Since the first modern vending machines began dishing out gum and postcards in the late 19th Century, coin-operated dispensers have supplied cupcakes, beetles, cigarettes, and even hypodermic needles.
Last week, Las Vegas became the first city in the United States to allow this kind of syringe dispensing machine, in an effort to reduce the spread of HIV and hepatitis C among heroin users and other injection drug users (IDUs). In the United States, 16 percent of IDUs have HIV, while a global study found 60-80 percent of drug injectors had hep C antibodies, indicating past or present infection—and that number is rising. The syringe vending machine program is a collaboration between Trac-B Exchange, a harm reduction center, the Southern Nevada Health District, and Nevada Access to Research, Education, Social Support & Health Care Assistance.
Syringe vending machines have existed in Berlin since 1988 and have been in France, Australia and Puerto Rico for years. Thanks to Congress lifting a ban on funding syringe exchanges in January 2016Trac-B Exchange was finally able to bring this trend to the US. Already, other needle exchange programs across the nation are calling Trac-B to ask how they can get their own.
"That's kind of how we see ourselves growing, helping other agencies in other areas get these machines," Chelsi Cheatom, program manager for Trac-B, told Motherboard. "We definitely want to see more of these machines all over Southern Nevada, eventually in different community-based organizations: health departments, or other public service agencies, inside emergency rooms or hospitals."
Las Vegas will get three machines to start, debuting at various outreach centers in May. Each package contains alcohol wipes, a sharps disposal container, condoms, and, of course, clean needles. The syringes are free, but users must first register a swipe card by providing a birthdate and the first two letters of their first and last name—keeping things slightly anonymous. Each machine also has a kiosk for disposing dirty gear.
Cheatom also hopes to soon offer vending machines for naloxone, an opioid overdose reversal drug, and is currently working with a pharmacy to figure out if such a machine would violate any Nevada laws. (For now, Trac-B offers naloxone at its office.)
It may seem counter-intuitive—wouldn't giving someone clean supplies encourage someone to mainline? But comprehensive studies from the Centers for Disease Control, the World Health Organization and numerous others have concluded, time and time again, that clean syringe access effectively reduces the spread of HIV and other blood-borne diseases. And, according to the American Medical Association, there is no strong evidence that such programs encourage drug use.
According to most harm reduction guidelines, if you're going to inject drugs, you should use a clean needle each and every time. This prevents abscesses, infections and damage to veins. You shouldn't ever share syringes with anyone, even your spouse or someone you know.
"There are a lot of people that don't understand the program or don't really see how it is a benefit to the community,' Cheatom said. "Any kind of communicable disease is a community problem. It's not just a problem within the person who's injecting…Wherever you are increasing any sort of disease in any community, you run the risk of it becoming a problem for everyone and becoming an outbreak. We want to reduce that risk."
It's only since 2013 that Nevada's attitude toward syringe exchanges has taken a tolerant turn. The vending machines mark the first time the Southern Nevada Health District has worked directly with a syringe access program. Trac-B, which sees around 150 people per month, is only the second storefront needle exchange in the state—the first being Change Point in Reno—and it only opened in January 2017.
"Nevada's a big state and there's a lot of smaller counties and smaller towns that may need their own program," Cheatom explained. In her view, a vending machine might be an ideal fix. "With these machines…it kind of takes away any chance of there being any bias in any organization against people that are injecting or a learning curve about what kind of supplies people need."