Qualitative exploration of public health vending machines in young adults who misuse opioids: A promising strategy to increase naloxone access in a high risk underserved population

BACKGROUND: Take home naloxone (THN) programs have been shown to effectively reverse opioid overdose events with limited adverse events, yet often miss young adults who use opioids. To identify opportunities for naloxone expansion, we conducted interviews with young adults who had used opioids. We explored young adults’ experience with current THN programs, and perspectives on ideal THN programs and emerging naloxone public health vending machine (PHVM) programs shown to increase access to sterile syringes in young adults. METHODS: We interviewed 16 young adults receiving substance treatment services within an integrated safety net healthcare system. Participants were 18–30 years of age with a history of nonmedical prescription opioid use. Interviews obtained the patient perspective of current THN, ideal THN and PHVM programs. Interviews were transcribed and coded by team-based methods. Themes were developed using an inductive-deductive iterative approach and defined through consensus. RESULTS: Treatment was often the first exposure to naloxone. Participants recommended easy to access programs for ideal naloxone distribution and had overall positive feedback on PHVMs. Three key themes were identified to improve naloxone uptake: knowledge, convenience, and privacy. Participants identified safety, lack of police presence, and low costs as important vending machine features. CONCLUSIONS: Our results identified implementation opportunities to increase naloxone uptake including convenient location and hours, privacy, and using trusted sources of information to improve program awareness. PHVMs present an opportunity to maximize these opportunities and increase access to naloxone in young adults.