Drug use and harm reduction practices of applicants to a public health vending machine service in Clark County, NV, 2021-2023.

backgroundIn 2017, Clark County, NV, implemented Public Health Vending Machines (PHVMs), an innovative approach to the dispensation of harm reduction supplies to persons who inject drugs (PWID), including sterile equipment and naloxone. Administrative data associated with PHVM operations can be valuable for understanding drug use behaviors among PWID. The current study examines the demographics and drug use profiles of PHVM registrants who completed the harm reduction survey between January 2021 to June 2023 with comparison to nation-wide trends.

methodsAll registration forms for PHVM services in Clark County, NV, between 1/1/2021-6/30/2022 with a completed harm reduction survey were included for analysis. Descriptive statistics were used to characterize differences in applicant demographics as well as self-reported injection and non-injection drug use, risk behaviors, and interest in harm reduction services. Logistic regression models tested the association between types of injection drug use and overdose and risk behaviors.

resultsA total of 637 PHVM applications with completed survey data were included for analysis. Respondents were an average of 36.1 ± 10.2 years old, 56.3% male sex, and 63.6% non-Hispanic White with 85.1% reporting injection drug use (IDU). Notably, greater proportions of respondents with histories of IDU also indicated non-injection drug administration, such as smoking and snorting. In the 3 months prior to registration, the majority of IDU respondents reported high risk drug use behaviors, including daily use, multiple injections per day, and opioid and stimulant co-use. Fentanyl was suspected in 62.1% of overdoses in the last 3 months. Compared to PWID using stimulants only, respondents with opioid and stimulant co-use had a higher likelihood of overdose (aOR 4.51; 95% CI 2.05, 11.1; p < 0.001) and re-using injection supplies (aOR 2.14; 95% CI 1.33, 3.48; p = 0.002). More opioid and stimulant co-use respondents were interested in treatment/detox and obtaining naloxone than those without co-use.

conclusionsThe demographics and drug use behaviors of the PHVM PWID are consistent with contemporaneous county and nation-wide. As the overdose crisis evolves, PHVM could be pivotal tools in the early detection of new risks to facilitate timely adaptation of harm reduction strategies to improve morbidity and mortality.