A wound care and immunization needs assessment for participants of a mobile syringe services program in Austin, TX.

BACKGROUND: People who inject drugs (PWID) are subject to injection-related harm, including skin and soft tissue infections. Syringe services programs (SSPs) provide sterile syringes, disposal of used syringes, and other supportive services. Given their contact and credibility with PWID, SSPs could facilitate triage and treatment of wounds and access to immunizations for communicable diseases. OBJECTIVE: This work aimed to assess wound care and immunization needs among participants accessing mobile SSP services in Austin, TX. METHODS: A 21-item mixed-methods survey was created to assess frequency and severity of wounds, wound care approaches, and vaccination status. Participants were included if they reported injection drug use and experienced a related wound in the previous 6 months. Interview sections included screening, demographics, wound care, and immunization status. RESULTS: A total of 21 participants completed the semistructured interview. A majority identified as male (n = 13, 61.9%), white (n = 12, 57.1%), and were unhoused (n = 12, 57.1%). The primary drug of injection was heroin alone (n = 14, 66.7%). Many avoided seeking wound care from health care providers (n = 16, 76.2%) owing to stigmatization (n = 13, 61.9%) and previous negative experiences (n = 7, 33.3%). Self-treatment of wounds included over-the-counter medications (n = 10, 47.6%), over-the-counter supplies (n = 10, 47.6%), and antibiotics (n = 9, 42.8%). In the past 5 years, few had received vaccination for hepatitis A and B (n = 3, 14.3%) or tetanus (n = 7, 33.3%), and many expressed interest in receiving vaccinations through the SSP. Interest for other expanded services included access to antibiotics, an on-site provider, wound care supplies, and education. CONCLUSIONS: PWID may avoid professional health care for wound care or immunizations owing to perceived stigma. Expanding availability of wound care services and immunizations directly through mobile SSPs is desired by participants and could positively affect public health.

Availability of buprenorphine/naloxone films and naloxone nasal spray in community pharmacies in Texas, USA.

BACKGROUND AND AIMS: Patients with opioid use disorder (OUD) must be able to obtain prescribed buprenorphine/naloxone films (BUP/NX) and naloxone nasal spray (NNS) from a pharmacy promptly to reduce risk for a recurrence of use and subsequent morbidity and mortality. Telephone audits have identified concerning gaps in availability of NNS within US pharmacies, but the availability of BUP/NX has not been rigorously evaluated. This study estimated the availability of BUP/NX and NNS in the US state of Texas and compared availability by pharmacy type and metropolitan status. DESIGN: A cross-sectional telephone audit with a secret shopper approach conducted from 18 May 2020 to 7 June 2020. Setting and Participants A random sample of 800 of 5078 (16%) community pharmacies licensed with the Texas State Board of Pharmacy. MEASUREMENTS: Primary outcomes included availability of a 1-week supply of generic BUP/NX 8/2 mg films and a single unit of NNS 4 mg, overall and by pharmacy type. Secondary outcomes included willingness and estimated time-frame to order BUP/NX if unavailable. FINDINGS: Data from 704 pharmacies (471 chain, 233 independent) were included for analyses. Of these, 34.1% of pharmacies (45.0% of chains versus 12.0% of independents, P < 0.0001) were willing and able to dispense a 1-week supply of generic BUP/NX and a single unit of NNS. BUP/NX alone was available in 42.2% of pharmacies (52.4% of chains versus 21.5% of independents, P < 0.0001). NNS alone was available in 60.1% of pharmacies (77.9% of chains versus 24.0% of independents, P < 0.0001). Of the 397 pharmacies with generic BUP/NX unavailable, 62.2% of pharmacies (73.9% of chains versus 48.0% of independents, P < 0.0001) indicated willingness to order. CONCLUSIONS: Most pharmacies in Texas do not appear to be willing and able to dispense prescribed buprenorphine/naloxone films and naloxone nasal spray to patients with opioid use disorder in a timely manner. Deficiencies in availability are markedly more pronounced in independent pharmacies compared with chain pharmacies.

Pharmacists are missing an opportunity to save lives and advance the profession by embracing opioid harm reduction.

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.