Substance Misuse Committee installs naloxone vending machines in Linn County

CEDAR RAPIDS — For some, new vending machines on the streets of Linn County will mean the difference between life and death.

The machines stocked with free naloxone, the drug that can reverse an opioid overdose, have been placed at seven locations:

In Iowa, the initiative is relatively new, following the installation of a similar measure in Des Moines several months ago. In other parts of the United States hit hard by the opioid crisis, naloxone vending machines have been in place for years.

“We know that we have individuals who are overdosing. We know we have individuals who misuse substances,” said Heather Meador, clinical branch supervisor for Linn County Public Health. “Our goal is to keep people alive and healthy, and be on the journey to the time where, hopefully, they’re ready for treatment.

“But I can’t get somebody into treatment if they’re dead.”

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Installed in mid-June, the Linn County machines were each stocked with 36 units of Narcan, the brand-name of naloxone. Machines also dispense hygiene kits and other harm reduction tools like condoms and wound care kits. The initiative is funded by a $150,000 award to the Linn County Opioid Settlement Funds — part of nationwide settlements with drug manufacturers.

Within three days, some of the machines managed by the Substance Misuse Committee of Linn County needed naloxone restocked. Ten days after they were installed, some machines had been restocked three times.

“I was a little surprised by how fast it was going out,” Meador said. “It tells us that people need this and want it.”

Why they’re necessary

With overdose deaths rising, experts say it’s no longer enough to simply have naloxone available behind the counter of a pharmacy.

From 2018 to 2020, the rate of opioid-related deaths more than doubled in Linn County, to 26.1 deaths per 100,000 population — outpacing Iowa as a whole and closing the gap on the higher overall U.S. mortality rate.

Iowa reported 475 fatal opioid overdoses in 2021, a 12 percent increase from the previous year, according to the Centers for Disease Control and Prevention.

“We meet people where they’re at — we don’t leave them there.” — Rod Courtney, CRUSH of Iowa Recovery Community Center

Nondescript machines in relatively discreet locations can dispense something many can’t bring themselves to ask their pharmacist about. There’s no risk for misuse because naloxone won’t cause harm if used on someone who isn’t overdosing.

“We’ve heard multiple times about people walking into pharmacies, and the pharmacist is taking demographic information, sometimes insurance information,” said Erin Foster, access center director for Linn County Mental Health Access Center. “It creates more barriers for people. The stigma for substance use is very high, and one of the reasons people don’t seek help.”

Keeping up with today’s drug world

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Many recipients of the reversal agent aren’t drug users themselves, but live with one or know one. That includes people like Deb Courtney, who has helped run CRUSH of Iowa Recovery Center with her husband since their son, Chad, died of an accidental fentanyl overdose.

“I wish this would’ve been here in 2016,” she said.

Back then, naloxone access was typically accessible only to medical providers. Courtney said it wasn’t widely known that you could administer more than one dose, if the first didn’t work.

Today, other recreational drugs are being laced with fentanyl, affecting those who would never otherwise use opioids.

“Chad wasn’t a fentanyl user, but that’s how he died,” said Rod Courtney, his father. “The first time could be the last in today’s drug world.”

The vending machines are more than a means of discreet access to a lifesaving emergency treatment. In Iowa, they are a visible marker of a new mentality among treatment programs, recovery programs and public health spaces.

As part of an evidence-based approach, Foster said harm reduction strategies are the most proven ways to keep a community healthy. But decades after “war on drugs” policies that marginalized many, changing the culture even within organizations that help drug users isn’t easy.

Several years after what he described as the “first wave” of harm reduction strategies, Rod Courtney believes measures like this one combined with outreach and follow-up work are starting a new chapter. Between May and June, CRUSH of Iowa reached 2,000 people through various programming.

“People in recovery are now getting their seat at the table. Now, we have a voice,” he said. “That’s a counter to the war on drugs. We meet people where they’re at — we don’t leave them there.”

More than just treatment to halt drug addiction, organizations are focusing on the nuances of long-term recovery. As the drug world changes rapidly, Foster said the rest of the world needs to find opportunities to catch up with it.

“It’s normalizing that anyone can need (naloxone,) and it’s smart for anyone to carry it on them,” Foster said. “I know how to do CPR, even though I’m not around people where I regularly have to do CPR.”

Comments: Features reporter Elijah Decious can be reached at (319) 398-8340 or elijah.decious@thegazette.com.