Likelihood of using a harm reduction vending machine among rural people who inject drugs in Appalachian Kentucky

Abstract

Background: Harm reduction vending machines (HRVMs) that dispense safe injection equipment and other supplies have operated globally for more than 30 years, yet few operate in the U.S., particularly in the rural epicenters of drug-related harms. This study explores likelihood of using HRVMs and correlates thereto among people who inject drugs in rural Appalachian Kentucky.

Methods: Respondent-driven sampling and outreach were used to recruit participants who were age 18 or older, resided in an Appalachian Kentucky county, and had used opioids and/or injected drugs to get high in the past 30 days. Interviewer-administered questionnaires elicited data on behavioral and demographic characteristics and likelihood of using HRVMs. Analyses were restricted to participants who injected in the past 6 months (n = 259). Generalized estimating equations were used to estimate adjusted prevalence ratios (APRs) for correlates to likelihood of using HRVMs, controlling for lifetime use of brick-and-mortar syringe service programs.

Results: Overall, 57 % reported being likely to use HRVMs. Participants who lacked consistent access to transportation, engaged in receptive and distributive syringe sharing, experienced more lifetime overdoses, and had unsuccessfully attempted to access medications for opioid use disorder (MOUD) reported being more likely to use HRVMs. Heroin and prescription opioid use were negatively associated with likelihood of HRVM use, as was experience of shame around drug use.

Conclusions: Most people who inject drugs in this rural Appalachian sample were likely to use HRVMs, with interest being highest among those at highest risk for injection-related infections and overdose and who had faced difficulty accessing MOUD.

Keywords: Appalachia; Harm reduction; Injection drug use; People who inject drugs; Rural; Substance use; Vending machine.