Evaluating the Impact of Harm Reduction Vending Machines on Supply Distribution: A 23-Month Pre/Post Evaluation

Background Drug overdose and related infections remain major public health challenges within the United States, with disproportionate burden among Veterans. Although syringe services programs reduce harms, reliance on face-to-face encounters and limited operating hours constrain access. Harm reduction vending machines (HRVMs) dispense sterile syringes, condoms, fentanyl test strips, and related supplies through private, low-barrier pathways that may overcome these barriers. Yet, evidence from integrated health systems, including the Veterans Health Administration (VHA), remains limited. We evaluated whether HRVM implementation was associated with changes in harm reduction supply distribution across VHA clinical and housing settings. Methods This retrospective quality improvement evaluation was completed July 2025. Primary outcome was change in total syringes dispensed (pre-HRVM implementation: 8/31/21 − 7/31/23; post-HRVM implementation: 8/1/23 − 7/1/25). Secondary outcomes evaluated change in condoms, fentanyl test strips (FTS), and sharps containers dispensed. Data were collected from HRVM software and clinical logs. Pre/post totals were compared with Chi-square goodness-of-fit tests (α = 0.001). Results All supply categories increased significantly post-HRVM implementation (p < 0.001). Syringe distribution increased 9.5-fold (3,420 to 32,390; +847%), condoms 16.9-fold (854 to 14,475; +1,595%), sharps containers 9-fold (74 to 664; +797%), and FTS 3.6-fold (1,857 to 6,701; +261%). HRVMs accounted for 59–101% of these increases. Conclusions HRVM installation was associated with substantial, sustained growth in supply distribution, suggesting HRVMs can expand low-barrier access and complement clinic-based services for Veterans facing logistical or stigma-related barriers. Rigorous time-series or regression studies linking distribution to clinical outcomes are warranted. Collectively, these findings support system-wide VA scale-up of HRVMs as a low-barrier complement to clinic-based services.