Dispensing ‘Free Chances at Life’: Public Health Vending Machines Are More Than a Novelty

In the lively, hard-partying college town of Iowa City, a beloved bar called The Deadwood Tavern attracts a motley crowd: townies, regulars in their 70s, and 20-something college students.

It’s somewhere to relax, fan out on Iowa football, and—as of August—pick up free naloxone, birth control, emergency contraceptives, gun locks, wound care kits, and needle disposal kits. They’re all available, free and anonymously, from the public health vending machine at the back of the bar. 

One of the bar’s regulars—a Johnson County public health official named Susan Vileta—suggested The Deadwood was the perfect place for the machine. She’d heard about the machines cropping up in other cities, she thought, “here's a way to get naloxone out in the community with a lot of other health and safety items.” 

The Deadwood’s owner, Ben Mummey, was up for it. Having seen fellow bar owners lose their businesses—and almost their lives—to opioid addiction, it felt like a no-brainer. “It doesn’t hurt anybody to give out free chances at life,” Mummey says.  

In late August, he posted a picture of the stocked vending machine on the bar’s Instagram. It racked up 1,700 likes, the bar’s most popular post by far. And most importantly: “The machine is being used,” he says. 

So far, the county has three machines—one at The Deadwood (its t-shirt motto: “Your favorite bartender’s favorite bar”), and two others at public libraries. All the products are free and require no registration or personal information to obtain. 

From their launch in late August through October, the county’s three vending machines have distributed 392 naloxone kits (two doses of the overdose reversal medication in each box), 470 packs of Plan B, 325 gun locks, 104 sharps containers, 272 hygiene kits, 273 wound care kits, and 473 condoms, and hundreds of other supplies. 

The machines have gained traction nationwide in recent years, and are now installed in dozens of cities including New York and Baltimore; outside fire stations in Washington D.C.; at a sheriff’s office in Ogden, Utah, and more. 

The machines are part of a “new guard” of approaches to an overdose crisis that demanded broader, more accessible services that can reach people who wouldn’t otherwise access traditional health or community services, says Rosemarie Martin, professor of population and quantitative health sciences at UMass Chan Medical School. Offering anonymous access to naloxone and other public health products without the need for a prescription, a pharmacy visit, and insurance processing is one key to that effort, she says. 

In some cases, opioid settlement funds have made it possible to launch the machines in “communities that probably wouldn’t have been able to set them up before,” says Martin.  

In Johnson County, Iowa, the machines and the life-saving naloxone nasal spray are one way Johnson County is spending its share of national opioid settlements, which are worth tens of millions of dollars distributed over several years. (Other products in the machines, like birth control, are funded through other grants and funding channels.)  

Vileta says that the vending machines—which cost about $5,000 each—help get around barriers to accessing naloxone. “Because a lot of places in Iowa, you can’t just hand [naloxone] out,” says Vileta. While other state grants require naloxone distribution to be done alongside training, the opioid settlement money had no such constraints, allowing them to vend the nasal spray with a leaflet of instructions. 

Still, the state faces “a lot of hurdles in terms of harm reduction, built into the law, unfortunately,” says Vileta. For example, the machines cannot distribute other life-saving harm reduction tools like fentanyl test strips and sterile needles because they are banned by laws restricting the distribution of items deemed drug paraphernalia.  

Expanding access to naloxone was one way to stem the overdose crisis within these constraints, says Vileta. From 2020–2023, 43 unintentional drug overdoses occurred in Johnson County. More than half of them involved at least one opioid and illegally made fentanyl was the most common. And in 67% of these cases, a bystander was present at the time of the overdose.  

While the machines intrigue people, their strength lies in being a “non-intimidating entry point” to broader care, says Daniel Arendt, a pain and palliative care pharmacist at the University of Cincinnati Medical Center. 

“You’re more likely to get someone who’s never engaged with harm reduction using a vending machine than showing up in person,” he says. 

Arendt helped pioneer one of the country’s first harm reduction vending machines, in Cincinnati. Since launching in February 2021, the single machine outside an HIV services nonprofit has used by more than 2,500 people, and the naloxone it dispenses has been used to reverse an overdose nearly 5,000 times, according to Arendt’s ongoing tracking data.  

The idea emerged during COVID, when in-person syringe exchanges were shut down. Partnering with the local HIV prevention nonprofit Caracole, Arendt saw the vending machine as a way to offer low-barrier, anonymous access to naloxone, fentanyl test strips, safer use kits, as well as resources for HIV and Hepatitis C testing, PrEP, pregnancy and wound care, and housing resources. 

“No ID, no names, no cameras. People can use it at 3 a.m. if that’s when they feel safe,” he explains. After taking an anonymous phone survey, users receive a code that allows them to access one product a week. They must re-register every 90 days by answering questions about how they have used the machines—and it’s that survey data that allows Arendt to measure the machine’s impact.  

“It’s not just a machine,” he says. “It’s a connection point—a way for people to take one small step toward being safer and healthier.” 

Overdoses in the U.S. declining overall, and Martin says that concerted efforts to de-stigmatize and expand access to harm reduction products deserve some credit for that. But low-barrier access to harm reduction tools remains uneven across the country—and it’s unclear how well these interventions will be funded long-term, says Martin. “It’s important that we celebrate the wins … but there’s a lot of work to do.” 

For her part, Vileta hopes to see public health vending machines in more places. She says Johnson County has enough money to fund a few more machines, and she’s had requests from communities eager to install them. She’s also approached some who are against the idea. But one challenge is finding more places, like Mummey’s bar, that are open late—or ideally, 24 hours a day—and willing to host them, especially in rural areas and communities that have shown resistance.   

In the hospitality industry, establishments worry about how it might reflect on their clientele, says Mummey. “They don’t want to talk about it happening in their bar.” 

Despite widespread substance use in the hospitality industry, there’s a stigma around addressing the issue. He hopes public health vending machines can normalize talking about the overdose crisis, and the solutions to it, because you never know who could benefit, Mummey says. When it comes to being touched by overdose crisis: “You either know someone, or they haven’t told you yet.” 

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