Harm reduction vending machines: Exploring and improving acceptability of a low barrier approach to reducing drug related harms

Project summary While syringe service programs remain a leading method of delivering harm reduction supplies in the United States, they remain underutilized by the most vulnerable populations of people who use drugs (PWUD). To reduce substance use related harms, we need to provide a suite of harm reduction service delivery approaches that address the needs of a diverse and evolving population of PWUD. This proposed project will examine an innovative approach to reducing infectious disease transmission and fatal overdose in an understudied Western region. Used internationally for decades, harm reduction vending machines (HRVMs) were implemented in Nevada in 2017 and contain supplies like syringe kits, naloxone, and fentanyl test strips. It is unknown if HRVMs are an acceptable and feasible mode of service delivery and if they address the unmet needs of underserved PWUD in the US. This study will explore how, why, and who uses (and doesn't use) this novel method of service delivery. We propose a theory driven exploratory mixed-methods study to address the following aims: 1. Determine who HRVMs are reaching by 1) estimating awareness, intention to use, and prevalence of HRVM use, and 2) describing the associations with demographics, behavioral characteristics, social and environmental factors, and perceived barriers and facilitators. 2. Identify what factors influence HRVM use through a Rapid Ethnographic Assessment consisting of field site observations, ethnographic mapping, and qualitative interviews. Findings from this proposed research will tell us who is using HRVMs, who is not using HRVMs, what motivates and restricts their use, and areas for improvement to increase utilization. This information is vitally important to policy makers, public health practitioners, funders, and community-based organizations where resources are limited, and data-driven decisions produce better outcomes. This proposal addresses the NIDA 2022-2026 strategic plan goal to accelerate the science of harm reduction and will be directly and immediately relevant to informing national drug control strategy.