What is a harm reduction vending machine and how does it work?

Harm reduction vending machines were installed at the entrance of Bucyrus and Galion hospitals as a result of a partnership between Crawford County Public Health and Avita Health System.

The machines provide free, easily accessible life-saving tools and disease prevention supplies, such as naloxone, fentanyl test strips, at-home COVID-19 test kits and male and female condoms.

“Everything is free,” said Crawford County Health Commissioner Kate Siefert. “You can get as much as you want or as much as you need.”

The machinesare funded by the Drug Overdose Prevention Grant. Each cost more than $10,000, said Siefert. The supplies are provided by Project DAWN, and Crawford County Public Health stocks the vending machines on weekdays.

“We cannot guarantee that all time the items are available, but we are doing our best to keep them full,” Siefert said.

Is it popular and up to date?

Crawford County is lucky to have the harm prevention vending machines. They were introduced in 1987 in Denmark and later in Germany, said Siefert. They were launched in the United States in 2017, but they are still new to more rural areas.

“So, we are very fortunate,” said Siefert.

The machines at Bucyrus and Galion hospitals were installed in October. In the first week, 900 free products were distributed, including 199 naloxone, 302 fentanyl test strips, 236 male condoms, 67 female condoms and 96 at-home COVID-19 test kits.

“COVID-19 test kids are huge,” Siefert said. “Condoms are very popular.”

The most popular items in the harm reduction vending machines are COVID-19 test kits and condoms, which helps reduce sexually transmitted infections and decrease the risk of COVID-19 spread.

Aim behind harm prevention vending machines

The main reason the machines were installed is the Crawford County Department of Health's attempt to battle the opioid epidemic that hit the county a few years ago, Siefert said.

“We just need to bring in everything available, and we just keep trying,” she said.

Crawford County overall seems to be in good shape in regard to the overdose problem. The number of deaths caused by overdoses decreased by 50% since 2017, from 18 overdose deaths to nine in 2022.

However, the problem is still there. According to the Ohio Department of Health latest drug overdose data released in 2020, from 2019 to 2020 the overdose rate in Ohio increased to 45.6 deaths per 100,000 population, but that varies from county to county.

For example, in 2020, Ashland has the lowest overdose deaths rate in the state with 11.3 deaths caused by overdose per 100,000 population. Scioto with 83.4 deaths is at the top. Crawford with its 37.5 overdose deaths per 100,000 residents is in the middle.

Crawford was not included in the list of 20 Ohio counties ranking highest on overdose deaths, according to Harm Reduction Ohio data of July 2022. This, however, does not satisfy the local specialists battling the drug use and overdose.

“A lot of metropolitan counties' numbers are higher, but because we are such a rural community, I think that the numbers are very surprising,” Rachel Evans from Third Street Family said.

In addition, she said, all people who passed away in 2022 have a known history of non-fatal overdoses.

Overdose problem components in Crawford County

The overdose problem has multiple layers to it, but one of is overdoses are often caused not by the drug of choice, but by certain chemicals, namely fentanyl, that if added to lighter drugs, such as marijuana, can cause deaths, according to Siefert.

The nine overdose deaths in Crawford County in 2022 were caused by fentanyl, a synthetic opioid approved by the Food and Drug Administration for use as an analgesic. Fentanyl testers are among the products available at the vending machines, and they help tell if the drug has fentanyl or not.

“A lot of times people aren’t realizing that fentanyl is mixed in with their drugs,” Siefert said. “They think it’s just marijuana, but it’s not.”

Fentanyl can be mixed with another drug that is becoming increasingly popular in Crawford County, said County Prosecutor Matthew Crall, which is methamphetamine.

Crall said two drugs are often mixed together because one is a stimulant, and the other one is a depressant. He said they also started to notice more fentanyl in the last several years due to market change.

“They work together to cause different things to happen in the body,” Crall said.

In case of overdose, the vending machines offer Naloxone and Naloxone products, such as Narcan. Naloxone mitigates the effects of fentanyl and is administered without prescription.

“The way it works is that it blocks the receptors so that your breathing can resume,” said Siefert. “It does help revive.”

The good thing about it, said Siefert, is even if the condition was not caused by overdose, Naloxone would do no harm.

“So, if you are not sure, maybe they were diabetic, and they have passed out, and you thought maybe they were overdosing and gave them Naloxone –  it would not hurt them at all,” said Siefert. “It is very safe.”

How do harm prevention vending machines help?

Community organizations have a long history of handing out Naloxone and Narcan. According to Together We Hurt, Together We Heal This year, Together We Hurt Program Coordinator Mary Jo Carle Together We Heal handed out 497 Narcan kits so far in 2023.

However, despite Together We Hurt, Together We Heal and other community organizations help with antidotes for fentanyl overdose and relevant trainings, the vending machines provide Narcan anonymously which can alleviate the stigma associated with addiction and overdose, said Carle.

In addition, community members have 24-hour access to the machines, and they light up at night, said Siefert. The process is easy — just select the item’s code as if using a standard drink or snack vending machine. No other information is required.

“People can basically drive right up,” said Siefert.

Battling the stigma of drug abuse

Carle said battling the stigma associated with addiction and overdose is even more important since a lot of drug problems that we see today were caused by the so-called opioid epidemic that hit Crawford County in 2007.

Evans said the generally accepted theory in the medical and behavioral health room in the 1990s was that we are trying to alleviate everyone’s pain, and for that reason pain meds were highly accessible, and they created a problem with opioids.

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“They had marketed it improperly,” said Evans. “A lot of the stories you hear from the people in recovery now where a doctor prescribed me at the time a legal pain medication and then through the restrictions and then us finding out everything, I had to turn to getting it illegally or getting it off the street, or then I turned to heroin.”

Other factors that contribute to addiction

She added that getting addicted or not while on prescribed pain medication often depends on mental health. At least 60% of people with an addiction issue, Evans said, also have an underlying health issue, such as anxiety, depression, and adverse childhood trauma.

“Sometimes when they are not comfortable in their own skin, we do things that are not necessarily good choices,” she said.

Other factors that may  contribute to making an individual more susceptible to substance addiction, according to the Ohio Public Health Association research article “Factors Related to Drug Overdose Deaths in Ohio” by Samuel Borgemenke are lower income, poverty, unemployment, and housing problems.

“Lower socioeconomic status, lower median household incomes and higher rates of child poverty, unemployment, and severe housing problems, was strongly correlated with higher rates of drug overdose deaths,” reads the article.

According to Evans, as soon as the restrictions with regard to pain relief prescriptions started to come about, people began to realize that some people were on so much pain relief medication that it was not healthy, and now they were going through an active state of withdrawal.

Healing

Carle said opioid withdrawal is associated with headaches and cramping pains, and it can take anywhere from a year to several years depending on how much and how often somebody was using drugs and how long they were addicted, to heal.

For better healing, the affected community members need support, such as rehabilitation houses organized by Together We Hurt, Together We Heal. But a lot of times a road to recovery starts with being able to access a free product that helps prevent a death from drug overdose.

“One death from an overdose is one too many for me,” said Carle.

This article originally appeared on Bucyrus Telegraph-Forum: Crawford County has new harm reduction vending machines - what they do