Zhang Alice, Carrillo Matthew, Liu Ryan, Ballard Sarah M, Reedy-Cooper Alexis, Zgierska Aleksandra E
Department of Family and Community Medicine, Penn State College of Medicine, Hershey, USA.
Department of Public Health Sciences, Penn State College of Medicine, Hershey, USA.
Harm Reduct J. 2025 May 28;22(1):89. doi: 10.1186/s12954-025-01236-6.
To stem rising fatal overdoses and other substance use/use disorder (SUD)-related harms, communities are turning to low-barrier harm reduction strategies, such as harm reduction-focused vending machines (VMs) that distribute naloxone, fentanyl test strips, and other harm reduction-related items. This systematic review aims to synthesize literature on VMs for SUD-related harm reduction.
Four databases (Embase, Cochrane, PubMed, MEDLINE) were searched from their inception through November 29, 2023. References of identified eligible articles and pertinent prior reviews were also searched for relevant eligible research articles describing VM's feasibility, acceptability, reach, and/or impact when used for SUD-related harm reduction. Data from eligible articles were systematically extracted and summarized.
The search found 45 eligible articles covering 30 separate studies involving 191,242 participants (190,576 VM users; 666 non-users). Most studies were conducted outside of the U.S. (n = 20), focused on individuals who injected drugs (n = 18), and evaluated syringe-dispensing VMs (n = 12). Of the 45 articles, the majority evaluated feasibility (n = 35), followed by acceptability (n = 21), impact (n = 17), and reach (n = 14). The feasibility-assessing articles noted high demand for VM-dispensed items, with usage mostly occurring outside of traditional business hours, and more syringes and HIV self-tests being dispensed compared to some in-person programs. The VMs were generally accepted by target populations, regardless of the items dispensed, and reached high-risk populations. Impact evaluation was limited and based on item dispensed. Seven articles examined the impact of syringe-dispensing VMs and described reductions in syringe sharing (n = 4) and drug use (n = 2), as well as stable or declining rates in drug use-related crime (n = 1). Articles evaluating the impact of HIV self-test-dispensing VMs (n = 3) described HIV detection rates ranging from 1.9% to 17.7%. Two articles reported reduced fatal overdoses after naloxone-dispensing VMs were implemented.
VMs show promise as a low-barrier method for reducing SUD-related harm, decreasing health disparities, and engaging hard-to-reach populations. Future implementation science-based research is needed to assess VMs' impact on individual and community health outcomes, including overdose.
为了遏制致命药物过量使用及其他与物质使用/物质使用障碍（SUD）相关危害的不断上升，各社区正在转向低门槛的减少伤害策略，例如以减少伤害为重点的自动售货机（VM），这些自动售货机分发纳洛酮、芬太尼检测试纸及其他与减少伤害相关的物品。本系统评价旨在综合关于用于减少与SUD相关伤害的自动售货机的文献。
检索了四个数据库（Embase、Cochrane、PubMed、MEDLINE），检索时间从建库起至2023年11月29日。还检索了已识别的符合条件文章的参考文献以及相关的既往综述，以查找描述自动售货机用于减少与SUD相关伤害时的可行性、可接受性、覆盖范围和/或影响的相关符合条件的研究文章。对符合条件文章的数据进行了系统提取和总结。
检索发现45篇符合条件的文章，涵盖30项独立研究，涉及191,242名参与者（190,576名自动售货机使用者；666名非使用者）。大多数研究在美国境外进行（n = 20），关注注射吸毒者（n = 18），并评估了分发注射器的自动售货机（n = 12）。在这45篇文章中，大多数评估了可行性（n = 35），其次是可接受性（n = 21）、影响（n = 17）和覆盖范围（n = 14）。评估可行性的文章指出，对自动售货机分发物品的需求很高，使用大多发生在传统营业时间之外，与一些面对面项目相比，分发的注射器和HIV自我检测更多。无论分发何种物品，自动售货机通常都为目标人群所接受，并覆盖了高危人群。影响评估有限且基于分发的物品。七篇文章研究了分发注射器的自动售货机的影响，描述了注射器共用情况的减少（n = 4）和药物使用的减少（n = 2），以及与药物使用相关犯罪率稳定或下降（n = 1）。评估分发HIV自我检测的自动售货机影响的文章（n = 3）描述的HIV检测率在1.9%至17.7%之间。两篇文章报告称，实施分发纳洛酮的自动售货机后，致命药物过量情况有所减少。
自动售货机有望成为一种低门槛方法，用于减少与SUD相关的伤害、减少健康差距并接触难以触及的人群。未来需要开展基于实施科学的研究，以评估自动售货机对个人和社区健康结果（包括药物过量）的影响。
