen where patrons will fill out a few anonymous survey questions asking for their age, gender identity and, if applicable, drug use.

Patrons can select from a number of color-coded bags that contain various items. One dedicated to fentanyl testing includes testing strips, cookers and sterile water, while a Safer-Snorting Kit has straws, plastic cards and razors. HIV self-testing kits, syringes and Narcan/Naloxone, an overdose reversing spray, are also available.

As more people utilize the service and DAP Health reviews survey questions, the harm reduction team will be able to determine what other items might be needed in the vending machine, said Neil Gussardo, DAP's harm reduction supervisor.

There are also QR codes on the machine to connect people to even more of DAP Health's harm reduction resources.

"It's really all about easy access, and a vending machine does that," said C.J. Tobe, DAP's chief of community health. "Anybody is going to be able to go into Hunters and be able to access these needed harm reduction supplies. Whether it's midnight, they just did a shot, they're finishing up some dancing with their friends and they're going to get a ride back to their hotel and do a pool party, they can take all the supplies they need to test their drugs, or reverse that overdose at their pool party or in their hotel room."

While these vending machines have popped up in Northern California cities like San Francisco and at Santa Clara University, DAP Health's will be one of few available in Southern California. The Pala Band of Mission Indians, in partnership with Harm Reduction Coalition of San Diego, installed a vending machine in April.

Positive results have been reported from these vending machines nationwide. A University of Cincinnati study found that a harm reduction vending machine located outside of HIV/AIDS service organization Caracole became the "largest harm reduction supplier in the county compared to other in-person syringe service programs." At the time the study was published, clients reported 288 overdose reversals with naloxone from the machine, and more recent numbers from December 2022 show that nearly 1,000 overdoses were reversed.

Additionally, two-thirds of people who reenrolled in the program to continue using the machine detected fentanyl within their drug supply by using test strips, which allowed them to either throw the supply away or use a lower dose 75% of the time that fentanyl was detected.

The next step is to add 24/7 access vending machines in multiple locations in Palm Springs to provide even more opportunities for harm reduction. Tobe said "a handful" of businesses, which he did not disclose, have expressed interest in hosting one of these machines and training staff members.

Other community spots have been discussed as well, though details were not shared on those locations, other than conversations have been taking place to determine which areas would be "most successful." Public parks and libraries are "probably not the best idea," Tobe said, but spots where first responders encounter people frequently utilizing drugs could be.

"We want to make sure we have those conversations to make sure the community feels safe and protected," he added.

A few undisclosed hotels off of Palm Canyon Drive/Highway 111 in Palm Springs and Cathedral City have also been identified as having high overdose death rates, Tobe said, so the team has provided Narcan, fentanyl test strips and other items in their lobbies.

Reflections on program

DAP Health's Syringes Services Program has been in operation for more than a year. During that time, officials have served more than 3,000 unique patients and provided nearly 1,900 referrals to recovery centers, primary care and mental health facilities, insurance coverage and other necessities, according to DAP Health data.

Gussardo and his team provide "just about anything" harm reduction-related at mobile booths and a standalone building, such as drug use tools, personal hygiene kits and referrals to hepatitis C and HIV testing and substance use resources in the valley.

"I think it's a huge success," Gussardo said. "We knew there was a need, but we didn't know what the response would be, and I think this is just tremendous."

A man who identified himself as Christopher is one of those who has utilized the program. He stopped by the harm reduction booth set up near Our Lady of Guadalupe one morning in June to ask about getting tested for hepatitis C and to pick up Narcan and a hammer (used for smoking heroin). While there, volunteer Suzanne Petersen and harm reduction educator Bree Clark explained how to use the nasal spray if Christopher sees someone experiencing an overdose, and what symptoms he could expect if he has hepatitis C.

Christopher, 40, from Yucaipa, has visited the booth in the past and said it serves as a way to "check in" with the organization and the people behind the program.

"I'm glad they're here," he said, holding a paper bag with all the items he collected.

Since living on the streets of Palm Springs, Christopher said he was "forced" into taking drugs and chose methamphetamines. He added that he's been sexually abused previously, so his drug usage allows him to stay up at night, keep watch and protect himself and others.

Most of the harm reduction program's clientele have been unhoused people, and employees have tried to set up mobile clinics in areas where they know many of them might frequent, such as spots that serve free daily lunches. The nonprofit also recently opened up a brick-and-mortar location at 1445 N. Sunrise Way, Suite 103, in Palm Springs. Hours and days of operation are 5 to 7 p.m. Monday and Thursday, and 9 a.m. to 1 p.m. Saturday.

Some people who stop by the harm reduction sites will ask questions, such as Christopher did, about products and services offered, while others will pick up what they need and be on their way, as was observed that same day. Spanish language translation is also available for those who need it.

Regardless of language, "people leave with what they came here for," Petersen said.

Among those is the increasingly important Naloxone, which is available as a nasal spray or injection. Between May 2022, and June 2023, 350 overdose reversals have been self-reported to the nonprofit.

"We speak to the people that we're serving. If someone took Narcan last week and they need more Narcan this week, we ask, 'Did it get used?'" Gussardo said. "We're able to provide the medication, which is great, but it's the folks that are living in the community that are doing the work of helping each other."

There is also a phone number and email address on the packaging that people can contact to notify DAP Health of its use.

It's a stat the group is especially proud of given rising overdose death rates in recent years. In 2021 (data from January to November), the Coachella Valley reported 183 overdose deaths, and the following year that number increased to 202, according to data from the Riverside County Overdose Data to Action Program. Last year, 127 overdoses were caused by methamphetamines and 117 were due to fentanyl (the dataset states the drug categories are not mutually exclusive, meaning more than one drug could have led to an overdose death). The Coachella Valley had the second-highest overdose death rate in the county, behind the northwest region.

DAP Health also has a peer support specialist available to discuss substance use and recovery with community members, as well as an outpatient drug-free treatment program to help reduce or eliminate alcohol and/or other drug use.

The harm reduction program has also given the nonprofit an opportunity to connect with people who are HIV- or hepatitis C-positive, many of whom might not be aware of their diagnosis, and refer them to the care they need. In the United States, the majority of new hepatitis C infections are due to injection drug use, and there has been a 4.9-fold increase in reported cases from 2010 to 2019, according to the Centers for Disease Control and Prevention. Additionally, new HIV infections among people who inject drugs increased 12% from 2014 to 2019. Over the last two years, 20% of new HIV cases at DAP Health have reported substance use, according to the nonprofit.

If someone needs an HIV or hep C test done and the mobile clinic is not offering it, Gussardo said the nonprofit would arrange for someone to be picked up and taken to DAP Health that same day. People can also receive safer sex kits at a mobile clinic, which include condoms.

"I think there's such a misconception with the harm reduction program. A lot of people just think, 'People are going to get free supplies and they're just going to use drugs.' It's really not," Tobe said. "It's more about a gateway or bridge of trust connecting the community who's using drugs to their medical home at DAP Health for any service that that patient wants."

Complex feelings

Much research has been done on the impacts harm reduction programs have on virus transmission rates and substance use treatments.

The Centers for Disease Control and Prevention states Syringe Services Programs are associated with an approximately 50% reduction in HIV and hepatitis C incidence. Additionally, people who inject drugs and regularly use a harm reduction program are more than five times as likely to enter treatment for a substance use disorder, and nearly three times as likely to report reducing or discontinuing injection drug use compared to those who have never used a similar program.

Regardless, it remains a complicated issue for some.

Riverside County District Attorney Mike Hestrin has seen overdose deaths drastically increase in recent years − specifically 690 in 2020, 806 in 2021 and 877 in 2022. Through May of this year, there have already been 328 overdoses, according to county data.

"It's a disaster," Hestrin said of local and nationwide numbers, which saw more than 100,000 overdose deaths in 2021.

When considering whether harm reduction programs could be the way forward in a crisis situation, Hestrin said "it's complicated." There are aspects to harm reduction he does support, such as providing access to Narcan/Naloxone. If first responders or those who use drugs didn't have access to it, "you could pretty easily add zeros to those (overdose death) numbers," he said. But that doesn't mean it doesn't come without risk.

"Fentanyl is 50 times more powerful than heroin and 100 times more potent than morphine. When someone goes down for a heroin overdose, it takes one shot or two shots of Narcan to revive them," he explained. "But if someone goes down from fentanyl, it’s so powerful that sometimes it takes six, seven or more shots of Narcan. That’s an issue our law enforcement is dealing with, training officers to know that you have to keep administering the Narcan. You can’t just do a dose and sit and look."

"It's important to not give the impression that, 'Hey, we've got this antidote, so feel free to use fentanyl to your heart's content,'" he added.

Hestrin also doesn't believe harm reduction is really as "compassionate" as it's often labeled to be.

"If harm reduction is not coupled with truth, which is, 'You have to stop using illegal street drugs, it’s going to kill you' ... That’s the message that gets missed by harm reduction folks, and it gets swallowed up in this modern notion of, 'Hey, we can’t judge anyone and this is a lifestyle they’re choosing and we have to respect that.' That’s nonsense," Hestrin said. "This is a poison that’s a scourge on our society. It’s not compassionate to enable their drug use and addiction."

Palm Springs Police Chief Andy Mills has also seen the impacts drug use has had on city streets, as he previously described seeing a man experiencing a fentanyl overdose with blood streaming from his nose and ears. In his time as the police department's leader, he said DAP Health is "always pretty thoughtful" about the impact of programs on the community, and that providing resources to reduce drug use is a "wise move on their part." But, similarly, he said it's important that they are not just providing an enabling environment where people can continue to use drugs.

The term "enabling" gets used a lot when discussing harm reduction programs. Tobe said DAP Health's program embraces it. A statement on the nonprofit's harm reduction website reads: "Entirely consistent with the nonprofit’s history and mission to end HIV, and to provide comprehensive health care to all, the program enables people to be safer, and to live their healthiest and happiest life through education and connection to care."

Dr. Scott Havens, medical administrator at the Betty Ford Center, acknowledged the controversy surrounding harm reduction programs. However, when looking at the name itself, he asked, "why would somebody not want to reduce harm?"

Havens pointed to a number of harm reduction measures already in place in daily life, like wearing a seatbelt while driving or ads to drink responsibly. It could be said that that the latter is also "enabling" people to drink, but it gives them safer options, like having a designated driver or using a rideshare service, so that they don't harm themselves or others, he said. When it comes to drug-related harm reduction programs, they should be viewed the same way.

"For better or worse, substance use is going to be part of our world. But we choose to minimize the harmful effects rather than just simply ignore it, or to even condemn them," Havens said. "If I have the means and the tools to help save lives and improve people's lives and to make it safer for them, then that's what harm reduction, to me, is enabling."

The well-known Rancho Mirage treatment center provides a number of harm reduction services to people. Havens said the Betty Ford Center is working to decrease barriers to treatment to help as many people as possible, and educate patients, families and communities about substance use.

Tobe understands the many complex feelings toward harm reduction because he experienced them himself. Before coming to DAP Health, Tobe started a syringe service program in Colorado in 2014. There, he met a nurse who reported using drugs in the morning, at lunch and after work. A number of assumptions about her drug use would likely come to one's mind, but she revealed to him that it all started when she was 12 and was injected by her stepfather.

He worked with her for 18 months to get to the point where she only used drugs after work so that she was not putting her patients at risk on the job. That experience changed his entire perception on drug use, he said, because he saw it could lead to behavior changes and helped him understand that "we don't know what people are going through day-to-day."

Many have also shared their concerns with Tobe on who is "worth saving" with harm reduction programs. People have told him someone who is employed or uses once a day is considered "worth it," while those who use 10 times a day, have lost their teeth or are incoherent are not and the program is just enabling them, he recalled.

But, to Tobe, the answer is simple: "If you have a heartbeat, you are a human, and you are worth saving."

Ema Sasic covers entertainment and health in the Coachella Valley. Reach her at ema.sasic@desertsun.com or on Twitter @ema_sasic.

This article originally appeared on Palm Springs Desert Sun: DAP Health unveils harm reduction vending machine at Hunters nightclub