To his credit, Dr. Rahul Gupta, the Director of the Office of National Drug Control Policy (ONDCP), has expressed an appreciation for harm reduction strategies to address the overdose crisis and appears committed to using them. The latest example is a plan to deploy drug paraphernalia “vending machines” in rural Kentucky.
As Sophia Heimowitz and I explained in a recent Cato policy analysis, state drug paraphernalia laws block harm reduction organizations from establishing syringe services programs (also called SSPs or “needle exchange programs”), a proven way of reducing the spread of HIV and other infectious diseases, distributing the opioid overdose antidote naloxone, and offering rehab services to people who use drugs. Kentucky law explicitly permits such programs. There are now 80 SSPs operating in Kentucky, more than any other state. Unfortunately, many people in the most rural regions of the state have not been using these services. Therefore, to improve outreach, the National Institutes on Drug Abuse (NIDA) is teaming up with the University of Kentucky School of Public Health to install kiosks containing clean syringes, fentanyl test strips, hygiene kits, condoms, naloxone, and other paraphernalia in rural parts of the state.
Such kiosks are nothing new. They have been used to reach isolated people in Canada, Australia, and Europe for decades. Several other states have recently deployed them. As the Washington Free Beacon reports, in some cases the kiosks contain smoking equipment. The ONDCP came under withering criticism when news leaked that it might endorse distributing “crack pipes,” and walked back the idea.
But as we learned at a Cato policy forum last June, there is a public health rationale for making smoking equipment available: an increasing number of IV drug users have switched to smoking opioids in addition to stimulants. Illicit fentanyl is being sold on the black market more and more often in pill form, and users find it easier to pulverize and smoke the pills than to liquify and inject them. (It is also safer since smokers can adjust the dose they inhale to the desired result rather than risk overdosing on an unknown quantity of intravenous fentanyl.) Smokers of illicit drugs use makeshift tubes of glass or metal which often produce cuts and sores in the oral area. Sharing smoking paraphernalia is another way to spread disease. The reporter at the Washington Free Beacon was unable to ascertain if the kiosks in Kentucky will contain smoking equipment.
Kiosks are no substitute for the human contact and interaction of syringe services programs. SSPs are more likely to succeed in bringing users into rehab. But kiosks certainly help get safe drug paraphernalia to hard‐to‐reach individuals. Hopefully the strategy will catch on and spread to other jurisdictions.
Jeffrey Singer
Jeffrey A. Singer is a senior fellow at the Reason Foundation, where he focuses on health care policy and drug policy. He is President Emeritus and founder of Valley Surgical Clinics, Ltd., Arizona's oldest and largest private group surgical practice. From 2017 to 2026, he served as a senior fellow in the Cato Institute's Department of Health Policy Studies and as a Visiting Fellow at the Goldwater Institute. Singer is a member of the Board of Scientific Advisors of the American Council on Science and Health and serves on the expert panel for Doctors for Drug Policy Reform. From 1994 to 2016, he was a regular contributor to Arizona Medicine, the journal of the Arizona Medical Association. He served on the Advisory Board Council of the Center for Political Thought and Leadership at Arizona State University from 2014 to 2018. His writings have appeared in peer-reviewed medical and scientific journals, as well as in publications such as the Wall Street Journal, Washington Post, USA Today, The Hill, and National Review. He has been a guest on national and local television and radio. Singer received his BA from Brooklyn College (City University of New York) and his MD from New York Medical College. He is a Fellow of the American College of Surgeons.
