Harm Reduction Kiosk Proof of Concept

Project Lead: Patrecia Williams, PhD

Background

Harm reduction services have proven to be effective in minimizing health risks and supporting the recovery of individuals affected by substance use disorders (SUD). Despite their proven benefits, these services often face societal stigmas. To overcome this challenge, recovery organizations, such as Bridging Hope, Inc. (dba Organization of Hope, Inc. or OOH), are collaborating with local community partners to demonstrate the safety, accessibility, and effectiveness of harm reduction services.

The Harm Reduction Kiosk Proof of Concept project is an innovative initiative that pilots the use of Harm Reduction Vending Machines (HRVMs) to provide discreet, safe, and judgment-free access to essential supplies for individuals in need. These outside 24/7 machines, consisting of 30+ items, serve as a bridge between harm reduction services and those who might otherwise avoid seeking help due to fear of stigma or discrimination.

This initiative is a partnership between OOH and various key community agency partners and staff leaders, including Liberty Tech and Rec (Kim Trueheart), Seventy Times Seven Behavioral Wellness Mission (Arthur Griffin), On Our Own (OOO) Cecil County (Chanelle Pounds), and the National Harm Reduction Vending Machine Coalition (Jessica Johnson).

HRVMs were strategically installed in four key Baltimore City locations in August 2023, including:

OOH’s home office at 218 E. Lexington Street

2222 North Howard Avenue

3901 Maine Avenue

1619 McKean Avenue

In preparation for the project, OOH developed a comprehensive system for participant registration, supply distribution, restocking, and data collection. Staff and community partners were trained in how to effectively use and manage the HRVMs to ensure maximum impact and accessibility.

Methods

The Harm Reduction Vending Machines (HRVMs) were in operation from August 2023 to November 2024, with three units running continuously throughout the period. One machine temporarily ceased operation due to vandalism but was swiftly repaired. These HRVMs were part of a broader effort to increase access to essential harm reduction supplies for individuals in need. They were available to participants enrolled in OOH’s Hope on Wheels (HOW) Program, which provides mobile hygiene and resource services. HOW includes mobile laundry facilities, toilets, and showers—critical support for individuals experiencing homelessness or SUD. Additionally, the HRVMs were accessible to participants engaged with local harm reduction organizations and new OOH participants.

Access and Registration

The HRVMs were designed to be easily accessible and user-friendly, with multiple options for registration:

In-person Registration: Individuals could register at OOH’s office locations or with partner harm reduction providers.

Online Registration: A simple online registration process was available through QR codes located on the HRVMs, OOH’s website, and at outreach pop-up locations. Clients could complete registration directly from their phones.

Privacy and Compliance: To maintain privacy and comply with state regulations, the online registration process collected minimal identifying information, such as initials, race, and date of birth, ensuring confidentiality while still allowing for service tracking. In emergencies, peers and hosting providers could access the HRVM without the usual registration process by using an emergency code to release kits directly.

Upon registration, clients received a unique user ID number that was necessary to access HRVMs. This ensured that the machines were only used by registered participants, maintaining a secure and organized system for both users and providers.

HRVM Features and Support

Each HRVM was stocked with over 30 essential items aimed at supporting harm reduction and recovery, including:

Naloxone (NARCAN)

Fentanyl and Xylazine test strips

Rapid HIV, HEP-C, and pregnancy tests

First aid and wound care kits

Hygiene kits, safe smoking kits

COVID-19 PPE (Personal Protective Equipment)

Men and Women Condoms

In addition to the essential harm reduction supplies, the HRVMs were equipped with disposable containers for the safe collection of used syringes. This feature ensured that individuals could dispose of syringes safely and responsibly, further promoting public health and safety in the community. Due to state regulations, disposable syringes were not initially available through the HRVMs; however, they were included following approval after the study period covered here, starting in August 2024.

Some items, like Naloxone and Public Health Emergency Safety Kits, could only be dispensed one-to-one per client each week, ensuring equitable distribution and accountability. To ensure adequate service, the distribution of these supplies was tracked by using an online software system, allowing OOH to monitor usage patterns, track inventory, and assess the evolving needs of the client population.

Outreach and Support Services

To enhance the effectiveness of the HRVMs, OOH deployed mobile peer outreach efforts to engage with the community. Peers were initially stationed at the HRVMs during the first 60 days of the project and continued to visit two to three times a week thereafter. These peer outreach efforts helped:

Facilitate registration for new users.

Increase awareness of the HRVMs and the available resources.

Guide on how to use certain items, with digital directions available via QR codes and printouts on the machines.

This hands-on approach ensured that individuals had the support they needed to access the harm reduction tools available and helped increase overall engagement with the program.

Results

During the study period, the OOH HRVMs saw significant usage, with the most highly accessed supplies being critical tools for harm reduction and public health. The total quantities distributed for each supply type are summarized in Table 1 below.

Among the most widely accessed supplies:

Nearly 3,000 hygiene kits were distributed, providing essential personal care products.

Approximately 4,000 wound care kits were provided to support individuals with injury or other healthcare needs.

Over 3,000 safe smoking kits were given out, helping individuals manage harm reduction while using substances.

A total of 10,000+ male and female condoms were distributed, promoting safe practices and reducing health risks.

Nearly 3,000 fentanyl test strips and nearly 3,000 xylazine test strips were provided to empower individuals with the ability to test their substances and reduce the risk of overdose.

Nearly 2,500 doses of Naloxone (Narcan) were given out, crucial in saving lives during opioid overdoses.

Almost 6,500 information packets were accessed, offering vital educational resources and guidance for individuals seeking support.

Although STI kits were initially considered for distribution, they were ultimately not provided. The cost of STI kits, ranging between $80 and $100 per kit, was significantly higher than the allocated grant amount, making it challenging to sustain inventory without compromising other essential supplies. Recognizing the importance of maintaining a broad range of supplies for continued support, the decision was made to forgo STI kits in favor of ensuring that other high-demand items could be consistently available.

To compensate for this gap, peer support specialists and other staff members worked closely with service providers and OOH’s Behavioral Health and Substance Disorder (BHSD) division to coordinate assessments, testing, and wraparound services. This collaborative approach ensured that individuals could access necessary testing and support, even if STI kits were unavailable through the HRVMs. This partnership with other providers and mobile units ensured comprehensive care and support for clients.

Discussion

Overall, study results underscore the critical need for accessible harm reduction services, particularly in marginalized communities, and demonstrates the effectiveness of HRVMs in providing vital resources to those who need them most. OOH’s HRVMs were a groundbreaking initiative, offering 24/7, nonjudgmental access to harm reduction services, providing lifesaving supplies and critical health resources to individuals who may not otherwise engage with traditional service providers. By removing barriers of stigma and facilitating discreet access to essential items, these HRVMs reached individuals who would typically avoid seeking help, empowering them to take proactive steps toward harm reduction and recovery.

The HRVM project also significantly strengthened community partnerships, fostering increased trust between organizations and broadening awareness and support for harm reduction efforts. The high demand for fentanyl and xylazine test strips, alongside the substantial distribution of Naloxone, underscores the lifesaving potential of these machines. The success of this pilot program has demonstrated that HRVMs are an essential tool in expanding access to life-saving resources for those in need.

Building on this success, OOH plans to expand the HRVM initiative, adding two new locations in Prince George’s County and Baltimore County. This study confirms that HRVMs are not just a service innovation—they are a vital mechanism for increasing access to critical harm reduction supplies, offering a new and practical approach to meeting the needs of vulnerable communities. OOH is committed to continuing this effort, ensuring more individuals can access the support they need, whenever they need it.

Table 1: Distribution of Harm Reduction Supplies

Figure 1: QR Code to Register for HRVMs