Effectiveness of pharmacy‐based needle/syringe exchange programme for people who inject drugs: a systematic review and meta‐analysis

Sawangjit, Ratree; Khan, Tahir Mehmood; Chaiyakunapruk, Nathorn

doi:10.1111/add.13593

Cited by 60 publications

(52 citation statements)

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“…A recently published systematic review with meta-analysis of pharmacy-based NEP demonstrated a 74% reduction in the odds of HCV infection (OR = 0.26, 95% CI, 0.18, 0.38) associated with pharmacy-based NEP participation [23]. However, the authors cautioned that this finding was unclear due to the very small number of included studies ( n = 2) and significant bias concerns.…”

Section: Discussionmentioning

confidence: 99%

“…However, included studies only examined structural and population level interventions, as opposed to the association between individual use of NEPs and HCV infection. Finally, a recently published systematic review with meta-analysis by Sawangiit et al [23] examined the effectiveness of pharmacy-based NEPs for PWIDs. However, in addition to specifically focusing on pharmacy-based NEPs, which may not always exchange needles [24], this study only examined the impact of these programs on the prevalence of HCV versus the prevention of new infections (incidence).…”

Section: Introductionmentioning

confidence: 99%

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Needle exchange programs for the prevention of hepatitis C virus infection in people who inject drugs: a systematic review with meta-analysis

et al. 2017

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BackgroundPrevious research on the effectiveness of needle exchange programs (NEP) in preventing hepatitis C virus (HCV) in people who inject drugs (PWID) has shown mixed findings. The purpose of this study was to use the meta-analytic approach to examine the association between NEP use and HCV prevention in PWIDs.MethodsStudy inclusion criteria were (1) observational studies, (2) PWIDs, (3) NEP use, (4) HCV status ascertained by serological testing, (5) studies published in any language since January 1, 1989, and (6) data available for measures of association. Studies were located by searching four electronic databases and cross-referencing. Study quality was assessed using the Newcastle Ottawa (NOS) scale. A ratio measure of association was calculated for each result from cohort or case–control studies and pooled using a random effects model. Odds ratio (OR) and hazard ratio (HR) models were analyzed separately. Results were considered statistically significant if the 95% confidence interval (CI) did not cross 1. Heterogeneity was estimated using Q and I 2 with alpha values for Q ≤ 0.10 considered statistically significant.ResultsOf the 555 citations reviewed, 6 studies containing 2437 participants were included. Studies had an average NOS score of 7 out of 9 (77.8%) stars. Concerns over participant representativeness, unclear adjustments for confounders, and bias from participant nonresponse and loss to follow-up were noted. Results were mixed with the odds ratio model indicating no consistent association (OR, 0.51, 95% CI, 0.05–5.15), and the hazard ratio model indicating a harmful effect (HR, 2.05, 95% CI, 1.39–3.03). Substantial heterogeneity (p ≤ 0.10) and moderate to large inconsistency (I 2 ≥ 66%) were observed for both models.ConclusionsThe impact of NEPs on HCV prevention in PWIDs remains unclear. There is a need for well-designed research studies employing standardized criteria and measurements to clarify this issue.Trial registrationPROSPERO CRD42016035315 Electronic supplementary materialThe online version of this article (doi:10.1186/s12954-017-0156-z) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Needle exchange programs for the prevention of hepatitis C virus infection in people who inject drugs: a systematic review with meta-analysis

et al. 2017

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Commentary on Sawangjit et al (2017): There is still much to be determined before policy makers can choose pharmacy needle and syringe programmes (NSP) confidently over other models of NSP provision A greater understanding of the modifiable factors that promote or hinder the outcomes of pharmacy needle and syringe programmes is needed to allow those who develop and commission such services to maximize outcomes and obtain the best return from investment.Across low-, middle-and high-income countries, pharmacies are a widespread feature of cities, towns, suburbs and rural areas. Pharmacies are often easily accessible, open long hours, support a range of health-care needs and provide anonymity to users.

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confidence: 99%

“…Commentary on Sawangjit et al (2017): There is still much to be determined before policy makers can choose pharmacy needle and syringe programmes (NSP) confidently over other models of NSP provision A greater understanding of the modifiable factors that promote or hinder the outcomes of pharmacy needle and syringe programmes is needed to allow those who develop and commission such services to maximize outcomes and obtain the best return from investment.…”

mentioning

confidence: 99%

“…It is against this background that pharmacy-based needle and syringe programmes (NSPs) developed in the 1980s. Sawangjit et al [1] demonstrate that people who inject drugs (PWID) and who use pharmacies as a source of injecting equipment report a reduction in risk behaviours (syringe sharing and unsafe disposal) compared to PWID who are not in contact with any NSPs. This evidence provides support for pharmacy NSP, but there is potential for pharmacy NSP to make a greater contribution.…”

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Commentary on Sawangjit et al. (2017): There is still much to be determined before policy makers can choose pharmacy needle and syringe programmes (NSP) confidently over other models of NSP provision

Scott

2017

Addiction

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Commentary on Sawangjit et al. (2017): There is still much to be determined before policy makers can choose pharmacy needle and syringe programmes (NSP) confidently over other models of NSP provision A greater understanding of the modifiable factors that promote or hinder the outcomes of pharmacy needle and syringe programmes is needed to allow those who develop and commission such services to maximize outcomes and obtain the best return from investment.Across low-, middle-and high-income countries, pharmacies are a widespread feature of cities, towns, suburbs and rural areas. Pharmacies are often easily accessible, open long hours, support a range of health-care needs and provide anonymity to users. Overhead and staff costs are met by the owner. It is against this background that pharmacy-based needle and syringe programmes (NSPs) developed in the 1980s. Sawangjit et al. [1] demonstrate that people who inject drugs (PWID) and who use pharmacies as a source of injecting equipment report a reduction in risk behaviours (syringe sharing and unsafe disposal) compared to PWID who are not in contact with any NSPs. This evidence provides support for pharmacy NSP, but there is potential for pharmacy NSP to make a greater contribution. To define this contribution, we need to understand pharmacy NSP in much greater detail.As the authors make clear, the model of injecting equipment provision from pharmacies included in the analysis varied. Pharmacies were either selling, supplying on a one-for-one basis or making unrestricted supply or exchange of syringes. Each of these methods is quite different, and will influence PWID's decisions to make use of services, against a background of what other options exist locally for them, and thus could potentially influence their risk behaviours. For example, the sale of injecting equipment requires PWID to have money to spend on it. Competing factors will be the need to fund drugs and the potential actions needed to acquire money. One-for-one exchange, although potentially free at point of use, does not allow for breakages or secondary supply to others, meaning that there is not enough equipment in circulation. Thus, both sale of syringes and one-for-one supply may limit the impact of pharmacy NSP. Unrestricted supply has the potential to provide greater coverage, but coverage levels need to be determined and compared against one-for-one and sales. Additionally, it is not known what level of coverage was attained in the studies analysed by Sawangjit et al., and we do not know what contribution pharmacy NSP models of supply make to overall coverage in the locality.Users of pharmacy and non-pharmacy NSPs in any one locality are, to some extent, the same people and to some extent different. We need to understand more clearly who uses pharmacy NSPs and under what circumstances they do so. Craine et al. [2] showed that users of pharmacy NSPs tend to report markers of decreased risk compared to users of specialist service NSPs, but more work is needed to understand why this is so. For exampl...

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Pharmacists and the opioid crisis: A narrative review of pharmacists' practice roles

Bratberg

Smothers

Collins

et al. 2019

J Am Coll Clin Pharm

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Introduction Nearly 2.5 million Americans have an opioid use disorder (OUD) related to prescription and/or illicit opioids. Pharmacists, as one of the most accessible care providers, are essential in mitigating the mortality and morbidity of the opioid overdose crisis. Pharmacists are involved in numerous care activities related to this crisis and to caring for patients with an OUD. Objective The objective of this paper was to conduct a literature review to highlight several pharmacist‐driven practices that provide a broad range of prevention, harm reduction, treatment, and recovery services to patients affected or potentially affected by the opioid crisis. Methods Articles had to meet the criteria of describing pharmacist‐led practice related to providing care to patients at risk of an opioid overdose, with an OUD, or related to opioid safety. The literature search was conducted in 2018 and utilized numerous sources including: OneSearch (EBSCOhost), PubMed, ScienceDirect, and the Journal of the American Pharmacists Association Opioid Topic Collection. Results Seven articles were chosen for inclusion in this review. These studies report on innovative programs and practices that describe the role of pharmacists in the opioid crisis. Studies demonstrate the types of involvement pharmacists have in caring for patients throughout the care continuum: actively engaged in upstream interventions aimed at preventing misuse and improve safety; screening and monitoring opioid prescribing and usage; providing access to naloxone; and, assisting in the recovery and rehabilitation process of patients with OUD, including collaboratively managing OUD with evidence‐based pharmacotherapy. Conclusion The studies included in our narrative review demonstrate how innovative programs and practices can expand the role of pharmacists throughout the entire spectrum of interventions applied to the opioid crisis by capitalizing on their existing skill sets and knowledge.

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Effectiveness of pharmacy‐based needle/syringe exchange programme for people who inject drugs: a systematic review and meta‐analysis

Abstract: Pharmacy-based needle/syringe exchange programmes appear to be effective for reducing risk behaviours among people who inject drugs, although their effect on HIV/HCV prevalence and economic outcomes is unclear.

Cited by 60 publications

References 42 publications

Needle exchange programs for the prevention of hepatitis C virus infection in people who inject drugs: a systematic review with meta-analysis

Needle exchange programs for the prevention of hepatitis C virus infection in people who inject drugs: a systematic review with meta-analysis

Commentary on Sawangjit et al. (2017): There is still much to be determined before policy makers can choose pharmacy needle and syringe programmes (NSP) confidently over other models of NSP provision

Pharmacists and the opioid crisis: A narrative review of pharmacists' practice roles

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