In a rural northeastern Maine county with some of the state’s highest overdose rates, the Mi'kmaq Nation is using a vending machine to save the lives of its citizens and their non-Native neighbors.
The machine, installed on March 1 at the Mi'kmaq Nation Health Department, dispenses free doses of Narcan, a life-saving medication that can reverse an overdose from opioids. Narcan, the brand name of the drug naloxone, has become an important tool in a growing overdose crisis driven by the presence of fentanyl — a highly addictive synthetic opioid 100 times stronger than morphine.
Mi'kmaq Nation Health Director Katie Espling told Native News Online that the Mi'kmaq community has seen an increase in opioid use in recent years.
"We recognize that there is an increase in substance-use disorder up here, tribally and in the larger community," Espling said. "It's been a lot more over the past few years. We recognized that we need to start addressing this a little bit differently."
Nationwide, more than 109,000 Americans died in opioid-related incidents in 2022, according to the Centers for Disease Control and Prevention (CDC). That's up more than 200% since 2000, and by all accounts, the situation is worsening.
While Americans of all races and ethnicities have been affected, the proliferation of opioid deaths has disproportionately affected Black, Indigenous, and People of Color (BIPOC) communities, especially Indigenous people.
As Tribal nations across Indian Country contend with rising numbers of opioid-related deaths, many are embracing harm reduction, an evidence-based public health strategy that aims to reduce the adverse effects of drug use — such as overdose and infectious disease. Harm reduction efforts often include clean needle exchanges and Narcan distribution. Advocates consider it an essential bridge between addiction and recovery.
Mi'kmaq Nation, which has a population of about 1,500 citizens, is based in the city of Presque-Isle in Aroostook County, Maine. The county bears the sixth-highest overdose death rate in the state, according to University of Maine data. Data from the CDC on drug overdose mortality by state rates shows Maine frequently in the top ten, or just outside of it, for deadly overdoses.
Mi'kmaq Nation partnered with the Center on Rural Addiction at the University of Vermont to apply for a grant from the federal Substance Abuse and Mental Health Services Association (SAMHSA) to fund the $12,000 vending machine.
The machine is located in the Mi'kmaq Nation Health Department entryway — an area that can be accessed 24/7. It holds around 300 Narcan nasal spray kits as well as Kloxxado, a form of naloxone that is doubled in dose. The machine is temperature-controlled and uses software to alert staff when it needs to be restocked.
Espling emphasizes that the vending machine is free and the life-saving treatments are available to both Native and non-Native people in the community.
“It’s such a crucial public health tool,” Espling said. “We want people to be able to have something that they can have free access to 24/7 and have anonymity.”
The Mi'kmaq Nation vending machine is the first in the region, and just the second in the state. The first is installed in a jail in Cumberland County, where the city of Portland is located.
Harm-reduction vending machines have existed for nearly three decades but are relatively new to the United States. The first harm-reduction vending machines were installed in Denmark in 1987. Today, there are hundreds across Europe, the United Kingdom and Australia. The vending machines offer the benefit of anonymity, 24-hour access, and data collection. Studies show they are often successful in reaching high-risk populations.
In recent years across the United States, as opioid-related overdoses have been on a steady rise, vending machines dispensing harm reduction supplies are starting to appear on college campuses and city health centers — and in tribal nations.
Last year, the Pala Band of Mission Indians made headlines when they installed the first Narcan vending machine on tribal lands.
As well, the Bois Forte Band in northern Minnesota installed two harm-reduction vending machines earlier this year. The Boise Forte machines dispense Narcan, fentanyl testing strips, AIDS tests, flashlights, toothpaste, soap and other personal hygiene products.
While harm reduction has been shown to reduce the negative effects of drug use, the public health strategy carries with it a stigma — primarily that it can encourage drug use. For this reason, advocates and tribal public health leaders and organizers say that community buy-in is essential to successful harm reduction programs.
In its campaign to prepare the community for the harm-reduction vending machine, the Mi'kmaq Health Department held events and distributed information about harm reduction to the community.
"We really wanted to be firm in our stance that harm-reduction does not support and enable drug use," Espling said. "We want to meet people where they are at to minimize the hazards of opioid use. We really wanted to make sure that people, if they had any concerns about it, (could) bring it directly to us.”
As it went to the community, the Mi'kmaq Nation Health Department had already been offering harm-reduction services for three years. Espling says staff has distributed thousands of free naloxone kits by than,d just to get it into the community.
Narcan is available at pharmacy chains, including Walgreens, Rite Aid, and CVS, for prices in the $40 to $50 range for two doses, putting it out of reach for those who need it most.
"We wanted to make sure it was available because it's so expensive in the pharmacy and not always available," Espling said.
The opioid crisis is now in its fourth wave, characterized by the presence of fentanyl in non-opioid drugs, such as methamphetamine and cocaine. Because of this, more and more people who do not have opioid substance-use disorder are dying of opioid overdoses.
"You never know if you are going to meet somebody or be in a position to give someone Narcan,” Espling said. “It's absolutely a gift, it really is."
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