I could take the judgment if you could just provide the service: non-prescription syringe purchase experience at Arizona pharmacies, 2018

Abstract

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.

A qualitative study on pharmacy policies toward over-the-counter syringe sales in a rural epicenter of US drug-related epidemics

“…Few studies have explored this topic in rural areas. Most qualitative research on OTC syringe sales in rural areas has focused on PWID experiences with purchasing OTC syringes in pharmacies [ 22 , 33 ] and hints at considerable pharmacy-based barriers to OTC sales. A landmark 2021 quantitative study conducted in three predominately rural US Appalachian states revealed significant differences in pharmacists’ behaviors and perceptions across state lines, suggesting that the political environment fosters some but not all pharmacist engagement in OTC syringe sales [ 20 ].…”

Exploration of pharmacist comfort with harm reduction behaviors: Cross-sectional latent class analysis

“…Pending further study, the differentiation between comfort with a topic (e.g., naloxone) and comfort with an approach (e.g., consultation) may be a meaningful way in which to determine what kinds of education and training can best support pharmacists. injection drug users in Arizona found that all of them had been refused syringe sales at a pharmacy and had experienced stigmatizing interactions with pharmacy staff members 9 ).…”

“…4 Although nonprofits and other organizations have articulated clear principles of harm reduction, 4 defining harm reduction practices and beliefs for research or field-specific practice can be complex. In the pharmacy profession, harm reduction practices have included, but have not been limited to, naloxone dispensing and education for the prevention of overdose, 5e7 pharmacy syringe sales for the prevention of blood-borne infections and other health sequelae, 8,9 and efforts to educate pharmacists about substance use and substance use disorders. 10 A 2016 agreement by 94 schools and colleges of pharmacy supported the use of evidencebased prevention programs grounded in harm reduction, namely, prescription drug monitoring, prescriber education, medication-assisted treatment, safe drug disposal, and overdose prevention through naloxone.…”

Come Back When You’re Sick: Pharmacy Discretion and Access to Preventive Services in an Arizona Secret Shopper Study, 2023

“…A 2018 study found that only 10% of interview participants had been sold syringes without a prescription in community pharmacies in the prior two years (2016-2018), with sales outcome variations at the same pharmacy and pharmacy chain. 25 Sales variation was also observed by pharmacy type in a survey among Arizona pharmacists conducted that same year, in which a majority (75%) of mass merchandizer pharmacies reported dispensing syringes without a prescription in the past two years, compared to 58% of chain pharmacies, 28% of food store pharmacies and 8.3% of independent pharmacies. 26 These ndings suggest the possibility that pharmacy discretion, or pharmacist discretion speci cally, may affect access to sterile syringes in Arizona.…”