Pharmacies as providers of expanded health services for people who inject drugs: a review of laws, policies, and barriers in six countries.

BACKGROUND: People who inject drugs (PWID) are underserved by health providers but pharmacies may be their most accessible care settings. METHODS: Studies in the U.S., Russia, Vietnam, China, Canada and Mexico employed a three-level (macro-, meso-, and micro-) model to assess feasibility of expanded pharmacy services for PWID. Studies employed qualitative and quantitative interviews, review of legal and policy documents, and information on the knowledge, attitudes, and practices of key stakeholders. RESULTS: Studies produced a mixed assessment of feasibility. Provision of information and referrals by pharmacies is permissible in all study sites and sale and safe disposal of needles/syringes by pharmacies is legal in almost all sites, although needle/syringe sales face challenges related to attitudes and practices of pharmacists, police, and other actors. Pharmacy provision of HIV testing, hepatitis vaccination, opioid substitution treatment, provision of naloxone for drug overdose, and abscess treatment, face more serious legal and policy barriers. DISCUSSION: Challenges to expanded services for drug users in pharmacies exist at all three levels, especially the macro-level characterized by legal barriers and persistent stigmatization of PWID. Where deficiencies in laws, policies, and community attitudes block implementation, stakeholders should advocate for needed legal and policy changes and work to address community stigma and resistance. Laws and policies are only as good as their implementation, so attention is also needed to meso- and micro- levels. Policies, attitudes, and practices of police departments and pharmacy chains as well as knowledge, attitudes, and practices of individual PWID, individual pharmacies, and police officers should support rather than undermine positive laws and expanded services. Despite the challenges, pharmacies remain potentially important venues for delivering health services to PWID.

The feasibility of pharmacy-based naloxone distribution interventions: a qualitative study with injection drug users and pharmacy staff in Rhode Island.

This study analyzed qualitative data from a Rapid Policy Assessment and Response project to assess the feasibility of a potential pharmacy-based naloxone intervention to reduce opioid overdose mortality among injection drug users (IDUs). We conducted in-depth, semistructured interviews with 21 IDUs and 21 pharmacy staff (pharmacists and technicians). Although most participants supported the idea of a pharmacy-based naloxone intervention, several barriers were identified, including misinformation about naloxone, interpersonal relationships between IDUs and pharmacy staff, and costs of such an intervention. Implications for future pharmacy-based overdose prevention interventions for IDUs, including pharmacy-based naloxone distribution, are considered. The study's limitations are noted.

Reported experiences during syringe purchases in Providence, Rhode Island: implications for HIV prevention.

Use of injection drugs remains a public health concern, with injection drug users (IDUs) experiencing an elevated risk of morbidity and mortality. While the sale of non-prescription syringes in pharmacies is legal in most states, some pharmacists choose not to sell non-prescription syringes, or opt to sell syringes in quantities too large for purchase by many IDUs. Thus, we sought to understand the interpersonal experience of syringe sale/ purchase, the implications of policies regarding syringe sales, and pharmacy staff and IDU (mis)perceptions about one another. We conducted in-depth, semi-structured interviews with 21 IDUs and 21 pharmacy staff (pharmacists and pharmacy technicians). Some important emergent themes were that individual experiences influenced overall perceptions, that IDUs and pharmacy staff differentiated between IDUs and other customers, and that some pharmacy staff demonstrated an understanding of the public health importance of accessible sterile syringes. Implications for future pharmacy-based interventions for IDUs are considered.