Meeting Veterans Where They Are: Harm Reduction Supply Distribution via Vending Machines

Abstract

Background:

Harm reduction vending machines (HRVMs) provide low-barrier access to supplies that reduce overdose deaths and infections. Evidence within Veterans Affairs (VA) and supportive housing settings is limited. We evaluated 8-month HRVM implementation measures at a VA Health Care System, mapped to RE-AIM (reach, effectiveness, implementation) domains.

Methods:

Prospective, single-system, single-arm, descriptive implementation evaluation across 15 HRVMs in VA health care and supportive housing settings. Measures/variables (RE-AIM): Reach—Veteran HRVM sign-ups/pathway, proportion accessed ≥1 product, sociodemographics; Effectiveness—resource acceptance (naloxone, overdose education, community harm reduction resources, substance use treatment, infection testing/care); Implementation—most frequently accessed products, comparisons by setting (total dispensed; proportion during business versus nonbusiness hours). Data sources: HRVM software; staff-completed survey for Veterans at HRVM sign-up. Case descriptive analyses were used.

Results:

Reach: 281 Veterans signed up for HRVM access, most commonly with colocated/on-site staff (54.8%). During the 8-month period, 70.8% accessed ≥1 product. Veterans were mean age of 60.2 ± 13.8 years, primarily male (90.2%), and represented diverse groups, with 40.2% white/Caucasian, 31.1% black/African American, and 10.8% Hispanic/Latinx. Effectiveness: Among all Veterans, 44.8% accepted naloxone, 19.9% overdose education, 13.5% community harm reduction resources, 11.4% substance treatment resources, and 10.3% infection testing/treatment. Implementation: 3567 products were dispensed, with a greater share at supportive housing versus health care settings (61.5% versus 38.5%), and housing settings showed substantially more after-hours dispensing (66.6%). On-site HRVM sign-ups were strongly associated with site-level dispensing (Spearman ρ = .80, P < .001). Frequently accessed items included syringes (n = 422), hygiene kits (n = 350), condoms (n = 337), and wound care kits (n = 312).

Conclusions:

HRVM colocation across health care and supportive housing reached Veterans and supported after-hours access where needs were greatest, while also linking many to naloxone, education, and health care resources. Findings demonstrate a feasible, scalable approach for integrating HRVMs into Veteran-centered public health strategies. Future research should evaluate longer term clinical outcomes, participant-reported outcomes, and cost.