UK study to test effectiveness of kiosk with harm-reduction goods as way to increase access and fight the stigma felt by drug users

An example of a harm reduction vending machine 
in Cincinnati (Photo from Kiosk Marketplace)

By Melissa Patrick
Kentucky Health News

To fight feelings of stigma that discourage intravenous drug users from getting clean needles at syringe-service programs, the University of Kentucky is starting a study that will put a vending machine with syringes and other harm-reduction supplies in an Appalachian Kentucky county. 

"Interest in reduction kiosks is soaring nationwide and the proposed project would provide critical and timely data to inform scale-up of this model, especially in rural areas of the country that have been severely impacted by substance use related harms," says a National Institutes of Health report describing the study.

The vending machine is called KyOSK, for Kentucky Outreach Service Kiosk. It will have "injection equipment, naloxone, fentanyl test strips, hygiene kits, condoms, and other supplies, as well as an innovative call-back feature" to help steer drug users into recovery, says the report. 

Research shows that there is a need for these harm reduction kiosks because people who inject drugs in Kentucky are under-utilizing the 82 syringe service programs that have been established in 63 of the state's 120 counties since 2015. Such programs are part of harm reduction programs that use a host of strategies to minimize the negative physical and social impacts of drug use. 

"Data from our research funded by NIDA’s National Rural Opioid Initiative revealed that nearly half of people who use intravenous drugs had never used the existing staffed SSPs and, over 24 months of follow-up, SSP uptake remained low and program drop-out was not uncommon," says the NIH report. 

The main reason drug users gave for not using the syringe programs was "fear of stigma," the report says, adding that most of those who cited stigma said they would prefer a vending machine or kiosk to get harm-reduction supplies. 

This is not a new idea. The report notes that harm reduction kiosks have been operating around the world for more than 30 years, and research shows that they can expand syringe access. However, the researchers note that few exist in the U.S -- and none in rural areas. 

The hope is that these machines, which do not require interaction with other persons, will allow drug users to obtain harm-reduction supplies more readily.

Early news reports about the grant referred to multiple vending machines, but the grant calls for one kiosk. A second county with a traditional syringe service program will be used for comparison in the study, said project leader April Young, an epidemiology professor in the UK College of Public Health.

Young said the site for the kiosk hasn't been determined. "The machine location and design will be determined by a design team involving local and state stakeholders," she said in an e-mail. The NIH report says the contents of the machine will be tailored to meet the needs of the community in which it is placed.

Up to 400 study participants will get a magnetic swipe card that will give them access to the kiosk. Young said study participants will be screened for eligibility and must be at least 18 years or old, and supplies will not be accessible to people who are not enrolled in the study. 

As with in-person syringe services, the study will try to direct drug users into treatment and recovery. Young said in the email, "There is also an innovative feature of our design that could help connect study participants to health services, including substance use disorder treatment, HIV testing and treatment, housing assistance, domestic violence support, and Medicaid signup." 

The $609,439 NIH grant, awarded in August, says "The proposed study will test the effectiveness, implementation outcomes, and cost effectiveness of a community-tailored, harm reduction kiosk in reducing HIV, hepatitis C, and overdose risk behavior in rural Appalachia." 

Scott Lockard, public health director for the Kentucky River District Health Department, said he is exploring whether such kiosks could work in the communities he serves. 

"We're exploring the ins and outs of the program," Lockard said. "We're exploring how the program can be utilized to best serve our clients. And I'm looking at potential locations within our district to position these machines so that they can best serve our population." 

Beyond that, Lockard said his agency is getting ready to install "NaloxBoxes" at its local health departments which will allow people in his district to get naloxone 24 hours a day. Naloxone, known by the brand name Narcan, is a medicine that rapidly reverses an opioid overdose. 

"We want to get as much naloxone out in the hands of the people as possible," he said. 

The Louisville Metro Department of Corrections has put "Narcan Boxes" in its jail, and on Friday, Sept. 9, one was used by an inmate to save the life of another inmate, who was overdosing on fentanyl, saving his life, Gladys Bautista reports for WLKY-TV.