Advancing Equitable Access to Harm Reduction: Implementation and Early Use of an Outdoor Harm Reduction Vending Machine, Kern County, California, 2023.

To reduce opioid-related morbidity and mortality, local coalitions on substance use prevention in Kern County, California, have sought to increase equitable engagement and reengagement with harm reduction supplies, including naloxone. Through a community-academic partnership and funding from the local managed health care plan in Kern County, we ordered, stocked, and monitored a temperature-controlled outdoor harm reduction vending machine (HRVM) in Bakersfield, California. We outlined the necessary steps for successful procurement and implementation of community-based HRVMs. To increase acceptability, we engaged in open dialogue with our partners, interested parties, and people with lived experience of substance use to inform the contents of the harm reduction supply kits. In addition, we consulted the literature, physicians, and epidemiologists to inform best practices for the quantity of supplies per kit and the frequency limits for dispensation. To ensure long-term sustainability, we secured grant funding from the California Harm Reduction Supply Clearinghouse to maintain a backstock of harm reduction supplies for the kits, successfully applied for the Naloxone Distribution Project through the California Department of Health Care Services for a continuous supply of free naloxone, and developed student internship and research assistant positions through our academic partner to support participant recruitment and data collection and management efforts. Our efforts culminated in the launch of the county's first HRVM and orders for 2 additional HRVMs. Through our experiences, we gained insight on how to improve the feasibility, acceptability, and sustainability of community-based HRVMs, which can enhance health equity.