Kentucky is one of the hardest hit states when it comes to drug overdose deaths. Dr. Jeff Singer discusses how the state can use kiosks that provide drug paraphernalia to address this problem as well as HIV/AIDS and fentanyl poisoning. The essence of harm reduction.
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.