University of Cincinnati professor, Daniel Arendt, PharmD and Director of Prevention with Caracole, Suzanne Bachmeyer, talk about a new way to prevent opioid overdose with a vending machine.
Interview conducted by Ivanhoe Broadcast News in 2022.
How did you get this started?
ARENDT: Let’s get started actually, shortly after I came to Cincinnati when I was first starting in my role in pain stewardship at UC, I was wanting to really build connections to the community, specifically the Harm Reduction community and I started going to some local meetings where I started meeting people like Suzanne and hearing all the different projects they are working on. learning about what they’re doing and distributing naloxone, sterilize syringes, any other things that can help keep people who use drugs safe? So started with some meetings between myself and others at CareCore to see how might I, as a pharmacist and as a researcher, potentially be able to help further those programs and really help a lot of people here in the community. And that quickly move to discussion of vending machines and this program and it just was a perfect match right there.
I know communities all across the United States have grappled with the best way to do this, their needle exchange and syringe distribution. There have been places where they’ve done community places like libraries and fire stations where you can get naloxone and nobody seems to have come up with the best method of distribution. What is it that you and your colleagues do?
ARENDT: So I wouldn’t necessarily say that we can or want to definitively say that this is the best way. I don’t know if anyone truly knows the best way to distribute it. I think the key is that distributing it is important in getting it into the hands of the people who need these types of resources. I think in the addiction world and in harm reduction there are a lot of people who’ve been doing this work for a long time and it hasn’t necessarily the same notoriety or public newsworthiness as it does now. I think there’s an important aspect of going to the people who are in this community and talking to them and finding what they need and how we can serve them as opposed to trying to say, here’s the way that’s going to work the best. Really having that reactive approach of saying, how can we meet you, where you are and how can we provide this in stigma freeways? I think one of the reasons our program has been successful is it removes some of those excess barriers. So if you have to go to a fire department or to a police station or an emergency department or anywhere else there’s that extra barrier, some stigmatization, there might be additional fear of legal consequences and things like that. The requirements of showing IDs or not being anonymous and you can get worried about incrimination or anything like that. I think the key is really that it’s a way that centers on the person who’s using. It prioritizes them their safety, their needs, their wants, and make sure that they have access with low barriers so there’s not too much standing in their way because they typically know what they need, our job is to make sure that the resources and support is available so that they can get it when they need it.
What’s available? How do you make sure that’s available to the people who need it, where they can have quick access in an anonymous way that makes them feel safe?
ARENDT: Yeah. So a variety of things are very helpful and each community might do it a little bit differently. I know every community also has different laws related to drug paraphernalia as well, which might change what is possible. So there’s a ton of things available and I really encourage anyone who’s working to distribute these things to do as much as you can and recognize that it might not be perfect, that we can continue to fight for more and more access. But typically what this is, is looking at things like naloxone, which can reverse an opioid overdose. Additionally, I wanted to just mention that it is extremely safe. It can be administered by anyone even without a history of medical training, even if they were to administer it to someone who isn’t actually overdosing on an opioid, it would have no negative consequences. It itself is not addictive, you will feel no different if I were to administer it to anyone of the people in this room or myself, you would see absolutely no change which I think is really important to know, but it’s so safe. Other things, things like fentanyl test strips. This is a very big thing because I liken this to a lot of people drink alcohol and if you were to go to a bar and order just a light beer, and you drink it and then you later find out that it was ever clear. It would be really bad and we would see a lot of unnecessary overdoses on alcohol because of it. When we talk about fentanyl and its role in the drug supply, it’s like that situation. The only difference is when you’re drinking a beer or anything else, you taste it and you’d be able to say, okay, that’s not what I ordered. If you’re injecting a drug, you don’t have that taste test type of situation so you only find out that it was contaminated or it contains fentanyl by overdosing and by then it’s really too late. Even if you have naloxone, you typically can’t administer naloxone to yourself. So you have to rely on community, but you also, when you have support and resources like fentanyl test strips, you can test your drug supply before you use. So you have an idea, is this contaminated with fentanyl? Am I at a higher risk of overdosing from this to help keep you safe, so then a lock zone is there as a fail-safe should someone overdose, we can reverse it, but then also fentanyl test strips so we can prevent those overdoses in the first place. Those are two of the big ones when it comes to overdose prevention. Additionally, when it comes to disease prevention, sterilized equipment is so crucial. Sterile syringes, sterile pipes, sterile cookers, having appropriate tourniquets and bleach or whatever else people might need to help keep them safe so that they’re not contracting HIV or hepatitis or another bloodborne illness. So there’s a variety of things that really are critically impactful for this community.
Talk to me about the numbers. Now that this program is set up, what have you seen?
ARENDT: We’ve seen a really overwhelming response and I’m certainly more than Suzanne anticipated as well. We actually just broke 1,000 separate clients who have registered with the program and utilized the machine, and we actually just broke that today. So I’m pretty darn excited about the timing of that. But that’s continuing to grow. We’ve also seen that not only are we seeing 1,000 clients who are using this and clamoring for more access to these types of programs. But we’ve seen more equitable access through the machine as opposed to other in-person harm reduction strategies. We’re seeing higher rates of people of different ethnic backgrounds and racial backgrounds utilizing the machine in part, we believe because we’re lowering some of the barriers and we’re reducing some of that stigma and shame that can be associated with harm reduction sometimes, unfortunately. And I think overall what we’re really seeing is a massive amount of overdoses reversed. So I mentioned we’ve worked and have about 1,000 separate clients registered for the program. We also measure how many of them come back and use the machine for a variety- for a long period of time, usually over about three months. And we tried to see one, how many people are using it long-term as well as what’s happening with them and how is the machine impacting them. We’ve seen people have told us we have reversed over 1,000 overdoses with the naloxone from the machine. They have tested and found fentanyl within their drug supply thousands of times. That’s resulted in people either throwing away that drug supply or at the very least using a lower dose of it than they otherwise would. So over 1,000 overdoses reversed and many more prevented by the awareness of what is actually in that drug supply.
How are you able to track tracking? Is it anonymous or is there a way of tracking? Do people have to sign in if they’re using it? How does that work?
ARENDT: Yeah, it’s a great question. So it is a fully anonymous process. The way it works is someone approaching the machine. There’s a phone number actually on the machine that will route them to one of our harm reduction coordinators. They don’t have to share their name or anything like that, will register them into our system, give them a unique client ID that’s specific to our program, then that works with the vending machine. It’s smart enough to know. Okay. Are you typing in your individual access code? So each code gets access to the machine to get one of every product for a week at a time. And then after about 90 days, that code is shut off to require that individual to call again and re-enroll. And that’s when we can ask those follow-up questions like, Have you received naloxone from us? And then when they tell you they have, then we can ask them how many times have you used that to reverse an overdose, which gives us a better understanding of not just how many patients we’re reaching and who those patients are, but how it’s affecting them. So we can start to directly relate between the overdose numbers we see in the community and specifically the impact of the vending machine.
Do you know how many overdoses there were in the United States last year? What are we looking at? Because I’ve heard the word epidemic.
ARENDT: Yes.
And is that accurate? Is that what we’re looking at?
ARENDT: It is absolutely accurate. Unfortunately, it was the opioid epidemic was declared a public health emergency actually a few years ago. And it’s still a public health epidemic. And actually the overdose crisis has continually gotten worse. We actually, if we- I think the opioid epidemic really entered the public lexicon in the early 2010s of recognizing how much of an issue it was. At that time, we were around 40,000 overdose deaths a year. Now, we are actually at over 100,000 overdose deaths a year. So it has dramatically increased. A lot of that coming from the presence of things like illicitly manufactured fentanyl and the drug supply. Here in Hamilton County, we are increasing overdose deaths as well. I believe in 2020, overdose deaths increased by about 30 percent. And then in 2021 they increased by another 15 percent. And again, reaching the 100,000 person benchmark is very unfortunate. One of the highlights of our program though, and one of the reasons we care so much about it is we’ve started to see local impacts on that trend to start to reverse course on that, we actually saw preliminary a decrease in overdose deaths in Hamilton County. Despite again, overdose death rates increasing throughout the rest of the nation and across Ohio as well. And that’s one of the things that we think is so critical is we know these interventions help individuals and we know that they prevent overdose deaths.
Do you have these specific statistics?
ARENDT: Yeah. Again, they were preliminary, but it was a reduction of about 10 percent based upon those preliminary findings. And I think it’s again important to recognize nationwide up 15 percent, preliminary for us, down 10 percent, which is pretty significant.
Is there anything I didn’t ask you that you want to make sure that people know?
ARENDT: I think one of the things that I always try to explain to people who are hearing about harm reduction for the first time, is recognizing that it’s okay if your first response to hearing about it is. Is that a good idea? Because a lot of people have that as their first response. It can sound counter-intuitive. But the fact of the matter and the reality of the situation is that people have used drugs for thousands and thousands of years. They’re going to continue. It’s a fact of life. And rather than simply saying, well, just don’t do that. We know that that doesn’t work. We know that simply policing and having the war on drugs doesn’t necessarily solve the epidemic and in some cases makes it work or it makes it worse. So harm reduction is really a change in that philosophy to say, we know people are going to use. And what our job is, is to do our best to keep those people safe to reduce the harm. I know that if someone has heroin and they want to use it, they’re going to use it. Finding a sterilized syringe is not the difference between someone using heroin and someone not using, it’s the difference between them using a sterile syringe or a non-sterile syringe. Having a lock zone doesn’t mean that they’re going to use or not use it. Are they going to be able to be revived if they are to overdose? It’s an understanding of just empathy and compassion and saying, instead of requiring you to do a certain number of things before I’ll provide treatment or care it is saying I’m going to meet you wherever you are at. I’m going to come to you and we’re going to see what the next steps are to keep you healthy and keep you safe.
How did “harm reduction” start?
BACHMEYER: So around November of 2020, we were looking at ways to get safer use supplies into the hands of our clients. With COVID and things were shut down, we knew that the individuals we serve had needs and we could not get those supplies into their hands. So we looked at implementing the harm reduction vending machine as a initially no-to-low contact service.
How did that work initially?
BACHMEYER: We did a lot of phone sign-ups for the vending machine, which it’s transitioned into more of- we do more face-to-face sign-ups with individuals now.
What is in the machine? What can clients get their hands on if they need?
BACHMEYER: They can get safer smoking kits, safer injection kits, injectable naloxone and nasal naloxone, band-aids, pregnancy tests, sharps containers, safer injection kits, and safer sex kits.
Safer smoking?
BACHMEYER: Yes. Our safer smoking kits support the community of people who smoke their drugs. So that would be cocaine or meth, sometimes heroin. And really we decided to put those in the machine so we could engage a greater community of people who use drugs.
Daniel mentioned this, and I want to play devil’s advocate because I know the question will come up and I’m sure it comes up in community meetings, isn’t there the concern that this is encouraging people to continue drug use or to use drugs?
BACHMEYER: So it is our belief that drug use is and will continue to be a part of some people’s lives. And we do not believe that providing supplies to keep people safe, to keep people from overdosing, and to keep people from contracting infectious diseases, enables them in any way, shape, or form.
How’s it working?
BACHMEYER: From my perspective, it’s working very, very well. We are able to engage people who would not have engaged with us with a traditional syringe service program or asking them to walk through our doors.
What is it that’s attractive to people?
BACHMEYER: I think it depends on the person. I think some people are very drawn to the programming because they don’t have to interact with us a lot. They can really interact at their own pace, build up that trust with us, and then engage and receive referrals or education or testing if they want that. It’s really a go-at-your-own-pace service. We don’t require anything of you other than the initial survey and checking in with us every three months.
Does it cost money for the services?
BACHMEYER: The services are entirely free.
So people who use these services aren’t paying for them. So how do you go about getting the funding and the support for this program?
BACHMEYER: We received a grant from a local foundation called Interact For Health, and they supported us in purchasing the machine as well as the supplies in the machine.
Is that an ongoing grant so they’ll continue to fund for now the materials?
BACHMEYER: No, that was just an initial year grant, a start-up grant.
How do you continue to provide the supplies then?
BACHMEYER: We provide them through government grants and private donations.
In terms of this being a potential model for other communities across the country, can you talk to me a little bit about the interests? Have you talked to other communities that are looking to expand and to possibly initiate the same kind of service or program?
BACHMEYER: We have. We’ve received an incredible number of calls from cities, agencies, health departments all across the country, all interested in replicating this program.
Any negatives to having this?
BACHMEYER: No.
Interviewer: Nothing you can think of?
Suzanne Bachmeyer: No.
Have you heard anecdotally as well without looking at the information that lives are being saved?
BACHMEYER: Absolutely. In fact, I do the vending machine registration with individuals occasionally on Thursday evenings and their response has been amazing from people saying they get Narcan and distribute it to the people who they use with people having it on their person at all times so they can prevent overdose with their friends, families, loved ones. And then we’ve also seen a number of people vending out of the machine who just love people who use drugs and want to have those supplies so they can be safer.
Is there anything I didn’t ask you that you want to make sure people know about this program?
BACHMEYER: I guess just harm reduction in general and the way we view it here at Caracole is really acknowledging that people will use drugs and providing the supplies for them so they can stay safer and remain healthy.
END OF INTERVIEW
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