A vending machine plugged in at Hope Services’ homeless shelter in Kona isn’t loaded with the typical Cheetos, Famous Amos cookies or packs of gum. Instead, it’s filled with Narcan, a nasal spray used to reverse the effects of an opioid overdose.
On the side panels of the white and purple machine, provided by the state Department of Health, it gives instructions on how to administer the spray.
“Naloxone should be given to any person who shows signs of an opioid overdose,” the panel reads, going on to list the signs: gurgling, gasping, snorting, blue lips or fingertips, will not wake up and slow or no breathing.
For the past few years, Hawai’i County leaders and community partners have been working to get Narcan, also known as naloxone, into the hands of the public as a way to combat the growing opioid crisis and rise in fentanyl, where one fatal overdose is occurring every seven days on Hawai’i Island, according to the Center for Disease Control and Prevention.
Forming the Hawai’i Island Fentanyl Task Force in 2021, the group has organized several Narcan giveaways. In November 2023, 150 Narcan kits were donated to Hawai‘i County. In July 2023, Hawai‘i County Department of Liquor Control completed the distribution of over 700 doses of Narcan Spray to its Dispenser licensees, including bars, restaurants, hotels, clubs and other establishments on Hawaiʻi Island.
To make naloxone more accessible, the Department of Health started sending over vending machines, each loaded with 63 boxes of the nasal spray, to the island. There are now seven islandwide.
Click here for a list and map of where the vending machines are located.
The Narcan is free and machines can be found in the following locations:
During a task force quarterly meeting on March 18, members discussed the frequency with which these machines are being used by the community.
During the Zoom meeting, Pua Carriaga, who provides admin support on the task force, reported on the three Hilo machines the task force maintains at the YMCA, the outpatient treatment center and detox center.
The YMCA location was initially filled on Jan. 5. It’s been refilled four times on Jan. 23, Feb. 8, Feb. 26 and March 14.
The machine outside the outpatient treatment center was initially filled on Feb. 28 and has not needed to be restocked as of March 19.
The detox center machine was filled on March 5 and has been refilled twice — once on March 12 and again on March 15.
Task force co-lead Dr. Kevin Kunz said fentanyl is infiltrating every drug, including marijuana, on the Big Island. The naloxone is another way community members can help prevent an opioid overdose.
Hawai’i Island police Lt. Edwin Buyten saw a vending machine for the first time a few weeks ago at the YMCA.
“I was intrigued,” Buyten said. “I thought it was a step in the right direction to save lives in the course of an overdose.”
The lieutenant, also a member of the task force, said like any vending machine, you punch in a number and it drops a box of Narcan.
“Anything we can do to reduce overdoses is a good idea,” Buyten said, adding the department doesn’t encourage drug use or illegal behavior.
Gary Yabuta, Director for Hawai’i’s High-Intensity Drug Trafficking Agency, said he doesn’t condone the Narcan vending machines because he thinks the nasal spray is already readily available to the public through various nonprofits and pharmacies.
However, they can’t hurt, Yabuta said. “It can only save lives.”
Yabuta does encourage people receive training when they get the naloxone so they have the basic responsibility of using Narcan.
It’s not just administering Narcan, Yabuta said. “You’ve got to keep them breathing.”
The naloxone is provided by the State Alcohol and Drug Abuse Program at the Department of Health. Each box costs $30.
The Hawai‘i Health and Harm Reduction Center also provided funding for the boxes through federal Overdose to Action grants.
Heather Lusk, executive director of the Harm Reduction Center, said refills are provided through the Department of Health as needed.
As for refills, it is different for each site as the DOH provides the naloxone directly to sites as needed.
While the instructions are spelled out on the machines themselves, Lusk said there is online training and people can request in-person instruction.
A few months ago, Mark Gordon, a member of the Waikōloa leadership group and Fentanyl Task Force, went to see the machine at Hope Services and noticed it was in a restricted area where there is housing for those experiencing homelessness.
“I’m thinking, the one in Kona, no one can get into it,” Gordon said, adding there is nothing in North or South Kohala.
Gordon reached out to Hawai‘i Health and Harm Reduction Center about getting a vending machine for his community and was put on a waitlist. While he doesn’t see a lot of fentanyl, the Waikōloa man is concerned about the elderly population in his community who take opioids for pain regularly.
“What if they forgot they took a dose, or too much?”
Gordon was told a vending machine alone costs $4,500.
Involved as an environmental health and safety consultant in the community, Gordon provides education on trying to get more people aware of opioid overdoses in the community and how to fight it with Narcan.
Hawai‘i Island police Lt. Edwin Buyten provided fentanyl arrest data during the quarterly meeting.
From Dec. 1, 2023, to March 1, 2024, 11 fentanyl arrests were made in West Hawai‘i. According to Buyten, 101 fentanyl pills and 200 grams of powdered fentanyl were recovered.
Capt. Aaron Mitchell with Hawai‘i Fire Department reported that from Feb. 1 to March 15, fire personnel responded to 31 overdoses where naloxone was administered to 29 of the individuals. Of those administered the nasal spray, nine were improved.
Kunz said the CDC has yet to release the overall mortality report for 2023. Once that is released, it will provide an updated picture of where Hawai’i is at concerning opioid overdoses and whether or not they are on the rise.
From what Yabuta sees, that is already the case saying narcotics teams are saying fentanyl has never been cheaper.
“We continue to lose the battle because people are naively finding fentanyl on the streets and they’re risking and even losing their lives,” he added. “It’s indiscriminate in targeting all communities.”
Yabuta said Hawai‘i Island Fentanyl Task Force is a model for community leaders and partners coming together to reduce fentanyl deaths.
“We need more of that partnership throughout the state,” he said.
The purpose of the task force is to reduce fentanyl deaths through education. Yabuta said. Hawai‘i Island is successfully getting the message out and educating people before they’re exposed to the synthetic opioid in the first place.
“We haven’t figured out how to reach people who don’t care if they’re taking that risk,” Yabuta said. “How do we convince people that every life including theirs is worth it?”
