RESUMO
BACKGROUND: Pharmacy syringe sales are effective structural interventions to reduce bloodborne illnesses in populations, and are legal in all but two states. Yet evidence indicates reduced syringe sales in recent years. This study was designed as a feasibility test of an intervention to promote syringe sales by pharmacies in Arizona. METHODS: A four-month pilot among three Arizona pharmacies measured feasibility and acceptability through monthly surveys to 18 enrolled pharmacy staff members. RESULTS: Pharmacy staff reported increased ease of dispensing syringes across the study. Rankings of syringe dispensing as 'easiest' among 6 measured pharmacy practices increased from 38.9 % at baseline to 50.1 % post intervention module training, and to 83.3 % at pilot conclusion. The majority (72.2 %) of pharmacy staff agreed that intervention materials were easy to use. Over 70 % indicated that the intervention was influential in their "being more open to selling syringes without a prescription to someone who might use them for illicit drug use," and 61.1 % reported that in the future, they were highly likely to dispense syringes to customers who would use them to inject drugs. A vast majority (92 %) reported being likely to dispense subsidized naloxone if available to their pharmacy at no cost. CONCLUSIONS: An education-based intervention was found to be feasible and acceptable to pharmacy staff and had an observed impact on perceptions of ease and likelihood of dispensing syringes without a prescription to people who may use them to inject drugs.
Assuntos
Seringas , Humanos , Seringas/provisão & distribuição , Arizona , Projetos Piloto , Farmácias/estatística & dados numéricos , Estudos de Viabilidade , Patógenos Transmitidos pelo Sangue , Serviços Comunitários de Farmácia , Comércio , Farmacêuticos , Antagonistas de Entorpecentes/uso terapêutico , Antagonistas de Entorpecentes/provisão & distribuição , Antagonistas de Entorpecentes/administração & dosagem , Naloxona/provisão & distribuição , Naloxona/uso terapêutico , Naloxona/administração & dosagemRESUMO
BACKGROUND: Personal syringe reuse (i.e., reuse of one's own syringes) can place people who inject drugs at increased risk for infectious disease but has received relatively little attention in published literature. The purpose of this study is to identify factors associated with syringe reuse among people who inject drugs in rural Kentucky. METHODS: Participants (n = 238) completed interviewer-administered questionnaires on syringe reuse and demographic, behavioral, and service access characteristics. Unadjusted negative binomial regression with cluster-robust standard errors was used to model the associations with a logged offset for number of injections in the past 30 days. RESULTS: The average age of the sample was 35 and 59.7 % were male. Most participants (77.7 %) reused syringes at least once in the past 30 days, using each syringe a median of three times. Reuse was higher among those who were older and reported a higher street price for syringes. Syringe reuse was lower among people who were within walking distance to a syringe service program (SSP) and who obtained most of their syringes from SSPs or pharmacies. CONCLUSION: Syringe reuse among people who inject drugs in rural Kentucky is common. However, these data suggest that increased access to syringes from SSPs and pharmacies, as well as policy-level interventions that reduce street syringe price, might reduce syringe reuse and related harms.
Assuntos
Reutilização de Equipamento , Programas de Troca de Agulhas , População Rural , Abuso de Substâncias por Via Intravenosa , Seringas , Humanos , Kentucky , Masculino , Abuso de Substâncias por Via Intravenosa/epidemiologia , Adulto , Feminino , Seringas/provisão & distribuição , População Rural/estatística & dados numéricos , Reutilização de Equipamento/estatística & dados numéricos , Programas de Troca de Agulhas/estatística & dados numéricos , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto Jovem , Região dos ApalachesRESUMO
ANTECEDENTES: En cumplimiento del inciso e, sobre nuestras funciones como UFETS, que dice: "Desarrollar evaluaciones de tecnologías sanitarias, incluyendo medicamentos, dispositivos y equipos médicos, procedimientos médicos o quirúrgicos y sistemas de organización, en forma sistémica y objetiva aplicadas a la salud, basándose en la mejor evidencia científica disponible", realizamos esta revisión rápida sobre la utilidad de la jeringa 10 ml precargada de solución salina (ClNa 0.9%) para la inyección de medios de contraste en tomografía computarizada o resonancia magnética. ESTRATEGIA DE BÚSQUEDA DE INFORMACIÓN: Pregunta Clínica: En pacientes con cáncer de mama, cuello uterino y estómago que requieren inyección de medios de contraste ¿Cuál es la utilidad de la jeringa 10ml precarga de solución salina (NaCl 0.9%) en la realización de una tomografía computarizada o resonancia magnética con contraste? Recolecciòn de los Manuscritos a Revisar: Tipos de estudios: La estrategia de búsqueda sistemática de información científica para el desarrollo del presente informe se realizó siguiendo las recomendaciones de la Pirámide jerárquica de la evidencia propuesta por Haynes y se consideró los siguientes estudios: Sumarios y guías de práctica clínica. Revisiones sistemáticas y/o meta-análisis. Ensayos Controlados Aleatorizados (ECA) Estudios Observacionales (cohortes, caso y control, descriptivos) No hubo limitaciones acerca de la fecha de publicación o el idioma para ningún estudio. Fuentes de información: De acceso libre o Bases de datos: Pubmed y Cochrane Fecha de búsqueda: Desde el inicio de los tiempos hasta la actualidad. Términos de Búsqueda Considerando la pregunta PICO se construyó una estrategia de búsqueda. Sin restricciones en el idioma y año. DISCUSIÓN: Durante la sesión de panel se discutió los artículos encontrados, así como las búsquedas realizadas en las principales agencias de evaluación de tecnologías sanitarias y las guías que reportan información al respecto de jeringas precargadas 10 ml NaCl 0.9%. Con respecto a los estudios encontrados se ha evidenciado que el uso de jeringas precargadas NaCl 0.9% en los 03 estudios ha sido favorable en reducción de infecciones del torrente sanguíneo relacionadas a catéter, disminución en el riesgo de reemplazo del catéter venoso periférico, disminución del riesgo para pacientes y mejoras en la seguridad de los trabajadores de salud y también podría llevar a una reducción en costos asociados. El primer estudio si bien fue realizado en pacientes oncológicos, se realizó en ambientes de quimioterapia y el segundo estudio fue un estudio cuasi experimental que abarco pacientes que acudieron o estaban en diferentes áreas hospitalarias y en el caso del tercer estudio no se logró tener acceso al manuscrito en versión extensa debido a que fue publicado hace menos de un mes y el acceso era limitado. Por ello, se ha planteado que la evidencia obtenida con respecto al uso de jeringas precargadas es indirecta por lo cual es difícil establecer una conclusión con respecto a su uso en un área específica como previo a la realización de tomografía con contraste o una resonancia magnética. CONCLUSIONES: En el Instituto Nacional de Enfermedades Neoplásicas se realizan anualmente aproximadamente 45000 exámenes radiológicos de tipo TC ó RM que requieren el uso de contraste en pacientes con cáncer de mama, estómago o cuello uterino en donde se utilizaría jeringas 10 mL precargadas con solución salina 0.9%. Se realizó una búsqueda sistemática y una búsqueda dirigida de la evidencia para evaluar la utilidad de la jeringa precargada 10 mL con solución salina 0.9% y no se encontró evidencia directa de su uso en la población específica; sin embargo, se han reportado algunos artículos científicos que encuentran evidencia favorable de su uso comparado con la jeringa cargada manualmente. Se encontraron 03 artículos que comparando la tecnología sanitaria "Jeringa 10 mL precargada con NaCl 0.9%" con la jeringa de carga manual, las jeringas precargadas presentan: un menor porcentaje de remoción de jeringa por complicaciones, reducción de la tasa de infección del torrente sanguíneo relacionada con el catéter y reducción de la tasa de fallo de colocación del catéter venoso. Adicionalmente, según informes de contraloría y en base análisis internos de la institución se ha priorizado un presupuesto para la atención del cáncer de mama, cáncer de cuello uterino y cáncer de estómago para el estadiaje y tratamiento que en base al riesgo identificado "contaminación por uso de jeringas cargadas manualmente" se establezca la medida de control "utilizar jeringa precargada previo al examen". Con respecto a la adquisición, está disponible en Latinoamérica y es de fácil adquisición a solicitud. Finalmente, en base a la evidencia encontrada y los documentos revisados a nivel institucional el panel establece la necesidad de que el área de costos realice un análisis de impacto presupuestario que nos permita conocer si la inclusión de la tecnología sanitaria "Jeringa 10 mL precargada con NaCl 0.9%" implicaría una reducción de costos en el área específica en la cual se va a implementar.
Assuntos
Humanos , Neoplasias Gástricas/diagnóstico por imagem , Seringas/provisão & distribuição , Neoplasias da Mama/diagnóstico por imagem , Espectroscopia de Ressonância Magnética/instrumentação , Tomografia Computadorizada por Raios X/instrumentação , Neoplasias do Colo do Útero/diagnóstico por imagem , Solução Salina/administração & dosagem , Análise Custo-Benefício/economia , Meios de ContrasteRESUMO
OBJECTIVE: Syringe drivers are the principle method of giving small-volume continuous infusions of important drugs to patients. Many of these drugs are critical for the maintenance of normal physiology. Anecdotal evidence abounds of severe patient instability on movement of syringe drivers during infusion. We aimed to define the variation in drug delivery seen in three syringe drivers, with changes in relative height between the syringe driver and the end of the giving set. DESIGN: Three syringe drivers (Alaris CC [Becton Dickinson], Perfusor Space [B Braun], and Synamed µSP6000 [Arcomed]) were analyzed for reliability of flow at 0.5, 1, 2, and 5 mL/h. SETTING AND SUBJECTS: This is an in vitro investigation. INTERVENTIONS: A small air bubble was introduced into the giving set, and the progression of this was documented before and after a vertical movement of the syringe driver by 25 or 50 cm upward or downward relative to the delivery port. MEASUREMENTS AND MAIN RESULTS: For all pumps, delivery was interrupted on movement of the pumps downward, and a bolus was given with movement of the pump upward. Delivery halted at lower pump speeds for longer than higher pump speeds. The maximum delivery interruption was 11.8 minutes. Boluses given on moving the pump up were calculated as the equivalent number of minutes needed to deliver the bolus volume at steady state. The maximum bolus given was equivalent to 15.8 minutes of delivery. We were unable to eliminate the effects seen by very slow, steady movement of the pumps up or down. Static height differences made no difference to delivery. CONCLUSIONS: Syringe drivers should not be moved vertically in relation to the patient. Critical drug delivery is interrupted for up to 12 minutes with relative downward movements, and significant boluses of drugs are given with relative upward movements. As far as possible, elimination of relative height movements is advised, and extreme caution is necessary if any movements are unavoidable.
Assuntos
Sistemas de Liberação de Medicamentos/métodos , Bombas de Infusão/provisão & distribuição , Seringas/provisão & distribuição , Estatura , Humanos , Reprodutibilidade dos TestesRESUMO
BACKGROUND AND AIMS: Injection drug use has increased in non-urban communities in the United States where sterile syringe access is limited. This study aimed to characterize how people who inject drugs in a predominantly rural state navigate syringe scarcity. DESIGN: Qualitative study. SETTING: New Hampshire (NH), USA. At the time of our study, syringe services programs were illegal in NH but pharmacies could sell ≤ 10 syringes without prescription. PARTICIPANTS/CASES: Twenty people aged ≥ 18 years who injected at least once in the past 30 days were recruited through provider referral, street-based recruitment and snowball sampling. MEASUREMENTS: Semi-structured interview guide. Verbatim transcripts were coded based on interview guide constructs and emergent themes. Analysis focused on pharmacy syringe access, unofficial syringe sources and related impacts on syringe sharing and reuse FINDINGS: Participants could identify no local pharmacies that sold syringes without prescription. Pharmacy purchase in neighboring counties, or across state lines, required private transportation and this, along with purchaser identification requirements, presented substantial access barriers. Interstate travel also exposed participants to vigilant policing of interstate highways and potential criminal justice involvement. Many participants thus resorted to informal syringe sources closer to home including purchasing syringes on the street, using discarded syringes, breaking into biohazard containers and constructing improvised syringes out of salvaged syringe parts, metals and plastics. Repeated re-use of syringes until they were no longer operational was common. Overall, syringe scarcity gave participants few options but to engage in syringe sharing and re-use, putting them at risk of serious injection-related infections. CONCLUSIONS: Limited sterile syringe access contributes to an environment in which people who inject drugs report that they are less able to refrain from risky injection practices.
Assuntos
Usuários de Drogas/psicologia , Uso Comum de Agulhas e Seringas/psicologia , Seringas/provisão & distribuição , Adulto , Feminino , Acessibilidade aos Serviços de Saúde , Humanos , Masculino , Programas de Troca de Agulhas , New England , New Hampshire , Farmácias/legislação & jurisprudência , Pesquisa Qualitativa , População Rural , Abuso de Substâncias por Via Intravenosa , Adulto JovemRESUMO
Background People who inject drugs (PWID) in rural areas of the United States have had limited access to syringe service programs (SSP). Rural SSP have recently surged, but accompanying research is lacking about PWID utilization, barriers, and preferences for SSP design and how those preferences vary by gender. Methods: Interviewer-administered surveys elicited information about utilization, barriers, and preferences for SSP design from 234 PWID recruited using respondent-driven sampling in Appalachian, Kentucky. Gender differences among reported barriers to utilizing SSP and preferences for program design were explored using Mantel-Haenszel chi-square tests. Results: Overall, 49% of PWID had ever utilized an SSP. The most common reasons for not utilizing an SSP were lack of awareness (23%), fear of being seen or disclosing drug use (19%), and lack of need (19%). The most preferred SSP design was located within a health department (74%) and operating during afternoon hours (66%). Men were more likely than women to prefer SSP in health departments (80% vs. 65%, p = 0.01), while more women than men preferred staffing by health department personnel (62% vs. 46%, p = 0.02). Women were less likely to favor evening hours (55% vs. 70%, p = 0.02). Fewer women wanted SSP nurses (78% vs. 90%, p = 0.01), social workers (11% vs. 24%, p = 0.01), or people who use drugs (20% vs 34%, p = 0.02) to staff SSP. Conclusions: Despite recent scale-up, SSP in Appalachia remain under-utilized. PWID were open to a range of options for SSP design and staffing, though there were variations by gender. Implementation research that identifies best strategies for tailored SSP scale-up in rural settings should be considered.
Assuntos
Programas de Troca de Agulhas/organização & administração , Programas de Troca de Agulhas/estatística & dados numéricos , Abuso de Substâncias por Via Intravenosa/psicologia , Seringas/provisão & distribuição , Adulto , Região dos Apalaches/epidemiologia , Feminino , Humanos , Kentucky/epidemiologia , Masculino , Fatores Sexuais , Abuso de Substâncias por Via Intravenosa/epidemiologia , Adulto JovemRESUMO
BACKGROUND: Sterile syringe access reduces injection-related health harms, yet access in the U.S. remains grossly inadequate. In California, syringe services programs (SSPs) are authorized mainly at the local level, and many communities remain underserved. State law also allows, but does not require, non-prescription syringe sales at pharmacies, but participation is low. We draw on the theoretical concept of "landscapes of antagonism" to examine how discordance between state and local decision-making contributes to uneven syringe access and health harms in California's Central Valley, where injection rates are high. METHODS: Our study took place in Fresno and Kern counties. We draw on participant observation and qualitative interviews with individuals who inject drugs and key informants to examine issues around syringe access. RESULTS: Overall, 8 key informants represented harm reduction, medical, and faith-based organizations. Among 46 people who inject drugs, mean age was 39 (range: 20-65), 37% were female, and 37% self-identified as Latino. About half of individuals at each site had ever successfully purchased from pharmacies, but limited locations and perceived judgement from pharmacy staff posed common barriers. There was no SSP in Kern County due to political opposition; Fresno's SSP has been run by volunteers for more than 20 years despite opposition, and recently gained authorization. Reflecting this disparity, all but two individuals in Fresno accessed syringes from the SSP, whereas only one person in Kern had ever been to an SSP. To fill gaps in access in both sites, individuals obtained syringes that were often already used from diabetics, friends, and people on the street, sharing and reusing syringes at dangerously high rates. CONCLUSION: Landscapes of antagonism create syringe access inequities that threaten to exacerbate disease transmission and other health harms. Our study raises questions about accountability for the health of people who use drugs and suggests a need for political action.
Assuntos
Acessibilidade aos Serviços de Saúde , Programas de Troca de Agulhas/organização & administração , Abuso de Substâncias por Via Intravenosa/complicações , Seringas/provisão & distribuição , Adulto , Idoso , California , Comércio/estatística & dados numéricos , Feminino , Redução do Dano , Disparidades em Assistência à Saúde , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Assistência Farmacêutica/organização & administração , Abuso de Substâncias por Via Intravenosa/epidemiologia , Adulto JovemRESUMO
Monitoring distributive syringe sharing (DSS) and syringe services program (SSP) use among persons who inject drugs (PWID) is important for HIV prevention. PWID aged ≥ 18 in 20 US cities were recruited for National HIV Behavioral Surveillance in 2015 using respondent-driven sampling, interviewed and offered HIV testing. Bivariate and multivariable analyses via log-linked Poisson regression with generalized estimating equations were conducted to examine associations between demographic and behavioral variables and DSS. Effect of SSP use on DSS by HIV sero-status was assessed by including an interaction between SSP and sero-status. Analyses were adjusted for sampling design. Among 10,402 PWID, 42% reported DSS. DSS was less likely to be reported among HIV-positive compared to HIV-negative PWID (aPR = 0.51, CI 0.45-0.60), and among those who primarily obtained syringes from SSPs versus those who did not (aPR = 0.82, 95% CI 0.77-0.88). After adjustment, those who primarily used SSPs were less likely to report DSS than those who did not among both HIV-negative PWID (aPR = 0.84, 95% CI 0.78-0.90) and HIV-positive PWID (aPR = 0.54, 95% CI 0.39-0.75). Findings support expansion of SSPs, and referrals to SSPs by providers working with PWID.
Assuntos
Infecções por HIV/prevenção & controle , Uso Comum de Agulhas e Seringas/estatística & dados numéricos , Programas de Troca de Agulhas , Seringas/provisão & distribuição , Adolescente , Adulto , Cidades/epidemiologia , Cidades/estatística & dados numéricos , Feminino , Humanos , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Vigilância da População/métodos , Abuso de Substâncias por Via Intravenosa/epidemiologia , Estados Unidos/epidemiologia , Adulto JovemRESUMO
BACKGROUND: Community pharmacies are important for health access by rural populations and those who do not have optimum access to the health system, because they provide myriad health services and are found in most communities. This includes the sale of non-prescription syringes, a practice that is legal in the USA in all but two states. However, people who inject drugs (PWID) face significant barriers accessing sterile syringes, particularly in states without laws allowing syringe services programming. To our knowledge, no recent studies of pharmacy-based syringe purchase experience have been conducted in communities that are both rural and urban, and none in the Southwestern US. This study seeks to understand the experience of retail pharmacy syringe purchase in Arizona by PWID. METHODS: An interview study was conducted between August and December 2018 with 37 people living in 3 rural and 2 urban Arizona counties who identified as current or former users of injection drugs. Coding was both a priori and emergent, focusing on syringe access through pharmacies, pharmacy experiences generally, experiences of stigma, and recommendations for harm reduction services delivered by pharmacies. RESULTS: All participants reported being refused syringe purchase at pharmacies. Six themes emerged about syringe purchase: (1) experience of stigma and judgment by pharmacy staff, (2) feelings of internalized stigma, (3) inconsistent sales outcomes at the same pharmacy or pharmacy chain, (4) pharmacies as last resort for syringes, (5) fear of arrest for syringe possession, and (6) health risks resulting from syringe refusal. CONCLUSIONS: Non-prescription syringe sales in community pharmacies are a missed opportunity to improve the health of PWID by reducing syringe sharing and reuse. Yet, current pharmacy syringe sales refusal and stigmatization by staff suggest that pharmacy-level interventions will be necessary to impact pharmacy practice. Lack of access to sterile syringes reinforces health risk behaviors among PWID. Retail syringe sales at pharmacies remain an important, yet barrier-laden, element of a comprehensive public health response to reduce HIV and hepatitis C among PWID. Future studies should test multilevel evidence-based interventions to decrease staff discrimination and stigma and increase syringe sales.
Assuntos
Compras em Grupo/legislação & jurisprudência , Redução do Dano , Uso Comum de Agulhas e Seringas/legislação & jurisprudência , Farmácias/legislação & jurisprudência , Abuso de Substâncias por Via Intravenosa/reabilitação , Seringas/provisão & distribuição , Adulto , Idoso , Arizona , Feminino , Infecções por HIV/prevenção & controle , Infecções por HIV/transmissão , Acessibilidade aos Serviços de Saúde/legislação & jurisprudência , Hepatite C/prevenção & controle , Hepatite C/transmissão , Humanos , Entrevista Psicológica , Masculino , Pessoa de Meia-Idade , Estigma Social , Adulto JovemRESUMO
More than 70,000 Americans died as a result of a drug overdose in 2017, and a substantial majority of those deaths involved an opioid. Supply-reduction interventions, such as prescription monitoring programs, tamper-resistant formulations, and prescribing limits have failed to reverse rising rates of opioid-related morbidity and mortality. Instead, they may be contributing to this trend by forcing people with opioid use disorder to an increasingly potent illicit market with scant resources for sterile injection. Pharmacists are recognized by governmental authorities, public health experts, and other health professionals as key partners in opioid harm reduction. This is reflected by the proliferation of state laws supporting pharmacy-based access to naloxone, an opioid antagonist that can rapidly reverse the effects of an opioid overdose. Expanded authority to distribute naloxone without an outside prescription, coupled with the provision of sterile syringes and evidence-based medications for opioid use disorder, represents a powerful opportunity for pharmacists to save lives while advancing the role of the profession. However, numerous studies have documented a lack of readiness among pharmacists to dispense naloxone and little willingness to provide sterile syringes. As a profession, it is imperative that we ensure all pharmacists receive adequate education regarding opioid harm reduction interventions and ongoing support to implement these interventions within their practices.
Assuntos
Overdose de Drogas/prevenção & controle , Transtornos Relacionados ao Uso de Opioides/complicações , Assistência Farmacêutica/organização & administração , Farmacêuticos/organização & administração , Overdose de Drogas/epidemiologia , Overdose de Drogas/mortalidade , Redução do Dano , Acessibilidade aos Serviços de Saúde , Humanos , Naloxona/administração & dosagem , Antagonistas de Entorpecentes/administração & dosagem , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Papel Profissional , Seringas/provisão & distribuiçãoRESUMO
Globally, punitive drug law enforcement drives human rights violations. Drug control tactics, such as syringe confiscation and drug-related arrests, also cascade into health harms among people who use drugs. The role of police officer characteristics in shaping such enforcement and measures to reform police practices remains underexamined. We evaluated gender differences in syringe confiscation and syringe-related arrest behaviors among municipal police officers in Tijuana, Mexico, where syringe possession is legal. In the context of the SHIELD Study focusing on aligning policing with harm reduction measures, our baseline sample covered municipal police officers who reported having occupational contact with syringes. We used multivariable logistic regression with robust variance estimation via a generalized estimating equation to identify correlates of syringe-related policing behaviors. Among respondent officers (n=1,555), 12% were female. After considering possible confounding variables, such as district of service and work experience, female officers were significantly less likely to report confiscating syringes or arresting individuals for syringe possession. Consideration of officer gender is important in the design of interventions to improve the health and human rights of people who inject drugs and other highly policed groups, as well as measures to safeguard officer occupational safety. The feminization of law enforcement deserves special consideration as an imperative in reducing the public health harms of policing.
Assuntos
Direitos Humanos/normas , Aplicação da Lei , Saúde Ocupacional , Polícia/estatística & dados numéricos , Saúde Pública/normas , Abuso de Substâncias por Via Intravenosa/epidemiologia , Adulto , Feminino , Humanos , Legislação de Medicamentos , Masculino , México/epidemiologia , Fatores Sexuais , Seringas/efeitos adversos , Seringas/estatística & dados numéricos , Seringas/provisão & distribuiçãoRESUMO
BACKGROUND: In Tajikistan, governmental policies leave the decision whether or not to sell syringes to people who inject drugs (PWID) to pharmacists' discretion. This exploratory study tests a theory-driven model explaining Tajikistani pharmacists' actual syringe sale practices to inform future HIV advocacy activities. METHODS: Data were collected via attempts to purchase syringes without prescription and a subsequent survey among a sample of 232 pharmacists in two cities (Dushanbe and Kulob) in Tajikistan in 2015. The survey collected data on attitudes and beliefs related to selling syringes to PWID, stigma against PWID and background contextual factors such as social conservatism, HIV and drug use knowledge. Structural equation modelling was used to assess the relationships between syringe sale practice and pharmacists' attitudinal and background factors. RESULTS: The majority (87.9%, nâ¯=â¯204) of sampled pharmacists agreed to sell syringes to the study research assistants without a prescription. According to the final model, agreeing to sell syringes was moderately associated with the reported intent to provide syringes without prescription (ßâ¯=â¯0.36, pâ¯<â¯0.001), lower stigma against PWID (ß=-0.43, pâ¯=â¯0.01), and stronger social conservatism (ßâ¯=â¯0.35, pâ¯=â¯0.02). Intent to provide syringes correlated with positive attitudes towards provision of syringes (ßâ¯=â¯0.35, pâ¯=â¯0.008), which in turn were negatively associated with stigma (ß=-0.54, pâ¯<â¯0.001) and positively with age (ßâ¯=â¯0.20, pâ¯=â¯0.03). Stigma against PWID was directly associated with social conservatism (ßâ¯=â¯0.47, pâ¯<â¯0.001) and inversely with university-level education (ß=-0.28, pâ¯<â¯0.001). CONCLUSION: We demonstrated the accessibility of over-the-counter syringes in urban pharmacies of Tajikistan and emphasized the role of stigma in shaping pharmacists' syringe sale practices. Advocacy interventions should target pharmacists to reduce stigmatization of PWID and ensure access to clean syringes.
Assuntos
Atitude do Pessoal de Saúde , Comércio , Farmacêuticos/estatística & dados numéricos , Seringas/provisão & distribuição , Adulto , Fatores Etários , Usuários de Drogas/psicologia , Feminino , Pesquisas sobre Atenção à Saúde , Humanos , Masculino , Assistência Farmacêutica/economia , Farmacêuticos/psicologia , Estigma Social , Abuso de Substâncias por Via Intravenosa/psicologia , Tadjiquistão , Adulto JovemRESUMO
BACKGROUND: Syringe Services Programs (SSPs) have been proposed as a key intervention to address increasing rates of opioid injection, overdose, and infectious disease transmission in the U.S. In recent years, multiple states and jurisdictions have enacted laws and policies to enable implementation of SSPs. These statutory and regulatory changes have resulted in the expansion of SSPs in a short period of time under a patchwork of different regulations and policies. Understanding how SSPs are responding to this evolving policy environment in the midst of a worsening opioid crisis can inform the development of strategies to maximize the role SSPs play in the response to the opioid crisis. METHODS: In-depth, semi-structured and audio-recorded interviews were conducted with 25 individuals running 23 SSPs in the U.S. A thematic content analysis was employed to identify and group themes across the domains of interest based on inductive and deductive coding of verbatim interview transcripts. RESULTS: Despite progress in expanding the number of SSPs in recent years, programs described encountering legal, policy, funding, and community barriers that are limiting the scope, scale, and reach of SSPs. To address these barriers, programs are employing multiple strategies to educate about and advocate for SSPs, engage policymakers and communities, combat pervasive stigma, strengthen funding, and reach at-risk populations. CONCLUSION: This qualitative study of a geographically diverse sample of SSPs provides key insights into the legal and policy barriers, funding challenges, and contextual factors impacting SSPs and the strategies programs are pursuing to counter these barriers. Coupling these strategies with policy changes that address the underlying legal and financial barriers and advancing efforts to combat stigma around drug use and addiction stand to substantially expand the role of SSPs as part of the public health response to the opioid crisis in the U.S.
Assuntos
Apoio Financeiro , Programas de Troca de Agulhas/legislação & jurisprudência , Epidemia de Opioides/prevenção & controle , Políticas , Avaliação de Programas e Projetos de Saúde , Seringas/provisão & distribuição , Humanos , Pesquisa Qualitativa , Estados Unidos/epidemiologiaRESUMO
OBJECTIVE: From 2011 to 2013, the Global Fund (GF) supported needle and syringe programmes in Mexico to prevent transmission of HIV among people who inject drugs. It remains unclear how GF withdrawal affected the costs, quality and coverage of needle and syringe programme provision. DESIGN: Costing study and longitudinal cohort study. SETTING: Tijuana, Mexico. PARTICIPANTS: Personnel from a local needle and syringe programme (n=6) and people who inject drugs (n=734) participating in a longitudinal study. PRIMARY OUTCOME MEASURES: Provision of needle and syringe programme services and cost (per contact and per syringe distributed, in 2017 $USD) during GF support (2012) and after withdrawal (2015/16). An additional outcome included needle and syringe programme utilisation from a concurrent cohort of people who inject drugs during and after GF withdrawal. RESULTS: During the GF period, the needle and syringe programme distributed 55 920 syringes to 932 contacts (60 syringes/contact) across 14 geographical locations. After GF withdrew, the needle and syringe programme distributed 10 700 syringes to 2140 contacts (five syringes/contact) across three geographical locations. During the GF period, the cost per harm reduction contact was approximately 10-fold higher compared with after GF ($44.72 vs $3.81); however, the cost per syringe distributed was nearly equal ($0.75 vs $0.76) due to differences in syringes per contact and reductions in ancillary kit components. The mean log odds of accessing a needle and syringe programme in the post-GF period was significantly lower than during the GF period (p=0.02). CONCLUSIONS: Withdrawal of GF support for needle and syringe programme provision in Mexico was associated with a substantial drop in provision of sterile syringes, geographical coverage and recent clean syringe utilisation among people who inject drugs. Better planning is required to ensure harm reduction programme sustainability is at scale after donor withdrawal.
Assuntos
Programas de Troca de Agulhas/economia , Programas de Troca de Agulhas/estatística & dados numéricos , Agulhas/provisão & distribuição , Abuso de Substâncias por Via Intravenosa/epidemiologia , Seringas/provisão & distribuição , Custos e Análise de Custo , Infecções por HIV/prevenção & controle , Hepatite C/prevenção & controle , Humanos , Estudos Longitudinais , México/epidemiologia , Agulhas/economia , Seringas/economiaRESUMO
INTRODUCTION: Risks of endotracheal tube cuff (ETTC) over inflation must be balanced with the need to achieve a minimum pressure of 20 cm H2 O. Methods have been developed to estimate adequate ETTC pressurization but do not provide accurate endotracheal tube cuff pressure (ETCP) measurements. Hence, different sized syringes may play a role in determining ETCP. OBJECTIVES: Determine optimal syringe size for recommended ETCP. METHODS: Two hundred patients were randomized to use of either a 10-mL syringe (standard syringe) or a 5-mL syringe (study group) for ETTC inflation. Following the insertion of the endotracheal tube, the ETTC was inflated per the attending anesthesiologist. Within 10 minutes of intubation, ETCP was measured with a hospital-provided manometer. RESULTS: The percentage of in range cuff pressures for the 5-mL group was 10.53% and 6.78% for the 10-mL group. 84.21% (n = 64) of the study group and 91.53% (n = 54) of the control group had cuff pressures exceeding 30 cmH2 O. Although our study did not demonstrate that syringe size was predictive of ideal cuff pressure ranges, the average cuff pressure for the 5-mL group was 55.8 cm H2 O versus 68.8 cm H2 O in the 10-mL group. CONCLUSION: Although both 5- and 10-mL syringes resulted in elevated cuff pressures after intubation, 5-mL syringes resulted in a lower degree of elevation. Use of a 5-mL syringe should be considered when inflating the endotracheal cuff to possibly reduce patient harm secondary to elevated cuff pressures. Further studies assessing smaller syringe sizes to reduce cuff pressures are warranted.
Assuntos
Manuseio das Vias Aéreas/instrumentação , Intubação Intratraqueal/instrumentação , Pressão/efeitos adversos , Seringas/normas , Traqueia/anatomia & histologia , Adulto , Idoso , Manuseio das Vias Aéreas/métodos , Anestesiologistas , Desenho de Equipamento , Feminino , Humanos , Intubação Intratraqueal/métodos , Masculino , Manometria/instrumentação , Pessoa de Meia-Idade , Assistência Perioperatória/normas , Seringas/provisão & distribuição , Traqueia/cirurgia , Prega Vocal/anatomia & histologia , Prega Vocal/cirurgiaRESUMO
INTRODUCTION: Intravenous medication errors (MEs) occur during medical emergency situations. An initiative, not yet in common practice, that could address these errors is safety labeling. The aim of this review was to identify and appraise research evidence related to the impact of user-applied medication safety labeling on reducing the incidence of MEs during rapid medical response intervention for patient deterioration in the ward setting. METHODS: A systematic search and review framework was used to conduct the review. A comprehensive database search was conducted of BioMed Central, Clinical Trials, Cumulative Index to Nursing and Allied Health Literature, Expanded Academic ASAP, Joanna Briggs Institute, MEDLINE, OVID, ProQuest Central, PubMed, Wiley Online Library, and World Health Organization Library. The Young and Solomon (2009) critical appraisal tool was used to critically appraise the identified research articles. Each article was then analyzed using a thematic network strategy to identify commonality. RESULTS: Four primary themes were identified; they were as follows: MEs occur during medical emergency responses (MERs); MEs occur throughout the medication administration process; MERs are stressful and are associated with MEs; and role of medication labeling in reducing MEs during MERs. DISCUSSION: Greater vigilance is required by health professionals during the medication administration process. The implementation of specific medication safety labeling into the MER could be beneficial in reducing the overall incidence of MEs. Further research is required to validate the merits of a MER medication safety labeling system.
Assuntos
Administração Intravenosa/métodos , Equipe de Respostas Rápidas de Hospitais/normas , Seringas/provisão & distribuição , Atenção à Saúde , Humanos , Incidência , Erros de MedicaçãoRESUMO
BACKGROUND: Increased access to sterile syringes has been shown to reduce HIV risk among people who inject drugs (PWID). Where syringe services programs (SSPs) are limited, pharmacies are an important sterile syringe source. We assessed factors associated with using pharmacies as the primary source of syringes among PWID from 20 US cities. METHODS: PWID ages ≥18 years were recruited for the 2015 National HIV Behavioral Surveillance using respondent-driven sampling. Using generalized estimating equation (GEE) models, we assessed demographic characteristics independently associated with participant-reported primary syringe source: pharmacies vs. SSPs. We calculated associations between primary syringe source and various behavioural outcomes, adjusted for participant characteristics. RESULTS: PWID who were <30 years old, female, white, and less frequent injectors were more likely have used pharmacies as their primary syringe source. Accessing syringes primarily from pharmacies, as compared to SSPs, was associated with receptive syringe sharing and unsafe syringe disposal; using sterile syringes, recent HIV testing and participation in an HIV behavioural intervention were negatively associated with primary pharmacy use. CONCLUSIONS: Pharmacies can play an important role in comprehensive HIV prevention among PWID. Linkage to HIV interventions and syringe disposal services at pharmacies could strengthen prevention efforts for PWID who cannot access or choose not to utilize SSPs.
Assuntos
Infecções por HIV/prevenção & controle , Uso Comum de Agulhas e Seringas/estatística & dados numéricos , Assistência Farmacêutica/estatística & dados numéricos , Abuso de Substâncias por Via Intravenosa/epidemiologia , Seringas/provisão & distribuição , Adulto , Cidades/epidemiologia , Cidades/estatística & dados numéricos , Feminino , Infecções por HIV/epidemiologia , Humanos , Masculino , Programas de Troca de Agulhas , Farmácias , Estados Unidos/epidemiologia , Adulto JovemRESUMO
OBJECTIVE: This review was undertaken to review epinephrine dosing, site and route of administration, focusing on special populations (patients weighing less than 15 kg, and obese patients); and to discuss storage and delivery of epinephrine in prehospital and hospital settings. DATA SOURCES: Review of published literature. STUDY SELECTION: Relevance. RESULTS: The recommended 0.01-mg/kg (maximum 0.3-0.5 mg) epinephrine dose in anaphylaxis is based on limited pharmacokinetic data in healthy volunteers. No pharmacokinetic or pharmacodynamics studies involving patients in anaphylaxis have been published. When epinephrine auto-injectors (EAIs) are used in infants, the dose increasingly exceeds the recommended dose as weight decreases, although the clinical significance of this is unclear. Limited data indicate that the intramuscular route and lateral thigh site are superior. Ultrasound studies suggest that 0.15 EAI needles may be too long for many patients weighing less than 15 kg, and 0.3 mg EAI needles may be too short for obese patients weighing more than 30 kg. A newly available 0.1 mg EAI has a lower dose and shorter needle better suited to patients weighing 7.5 to 15 kg. In some medical settings, vials and syringes may provide a safe, efficient alternative with substantial cost savings over EAIs. CONCLUSION: EAIs should be available in the community with doses and needle depths that meet the needs of all patients. More research on epinephrine pharmacodynamics are needed in children and adults in anaphylaxis, to better delineate what optimal doses should be. Optimizing epinephrine dose and delivery has the potential to improve anaphylaxis outcomes and prevent adverse events.
Assuntos
Agonistas Adrenérgicos/farmacocinética , Anafilaxia/tratamento farmacológico , Epinefrina/farmacocinética , Autoadministração/instrumentação , Adolescente , Adulto , Anafilaxia/fisiopatologia , Peso Corporal , Criança , Pré-Escolar , Relação Dose-Resposta a Droga , Esquema de Medicação , Cálculos da Dosagem de Medicamento , Humanos , Lactente , Injeções Intramusculares/métodos , Agulhas/provisão & distribuição , Seringas/provisão & distribuiçãoRESUMO
BACKGROUND: Recent work by McCormack et al. (2016) showed that the inclusion of syringe stockpiling improves the measurement of individual-level syringe coverage. We explored whether including the use of a new parameter, multiple sterile syringes per injecting episode, further improves coverage measures. METHODS: Data comes from 838 people who inject drugs, interviewed as part of the 2015 Illicit Drug Reporting System. Along with syringe coverage questions, the survey recorded the number of sterile syringes used on average per injecting episode. We constructed three measures of coverage: one adapted from Bluthenthal et al. (2007), the McCormack et al. measure, and a new coverage measure that included use of multiple syringes. Predictors of multiple syringe use and insufficient coverage (<100% of injecting episodes using a sterile syringe) using the new measure, were tested in logistic regression and the ability of the measures to discriminate key risk behaviours was compared using ROC curve analysis. RESULTS: 134 (16%) participants reported needing multiple syringes per injecting episode. Women showed significantly increased odds of multiple syringe use, as did those reporting injection related injuries/diseases and injecting of opioid substitution drugs or pharmaceutical opioids. Levels of insufficient coverage across the three measures were substantial (20%-28%). ROC curve analysis suggested that our new measure was no better at discriminating injecting risk behaviours than the existing measures. CONCLUSION: Based on our findings, there appears to be little need for adding a multiple syringe use parameter to existing coverage formulae. Hence, we recommend that multiple syringe use is not included in the measurement of individual-level syringe coverage.
Assuntos
Programas de Troca de Agulhas/estatística & dados numéricos , Agulhas/provisão & distribuição , Abuso de Substâncias por Via Intravenosa/epidemiologia , Seringas/provisão & distribuição , Adolescente , Adulto , Idoso , Analgésicos Opioides/administração & dosagem , Feminino , Humanos , Entrevistas como Assunto , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Agulhas/estatística & dados numéricos , Tratamento de Substituição de Opiáceos/estatística & dados numéricos , Assunção de Riscos , Fatores Sexuais , Seringas/estatística & dados numéricos , Adulto JovemRESUMO
Nevada's pilot vending machine program encourages users to enter treatment programs.