Comparing Harm Reduction Vending Machines and In-Person Overdose Prevention Services in Practice: A Case Study From Rhode Island

OBJECTIVE: Improved harm reduction approaches are needed to address the ongoing opioid epidemic in the United States. The study aimed to evaluate the statewide implementation of harm reduction vending machines (HRVMs) and existing in-person harm reduction services. DESIGN: We analyzed 2 years of data from in-person harm reduction encounters and an HRVM pilot program between January 1, 2022, and December 31, 2023. SETTING: Rhode Island. PARTICIPANTS: This analysis compared unique persons served, total encounters, types of products dispensed, and time and day of transaction (weekday vs weekend) for in-person services provided by state-funded community organizations and the HRVMs in operation during the pilot program. MAIN OUTCOME MEASURES: At each encounter, the date, location, sociodemographic information, and product(s) dispensed were recorded, among other information for both in-person and HRVM services. RESULTS: Over 15 000 people accessed in-person and HRVM services during the 2-year study period (N = 15 267 in-person; N = 485 HRVM or both). Overall, 38% were female, and 64% were white and non-Hispanic. People who frequented the HRVMs tended to be an average of 5 years younger ( P < .001). Twenty-eight percent of HRVM encounters happened over the weekend, while only 2% of in-person encounters occurred during this time. Notably, 29% of HRVM encounters occurred overnight or during the early morning hours. Safer injection kits, safer smoking kits, and naloxone kits were the 3 most common products dispensed during in-person encounters, with 68% of encounters also supplying basic needs like water, snacks, and clothing. Safer injection kits represented 89% of products dispensed by the HRVMs. CONCLUSIONS: HRVMs are a feasible method of distributing harm reduction supplies as a complement to in-person services. HRVMs could complement other services already offered in many communities. Around-the-clock access is a key component of effective HRVMs.