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Abstract

Objective:

Many rural people who inject drugs do not use syringe service programs (SSPs). In addition, people who use drugs but do not inject may perceive that SSPs are not intended for their use. Harm reduction vending machines (HRVMs) may be preferred by some individuals. This study examines attitudes and preferences regarding HRVMs to consider possibilities for enhancing the reach of harm reduction services. Method:

Structured surveys were conducted with 712 people who use drugs in two rural Appalachian counties in Kentucky. Participants rated the acceptability/appropriateness of SSPs and HRVMs; HRVM preference was the difference between the two scales. Linear regression models estimated SSP acceptability/appropriateness, HRVM acceptability/appropriateness, and HRVM preference across five groups differentiated by their SSP use, injection, and syringe sharing behaviors.

Results:

Average ratings for acceptability/appropriateness of the SSP and HRVM were favorable (4.17 and 4.49, respectively, on a scale from 1 to 5), but HRVM acceptability was significantly higher (t = -14.21, p < .001). Compared with the reference group, individuals who inject but do not share syringes or use the SSP (b = .240, p < .01) and those who inject and share syringes without using the SSP (b = .402, p < .001) showed a greater preference for HRVMs than those who inject and use the SSP. People who did not inject had a greater preference for HRVMs (b = .383, p < .001) than people who inject and use the SSP.

Conclusions:

HRVMs may engage people not currently using SSP services and those who use drugs without injecting, thus expanding the reach of harm reduction services, particularly in rural areas.

Document Type

Article

Publication Date

2026

Digital Object Identifier (DOI)

https://doi.org/10.15288/jsad.25-00120

Funding Information

This research was supported by National Institute on Drug Abuse (NIDA) Award Numbers 2R01DA033862, R01DA024598, and R01DA055872. The content is solely the responsibility of the authors and does not represent the official views of NIDA. The device to facilitate syringe disposal and dispensing in the KyOSK Study is intellectual property of the University of Kentucky, with April M. Young designated as the inventor.

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