“There’s absolutely no downside to this, I mean except community opposition:” A qualitative study of the acceptability of vending machines for harm reduction

Abstract

Abstract Background: Vending machines for harm reduction (VMHR) are an innovative approach to deliver life-saving materials, information, and treatment for hard-to-reach populations, particularly for persons who inject drugs. The current study explores stakeholders’ perspectives on the feasibility and acceptability of VMHR in Philadelphia. Methods: From October 2021 to February 2022, we conducted 31 semi-structured interviews with potential end-users, staff, and leadership at a local federally qualified health center, and community members. Trained coders extracted themes from interview transcripts across four key domains: materials and logistics, location, access, and community introduction. Results: All stakeholder groups endorsed using VMHR to provide supplies for wound care, fentanyl test strips, naloxone, and materials to connect individuals to treatment and other services. Providing syringes and medications for opioid use disorder elicited a broader range of acceptability. Stakeholders held varying views on the location and placement of the machines, but almost all agreed that a machine should be placed in the highest drug use areas. Stakeholders suggested several strategies to introduce and gain community acceptance of VMHR, including community education, one-on-one conversations with community members, and coupling the machine with safe disposal of syringes and information to link individuals to treatment. Conclusions: Stakeholders were generally receptive to VMHR. The current study findings are consistent with qualitative analyses from outside of the United States and contribute new ideas regarding the anticipated community response and best methods for introducing these machines to a community. With thoughtful planning and design, VMHR could be a feasible and acceptable modality to reduce death and disease transmission associated with the opioid and HIV epidemics in cities like Philadelphia.