Flint, MI—Against a beige brick wall on the east side of Flint’s downtown bus station is a single vending machine. It seems unremarkable, but on closer inspection instead of candy and bags of potato chips, it dispenses boxes of fentanyl testing strips and Narcan, a potentially life-saving medication that reverses opioid overdose.
The machine debuted on February 9, 2023, and as of March 24, roughly six weeks later, it had distributed more than 2,100 individual test strips and 904 Narcan kits.
“That first week was crazy,” recalled Carrie Chanter, Director of Prevention, Health & Wellness at Genesee Health System (GHS), one of the multiple partners that helped bring the vending machine to Flint. “We were getting through 50 [kits] a day.”
Chanter noted that distribution levels have since dropped slightly, though they are still seeing need to restock the machine two to three times a week.
“It’s balancing out a bit,” she said in mid-March. “Instead of 50 a day we’re at 25 a day.”
For her part, Kelly Ainsworth, the project director for Mental Health & Substance Use Initiatives at the Greater Flint Health Coalition (GFHC), another partner, said she wasn’t shocked by the early distribution numbers.
In fact, she was glad that they were high.
“You know, I’m not surprised. I’m very pleased,” Ainsworth said. “I’m very pleased that our community embraced that resource. I’m pleased that they felt comfortable to utilize it.”
That comfort was a key reason why Ainsworth, Chanter and other community resource providers felt the vending machine would be a positive tool in combating the opioid epidemic in Flint and Genesee County: it helps take some of the stigma out of safe drug use.
Reducing such stigma is a priority for those who practice harm reduction, a set of strategies with the goal of reducing or preventing negative consequences of substance use.
“With Genesee County being the third highest overdose death rate in the entire state, we knew that we needed to provide more opportunity for people to access this life-saving resource in a way that is not stigmatized,” Ainsworth explained.
Proponents of harm reduction strategies note the method is nothing new, but only recently has it been made more visible with the growing availability of syringe service programs and publicly-accessible Narcan vending machines throughout the state.
“We already have a lot of organizations that do distribution,” Ainsworth said, though she called Flint’s vending machine’s numbers “significant.”
“[These numbers] represent that this is something our community is telling us that they need, that they were looking for,” she said.
What is harm reduction?
Yashica Ellis is Prevention Team Lead for Wellness AIDS Services, a Flint-based organization that offers a host of LGBTQIA+ programs alongside naloxone access and overdose education.
When asked to explain harm reduction, Ellis went on to explain that many people apply non-drug-related methods of harm reduction almost daily.
“It is us using seatbelts in a motor vehicle,” she said. “Using condoms is harm reduction, wearing a helmet when you ride your bike or scooter is harm reduction—it’s not a new concept.”
But as it relates to drug use, Ellis added, harm reduction strategies are not as widely accepted and therefore practiced.
She said though harm reduction has become slightly more commonplace since Wellness began offering its syringe service program in 2010, she feels “respectability politics” and ongoing stigma mean her work is regularly misunderstood.
“You’ve got some people who only hear—or they perceive—that we’re just enabling drug use,” Ellis said. “But that is so not what it is.”
Across the community resource providers Flint Beat spoke with, all said they have received similar feedback at one time or another.
Chanter, with GHS, said that while addiction is considered a brain disorder, she rarely finds the greater public is willing to treat it as they might other medical diagnoses.
It’s a point Andrea Foster, the director for opioid response program development at the Michigan Health Improvement Alliance (MiHIA), echoed. Further, she said, that view can be problematic when considering the response people have to more “acceptable” medical issues and interventions.
“No one’s going to look at [a defibrillator] and someone who’s having a heart attack and say, ‘Well, you should have had less cheeseburgers, so we’re not going to save your life,’” Foster said.
But for whatever reason, Ellis added, when it comes to syringe service programs or Narcan access for a person who uses drugs, some people readily refuse to offer the same life-saving measures.
“I remember going to my local grocery store and getting out of my car and damn near stepping on syringes in the parking lot,” Ellis recalled.
She said she went into the store and spoke to the manager on duty, explaining that she could provide overdose training to the staff and free naloxone to reverse overdoses that might occur on the property.
“Instead of taking my info and sending it up the food chain, she instead lectured me on how it wasn’t right that an ‘addict’ could access naloxone for free, but she had to pay $400 for an EpiPen for her kid.”
Ellis said this was “just a bit of the type of pushback” harm reduction workers get. “You know, not everybody is on board or sees the beauty in giving someone that second, third or even 20th chance.”
Why are harm reduction strategies important in Flint?
According to a 2022 coroner’s report Ellis shared, there were 248 deaths from overdose in Genesee County last year.
Of those, 173, or roughly 71 percent, happened in Flint.
That’s not to say the opioid epidemic is affecting Flint residents more than others in the county, Ellis clarified. The report only notes where overdose deaths occurred.
But while the county’s most recent overdose death data doesn’t indicate residency, it can show where access to naloxone or testing strips for fentanyl—a sometimes-fatal synthetic opioid that’s found its way into recreational drug supplies—might be most helpful.
“People don’t overdose and say ‘I need to go find my doctor.’ People don’t overdose and say, ‘I need to get to the pharmacy,” Ainsworth said. “People overdose, and they’re at the mercy of Narcan being available where they’re at.”
That’s why it’s no accident that the partners who brought the Narcan and fentanyl test strip vending machine to Flint placed it in the city’s downtown bus station. They noted it’s a “high traffic” space where the free, potentially life-saving resource can be accessible to anyone at nearly all hours of the day.
“Having a vending machine in the community—planted right downtown where we’re seeing the highest amount of overdose happening—is a really strong way to ensure that when that overdose happens, people will have access to that resource,” Ainsworth said. “And they’ll know where to get it, so they can have it on hand to be prepared for an overdose emergency moving forward.”
Do harm reduction strategies work?
Steve Alsum is the executive director of Red Project, a Grand Rapids, Mich.-based non-profit that offers overdose resources and naloxone distribution among its other work in HIV prevention and health-related service access.
Alsum said when Red Project began distributing naloxone in 2008, it was the first program in the state to do so directly to community members. But, he noted, there was already “a wealth of data showing that naloxone programs work.”
Alsum pointed to multiple peer-reviewed studies and two more 2010s reports from Boston University, which concluded that Massachusetts communities that introduced overdose education and nasal naloxone distribution (OEND) programs saw a decrease in opioid overdose death rates.
“So, basically, what the data says—and the peer reviewed journal articles have stated—is that with naloxone, the more the better,” Alsum summarized. “There’s pretty much a dose-dependent effect on community-level overdose rates, so that the more that you can make naloxone available per capita, the bigger impact you’ll have on community overdose rates.”
Aside from looking at reduced overdose death rates, some programs also track Narcan use or overdose reversals, though there are limitations with such methods.
“I mean, it’s always going to be a challenge to say ‘Is this working? Is this being effective?’” Foster, with MiHIA, said. She explained that there are “many factors” at play when it comes to tracking overdose reversals since that data tends to be either self or first responder-reported.
Foster’s team supports multiple community service providers in Michigan, and she said that some of the populations those providers work with can live a more transient lifestyles, making it difficult for individuals to report their updates.
Plus, she said, while EMS and law enforcement are also meant to report overdose information, that, too, is hard to ensure is happening every time it should.
“You’re not gonna have a [overdose reversal] report, necessarily, from EMS or law enforcement because it worked, right? It saves a life,” she said.
As for Red Project, Alsum said the organization’s overdose reversal data is entirely self-reported by the communities it serves, and according to its website, the nonprofit has learned of 337 naloxone uses so far this year, and 1,200 since 2013.
While the numbers in the Grand Rapids area are encouraging, Alsum added that Red Project felt more pressure to gather reversal information earlier on in offering OEND. That’s changed as more organizations have adopted similar harm reduction practices and naloxone has become less-restricted.
“At this point, with the level to which other organizations are providing the service, and the state support that exists for the service in recent years, we haven’t focused as much on making sure that we capture all the reversals,” Alsum said. “But you know, with that being a self-reported thing, you’ve really got to consider reported reversals as very much the minimum of how the program is impacting the community.”
What’s next?
Local providers said it’s too soon to try to measure “success” in terms of overdose death rates or reversals based on the introduction of Flint’s centralized vending machine. However, they thought the machine’s early distribution numbers—1,500 test strips and 904 Narcan kits—were already a show of success in the approach.
“Internally, we all look at it as a success because in our minds, the more Narcan that’s out in the community, the more chances we have to save people,” Chanter said.
For Ainsworth, the next step is about assessing and connecting the fuller breadth of harm reduction approaches to opioid use in the area.
“We have a lot of different groups providing Narcan, and we’re in the process of developing a harm reduction network at the Greater Flint Health Coalition,” she told Flint Beat.
Ainsworth said she wants to look at why the machine has been a particularly effective distribution channel so that she and other area providers can employ the best possible strategies to remove stigma around safe drug use and support the communities that they serve.
“You know, are people accessing it via the vending machine because it’s low pressure? It’s anonymous, essentially? It’s free?” she explained, or is it because they can “grab-and-go, or they don’t have to talk to somebody?”
Ainsworth said she and other partners will be looking at whether the vending machine is truly the best strategy, or if it might be better to meet people be face-to-face and offer direct training instead of relying on them to scan QR codes for instructional information.
For Ellis, whose organization has been offering that face-to-face and instructional approach for many years, she said she’s in for an “all of the above” approach.
“We installed our [Narcan vending machine] in front of our building last week,” Ellis said on April 5.
She explained that while Wellness Services has no affiliation with downtown’s machine, she knows both will help people access life-saving resources during or after normal business hours, which she views as a good thing.
“As it relates to people who use drugs, harm reduction basically says ‘peeps is going to people.’ That means that they gon’ do drugs… We’re not getting around that,” Ellis said. “So what are we gonna do? We are going to meet the people where they are at. That’s what we’re gonna do.”
Flint now has multiple Narcan and fentanyl testing strip vending machines throughout the city. Harm Reduction Michigan, a health equity organization based in Traverse City, provided modified newspaper box machines to Serenity House (1019 Church St.) and UCAN (4800 S. Saginaw St.) in October 2022, the city’s downtown machine (615 Harrison St.) debuted in February 2023, and Wellness Services (311 E. Court St.) installed theirs in late March.
Harm Reduction Michigan is now working on mapping the 52 machines they’ve so far placed across the state, according to its executive director Pam Lynch, and the Michigan Department of Health and Human Services is regularly updating its own map of Narcan vending machines throughout Michigan, as well.
While the Harm Reduction program is a huge asset, Flint needs a more robust Medication Assisted Treatment (MAT) program.