The police chief of the small Kentucky city of Vine Grove knew from heart-rending experience why he needed a vending machine outside his office.
Kenneth Mattingly’s daughter was twice brought to the brink of death by heroin and twice pulled back by paramedics carrying an antidote, naloxone. Then Mattingly responded to an opioid overdose call early last year at which a woman saved a friend’s life because she was carrying a naloxone spray, often known by its brand name Narcan.
“She was a recovering addict herself and she happened to have Narcan she had gotten from one of her treatment facilities. So she hit him with a dose and brought him around. We hit him with a couple more and basically saved his life,” he said.
“That got me to thinking. He would probably have died if she hadn’t had Narcan. I gave my police officers Narcan to carry on duty but it still takes them time to get there and people die in the meantime.”
Police officers and paramedics regard naloxone as something of a miracle drug. A spray of the antidote can reverse an overdose so fast that within a few minutes a person is standing up and walking away, sometimes unaware just how close they came to dying. But it takes nearly 10 minutes on average for a paramedic or the police to reach someone overdosing. In rural areas, it can be a lot longer.
There is, on average, a death a week from opioids in Vine Grove and surrounding Hardin county – not atypical for a region hard hit by the worst drug epidemic in US history. Mattingly thought it would be a good idea if everyone who knew someone addicted to the drugs had naloxone on hand. But how to get what was technically a prescription drug into the hands of the general public?
Watching the news one evening, the police chief was struck by a report about a hospital in Indiana installing a vending machine to dispense naloxone for free and with no questions asked.
Within months, Mattingly had won the support of the city’s mayor and put in place Kentucky’s first naloxone vending machine, repurposed with a disabled payment function from the same kind that dispense chocolate bars and cans of soft drinks, in an alcove outside Vine Grove police department.
The location was apparently not a deterrent as the machine was emptied within 24 hours, a reflection of the extent of the opioid epidemic in a state where overdose deaths jumped 49% in 2020. Kentucky has the third highest drug overdose death rate in the country.
Mattingly, who left the police department last month to work as a detective in a neighbouring town, sometimes spoke to those collecting naloxone as the machine was repeatedly restocked.
“It ran the gamut of people. I had a 75-year-old grandfather whose son is an addict and he was coming over to visit that weekend. He said he wanted to have Narcan at home in case his grandson overdoses. There were some construction workers who encountered people who overdosed, so they were coming to get it,” he said.
“I told people, take two or three boxes. Put it in your home, keep it in your car, keep it in your bathroom, keep it wherever you think you might need it.”
Naloxone vending machines have proliferated across the country, from rural counties to college campuses and jails, as the US continues to struggle to contain the rising toll of an epidemic the Centers for Disease Control and Prevention estimates has claimed more than 700,000 lives since the crisis took off in 1999, driven by drug manufacturers pushing prescription painkillers.
Nearly 110,000 people died of drug overdoses in the US last year, the vast majority from opioids. But now the rising death toll is mostly the result of fentanyl, a potent opioid up to 100 times stronger than morphine. The drug is frequently produced in China and smuggled into the US via Mexico to be laced into heroin, cocaine and methamphetamine.
Earlier this month, New York, which sees a drug overdose every four hours, announced that it will join cities from Philadelphia to San Diego in installing vending machines stocked with naloxone sprays. Municipalities and organizations across the country are placing them in fire stations, libraries, even churches. No payment is required although some machines offer the user the opportunity to input basic demographic data and to seek counseling.
Wayne State University in Michigan has already installed 15 naloxone vending machines in public squares, local jails and its own campus in Detroit. It has funding to place another 20 this year.
Matt Costello, the programme manager for the Center for Behavioral Health and Justice at Wayne State, said the machines are designed to make it quick and easy to obtain naloxone, no questions asked. They have already distributed more than 19,000 antidote kits.
“Our thought was ‘How do we create a low-barrier, effective way of making naloxone available to even those who weren’t opioid-involved?’ We understand that people who take a naloxone kit may not even be an opiate user because you’re not going to use it on yourself. It’s for a rescue situation. Many times people are getting these kits to help others,” he said.
The food and drug administration and Biden government have sought to make it easier to obtain naloxone without a prescription by declaring a public health emergency, and states have passed their own access laws. But Costello said that is not without its issues.
“We had two separate occasions where a deputy went in to a pharmacy and got a free naloxone kit, no problem. But when they went to their primary care physician for another appointment, the doctor said: ‘I didn’t know you have a problem with opioids. I see you’ve been getting naloxone.’ It was showing up on their medical records. That is a barrier we felt didn’t need to be there,” he said.
There are almost no downsides to the drug. It is safe to administer repeatedly to someone overdosing. It is not addictive and cannot be misused to get high.
New Jersey’s governor, Phil Murphy, regards naloxone as so safe that earlier this month he announced that his state will allow anyone as young as 14 to get free supplies from a pharmacy without a prescription or having to identify themselves.
“To be sure, naloxone alone is not going to end the opioid epidemic. Turning back this challenge requires constant vigilance from all of us,” he said. “But this nation-leading policy will ensure that a crucial and lifesaving tool is put in the hands of more people, free and anonymously, so we can save more precious lives and allow individuals struggling with addiction to seek treatment.”
Yet Mattingly said there were still objections to the vending machine in Vine Grove.
“I got accused of bringing drug addicts in. People said they were going to sit in our parking lot to inject heroin and get their friends to Narcan them, and that they were then going to break into people’s cars in order to get money to get more drugs. That’s never ever happened,” he said.
“I caught a lot of flack for it, as did the mayor. But we rode the storm out and it became something, that once that the negativity died down, I’m telling you, every time I filled that machine up, within a couple of days it was empty. There was definitely a humongous need in the community.”
Mattingly, who has saved several lives with naloxone, said Vine Grove has felt the benefit with a drop in emergency calls because of overdoses, although it is too early to say how many lives are being saved.
Costello said the proliferation of naloxone vending machines is a reflection of how deep the opioid epidemic has penetrated American society, and how far it still has to run.
“Change is a slow process but we now see that there is the recognition of the need for rescue, like Narcan, as well as the need for treatment. That negative perception of people who become embroiled in a difficult addiction is changing,” he said.
“The evolution of this has been monumental. Now we’re seeing creative other uses for Narcan distribution. Old newspaper boxes you used to put a coin in are being repurposed now for Narcan distribution.”
