Leveraging Technology

Episode 4: Leveraging technology: Expanding Veteran access to harm reduction resources through vending machines 

Featuring:
Tessa Rife-Pennington, PharmD, BCGP
Harm Reduction Coordinator
Clinical Pharmacist Practitioner
San Francisco Veterans Affairs Health Care System
Volunteer Clinical Assistant Professor
University of California, San Francisco, School of Pharmacy

Andrew "Andie" Ruggles (he/they), LCSW
San Francisco Veterans Affairs Downtown Clinic

Hosted by:
Beth Dinges, PharmD
Harm Reduction Coordinator
Clinical Pharmacist Practitioner
VA Illiana Healthcare System

Episode four introduces harm reduction vending machines (HRVMs)! HRVMs are an evidence based and successful strategy to address many barriers Veterans face when seeking harm reduction strategies, including syringe services programs, overdose education, and naloxone. Presenters Andie Ruggles and Tessa Rife-Pennington, from the San Francisco Veterans Affairs Health Care System Harm Reduction Program, discuss how and why their program chose to implement HRVMs, how the machines work to increase Veteran access to resources, key implementation strategies and lessons learned, opportunities to include multidisciplinary team members and learners, and ongoing future research.  

Find us online at amersa.org, and see our tweets at x.com/AMERSA_tweets.

Funding for this initiative was made possible by cooperative agreement no. 1H79TI086770 from SAMHSA. The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.

Learn more about PCSS-MOUD at pcssnow.org.

Episode Transcript

Kinna Thakarar (00:13):
I'm Kinna Thakarar and welcome to the
podcast series, Harm Reduction,Compassionate Care for People
Who Use Drugs.
Harm Reduction is a socialjustice movement started by and
for people who use drugs, andit's a philosophy of care and
practical set of strategies tooptimize people's health,
safety, and rights.
We want to acknowledge and honorthe long history of street

(00:33):
medicine and healthcaredeveloped by people with lived
and living experience to keepone another alive and safe
through community care.
Whether you're a seasoned harmto the concept, we're glad
you're here and hope you'lllearn something new and are
curious to explore seeingpatient care through a harm
reduction lens.
This podcast series is broughtto you by the Providers Clinical
Support System, Medications forOpioid Use Disorder Project, and

(00:56):
AMERSA.
This week we welcome dr.
Beth dinges in conversation withdr.
Tessa Rife- Pennington, and AndyRuggles to discuss leveraging
technology, expanding veteranaccess to harm reduction
resources through vendingmachines.

Our host (01:08):
beth Dinge's PharmD, pronoun she, her, has been a
clinical pharmacist at variousVeterans Affairs facilities over
the past 20 years.
She currently works as a HarmReduction Coordinator at Illiana
Veterans Affairs HealthcareSystem in Danville, Illinois.
Here, she piloted the VA's firstsyringe program in 2017, which
was a shark tank winner and amodel for many VA facilities.

(01:31):
She is a 2024 Innovation Fellowwith the mission to incorporate
veterans with lived livingexperience into harm reduction
programming.
Overall, she is committed tocreating a more engaging and
less stigmatizing healthcareenvironment for people who use
drugs.
Tessa Rife Pennington, PharmD,BCGP, pronouns she, her, is a
clinical pharmacist practitionerat the San Francisco Veterans

(01:51):
Affairs Healthcare System andvolunteer clinical assistant
professor at the University ofCalifornia, San Francisco School
of Pharmacy.
Since graduating from the WestVirginia University School 2010,
she has worked in a variety ofroles within the Veterans Health
Administration, includingmedication therapy management,
academic detailing, and pain andopioid stewardship.

(02:13):
She currently serves as the harmreduction coordinator and is
passionate about expandingaccess to harm reduction
resources for veterans withlived or living experience of
homelessness and drug use.
Her work is driven by and aimsto reduce the increasing rates
of Fentanyl involved overdosedeaths among both veterans and
community members in NorthernCalifornia.
Andy Ruggles, LCSW pronouns, he,they is a medical social worker

(02:36):
at the San Francisco VeteransAffairs Healthcare System.
Andy finds passion in workingboth clinically and
administratively advocating formarginalized populations.
A proud neurodivergent humanwith nearly 15 years of personal
sobriety from opioid use, Andyis a current doctoral student
that utilizes a trauma informedperspective to promote diversity
and equity in their daily life.

(02:56):
As a member of the HarmReduction Committee, Andy works
under Tessa Rife Pennington toprovide education and support to
staff acting as harm reductionadvocates within each clinic of
the healthcare system.
The presenters reported nothingto disclose.
Thanks for joining us, Beth,Tessa, and Andy.

Beth Dinges (03:11):
Thanks so much, Kina, and welcome to our
listeners.
So good to have everyone heretoday.
My name is Beth and I'll be yourmoderator.
Today we're talking all aboutharm reduction vending machines.
What are they?
What's the evidence?
And how do we put at all intopractice?
Joining us today are twoexperts, Tessa and Andy, both
with VA San Francisco, who willshare their experiences.

(03:31):
Let's get started.- So what areharm reduction vending machines?
What do they do?
Who are they for?
What's in them?

Tessa Rife-Pennington (03:39):
Vending machines, they're just like
regular vending machines thatprovide or dispense things like,
chips, soda, candy bars.
They have been repurposed in areally cool way to dispense
supplies that support harmreduction.
Things like sterile syringesfor, reducing risk for HIV and

(04:00):
hepatitis C, as well as naloxoneor Narcan kits for opioid
overdose reversal.
They have been available inother countries for many years.
Denmark had the first vendingmachine in 1987.
So quite a while ago thesemachines have been available.
Many programs in Europe haveimplemented harm reduction

(04:22):
vending machines, but the U Shas been a bit slower to catch
on.
We had the first program inPuerto Rico in 2009, but not
until more recently in 2017,there was a vending machine
program, with many machines inNevada.
It's a great evidence basedpractice and they help increase
access to harm reductionsupplies in a way that reduces

(04:44):
stigma, increases anonymity,increases access in different
geographic areas like ruralareas, and promote access for
people who may not be able to orready to engage with syringe
services programs becausethere's no interaction with a
person, you're just interactingwith a vending machine.

Beth Dinges (05:04):
How did you guys decide to pursue these vending
machines?
Could you describe a little bitof the pathway to get you to
where you are today?

Tessa Rife-Pennington (05:11):
It's definitely been not an easy
journey, but a very much lovedjourney.
Starting in 2019, I did a pilotto distribute fentanyl test
strips and teach veterans aboutrisks of fentanyl involved
overdose and get their feedbackon the education and the test
strips.

(05:32):
That led to another project forcreating and distributing harm
reduction kits for saferinjection, hygiene, wound care,
resources for veterans who arein supportive housing facilities
in the San Francisco Bay Area.
That led to another projectwhere we did telephone and in

(05:52):
person outreach to veterans insupportive housing to get them
connected to these resources.
And through all this process Iwas kind of taking harm
reduction supplies in plastictotes on the bus to housing
sites, trying to get veteransresources.
And it was really tough,carrying two large totes on the

(06:12):
bus.
I was trying to brainstorm how,how do I increase access based
on veteran feedback?
They wanted more supplies, likea wider range of options access
more regularly than one personcould support bringing to
housing sites.
That kind of led me to this ideaof different types of dispensing

(06:34):
pathways.
And I found some communitypartners like the Las Vegas
program and a program in RhodeIsland that have been using
vending machines for a couple ofyears now with great success.
And so I joined a communitygroup to learn from them.
That really just seemed like agreat fit for increasing our
access in supportive housing andalso in rural areas in Northern

(06:58):
California, where hadn't reallybeen able to increase our
program reach.

Andie Ruggles (07:04):
Tessa, I love the image of you just carrying these
large totes on a public bussystem.
When people think of California,they think of LA or San
Francisco.
And while I'm based in SanFrancisco, there are clinics
going all the way up to Eureka,which is five and a half hours
north with a lot of rural areain between.
So this is so critical for thoseareas and providing care.

Beth Dinges (07:27):
So I'm curious, what exactly goes into these
machines?
We said it's not snacks or chipsor soda, but what all goes into
the machines?

Andie Ruggles (07:36):
I can take that one.
The great thing about thesemachines is that they are so
varied and offer so manydifferent types of resources.
So when we're talking about harmreduction, the predominant thing
that we think of is individualswho use substances, but harm
reduction is such a spectrum.
And so we really tried to focusthat when we were developing the
idea of what to put in thesemachines.

(07:57):
So all supplies are completelyfree.
There are no copays.
They do have to register for theprocess, which we can talk about
in a bit, but the suppliesaccess are also anonymous.
The machines that we actuallyhave currently is a pilot
program, so it's looking to beupdated as we find out more
information and get better butwe, as Tessa mentioned, have

(08:17):
safer injection supplies.
So we have sharps containers ofvarious sizes, alcohol swabs,
disposable tourniquets fivedifferent sizes of insulin
syringes with more that we canorder and then as well as
cookers with cottons for moresterile use, we also have
hygiene supplies.
So we have toothbrushes,toothpaste, soap, washcloth,

(08:38):
tablets, and combs, all in asingle hygiene kit, as well as
mouthwash, lotion, deodorant,sunscreen, and even hand
sanitizer.
And then beyond that, we alsooffer safe erectile use kits,
sniffing and snorting kits, um,wound care kits, which include
bandages, as well as medicaltape and things to sterilize.

(09:00):
We also offer sterile water.
as well as safer sex supplieslike condoms of various sizes
and lubricant.
And then a big ticket item thatwe offer is fentanyl and
xylosine test strips, which alsocome with instructions and micro
scoops.
But beyond what's actually inthe machines, we also keep some
other things on site that due topolicy require prescriptions.

(09:23):
So something like plan B, oremergency contraceptive
prescription naloxone, alsocalled Narcan.
Those are things that requireprovider prescriptions, provider
intervention.
But we do keep those on site.
And if someone doesn't want toask a provider or isn't linked
with health care, they stillhave access to those supplies we

(09:44):
can message Tessa who canprovide that prescription for
those things.
It's really a broad variety ofmaterials that we offer.

Beth Dinges (09:53):
Amazing array.
I have to be honest.
I was thinking that it wasmostly just syringes, but it's a
whole spectrum in there.

Andie Ruggles (10:00):
It is absolutely.

Tessa Rife-Pennington (10:01):
it's been really cool to see you like the
highest uptake items and alsosurprising the hygiene and wound
care kits are the most popularby far.
Then condoms, both sizes ofcondoms and lubricant are kind
of next most commonly dispensed.
So really supporting people andstaying safe and and then of the

(10:23):
safer use supplies, the 31 gaugesyringes and the safer sniffing
snorting kits are the mostcommonly accessed.

Beth Dinges (10:30):
No, those are great things to know as I try and
replicate your guys's pilot atmy site.
If I'm a veteran, I come across1 of these vending machines and
I want to use it.
How do I get started?

Andie Ruggles (10:41):
It takes very little time.
It's actually a five minute orless registration process.
And the registration only takesone time.
After that, it's free and openaccess.
So we have points of contact ateach site, and, or Tessa, who is
available by phone, is ouramazing program manager.
With that the process itself isvery simple.
The point of contact, or Tessa,would be Ask the veteran some

(11:04):
very basic questions that ourfunding requires.
Asking things like have theyexperienced any unhoused nights
in the last six months?
Have they experienced orwitnessed an overdose in the
last six months?
And are they interested ineducation or access to Narcan,
to sterile syringe programs?
As well as to sexual infectiondisease testing and or

(11:26):
treatment.
So once we get that information,we provide them with a laminated
wallet card that has a barcodeon it.
They can access multipleresources per day.
There's a very high limit tomany of these resources.
The thing about this is thatquestionnaire that we provide
also allows us to link them tocommunity based services that we

(11:47):
partner with.
So community based sterilesyringe programs, substance use
disorder treatment programs HIV,HCV, STI testing and treatment,
housing resources.
So when we're asking for thatregistration, we're also able to
link them to all of these otherholistic and surrounding,
encompassing programming, whichis really fantastic.

(12:10):
The important thing to rememberwhen we're registering veterans
is that any eligibility statuscan register.
It's very low barrier.
They are not required to beenrolled in healthcare.
They're not required to have adoctor.
Obviously the point of ongoinghealthcare is we want to get
some options available if theywish to pursue healthcare.
Which is great that we havethese in our outpatient clinics.

(12:33):
It's also important to rememberthat when we're registering
veterans.
It's not just social workers andclinicians that are registering.
We have a multidisciplinaryteam.
So our front desk staffsometimes assists with
registering.
We have licensed vocationalnurses, registered nurses, PCPs,
both MD and nurse practitioners,as well as a physician's

(12:54):
assistant.
We have social workers rangingfrom mental health social work
to medical social work tohousing social work.
We have psychologists and even apsychiatrist that are willing to
step in and have theseconversations.
It's a very broadmultidisciplinary team that's
allowing this very simple fiveminute registration that allows

(13:17):
the veterans to access thismoving onward.

tessa-rife-pennington-- (13:20):
Veteran comes in to a clinic, we have
phone numbers on the machine.
If they want to call me or oneof the onsite points of contact
to register over the phone, orthey can register in person at
the clinic and meet with one ofthe points of contact.
And I do in person outreach tosix supportive housing sites

(13:42):
where we have a vending machinein the housing site where
veterans live.
So I go once a month and workwith the social workers and case
managers on site to get all ofthe veterans registered who
might be interested inresources.
We have lot of different teammembers across disciplines
helping veterans get accesswhich has really just been

(14:05):
helpful to have all of thedifferent options.
We have telephone in person.
We also have a referral processin the electronic medical record
where any person can refer aveteran to get signed up for the
vending machines.
We try to make it as low barriereasy access as possible.

Beth Dinges (14:25):
I think two things stand out to me.
One, I love that you're takingadvantage of a integrated
healthcare system, all thedifferent disciplines that are
under one roof.
But I also like that you guysare a bridge to what else is in
the community.
It's not all what's available inthis VA bubble.

Andie Ruggles (14:43):
Beth, that's so critical.
In order for us to provide trueharm reduction, we have to be
integrative and collaborative.
There are so many amazinggrassroots organizations that
are just doing on the groundwork that we really need to tap
into because they're the onesthat are seeing these humans
every single day.

Beth Dinges (15:03):
Such a good point and they're the ones that have
been doing it for decades,right?
Whereas I feel it's somethingrelatively newer to health care.
Where did you get the money tosupport this program?

Tessa Rife-Pennington (15:13):
It's not a one answer question.
It's been a journey with findingfunding and sourcing all of the
different pieces to make theprogram work.
This started out as my sidehustle, not a full time job, but
I just really wanted to makethis happen within our

(15:34):
healthcare system.
I was working on it on theside-- was able to get funding
through the National VA Officeof Pain Management, Opioid
Safety, and Prescription DrugMonitoring Program, or PMOP.
They funded the vendingmachines, which cost about 11,
000 each.
They also funded the initialpurchase of all the supplies

(15:57):
that go in the machines.
And then going forward, it'sbeen kind of a mix of funding
from PMOP, funding from theNational VA Office of Mental
Health and Suicide Prevention,funding from our local San
Francisco Veterans Affairshealthcare systems.
That's been kind of a mix.

(16:18):
In terms of staffing, it'sreally excited that we have some
full time staffing now.
My position is a full time harmreduction coordinator, so I get
to do this every day.
And then we have another fulltime staff member, a logistic
service supply technician, whoI'm really grateful to have

(16:39):
because he receives all of oursupplies, unpackages and
repackages them, maintains theinventory, and is now in charge
of restocking the vendingmachines.
Which was really hard to manage15 machines across Northern
California as one person.
So, and as a side hustle.
Two full time staff now andwe're funded by the mental

(17:03):
health and suicide preventionoffice.

Andie Ruggles (17:05):
Then in addition to the staffing, we have
currently, we're still outrolling this program, but we
have 21 points of contact fromall those multidisciplinary
aspects that we talked about.
So in addition to, and Tessa, Idon't know how you did 15
machines, across going all theway up to five and a half hours
North and two hours South.
That was huge, but now we have21 amazing volunteers who are

(17:28):
adding this into their day today work and other positions.

Tessa Rife-Pennington (17:32):
Ideally we have a few or several people
around each vending machinelocation that support the
veteran experience piece.
If there are any issues with themachines, I know every now and
then an issue crops up and Ilearned how to manage another
technical aspect of vendingmachines.

(17:53):
So it helps to have many teammembers who can support.
A lot of our staff arevolunteering their time, it's
not part of their work dutieslike Andy.
Just really appreciate people'sinterest in volunteering with
the program.

Beth Dinges (18:07):
What do you think your biggest wins have been?
Along the same note, what arethe biggest challenges?
I'm sure there's a very longlist for each of those, but
let's start off with thepositive part.
What have been some of your winsalong the way?

Tessa Rife-Pennington (18:23):
I'm really excited to share.
We have about 300 veteransalready signed up for the
vending machines.
So we launched the machines fromAugust to September of 2023 and
already have 300 veterans usingthe machines.
It's not just one machine.
They have access to allmachines, so some of the

(18:45):
veterans are using threedifferent vending machine
locations, which just reallygets that kind of the access in
housing and access in VAlocations.
So wherever they are, they canget what they need.
One big win, I think for for usas a harm reduction and syringe
services program, we have reallyincreased our syringe access--

(19:08):
pre vending machines we hadlower rates of syringe access
and now we've kind of taken outthe provider driven approach and
we just let veterans get them asthey need them.
There are a lot more peopleaccessing syringes now that it's
anonymous and there's no healthcare provider as an in between.

(19:28):
Our previous process was for meto prescribe them and that
requires interaction with ahealth care provider.
We know that people who usedrugs face so much stigma and
discrimination in the communityand health care by health care
providers.
So I think seeing increasedsyringe access is huge.
I think one thing that I love ishearing stories from veterans

(19:52):
while I'm working on the vendingmachines, like in the housing
sites and at the clinics.
Veterans will come by and tellme stories of using their Narcan
to save people.
It's just, so incredible to hearstories of veterans saving
lives.
Other veterans use the sharpscontainers and the machines to
pick up syringes in thecommunity.

(20:13):
They get syringes to hand themout to other people who need
them.
It's been a really coolexperience seeing how veterans
become peer distributors andpeer educators and like taking
the conversations we have tohelp save other people.
Those are some of the mostrewarding experiences, just
hearing how many other people wecan help just by having one

(20:37):
vending machine.

Andie Ruggles (20:38):
The biggest part of the wins here are seeing the
community come together.
As someone with lived experienceand nearly 15 years of sobriety,
it's still a daily aspect and tosee staff who have living
experience and veterans who areliving with substance use and

(20:59):
mental health concerns providingtheir own feedback, saying what
they want and getting it out ofthis program as we adapt and
shift to really focus on whatthey need in the moment.
And I think that's reallyfantastic.
I also think that reduction is aculture shift.
And so as we are providingopportunities for learners

(21:23):
through the residents, both inpharmacy as well as public
health, as well as a social workintern that I'm taking on this
upcoming year well as providingeducation and ongoing support
for our multidisciplinary team.
Really providing ongoingeducation, community support,
opportunities for individuals tosupport each other, especially

(21:44):
as we have harder conversations,which is one of the challenges
that we can talk about.
All of that really provides fuelfor your soul to know that you
are making a difference in theday to day lives of these
veterans that we're serving andthe staff that are wanting to
support them.

tessa-rife-pennington---sh (22:00):
I'll just kind of piggyback on what
you said, Andy, about havinglearners involved.
I think this has been such acool opportunity to engage with
learners from differentdisciplines in harm reduction
work-- from pharmacy studentsand interns to other, I have a
public health intern from alocal university and just

(22:23):
getting more learnerinvolvement.
This work is not necessarilypart of our curriculum training
in school.
I know in pharmacy school, Ididn't really have a learning
experience in harm reduction.
I think Increasing thoseopportunities for learners
across disciplines is reallyimportant because the earlier we

(22:46):
start integrating theseconcepts, the more normal it
will be and the more people willincorporate these concepts in
their practice.

Andie Ruggles (22:54):
Absolutely.
I would also say that we've hadsome challenges with this
program.
And I would say specifically thestigma and discrimination that
you mentioned.
Part of that we're turning intothat win is, as I mentioned,
community space.
So providing ongoing meetingswith our point of contacts and

(23:14):
with full time staff who areinvolved to provide a chance to
counteract that stigma withaffection and with ongoing
education and support for eachother.
We have daily stories that areshared in that chat of people
thanking staff for providingthose resources for them.
I would also say the fact thatthis is not a no barrier

(23:36):
program.
It is low barrier.
We try to make it as low barrieras possible, but we also work in
a healthcare system and onlyservice veterans.
The fact is, is that not anyonecan come in off the street and
access these vending machinesprogram, which would truly be
ideal that they could just comein, press a button and get what
they need.
But that is a challenge that itis low barrier, and we do

(23:56):
encourage our veterans to takematerials and hand them out to
friends who are not veterans andto provide those resources to
all of those involved that needthem.
But there are some limitationsthere.

Tessa Rife-Pennington (24:07):
In Addition to those challenges, I
definitely would say that spacehas been a huge challenge.
Having 15 vending machinesrequires quite a large amount of
space to receive all of thesupplies because while the
vending machines are spread outall the supplies that go in the
machines come to the mainhospital.

(24:29):
So we receive, many many boxesof items unpackage them some of
the items need packaged in a waythat they will dispense out of
the machine, which has been alearning curve.
I thought initially that wecould just put items in the
machine and they would properlydispense.
But they, some of them neededbagged or packaged, which takes

(24:51):
time.
Getting the items from thehospital to all of the other
locations.
We're fortunate enough to get alarge Connex shipping container,
like a literal shippingcontainer for all of our
inventory.
It takes up quite a bit of spacefor 15 machines.
Our logistics technician spendsa lot of time packaging and

(25:13):
getting all the items ready.
So ideally, we would haveadditional team members to
support the amount of workthat's needed to support all the
machines.
Other things that didn'tanticipate, like some of the
machines didn't fit in thelocations we had planned for
them to go because they, whilethey fit in the destination,

(25:33):
they didn't fit through theentryway.
We had to reconfigure some plansfor where we wanted them to go.
We also had we had an, acomplaint at one of the
locations in regards to seeingsyringes where some of the
residents have children and theywere concerned about children
seeing syringes in the housingbuilding.

(25:54):
So two of our machines weremoved out of the front lobby
area to one is in a parkinggarage and one is in a bicycle
room which while those areas mayafford more privacy, it's also
kind of like putting a machinein another area, which may not
be as desirable or accessible.

(26:15):
So there have been definitelysome challenges regarding
stigma.
But again, every time I'm at themachines, so many people come by
and thank us for what we'redoing.
It's not an overnight culturechange.
It's a, gradual, gradual changethat we're hoping to steadily
see in the right direction,which I think we are.

Beth Dinges (26:37):
I empathize with that a lot.
Just the amount of"no's" andobstacles along the way and
really hanging on to the littlesnippets and feedback that you
get from the veterans, likethose little moments that keep
you going.
Where do you see this programgoing?
Any plans for expansion?
And how do you determine if it'sworking?

(26:58):
Any metrics that you're holdingyourself to?
How do you evaluate progress

Andie Ruggles (27:02):
Oh, that's such a good question.
I would say my primary focus isgoing to be expansion of points
of contact and staff andeducation.
Just continuing to reach out andget that multidisciplinary team
and bring in as many differentdisciplines as possible.
So that way we can learn fromeach other and really bring in
veterans every single step ofthe way to make sure we're

(27:23):
hearing from those with livingexperience to actually serve the
needs that they have.

Tessa Rife-Pennington (27:28):
In addition to that, we have a
couple of different projectsgoing.
I have a research funded projectthrough the University of
California, San Francisco toevaluate feedback from veterans
who live in supportive housingwhere a vending machine is
located as well as the staff whowork there.

(27:49):
So we're going to be evaluatingfeedback on the machines, the
items within the machines,impact on quality of life and
health outcomes.
We're hoping to use thatfeedback to improve what we have
in the machines as well as otherservices that we're offering.
As Andy mentioned, this is thepilot and we're hoping to

(28:11):
continue learning from ourveterans and our staff so we can
keep making improvements.
Some things that I've heard sofar, people are interested in
access to COVID 19 tests.
We're looking at point of careor oral testing for HIV,
hepatitis C, and sexuallytransmitted infections, and how

(28:31):
we can either have that in themachine or as a resource that we
offer.
We also have a qualityimprovement project where we're
serving staff who work at theoutpatient clinics where we have
the vending machines to getfeedback on what type of harm
reduction training they'reinterested in and better

(28:52):
understand their competenciesand perspectives around harm
reduction so that we can offertraining to our staff to really
help increase awareness andsupport for this initiative.
Down the line would love toexpand our team to include a
peer and a social worker fulltime in addition to Andy's

(29:13):
support full time social workerand another prescriber like a
nurse practitioner would beamazing so that we could have
HIV prep, medication for opioiduse disorder like buprenorphine,
really make it low barrier andeasy to access.

Andie Ruggles (29:29):
I would also love to add into that team, a mental
health provider like ourcontingency management team just
providing that all aroundholistic care.
If we're going to dream big, Iwant to dream to the max that we
can.

Beth Dinges (29:41):
I'm starting on the journey of purchasing a vending
machine for our facility.
And I'm finding it all a bitoverwhelming and daunting.
I know many other sites arelooking to get started too.
If you could break it down alittle bit, like what advice
would you offer to someone who'sjust getting started in a very
like pragmatic sense where it'sactually approachable.

Tessa Rife-Pennington (30:02):
I would say similar to other harm
reduction work, people in thecommunity have been doing this
work for a while.
We have so much to learn fromthem.
They're the experts.
Joining the community roundtablewebinar group that meets to talk
about how to get started withvending machines, that's where I

(30:23):
got started.
They have a wealth ofimplementers across the United
States who have, who work indifferent states.
There's like all the differentregions of the United States.
So you can see what companiespeople work with in different
regions, what works well, whatchallenges have come up across

(30:44):
all these different programs.
It's a really great place to getstarted.
When I was getting started, Imet with several implementers in
the community to just like Q anda, like, how did you do this?
What challenges came up, askingspecific questions that I didn't
have time to ask on the biggroup call.
And that was really helpful forgetting an overall sense of how

(31:08):
these work and where do I getstarted?
What companies are out there?
From there, you can find outwhat vending machine companies
exist, and then just contactingthem, meeting with their
representatives to find out howthe machines work, how much do
they cost asking questions abouthow they would fit into a

(31:30):
specific setting, like withinthe Veterans Health
Administration, we have veteranprivacy, we have to make sure
that we're taking precautionsfor and like how are they going
to connect to Wi Fi andelectricity, all of those things
just like really figuring outhow they work.

Andie Ruggles (31:47):
There's a phrase in the community of know your
people.
I would say that's reallycritical as you are building a
program, know that you are goingto get kickback and know that
you are going to get somenegative feedback and really
surround yourself with peoplewho believe in this mission that
you're working to implement atyour site.
Because those are the peoplethat are going to continue to
push you forward and provide youthe support and validation

(32:10):
knowing that you are working tomake a difference in the lives
of so many.
So really know your people andwork with them to better the
lives of everyone.

Tessa Rife-Pennington (32:19):
I love that Andy and just to add I
think knowing your people andknowing what they need.
As a health care provider, wecan't always assume that we know
what our people need.
We have to ask them, what do youneed to be safe and healthy and
alive?
I think that's been somethingthat we've tried to do along the

(32:39):
whole journey is incorporatefeedback from veterans and from
our staff about what themachines will look like and what
supplies are in the machines.
Having involvement from yourparticipants the entire way is
really critical to making surethat the program actually is
well informed and meets theneeds of participants.

Andie Ruggles (33:02):
And be willing to accept that even though we have
decades of research in harmreduction, we are still learning
every single day.
And every single day, we'regoing to learn more and more
about what's needed and what'snot needed, what hasn't worked.
if we think that it's valid andthere's data to show that it's
significant and relevant.
It may not be at your site or inyour community.

(33:24):
Recognizing that we really haveto bring in those with active
living experience into thisevery single step

Kinna Thakarar (33:32):
That was Dr.
Tessa Reif Pennington, AndyRuggles, and Dr.
Beth Dinges in conversation onharm reduction, compassionate
care for people who use drugs.
Thank you for listening.
Please take a moment to completeSAMHSA's post event evaluation
survey on the AMERSA podcastpage at www.
dot AMERSA dot.
Org forward slash harm reductionpodcast.
We welcome any comments,questions, or other feedback for
presenters.
You can send those directly toAMERSA through the contact us

(33:54):
form at AMERSA.
org.
To learn more about theprovider's clinical support
system, Medication for OpioidUse Disorder Project, and AMERSA
please visit our websites atPCSSMOUD.
org and AMERSA org.
Funding for this initiative wasmade possible by Cooperative
Agreement No.
1 H 79 TI 086 770 from SAMHSA.
The views expressed in writtenconference materials or

(34:14):
publications and by speakers andmoderators do not necessarily
reflect the official policies ofthe Department of Health and
Human Services, nor does mentionof trade names, commercial
practices, or organizationsimply endorsement by the U.
S.
government.
Thank you for listening.