A Canadian pilot project is testing an opioid vending machine that dispenses safe doses of hydromorphone to individuals with opioid use disorder to determine whether it can reduce overdose deaths from illicit use of fentanyl and heroin. As part of the MySafe harm reduction project, screened and registered opioid addicts who are at high risk for overdose can access prescription hydromorphone from a vending machine located in the Downtown Eastside area of Vancouver, British Columbia ― a disadvantaged neighborhood known for its high levels of social problems, including drug use, homelessness, and mental illness. "Thousands of people are dying of overdoses by buying fentanyl and heroin on the street, which is often contaminated, and we are giving them very few options," project leader Mark Tyndall, MD, professor of medicine at the University of British Columbia School of Population and Public Health, Vancouver, told Medscape Medical News. "In cases of overdose, we rush in with naloxone and then give them no alternatives for the next day, when we have drugs that people could use and use them safely. It's unethical," said Tyndall. Safe Supply Since 2016, more than 5000 individuals have died from an opioid overdose in British Columbia. "We had to do something to stop people buying mystery drugs from criminal gangs. We know that people given a regular, safe supply of drugs do better than those who are fishing on the street for their drugs," Tyndall added. Said to be the "world's first biometric opioid dispensing machine," MySafe scans the internal vein pattern in peoples' palms to verify their identity. Similar to an ATM, the MySafe machine weighs 800 lb and is bolted to the floor. It only dispenses individually prescribed, appropriately dosed hydromorphone tablets to users who have been registered and screened. Participants can use the machine up to four times per day. So far, 15 individuals who are deemed to be at very high risk for a fentanyl overdose are registered users. Tyndall would like to increase this number and extend the program to other high-risk locations. He noted that his team is also developing a smartphone app to help individuals track their drug use and provide them with "ample opportunity for them to engage with treatment when they are ready," he said. The MySafe machine can deliver messages and may provide a focal point for connecting people to services, he added. "I do believe if you allow people to stabilize their drug routine a little bit more by having a secure and safe place where they can get their drugs, then there will be much more time for connection," said Tyndall. "The idea of having a machine dispense the drugs gives people some control and autonomy." Commenting on the MySafe project, the Ministry of Mental Health and Addictions of British Columbia told Medscape Medical News in an email that people with substance use problems deserve access to safe, effective medical treatment. "We are always interested in new research and will await the results of Dr Tyndall's work and the MySafe project while we continue the work we are doing to scale up access to prescription medication alternatives to toxic street drugs as part of a full continuum of care. Our focus has always been on a comprehensive response to the crisis including prevention, enforcement, harm reduction and treatment and recovery," the ministry said. Cross-Border Applicability Tyndall believes this approach could work in the United States. Ricky Bluthenthal, PhD, associate dean for social justice and professor in the Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, agrees. "There is no reason why it wouldn't work" in US communities or other countries where there is a high rate of overdose deaths, Bluthenthal told Medscape Medical News. "Humans are pretty similar across country lines, and when you're talking about biomedical interventions or public health interventions, they cross borders pretty well." Bluthenthal noted that during the past 6 or 7 years, thousands of people have died from opioid overdose in Vancouver, "mostly due to fentanyl contamination in the heroin supply, but also due to social determinants of health related to availability of treatment, homelessness, and isolation. They had to do something, and it led to some paradigm-shifting thinking in terms of approaching these challenges," he said. For those who argue it's better to get more people into drug treatment, Bluthenthal said, "I wish." "We have made it so hard to get people into treatment. Opioid agonist treatments are so harshly regulated that it's really difficult for the people who need them to get these drugs. I'd be in favor of vending machines dispensing buprenorphine," he said. Source
