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Heroin Addiction and Related Clinical Problems: 2020, 22, N4 (pages: 29 - 38)

Harm Reduction 24/7: Evaluation of the Vending Machine Program for Drug Users in North Rhine-Westphalia, Germany.

Deimel D., Felix O., Bock C., and Stöver H.

Summary: Background: Needle and syringe programmes (NSP) are considered effective and efficient methods of reducing high-risk injecting practices and blood-borne virus transmission. The distribution of sterile needles, syringes and other equipment via syringe vending machines in public areas and prisons is done in Germany in about 120 cities. This service guarantees an anonymous 24/7 access to sterile equipment. North Rhine-Westphalia (NRW) is the most populous federal state of Germany. Of the 160 vending machines currently in operation throughout Germany, 113 are in NRW, operating since 30 years. Aim: This analysis presents the results of an evaluation of the work of vending machine operators in NRW. The central concern was to illustrate the current supply situation with harm reduction materials in the local structures. Another aim was to generate practice-based evidence for operating the vending machines, making it possible to further development the project. Methods: The vending machine operators were surveyed using an online questionnaire with 69 questions about their experiences and assessments as experts. All operators were contacted via e-mail to participate in the survey. 36 operators participate at the survey (59% response rate). Results: In the absence of a 24/7 supply of harm reduction materials covering the whole of NRW the supply of sterile equipment via vending machines represents an additional offer to existing institutions and syringe distribution points for drug users in NRW. In 2016, 138,765 syringes were dispensed to PWID in NRW via the 113 vending machines. Of all syringes distributed to PWID in NRW, the proportion dispensed via vending machines ranged from 6.0% to 7.2% between 2014 and 2016. In cities, between 1.2% and 8.3% of dispensed syringes were via vending machine, while in regional and rural areas the proportion of syringes dispensed via vending machines was between 90.3% and 100%. The installation and operation of a new syringe vending machine can be accompanied by conflicts in the community (e.g. with local residents and businesspeople). Conclusion: Syringe vending machines represent a very good supplement to the existing supply system of harm reduction materials for PWID. However, they are not a replacement for existing and established addiction help services.