Anonymous Distribution of Naloxone via Vending Machines Raises Uptake by Ex-Prisoners, Rutgers Researchers Find

Making the medication, used to reverse an opioid overdose, freely available may help reduce the stigma associated with treatment

Retailers love vending machines for the consumer convenience and low overhead. These same attributes are starting to appeal to public health experts looking to reduce rates of opioid-related overdose deaths.

In a new study published in the Journal of Substance Use and Addiction Treatment, Rutgers University-New Brunswick drug policy researcher Grant Victor found that by distributing free naloxone – a nasal spray used to reverse or limit the effects of opioids (also known by its brand name Narcan) – via vending machines, county jails could sharply increase the number of doses provided to inmates at release.  

“While vending machines won’t replace the warmth and care you get from someone who works in a harm reduction organization, our work suggests they can be cheap, easy and underutilized technology for delivering life-saving medication,” said Victor, an assistant professor in the Rutgers School of Social Work and lead author of the study.

Past research has demonstrated that the risk of experiencing a fatal opioid overdose is highest among people recently released from prison. A 2021 study by Victor found about one in five overdose deaths in a major metropolitan area were attributed to those who had been incarcerated during the previous two years.

The vulnerability of former prisoners is compounded when overdose prevention support – naloxone and drug-checking technologies such as fentanyl test strips, for instance – aren’t readily accessible, Victor said. Making naloxone available to inmates immediately after their release has proven to be a successful strategy for lowering rates of overdose deaths.

To assess whether novel naloxone distribution could increase uptake of the overdose prevention medication in correctional facilities, Victor and colleagues at Wayne State University in Detroit designed and distributed naloxone vending machines to six county jails in Michigan.

The machines were easily accessible by discharged inmates and anyone visiting the jail facilities.

Most of the prisons that participated were distributing naloxone before the vending machine program, but only in property boxes returned to detainees at release. By contrast, the vending machine naloxone was available for free, without limitations or restrictions.

Boxes containing two Narcan nasal sprays – which retail for about $57 – were paid for by a Centers for Disease Control and Prevention Overdose Data to Action grant. The vending machines required little to no maintenance by jail staff, which Victor said helped to reduce the administrative burden.

Six months after installation, Victor analyzed order data recorded by the Michigan Department of Health and Human Services and found the total number of naloxone boxes distributed across the six jails had increased by 63.5% – to 6,708 boxes from 4,104 boxes.

Victor said his current study didn’t assess why former inmates were taking more naloxone home after the vending machine program began, but he has a theory.

Stigma regarding drug use and naloxone’s utility has been cited as a barrier to distribution. One way to overcome this hesitancy is static naloxone dispersal, passive methods of delivery that are meant to eliminate the need to interact with another person.

“Vending machines may hold promise as a low-barrier naloxone distribution conduit, because vending machines provide an anonymous mechanism for access,” the researchers wrote.

Victor said the findings could hold lessons for other distribution programs and might help convince more prisons and jails to follow suit.

“This cheap and easy method of distributing naloxone was embraced by some of the more progressive jails in our study, which might offer a path forward for others,” Victor said. “As a society, if we're going to continue to police and criminalize people with serious health issues related to opioid use disorder, we need to do more to help them escape a vicious cycle.”