Bags of heroin, some laced with fentanyl. (Photo by Drew Angerer | Getty Images)
By next summer, residents of Milwaukee County will begin seeing signs of a new harm reduction and prevention strategy, adopted as drug-related deaths in the area continue to rise. Plans are underway to begin deploying harm reduction vending machines to neighborhoods afflicted by a wave of drug-related deaths. The vending machines will be stocked with the anti-overdose medication Narcan, fentanyl testing strips and other supplies — all available free of charge.
“All of the literature around prevention of people dying from overdoses basically says that harm reduction is a big piece of that,” Mike Lappen, administrator at the county’s Behavioral Health Services (BHS), tells Wisconsin Examiner. Narcan, recently fentanyl test strips and safe injection supplies are key to helping people who are using drugs stay alive “while they’re in that stage where they may not be quite ready to recover,” says Lappen. “But if we help them, they’re connected to us, then when they do elect to seek treatment and try to stop using, then at least they have a relationship with us.”
Lappen discussed the vending machine plan during the Oct. 31 meeting of Milwaukee’s City-County Heroin, Opioid & Cocaine Task Force meeting. In October, 20 vending machines were purchased from HRI Vending using funding from the State Opioid Response 2 (SOR-2). Medication lock bags, Deterra Deactivation pouches, gun locks, fentanyl test strips and nasal Narcan were sent to HRI Vending for coil fitting with the machines. Planning as to exactly where the vending machines will be located, how they will be supplied and other logistics are still being hashed out. During the task force meeting, Lappen also highlighted other proposals submitted by BHS, including preserving the county’s ability to provide medication-assisted treatment to people incarcerated at the House of Corrections.
In November, at a county harm reduction coordination meeting outlining efforts to curb overdoses, health department officials gave a presentation on the vending machines. The next phase will come in December, when HRI Vending will customize 11 vending machines and deliver them to the Marcia P. Coggs Building.
Last year, 644 people died of a drug-related cause in Milwaukee County. The figure broke a new record, and eclipsed the last record number of 544 which had been set the prior year. Fentanyl is largely driving the surge of deaths regardless of community, demographic, political affiliation and other factors that divide people in one of America’s most segregated cities. Ever year for the last five years Milwaukee County has set and broken records for fatal overdoses. Now, drug-related deaths outpace car accidents and homicides combined, two of the most high-profile issues in Milwaukee.
During 2021, roughly 80% of the drug-related deaths that occurred in Milwaukee County involved some form of fentanyl. Deaths related to cocaine, methamphetamine and counterfeit prescription pills have continued to rise. Deaths solely caused by heroin, on the other hand, have dropped dramatically in Milwaukee County.
Although the vending machines were provided by the county, maintaining harm prevention and treatment services may become a challenge. A summary draft of the county’s 2023 budget included a cut to BHS that amounts to a 5.3% of its budget. An analysis conducted by Wisconsin Policy Forum also detected gaps in data collection and discontinuity among Milwaukee County’s landscape of substance use disorder services. One gap is a lack of data from BHS showing whether people who enter detox service receive follow-up services including therapy. BHS has also “largely lost its ability to track the imbalance between demand and supply of residential treatment—including for special populations like women and children—because providers now bill Medicaid directly and maintain their own waiting lists,” the Wisconsin Policy Forum analysis noted.
Strengthening and coordinating the landscape of treatment and harm reduction services in Milwaukee County is a crucial step. The harm reduction vending machines are a small part of a strategy the county is continuing to develop. “Our vending machines will be right where they need to be,” Lappen tells Wisconsin Examiner. “They’ll be in key neighborhoods and they will reflect that reduction in barriers to access that we are really working for.” Although some areas do experience regular clusters of overdoses, generally speaking the entire county is affected by these deaths. From north to south, east to west, urban and suburban alike, people continue to die by drug overdose.
Several county supervisors are already on board with deploying the vending machines. “It’s a totally commonsense approach,” Sup. Ryan Clancy tells Wisconsin Examiner. “Having harm-reduction implements available where they need it, when they need it, and without a lot of obstruction. I mean, not having to talk to anybody or register and everything else I think is a big deal. It’s been used in other places really successfully, I’m really glad we’re embracing that.”
Sup. Sheldon Wasserman was also happy to see the county take a new direction with harm reduction. “I think what we’re dealing with in this country is the amount of death that’s because of the fentanyl overdose problem,” says Wasserman. “The numbers are absolutely at record levels and people are dying.” Wasserman stresses that drug use has always gone on. The issue now is that much of the illicit drug supply is tainted with fentanyl, which is active at amounts equivalent to a grain of salt. “We need to have help, and I see these vending machines as a way to help a tremendous amount more than ever.”
Stigma is something the program will inevitably face. Many residents may not be excited about a harm reduction vending machine being deployed in their neighborhood, thinking it either encourages drug use or that the problem only exists elsewhere. Lappen has been in public meetings where people argued their neighborhood had no drug problem, only to be proven wrong by data. Wasserman supports other strategies including needle exchange, which have been around for years. Clancy also supports the idea of safe injection sites, the first of which was opened in New York.
Sup. Dyango Zerpa tells Wisconsin Examiner that as the vending machine plan takes shape, the safety of the public will be paramount. Planning is underway to ensure that the vending machines will be secured in case people try to dump the entire machine and that they will be well monitored.
Drug overdose and abuse, Zerpa says, is one of the top issues among residents of his district. “There are neighborhood groups that go out with gloves simply just to pick up the needles,” said Zerpa, “it is such a pervasive problem in our neighborhood. And the amount of deaths in my district are the highest in Milwaukee County. And if it’s the highest in Milwaukee County, then it might be the highest in the state.” Zerpa adds, “The Medical Examiner’s Office is overloaded with these overdose deaths and a lot of them come from our district.”
By January, the harm reduction vending machine request application will be shared with businesses, nonprofits, religious organizations and public buildings for bids. Agencies will be selected based on their ability to meet basic requirements, such as available space and their relationships with the surrounding communities. The following month, the vending machines will be delivered to the selected agencies. Each agency will train on how to use the machines, as well as how restocking procedures work. Between February and May, community members will canvass neighborhoods with fliers, resources, and vending machine maps. Live demonstrations will also occur as the vending machines get closer to full deployment.
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