If you’ve ever even heard the term “prescription drug vending machine,” you probably pictured something similar to snack machines where you pick up a Diet Coke or a bag of Doritos: Insert some money (or swipe a card) and out pops a package of pills. It’s a common misconception, says Robert Bang, vice president of client services for InstyMeds, which rents its drug-dispensing machines to roughly 200 facilities in the U.S., primarily health centers, emergency rooms and urgent care centers. Most recently, Arizona State University (ASU) was added to the list, following the first campus to work with InstyMeds, Florida State University. ASU added the machine to its Health Services building in late 2014 after the closure of its on-campus pharmacy.
InstyMeds are not vending machines, though, but rather medication dispensers, explains Bang. Here’s how they work: In lieu of a prescription a patient gets a voucher from their doctor with a code that works for only 24 hours at a designated dispenser (sorry, no refills allowed). The patient enters the code and his or her birthdate, then puts in a credit or debit card for the co-pay — and out pops the packaged, labeled medication. The dispensing process takes only 90 seconds — in other words, no long lines at the pharmacy and no worries about store hours. In fact, the concept for InstyMeds was partly created out of the frustration of a former ER doc who couldn’t get an antibiotic after hours for his sick 5-year-old.
While the medications that are offered vary by location, InstyMeds machines mostly dispense antibiotics like amoxicillin, azithromycin and Tamiflu, antihistamines, inhalers, pain relievers and over-the-counter medications — “meds you need right now to feel better,” Bang says. “We’re not about dispensing chronic medication or repeat pain meds,” including opioids. The company also has a 24-hour call center to answer questions about how to use the dispenser, medication, insurance coverage and cost; the machines, which weigh a little under a ton, are locked and monitored, adds Bang.
No matter how many security measures are in place, however, stocking medications that can be abused — such as opioids, benzodiazepines and attention deficit disorder medications — in dispensers would be risky, says John O’Neill, director of addiction services at The Menninger Clinic in Houston. For the dispensation of antibiotics and drugs that don’t carry a risk of abuse or misuse, though, “I can certainly see how helpful it could be for a college student or someone who needs something after hours,” acknowledges O’Neill. “But,” he adds, “I really hesitate to embrace this idea, especially for controlled substances. I’ve worked in addiction long enough to be concerned that where there’s a will, there’s a way. People get very creative and they find every strategy … every technique to find a way to abuse a substance.”
O’Neill is one of many addiction treatment experts who are against the idea of using machines to deliver prescription drugs with the potential for abuse. After all, the inappropriate use of some prescription medications remains a growing problem – nearly seven million Americans abuse them, according to the National Institute on Drug Abuse. And in 2010, pharmaceutical drugs and opioid pain medications caused over 38,000 deaths — more than the lives lost to car crashes and firearms.
Vending Machines in Addiction Treatment
Vending machines for meds aren’t new. They’ve been used — somewhat controversially — in drug harm-reduction programs to dispense syringes in Australia, and in Canada to dispense crack pipes in an effort to reduce the spread of blood-borne illnesses like hepatitis C and HIV. “These harm reduction measures have good [evidence] that shows they help reduce disease and illness,” explains O’Neill. “They don’t, from the evidence, increase the ability of someone to use drugs. More people aren’t going to use drugs because they get clean crack pipes.”
However, O’Neill believes the potential risks of using these dispensers for drugs that help people maintain recovery — like methadone and suboxone — is too great: “Even with the various medications that are used to help with cravings and withdrawals, there’s potential for abuse,” he cautions.
Even potentially lifesaving overdose medications, such as naloxone (brand name: Narcan), require some instruction to use correctly, adds Charles O’Brien, MD, PhD, of the Charles O’Brien Center for Addiction Treatment in Philadelphia, and Kenneth Appel Professor in the Department of Psychiatry at the University of Pennsylvania. “While Narcan has no abuse potential and can save lives in the event of opioid overdose, it can also precipitate serious opioid withdrawal,” he says. “It can be given to friends, family and first responders – but with a little advanced training.” Currently, there are no plans to add overdose medications to the machines or dispensers. But “Good Samaritan” laws in 27 US states are helping to get naloxone into the hands of more people who could save friends, family or even strangers who might otherwise die of an overdose from heroin or an opioid painkiller.
Whether used in rehab, a hospital or on a campus, O’Neill says that when it comes to medications with the potential for abuse, there’s no substitute for human interaction and physician monitoring. “I get it that we’re stretched thin in terms of health care providers and being able to talk to people and be with them,” he says. “But we have such a problem with addiction that we actually need more health care providers spending more time and more attention to the substances that we’re giving out to everyone rather than less.”