In Oklahoma, state officials are launching a program for residents to get free naloxone and fentanyl test strips from strategically placed “vending” machines. But even the most robust installation campaign will struggle to reach everyone across the large, mostly rural state.
The harm reduction machines will be rolled out over the summer and fall, as the Oklahoman reports, supervised by the state Department of Mental Health and Substance Abuse Services.
Naloxone is a medicine that reverses opioid overdoses, while fentanyl test strips are tools that can quickly and easily alert people to the presence of the drug in their sample. And things have moved fast in this regard: It was only on May 2 that Governor Kevin Stitt (R) signed into law a bill to decriminalize fentanyl test strips, meaning police can no longer count them as drug “paraphernalia.”
“They’re fairly low-barrier; all you have to do is put your zip code in.”
The new program has been welcomed by local harm reductionists. Putting the machines “in the zip codes with the highest overdose rates would be ideal, and putting them in places with 24-hour access,” Andrea Haddox, founder and executive director of the Oklahoma Harm Reduction Alliance (OKHRA), told Filter. She’s impressed, she added, “that they’re fairly low-barrier; all you have to do is put your zip code in.” The machines will also provide information, including access to Spanish-language tutorials.
OKRA, which is based in Tulsa, has worked with the state on harm reduction, but was not directly involved in the new initiative.
Haddox emphasized that Oklahoma’s overdose crisis is not just about its big cities—Oklahoma City and Tulsa—but also impacts vast rural areas of the state, where people are far more dispersed. The counties hardest hit by overdose are Blaine, Beckham, Coal, Pushmataha and Choctaw—all predominantly rural, and three of which include Indigenous reservation lands.
The first machine will be installed at the Tulsa Day Center, a shelter for unhoused people. Haddox said this is a good choice, and that the machine is sure to be used frequently. But she cautioned the state to target numerous different populations to reach everyone in need.
“A barrier is just getting to the machines,” she said. “You might be able to put one [in], but how are people going to access it if they don’t have a car, they live way out in the country and don’t have any transportation? In theory the vending machines are great, but we need to get them to where people are.”
OKHRA has a partnership with NextDistro, which provides free mail-order naloxone, with the ability to reach people whom vending machines might miss.
Oklahoma’s overdose death rate, adjusted for population, has been climbing ever since 2000—fluctuating in some years but rising faster overall than the national average. After a downward turn between 2016-2019, deaths spiked by 67 percent from 2019-2021, reaching a record high of over 25 deaths per 100,000 people.
“That just shows you we need more resources for health care and housing.”
The profile of these deaths has also changed dramatically in the last 20 years. For nearly a decade from 2007-2016, prescription opioids were the drugs most often involved, but that’s no longer the case. Fentanyl-involved fatalities have meanwhile risen from 47 total in 2019 to nearly 300 in 2021—three out of four opioid-involved deaths. However, methamphetamine is the now drug most frequently involved, at two in every three deaths. Since 2007, annual deaths involving meth have risen from 39 to 619 total.
Haddox said that many of the people she’s met who use meth have conditions such as ADHD or narcolepsy, and many are unsheltered. “That just shows you we need more resources for health care and housing to provide people what they need. In the absence of all other options, what do you do? You can’t get a prescription or health insurance and you can’t stay awake, you’re going to find meth that will help you stay awake.”
Much of OKHRA’s focus is on harm reduction education.
“We have a ‘methampeta-zine’ that we give out,” Haddox said. “We talk about overamping with people; we have found a way to wash fentanyl off of meth and be able to use it still. We try to engage people as much as possible when talking about the drug supply they’re seeing on the street as well, about what changes they’re seeing—just making people aware, because we don’t know until we know.”