Low-barrier access to life-saving harm reduction

How Carelon Behavioral Health’s naloxone vending machine program in Washington is reversing opioid overdoses and saving lives

 

The Carelon naloxone vending machine program

Naloxone is a medicine that rapidly reverses an opioid overdose.  By attaching itself to an individual’s opioid receptors, naloxone blocks the effects of opioids. While naloxone is not a treatment for opioid use disorders, the medicine quickly restores an individual’s breathing that has slowed or stopped due to an opioid overdose.¹

In 2021, Carelon Behavioral Health partnered with Thriving Together NCW, an organization that works to improve the health and well-being of North Central Washington residents, to introduce the first naloxone (Narcan) vending machines in Washington State. Implementing public health vending machines is an evidence-based strategy that communities use to mitigate opioid overdoses and deaths. The machines dispense the lifesaving medicine directly to the individuals who need it. ²

Carelon’s naloxone distribution method allows individuals to anonymously access free nasal naloxone on demand, seven days a week, without a prescription. The program operates throughout eight counties in three regions of Washington, focusing on low-barrier access to life-saving harm reduction.
 

Origins of the Washington program

The program began in October 2021, due to several factors. “North Central Washington had an active grassroots recovery movement and Washington State was increasingly emphasizing recovery-based programs,” says Leah Becknell, Account Director, Carelon Behavioral Health. “We had some extra funds in our program that we were looking to allocate and discovered this innovative opportunity.”

Around the same time, the team learned about the naloxone vending machine program in Las Vegas ³ through a Thriving Together NCW colleague. “The Las Vegas initiative was very successful. However, due to our colleague’s lived experience, he identified several barriers to access, such as pre-registration requirements, cards, and codes. These discoveries prompted collaborative conversations between our teams as to how we could operate a similar but low-barrier program. Through the Thriving Together partnership, we felt we developed a strong understanding of the challenges that people in active addiction face and how to best reach them,” Becknell adds.
 

How the Washington program operates

“The program first piloted in North Central Washington, and now covers three regions in the state,” says Christal Eshelman, Program Manager, Carelon Behavioral Health. “Thirteen machines are located in various sites throughout our three regions. Sites vary, as they include resource hubs, sleep centers, recovery organizations, libraries, churches, behavioral health agencies, and rural hospitals.”

Eshelman emphasizes the low-barrier access to the machines. “An individual can walk into an agency, make their selection from the vending machine, and the naloxone falls out. It is free, there is no tracking, and individuals are welcome to visit agencies as many times as they need to for naloxone. We also place surveys by the machines, but surveys are voluntary and anonymous.”

The brand of naloxone available from the machines is Narcan, which individuals administer through a nasal spray. “An advantage of Narcan is the nasal spray administration. While naloxone can be administered intramuscularly, that method requires syringes, and many community members aren’t comfortable with that option. So, the nasal spray is a lower barrier option for community accessibility,” adds Eshelman.

Program administrators monitor and restock the machines regularly to ensure that they are never empty.
 

Community support for the program

The community supports the vending machine program, which is a crucial factor in the program’s success. “We were very happy that the community has been so welcoming, in all areas of the state. Several law enforcement partners have been very supportive, observing directly how Narcan saves lives,” says Becknell. “Libraries have also been key partners, expanding their reach as our program grows. Librarians are excited about this solution. Our program offers them an opportunity to support and interact with some of their most vulnerable clients.”

Eshelman adds that some locations are staffed by recovery coaches. “While recovery coaches are not part of the Carleon funded program, recovery coaches can engage individuals accessing naloxone if the individuals seem approachable. Coaches report that such interactions often lead to a conversation around harm reduction or treatment and start a relationship that can help people make a change.”

Whether or not an agency staffs recovery coaches, the agencies play a vital role. “What makes the program work is the host sites in a variety of locations,” says Becknell.

Becknell also points out how opioid overdose knowledge is now common and widespread. In a recent survey , three in ten U.S. adults said they know someone who has been directly affected by opioid addiction. More than half of the group said they know someone who died from using opioids. Additionally, one in seven adults reported that they had been directly impacted by opioid addiction.⁴

“Communities generally know about overdose at this point, which has been advantageous in our launching a successful program,” she says.
 

Program survey results

Based on internal 2024 data, Carelon reported the following program results:

• 95.5% of Narcan doses administered on an individual experiencing an overdose resulted in an overdose reversal.
• 38% reported this was their first time accessing Narcan.
• 40% reported that Narcan they received from this machine in the past helped reverse an overdose.
• 53% of cases reported that 911 was not called.
• 64% of cases reported the individual did not go to the emergency department or hospital.
  
  

How the Carelon naloxone vending machine program makes a difference

Carelon’s program makes a difference in several ways. “This program helps to reduce the stigma individuals often experience when seeking help for opioid addiction,” says Becknell. “Participants report that the low barrier to access at these agencies helps normalize picking up naloxone. When individuals use the machines, they experience more privacy and anonymity, which encourages access.”

The program’s goal is harm reduction. “Individuals can pick up naloxone, use it themselves, or give it to friends, family, or fellow community members. Getting naloxone is a small step that may lead an individual to other supports or treatment. The program is saving lives, which is what harm reduction is about,” concludes Becknell.