It’s a simple concept, but it aims to have an impact on the community’s complex struggle with drugs like fentanyl: Put a vending machine with the opioid-overdose reversal medicine naloxone in a busy, central location, where folks can get it for free.
Denver Health, the state’s flagship safety net hospital, did just that Monday morning, holding a ribbon cutting and unveiling of its first naloxone vending machine, affectionately called VENDY.
The blue machine is located in the middle of the Denver Health campus, next to a historic red brick and sandstone building south of the entrance to its emergency department on Bannock Street.
The hospital’s Outpatient Behavioral Health Services is behind the launch of the machine. Its leaders say it will make a difference.
“This is so much more than just a vending machine, more than a soda, more than a snack. This is lifesaving medication and life-affirming self-care available completely for free 24/7,” said Dr. Sarah Christensen, the hospital’s medical director of Outpatient Substance Use Disorder Treatment.
“You don't need insurance or a prescription. You don't need to engage with the health care system if you're not ready and share your deepest, darkest secrets with everyone, you simply show up, push a few buttons, and be ready to save a life,” Christensen said. “If only everything in health care could be so simple.”
The machines are just the latest in harm reduction for Denver Health
Denver Health helped pioneer harm reduction strategies, said Dr. Christian Thurstone, chair of Behavioral Health. That included use of medications like methadone, buprenorphine and, a couple of decades ago, naloxone, often called by its brand name Narcan.
“In those days, we had to take two test tubes, we had to mix them together, and then we had to somehow figure out how to administer the Narcan,” Thurstone said. “So it was not an easy process. We've come so far.”
Nicole Wagner, PhD, an assistant professor with the CU School of Medicine, said the project has been in the works for about five years.
“It really started when I was looking at data and saw that we had this lifesaving medicine that prevented these opioid overdose deaths, but we weren't getting them to people who were using substances very well,” she said. “And so we asked people, ‘How do we do this better? How do we get this to you?’ And what we learned was there were some really innovative communities, a handful of them throughout the country who were using these vending machines.”
The $10,000 machine comes to the Denver community through the National Institute of Drug Abuse's "Vending machine Naloxone Distribution in Your community" (VENDY) program.
How does Naloxone work?
VENDY holds 48 boxes of naloxone. Each box contains two doses.
If a person’s breathing has slowed or stopped due to an overdose from an opioid (like heroin, fentanyl, oxycodone, morphine, codeine and hydrocodone) naloxone can quickly restore normal breathing, according to the National Institute on Drug Abuse. But it isn't a treatment for opioid use disorder.
Naloxone is harmless to someone who does not have opioids in their system.
A private and accessible way for people to get naloxone
As the machines have popped up elsewhere in the state and the country, the doctors and other Denver Health providers got insightful comments from patients.
“What we heard from them was, ‘There was a lot of time, particularly early in my use, where I would not have gone to a pharmacist,’” Wagner said. “[Those patients said,] ‘I would not have gone to my doctor and told them I was using and asked for Naloxone.’ And so this vending machine is a way that they felt like they could really get that privacy that they needed and be able to get those supplies. And they were really comfortable with that.”
“We hope we get a lot of dispenses. We want it out in the community available to everybody, so we're going to keep it fully stocked at all times. Twenty-four hours a day, seven days a week,” said Scott Cardona, the assistant director of acute care pharmacy operations.
The central location was key, officials said.
“And our patients told us they wanted it here. They said they liked it in this location where they felt comfortable, where people were providing their services, and they told us they wanted it available 24 hours a day,” said Wagner. “And so that's why it's outside. And we have accessibility right here in a place where they use and feel comfortable using.”
Fatal drug overdoses, both in Denver and statewide, dropped in the first half of last year, according to The Denver Post. That echoed national numbers. Fentanyl and other opioids drove record numbers in recent years.
“We are plateauing for the first time in a decade,” Christensen said. “It's not clear that numbers are going down, but we maybe have stopped the increase at the moment.”
As easy as pressing a few buttons
After the cutting of a blue ribbon, Wagner showed how the machine works. You push some buttons on a touch screen, enter a code that’s shown on the machine, and soon a bag with Narcan inside falls to the bottom for retrieval.
Wagner showed how easy it is to use, grabbing the white package from the machine.
“These are different instructions for how to use the Naloxone kit in Spanish and in English,” she said.
JJ Keller, a peer recovery coach at Denver Health, who works with teenagers, attended the event, wearing a hat with the words “I Carry Naloxone.”
He thought young people would make use of it.
“I mean, word of mouth goes pretty quickly in Denver, especially amongst the community who tend to use drugs. And so I feel like this, hopefully, it'll be a big success and save a lot of lives,” Keller said.
'If I just mail it to him, I'll feel better'
The first customer of the free machine was Vicente Garcia, who tucked the package in his jacket.
“I'm going to mail it to my cousin. I already thought about it. So he lives in Trinidad, and they don't know a lot about it or whatnot, and so I figured I could just send him a care package,” Garcia said. “I don't think he has Narcan or they have it available. Maybe his mom does or something, but if I just mail it to him, I'll feel better.”
He noted his cousin had been struggling with fentanyl and overdosed twice.
When asked if he thinks the VENDY machine will help others, Garcia said it would.
“Oh, yeah, big time. People don't know where to go get Narcan,” he said. “They don't know where to go. And if it's easily available and there's not a camera on you and there's not a bunch of people watching you, you can just be discreet about it. So that's what I like.”
Wagner said she and her colleague will be researching the effectiveness, distribution, costs and level of community integration of the project.
