Harm Reduction Vending Machines in Supportive Housing for Veterans

Importance Harm reduction vending machines (HRVMs) are an evidence-based strategy to provide low-barrier access to harm reduction and health supplies; however, little is known about their perceived impacts in permanent supportive housing for US veterans. Objective To evaluate veteran and staff perspectives on the perceived impacts and concerns associated with HRVMs deployed in permanent supportive housing buildings. Design, Setting, and Participants This qualitative study consisted of semistructured interviews with veteran residents who had formerly experienced homelessness and on-site staff in 6 California-based permanent supportive housing buildings from August through December 2024. Purposive sampling was used to recruit diverse participants across 6 housing buildings. Exposure HRVMs stocked with standardized harm reduction, sexual health, hygiene, and wellness supplies and colocated in supportive housing buildings for at least 5 months. Main Outcomes and Measures Interviews were analyzed using thematic analysis to identify key themes. Results A total of 60 participants completed interviews (44 veterans and 16 staff); 14 staff completed the demographic survey. Veterans had a mean (SD) age of 62.1 (14.8) years, and 40 (90.9%) were men; staff survey respondents had a mean (SD) age 44.9 (7.8) years, and 9 (64.3%) were men. Interviews lasted a mean (range) of 37 (12-78) minutes. Three overarching impact themes comprising 9 subthemes were identified: (1) expanded access to harm reduction resources, including around-the-clock, no-cost access and staff-supported resource navigation; (2) safety, health, and well-being, including safer substance use, sexual health prevention, self-care, and improved comfort and peace of mind; and (3) community conditions, social support, and normalization, including peer and family support, normalized HRVM use, and no perceived increase in visible disorder or safety concerns. Three cross-cutting concerns involved stigma and privacy when accessing HRVMs, perceptions of enabling substance use, and placement around children. Conclusions and Relevance In this qualitative study, veterans and staff described HRVMs in supportive housing as acceptable and supported perceived benefits across access, safety and health behaviors, and community conditions, while highlighting concerns about stigma, placement, and enabling substance use. Future studies should evaluate downstream clinical, service engagement, and housing outcomes.