Naloxone Vending Machines – Combatting Opioid Overdoses Among High-Risk Populations

One in five overdose deaths is among individuals recently released from jail

Overdose is the leading cause of death for individuals released from jail, and overdose rates are more than 100 times higher among people who have been recently incarcerated than among the general population. The high rates are due in part to these individuals’ reduced tolerance to opioids after spending time in jail and to increased toxicity in the illicit drug market. As a result of the dramatic increases in overdose fatalities among this population, many jails are pursuing innovative practices to curb overdose morbidity and mortality. Jail settings offer a unique opportunity to screen individuals for opioid use disorder (OUD) and provide them with access to medications that prevents an overdose. Naloxone is one such medication that reverses an opioid-related overdose, and it has become an important tool to combat the overdose epidemic.

Although some jails provide naloxone and other medications to individuals who screen positive for OUD, many individuals are released from jail within a few hours or days, which limits their opportunity to access these medications. Despite jail facilities being an important setting in which to distribute naloxone, staffing shortages and other time and resource constraints in county jails can create barriers to naloxone distribution.

To mitigate these administrative barriers, vending machines have emerged as a strategy for widespread distribution of naloxone. Vending machines can be customized to provide naloxone in a secure, organized, and stigma-free manner. Additionally, they can be placed in the lobby of jails, which allows visitors and the general public to access the medication as well, expanding the distribution of naloxone in the community.

RTI International’s contributions to naloxone vending machines in jails  

Momentum around naloxone vending machines among law enforcement agencies continues to increase, and many jurisdictions across the United States are adopting this new practice. RTI staff members Dr. Bradley Ray and Melissia Larson have been at the forefront of this movement and lead efforts to assess the impact of this novel option.

In 2021, Dr. Ray assisted in the design of one version of a naloxone vending machine in partnership with Shaffer Distributing. To decrease access barriers to the machine, Dr. Ray used funding from the Centers for Disease Control and Prevention’s Overdose Data to Action grant to install 15 naloxone vending machines in jails in Michigan. He also partnered with the organization Overdose Lifeline in Indiana to install 10 vending machines in Indiana. Following the installation of these machines, staff reported overwhelming support for and positive experiences with the machines.

In her previous role at the North Carolina Harm Reduction Coalition (NCHRC), Melissia Larson led the implementation of naloxone vending machines in jail facilities across seven counties in North Carolina. In early 2022, NCHRC was contacted by the National Center for State Courts, which was working to identify jails in North Carolina in which to place naloxone vending machines. Leveraging its strong relationships with many communities interested in expanding their naloxone distribution, especially to high-risk populations, NCHRC was quickly able to bring together a team of interested community partners to connect with their local Sheriff’s Offices for placement of the machines. The team then explored who would take the lead on filling the machine and coordinated efforts to design educational resources, including machine stickers and posters, that provided instructions on naloxone administration. In total, seven machines were placed in North Carolina jails in the summer of 2022.

Law enforcement agencies have reported positive experiences with naloxone vending machines, and as a result, an increasing number of jurisdictions across the United States are requesting machines for their jail settings. 

Opportunities to collaborate and take action

Jurisdictions that are interested in learning more about implementing naloxone vending machines should consider the following: 

• Determine what strategies (if any) your jurisdiction is already using to get naloxone to people recently released from jail and whether there are opportunities to leverage existing systems and partnerships.
• Identify local partners that will take the lead in monitoring and restocking the vending machines. Responsible entities could include the department of health or local harm reduction organizations.
• Develop educational resources on naloxone administration and treatment resources for placement at or near the vending machines.

Training and technical assistance on this topic are available through RTI thanks to the Bureau of Justice Assistance’s Comprehensive Opioid, Stimulants, and Substance Abuse Program’s (COSSAP’s) Training and Technical Assistance collaborative, for which Dr. Ray serves as the Project Director and Melissia Larson serves as a subject matter expert. Training and technical assistance are also available to jurisdictions that are not receiving COSSAP funds.

Click here to learn more about RTI’s work as a COSSAP TTA provider, and here to learn more about COSSAP TTA opportunities. To learn more about RTI’s work in policing research and investigative science, click here.