Using Pharmacies in a Structural Intervention to Distribute Low Dead Space Syringes to Reduce HIV and HCV Transmission in People Who Inject Drugs

Abstract

Ongoing injection drug use contributes to the HIV and HCV epidemics in people who inject drugs. In many places, pharmacies are the primary source of sterile syringes for people who inject drugs; thus, pharmacies provide a viable public health service that reduces blood-borne disease transmission. Replacing the supply of high dead space syringes with low dead space syringes could have far-reaching benefits that include further prevention of disease transmission in people who inject drugs and reductions in dosing inaccuracies, medication errors, and medication waste in patients who use syringes. We explored using pharmacies in a structural intervention to increase the uptake of low dead space syringes as part of a comprehensive strategy to reverse these epidemics.

Event-level analyses of sex-risk and injection-risk behaviors among nonmedical prescription opioid users

“…Pharmacies are the primary source of syringes for most PWID (39, 40), and almost all retail pharmacies sell both low dead space insulin syringes and high dead space syringes (20). The finding that nonmedical prescription opioid injection was independently associated with sharing a high dead space syringe is consistent with findings from a previous study.…”

Dead space in over-the-counter syringes: The implications for HIV and HCV transmission

“…A proposed strategy to increase LDSS availability is a structural intervention that systematically influences syringe-ordering practices (Oramasionwu, et al, 2015). Ordering of LDS-only products would reduce HDSS inventory and ultimately increase LDSS use by PWID that purchase syringes in the pharmacy.…”

“…A c c e p t e d M a n u s c r i p t 6 Syringe service programs are effective at reducing injection-related risks for PWID, however, they are authorized in only 18 U.S. states (Oramasionwu, Johnson, Zule, Carda-Auten, & Golin, 2015). Even given state regulations, drug paraphernalia laws, and pharmacy-specific syringe sales, all U.S. states, to some extent, permit pharmacy nonprescription sale of syringes (Oramasionwu, et al, 2015).…”

“…Even given state regulations, drug paraphernalia laws, and pharmacy-specific syringe sales, all U.S. states, to some extent, permit pharmacy nonprescription sale of syringes (Oramasionwu, et al, 2015). These "over-the-counter" syringe sales can result in a 4-fold decrease in receptive syringe sharing among PWID, thereby lowering the risk of injection-related disease transmission (Pouget et al, 2005).…”

Usage of low dead space syringes and association with hepatitis C prevalence amongst people who inject drugs in the UK

“…Our study also provides crucial information for interventions aiming to increase the use of LDSS amongst PWID, a few of which have recently been initiated(Huong et al, 2015; Oramasionwu et al, 2015). LDSS use is highly related to the type of drug used and the body site injected into; so to operationalise the World Health Organization guidelines we need needles that meet the needs of all PWID while also minimising their dead space.…”