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Pollini RA, Paquette CE, Slocum S, LeMire D. 'It's just basically a box full of disease'-navigating sterile syringe scarcity in a rural New England state. Addiction 2021; 116:107-115. [PMID: 32415706 DOI: 10.1111/add.15113] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 11/29/2019] [Accepted: 05/13/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND AIMS Injection drug use has increased in non-urban communities in the United States where sterile syringe access is limited. This study aimed to characterize how people who inject drugs in a predominantly rural state navigate syringe scarcity. DESIGN Qualitative study. SETTING New Hampshire (NH), USA. At the time of our study, syringe services programs were illegal in NH but pharmacies could sell ≤ 10 syringes without prescription. PARTICIPANTS/CASES Twenty people aged ≥ 18 years who injected at least once in the past 30 days were recruited through provider referral, street-based recruitment and snowball sampling. MEASUREMENTS Semi-structured interview guide. Verbatim transcripts were coded based on interview guide constructs and emergent themes. Analysis focused on pharmacy syringe access, unofficial syringe sources and related impacts on syringe sharing and reuse FINDINGS: Participants could identify no local pharmacies that sold syringes without prescription. Pharmacy purchase in neighboring counties, or across state lines, required private transportation and this, along with purchaser identification requirements, presented substantial access barriers. Interstate travel also exposed participants to vigilant policing of interstate highways and potential criminal justice involvement. Many participants thus resorted to informal syringe sources closer to home including purchasing syringes on the street, using discarded syringes, breaking into biohazard containers and constructing improvised syringes out of salvaged syringe parts, metals and plastics. Repeated re-use of syringes until they were no longer operational was common. Overall, syringe scarcity gave participants few options but to engage in syringe sharing and re-use, putting them at risk of serious injection-related infections. CONCLUSIONS Limited sterile syringe access contributes to an environment in which people who inject drugs report that they are less able to refrain from risky injection practices.
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Affiliation(s)
- Robin A Pollini
- West Virginia University, Morgantown, WV, USA.,Pacific Institute for Research and Evaluation, Calverton, MD, USA
| | - Catherine E Paquette
- Pacific Institute for Research and Evaluation, Calverton, MD, USA.,University of North Carolina, Chapel Hill, NC, USA
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Pollini RA, Ozga JE, Blanchard D, Syvertsen JL. Consider the Source: Associations between Syringe Sources and Risky Injection Behaviors in California's Central Valley. Subst Use Misuse 2021; 56:2007-2016. [PMID: 34379030 DOI: 10.1080/10826084.2021.1963987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Sterile syringe access is critical to prevent serious viral and bacterial infections among people who inject drugs (PWID) but many areas across the United States lack sufficient access. Although California law allows nonprescription pharmacy syringe sales and syringe services programs (SSPs), access gaps remain in the largely rural Central Valley. OBJECTIVE The purpose of this study was to examine syringe access and related injection behaviors among PWID in Fresno, California. METHODS We used respondent driven sampling to recruit 494 individuals for a survey about syringe access and injection behaviors between April and September 2016. Participants were ≥18 years old and injected at least twice in the past 30 days. Descriptive statistics examined syringe access and logistic regression determined if discrete syringe source categories were significantly associated with syringe sharing and/or reuse. RESULTS A majority (67%) obtained syringes from an authorized source; SSPs were most common (59%), while few reported pharmacy purchase (14%). Unauthorized sources were even more common (79%), primarily friends (64%) or someone on the street (37%). Compared to PWID who used only authorized sources, those using only unauthorized sources had a higher odds of syringe sharing (AOR = 3.40, 95% CI: 1.66, 6.95) and syringe reuse (AOR = 6.22; 95% CI: 2.24, 17.29), as did those who reported mixed sources (AOR = 3.78; 95% CI: 1.90, 7.54 and AOR = 4.64; 95% CI: 2.08, 10.35). CONCLUSIONS Our findings demonstrate a need to expand syringe access in nonurban California to prevent the syringe sharing and reuse that contributes to serious viral and bacterial infections among PWID.
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Affiliation(s)
- Robin A Pollini
- Pacific Institute for Research and Evaluation, Calverton, Maryland, USA.,Department of Behavioral Medicine & Psychiatry, West Virginia University, Morgantown, West Virginia, USA.,Department of Epidemiology, West Virginia University, Morgantown, West Virginia, USA
| | - Jenny E Ozga
- Department of Behavioral Medicine & Psychiatry, West Virginia University, Morgantown, West Virginia, USA
| | | | - Jennifer L Syvertsen
- Department of Anthropology, University of California, Riverside, Riverside, California, USA
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Janulis P, Montgomery BW, Anthony JC. Estimated effect of US state syringe sale policy on source of last-used injection equipment. Int J Drug Policy 2020; 76:102625. [PMID: 31838243 DOI: 10.1016/j.drugpo.2019.102625] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 10/22/2019] [Accepted: 12/03/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Many people who inject drugs (PWID) lack access to a new sterile syringe each time they inject, with increased risk of injection-related harms, including spread of communicable diseases. In the United States (US), restricted access is largely due to state laws and policies regulating syringe access. Our aim in this US-focused study is to estimate variations in syringe acquisition behavior in relation to state-level syringe sale policies, drawing upon self-identified PWID in a nationally representative sample survey. METHODS Estimates were obtained on the source of the last used syringe from participants of the National Survey on Drug Use and Health (NSDUH) years 2002-2011. States were classified as having restricted syringe policies if they had any restriction on the sale of syringes during the study period (e.g., required a prescription or limited the number being sold). RESULTS In states with unrestricted syringe sale policies, PWID were more likely to have obtained their most recently used syringe from a safe source (Difference (%) = 9.8, 95% CI: 1.9, 17.7). This difference was largely driven by a larger percent of injectors obtaining syringes from a pharmacy in unrestricted states (Difference = 20.4, 95% CI: 12.2, 28.6) but was partially offset by fewer injectors obtaining syringes from syringe exchange programs (Difference = -10.7, 95% CI: -16.1, -5.3). CONCLUSION These new findings, taken with other evidence, should help promote removal of policy barriers that now thwart syringe acquisition from a safe source. We hope this additional evidence will provoke policy discussions and may influence regulations that promote public health and reduce the spread of communicable diseases.
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Abstract
The United States is in the midst of a nationwide public health emergency: an epidemic of opioid misuse and abuse that has been called the deadliest drug crisis in American history. This article reviews the current status of the opioid epidemic, the trends over the last 30-40 years that may have contributed to the epidemic, and a population health approach to addressing the epidemic. The epidemic is conceptualized from a population health perspective-an upstream and midstream perspective focusing on prevention and a downstream perspective targeting access to evidence-based interventions and maximizing health whether using or abstaining. Within the context of acute care, this approach will include patient screening for opioid use and other risk factors for addiction, use of opioid-sparing analgesics, and follow-up care that addresses pain and pain relief without opioids. For individuals who need addiction treatment, a gradualism philosophy is put forward. Gradualism recognizes the incremental nature of behavior change and recommends strategies to maximize health and functioning-through harm reduction-at all points along the journey to overcome addiction. Working within communities to address the broad factors that contribute to opioid-related substance use disorder is also essential.
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Affiliation(s)
- Susan Salmond
- Susan Salmond, EdD, RN, ANEF, FAAN, Executive Vice Dean and Professor, School of Nursing, Rutgers, The State University of New Jersey, Newark, NJ, and Research Editor for Orthopaedic Nursing. Virginia Allread, MPH, Executive Assistant, School of Nursing, Rutgers, The State University of New Jersey, Newark, NJ
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5
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Pollini RA. Self-reported participation in voluntary nonprescription syringe sales in California's Central Valley. J Am Pharm Assoc (2003) 2017; 57:677-685. [PMID: 28807658 DOI: 10.1016/j.japh.2017.06.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 05/25/2017] [Accepted: 06/14/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVES California Senate Bill 41 (SB41), effective January 2012, is a human immunodeficiency virus/hepatitis C virus prevention measure designed to expand syringe access among injection drug users (IDUs) by allowing pharmacies to sell syringes without a prescription. This study assesses self-reported implementation of SB41 and characterizes barriers amenable to intervention. DESIGN Interviewer-administered survey. SETTING AND PARTICIPANTS Fresno and Kern Counties, CA. Pharmacists and other pharmacy staff (n = 404) at 212 pharmacies. OUTCOME MEASURE Self-reported nonprescription pharmacy sales to known or suspected IDUs. RESULTS Overall, 29.3% of participants said their pharmacy would sell nonprescription syringes to a known or suspected IDU, whereas a far higher proportion (79.3%) would sell nonprescription syringes to a person with diabetes. More than one-half said that their pharmacy requires nonprescription syringe purchasers to enter their signature and name and address in a log book although that is not required under SB41. Fewer than 2 out of 3 participants (61.1%) knew that it is legal to sell nonprescription syringes to IDUs. That knowledge, as well as having syringe sales practices based on both store policy and discretion, were positively associated with IDU syringe sales after controlling for other factors. Working at an independent pharmacy, agreeing that only people with "medical conditions" such as diabetes should be able to buy syringes, and viewing syringe sales to IDUs as "not good business" were independently but negatively associated with IDU syringe sales. CONCLUSION This study complements an earlier syringe purchase trial documenting low participation in voluntary nonprescription syringe sales under SB41 in Fresno and Kern Counties. In the absence of legislation requiring mandatory syringe sales, interventions should be developed to increase knowledge of the law and frame addiction as a medical condition, with a special focus on independent pharmacies. Informational interventions should stress the need to eliminate log book documentation requirements, which may serve as a barrier to IDU purchase.
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Abstract
OBJECTIVE To assess implementation of California Senate Bill SB41 in two inland California counties where prevalence of injection drug use is among the highest in the nation. DESIGN Syringe purchase trial. SETTING Fresno and Kern counties, California. PARTICIPANTS All 248 community pharmacies in the counties. MAIN OUTCOME MEASURE Successful or unsuccessful syringe purchase attempt. RESULTS Only 52 (21.0%) syringe purchase attempts were successful. The proportion of successful attempts did not vary by county or by data collector ethnicity. The most common reasons for unsuccessful syringe purchase attempts were prescription requirements (45.7%), the requested syringe size was not available (10.7%), and the pharmacy did not sell syringes (9.7%). In addition, some syringe purchase attempts (4.1%) were unsuccessful because the data collector was asked to purchase more syringes than allowed by law. Although 80% and 78% of Fresno and Kern residents, respectively, live within a 5-minute drive of a community pharmacy, less than one-half live within a 5-minute drive of a community pharmacy that sold syringes. CONCLUSION SB41 has not resulted in broad pharmacy-based syringe access in California's inland counties, where a disproportionate number of cases of human immunodeficiency virus (HIV) infections are associated with injection drug use. Additional steps by legislative bodies, regulatory agencies, and professional organizations are needed to actively engage pharmacies in expanding nonprescription syringe sales to reduce HIV transmission among injection drug users.
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Rose VJ, Lutnick A, Kral AH. Feasibility of providing interventions for injection drug users in pharmacy settings: a case study among San Francisco pharmacists. J Psychoactive Drugs 2014; 46:226-32. [PMID: 25052881 DOI: 10.1080/02791072.2014.921745] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
In addition to syringe exchange programs, pharmacies are important venues where injection drug users (IDUs) can access non-prescription syringes and other prevention interventions. This study assessed the feasibility of providing a range of interventions for IDUs in pharmacy settings. Semi-structured qualitative interviews were conducted with 23 participants (policy makers, owner/managers, dispensing pharmacists, and pharmacy staff) from independent and chain/retail pharmacies in San Francisco, California, USA. The highest level of support was for a coupon syringe program and educational materials. Several overarching themes illustrate challenges to implementing pharmacy-based preventive interventions: time, space, sufficient staff, pharmacist training, legal considerations, pharmacist attitudes toward IDUs, and cost and reimbursement issues. This study provides concrete examples of the types of preventive services that pharmacists support and consider feasible, and illustrates that pharmacists welcome the opportunity to broaden their role as critical partners in public health matters related to injection drug use.
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Affiliation(s)
- Valerie J Rose
- a Director of Policy and Evaluation Research, Rose Associates , Public and Community Health Consulting , Oakland , CA
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Abstract
OBJECTIVE To summarize current research findings on pharmacy nonprescription syringe distribution to prevent the spread of human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) among injection drug users (IDUs), including research on pharmacist attitudes and behavior, drug user attitudes and behavior, and the health impact on HIV/AIDS risk behavior. DATA SOURCES Data were collected using PubMed and PsycINFO through July 2011. Search terms used were pharmacist or pharmacy and syringe or syringe exchange or needle or needle exchange. Two journals (Journal of Urban Health and Journal of the American Pharmacists Association) with a high number of hits were manually inspected. Reference sections for each article also were examined. STUDY SELECTION Studies were included if they examined attitudes toward, experiences with, or the impact of pharmacy nonprescription syringe distribution for the purpose of preventing the spread of HIV/AIDS among IDUs in the United States. Studies were excluded that mentioned these topics in passing or did not report empirical results. DATA SYNTHESIS 47 studies were identified that met the inclusion criteria. Studies included a diverse range of perspectives, including pharmacist viewpoints, IDU attitudes, and evaluations. CONCLUSION According to the available literature, many pharmacists express willingness to sell and report selling syringes to customers without a prescription. IDUs show willingness to use pharmacies to obtain syringes. Finally, pharmacy syringe sale and the legalization of this practice appear to have a positive impact on HIV risk behavior. Accordingly, the nonprescription sale of syringe should be promoted. However, the literature remains incomplete and future research is required.
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Affiliation(s)
- Patrick Janulis
- Department of Psychology, Michigan State University, East Lansing, USA.
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Pollini RA, Rosen PC, Gallardo M, Robles B, Brouwer KC, Macalino GE, Lozada R. Not sold here: limited access to legally available syringes at pharmacies in Tijuana, Mexico. Harm Reduct J 2011; 8:13. [PMID: 21609471 PMCID: PMC3121588 DOI: 10.1186/1477-7517-8-13] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Accepted: 05/24/2011] [Indexed: 11/20/2022] Open
Abstract
Background Sterile syringe access is a critical component of HIV prevention programs. Although retail pharmacies provide convenient outlets for syringe access, injection drug users (IDUs) may encounter barriers to syringe purchase even where purchase without a prescription is legal. We sought to obtain an objective measure of syringe access in Tijuana, Mexico, where IDUs report being denied or overcharged for syringes at pharmacies. Methods Trained "mystery shoppers" attempted to buy a 1 cc insulin syringe according to a predetermined script at all retail pharmacies in three Tijuana neighborhoods. The same pharmacies were surveyed by telephone regarding their syringe sales policies. Data on purchase attempts were analyzed using basic statistics to obtain an objective measure of syringe access and compared with data on stated sales policies to ascertain consistency. Results Only 46 (28.4%) of 162 syringe purchase attempts were successful. Leading reasons for unsuccessful attempts were being told that the pharmacy didn't sell syringes (35.3%), there were no syringes in stock (31.0%), or a prescription was required (20.7%). Of 136 pharmacies also surveyed by telephone, a majority (88.2%) reported selling syringes but only one-third (32.5%) had a successful mystery shopper purchase; the majority of unsuccessful purchases were attributed to being told the pharmacy didn't sell syringes. There was similar discordance regarding prescription policies: 74 pharmacies said in the telephone survey that they did not require a prescription for syringes, yet 10 of these pharmacies asked the mystery shopper for a prescription. Conclusions IDUs in Tijuana have limited access to syringes through retail pharmacies and policies and practices regarding syringe sales are inconsistent. Reasons for these restrictive and inconsistent practices must be identified and addressed to expand syringe access, reduce syringe sharing and prevent HIV transmission.
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Affiliation(s)
- Robin A Pollini
- Division of Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA.
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Abstract
At the start of the HIV epidemic, 50% of new infections were among injection drug users (IDUs) in New York City. While HIV has declined among IDUs since the mid-1990s, parenteral transmission continues to overburden Blacks/Hispanic IDUs. Individual risk behaviors do not explain the distribution of HIV/AIDS among IDUs. Social and/or structural factors are likely fueling racial disparities creating a high-risk socioenvironmental context. While increased access to structural interventions (i.e., syringe exchange and pharmacy syringe access) is needed, it may not be sufficient to eliminate HIV/AIDS disparities among IDUs. Research on incorporating structural factors into intervention strategies is needed.
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Affiliation(s)
- Silvia Amesty
- Center for Family and Community Medicine, College of Physicians and Surgeons, Columbia University, New York, New York 10032, USA
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11
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Jenness SM, Hagan H, Liu KL, Wendel T, Murrill CS. Continuing HIV risk in New York City injection drug users: the association of syringe source and syringe sharing. Subst Use Misuse 2011; 46:192-200. [PMID: 21303239 PMCID: PMC4797646 DOI: 10.3109/10826084.2011.521467] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Sterile syringe access is an important means to reduce HIV risk, but many injection drug users (IDU) who obtain syringes from sterile sources continue to share syringes. We examined the factors associated with continuing syringe sharing in New York City. We recruited 500 active IDU in 2005 through respondent-driven sampling. In multiple logistic regression, not obtaining all syringes in the past year exclusively from sterile sources was associated with increased syringe sharing. Ensuring adequate syringe availability as well as engaging and retaining nonusers and inconsistent users in sterile syringe services may increase sterile syringe access and decrease syringe sharing.
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Affiliation(s)
- Samuel M Jenness
- HIV Epidemiology and Field Services Program, New York City Department of Health and Mental Hygiene, New York, New York 10013, USA.
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Garfein RS, Stopka TJ, Pavlinac PB, Ross A, Haye BK, Riley ED, Bluthenthal RN. Three years after legalization of nonprescription pharmacy syringe sales in California: where are we now? J Urban Health 2010; 87:576-85. [PMID: 20535641 DOI: 10.1007/s11524-010-9463-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
In January 2005, passage of California Senate Bill 1159 enabled California's county or city governments to establish disease prevention demonstration projects (DPDPs) through which pharmacies could subsequently register to legally sell up to 10 syringes to adults without a prescription. California's 61 local health jurisdictions (LHJs) were surveyed annually in 2005-2007 to monitor the progress of DPDP implementation and assess program coverage, facilitators, and barriers. Completed surveys were returned by mail, fax, e-mail, phone, or internet. We analyzed 2007 survey data to describe current DPDP status; data from all years were analyzed for trends in approval and implementation status. By 2007, 17 (27.9%) LHJs approved DPDPs, of which 14 (82.4%) had registered 532 (17.8%) of the 2,987 pharmacies in these 14 LHJs. Although only three LHJs added DPDPs since 2006, the number of registered pharmacies increased 102% from 263 previously reported. Among the LHJs without approved DPDPs in 2007, one (2.3%) was in the approval process, seven (16.3%) planned to seek approval, and 35 (81.4%) reported no plans to seek approval. Of 35 LHJs not planning to seek approval, the top four reasons were: limited health department time (40%) or interest (34%), pharmacy disinterest (31%), and law enforcement opposition (26%). Among eight LHJs pursuing approval, the main barriers were "time management" (13%), educating stakeholders (13%), and enlisting pharmacy participation (13%). The17 LHJs with DPDP represent 52% of California's residents; they included 62% of persons living with HIV and 59% of IDU-related HIV cases, suggesting that many LHJs with significant numbers of HIV cases have approved DPDPs. Outcome studies are needed to determine whether SB 1159 had the desired impact on increasing syringe access and reducing blood-borne viral infection risk among California IDUs.
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Rose VJ, Backes G, Martinez A, McFarland W. Non-prescription syringe sales in California: a qualitative examination of practices among 12 local health jurisdictions. J Urban Health 2010; 87:561-75. [PMID: 20405227 PMCID: PMC2900573 DOI: 10.1007/s11524-010-9445-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Legislation permitting non-prescription syringe sales (NPSS) was passed in 2004 in California as a structural intervention designed to expand access to syringes for injection drug users. As of December 2009, 19 of California's 61 local health jurisdictions (LHJs) have approved policies to authorize pharmacies to sell non-prescription syringes. The legislation faces termination in 2010 if current evaluation efforts fail to demonstrate outcomes defined in the legislation. Using qualitative methods, we examined the systems and procedures associated with implementation; identified facilitators and barriers to implementation among 12 LHJs, and documented the role of public health in initiating and sustaining local programs. We identified consistent activities that led to policy implementation among LHJs and discovered several barriers that were associated with failure to implement local programs. Factors leading to NPSS were public health leadership; an inclusive planning process, marketing the program as a public health initiative; learning from others' efforts, successes, and failures; and identifying acceptable syringe disposal options in advance of program implementation. Health departments that were confronted with political and moral arguments lost momentum and ultimately assigned a lower priority to the initiative citing the loss of powerful public health advocates or a lack of human resources. Additional barriers were law enforcement, elected officials, and pharmacy opposition, and failure to resolve syringe disposal options to the satisfaction of important stakeholders. The lessons learned in this study should provide useful guidance for the remaining LHJs in California without NPSS programs.
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Affiliation(s)
- Valerie J Rose
- Policy and Evaluation Research, Public Health Foundation Enterprises, Inc., c/o 3311 Florida Street, Oakland, CA 94602, USA.
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Riley ED, Kral AH, Stopka TJ, Garfein RS, Reuckhaus P, Bluthenthal RN. Access to sterile syringes through San Francisco pharmacies and the association with HIV risk behavior among injection drug users. J Urban Health 2010; 87:534-42. [PMID: 20526690 PMCID: PMC2900569 DOI: 10.1007/s11524-010-9468-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Increased options for syringe acquisition and disposal have been associated with reductions in high-risk behaviors. This study determined the extent of pharmacy uptake in accessing syringes among injection drug users (IDUs) and estimated associations between pharmacy uptake and safer injection/disposal practices. Two years after the implementation of California's Disease Prevention Demonstration Project, which removed restrictions to non-prescription syringe sales through pharmacies with local authorization, IDUs were recruited through street outreach in San Francisco and interviewed regarding recent syringe acquisition, use, and disposal. The sample of 105 persons included a high proportion of men (67%), people of color (49%), and homeless persons (71%). The most common syringe source was a syringe exchange program (SEP) (80%), with pharmacies being accessed by 39% of respondents. The most commonly cited source of disposal was a SEP (65%), with very few reports of pharmacy disposal (2%). Adjusted analysis showed that unsuccessful attempts to purchase syringes at a pharmacy increased the odds of both injecting with a used syringe and giving away a used syringe. Using a SEP decreased the odds of unsafe injection and disposal practices. Thus, 2 years after the initiation of the California Disease Prevention Demonstration Project, results from this small study suggest that SEPs still provide the majority of syringe distribution and disposal services to San Francisco IDUs; however, pharmacies now augment syringe access. In addition, unsafe injection behavior is reported more often among those who do not use these syringe sources. These results are consistent with prior studies in suggesting that increasing the availability of syringes through SEPs and pharmacies, and developing bridges between them, may further reduce syringe-related risk.
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Affiliation(s)
- Elise D Riley
- Department of Medicine, University of California, San Francisco, CA, USA.
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Cooper EN, Dodson C, Stopka TJ, Riley ED, Garfein RS, Bluthenthal RN. Pharmacy participation in non-prescription syringe sales in Los Angeles and San Francisco counties, 2007. J Urban Health 2010; 87:543-52. [PMID: 20549568 PMCID: PMC2900565 DOI: 10.1007/s11524-010-9483-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Increasing sterile syringe access for injection drug users (IDUs) is one way to prevent HIV and hepatitis C virus (HCV) transmission in this population. In 2005, California Senate Bill 1159 allowed counties to adopt the Disease Prevention Demonstration Project (DPDP). Where enacted, the DPDP allows pharmacies that register with the county to sell up to ten syringes to adults without a prescription. In the current study, we describe pharmacy participation in nonprescription syringe sales (NPSS) in two counties in California and examine factors associated with NPSS. Telephone and in-person interviews were conducted in Los Angeles (LA) and San Francisco (SF) with 238 pharmacies in 2007 (n = 67 in SF; n = 171 in LA). Quantitative survey items captured pharmacy registration with the county, pharmacy policies/practices, episodes and conditions of NPSS and refusals to sell, potential negative consequences of NPSS, and staff attitudes regarding HIV and HCV prevention for IDUs. Overall, 42% of pharmacies reported NPSS (28% in LA and 81% in SF), although only 34% had registered with the county (17% in LA and 76% in SF). Many pharmacies required proof of a medical condition (80% in LA and 30% in SF) and refused NPSS if the customer was a suspected IDU (74% in LA, 33% in SF). Few negative consequences of NPSS were reported. In multivariate logistic regression analysis, we found that the odds of NPSS were significantly higher among pharmacists who thought syringe access was important for preventing HIV among IDUs [adjusted odds ratio (AOR) = 2.95; 95% confidence interval (CI) = 1.10-7.92], were chain pharmacies (AOR = 12.5; 95% CI = 4.55-33.33), and were located in SF (AOR = 4.88; 95% CI = 1.94-12.28). These results suggest that NPSS were influenced by pharmacists' perception. NPSS might be increased through greater educational efforts directed at pharmacists, particularly those in non-chain pharmacies.
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Affiliation(s)
- Erin N Cooper
- Urban Community Research Center, Sociology Department, California State University Dominguez Hills, 1000 East Victoria Street, Carson, CA 90747, USA
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Pollini RA, Lozada R, Gallardo M, Rosen P, Vera A, Macias A, Palinkas LA, Strathdee SA. Barriers to pharmacy-based syringe purchase among injection drug users in Tijuana, Mexico: a mixed methods study. AIDS Behav 2010; 14:679-87. [PMID: 20300820 PMCID: PMC2865643 DOI: 10.1007/s10461-010-9674-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Injection drug users (IDUs) may be denied purchase of sterile syringes even where purchase without a prescription is legal. This study examined barriers to over-the-counter (OTC) syringe purchase among IDUs in Tijuana, Mexico. A quantitative survey and subsequent focus groups were used to quantify barriers to purchase, identify their correlates and provide in-depth exploration of syringe purchase experiences. Of 627 IDUs, 81% purchased a syringe in the past 6 months and 16% were refused or overcharged. Factors independently associated with refusal/overcharging were homelessness, receptive syringe sharing, >5 uses per syringe, and number of lifetime abscesses. Few pharmacies sold syringes to IDUs, who adapted by limiting purchase attempts to pharmacies known to sell syringes consistently. Failed purchases occurred when drug withdrawal required purchase at unusual times or locations, often following release from jail. IDUs reported syringe sharing, syringe reuse, and searching through unsecured medical waste for syringes in response to failed purchase attempts. Interventions to expand OTC syringe sales to IDUs, particularly near detention facilities, will facilitate safer injection practices.
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Affiliation(s)
- Robin A Pollini
- Division of Global Public Health, Department of Medicine, School of Medicine, University of California San Diego, 9500 Gilman Drive, Mailcode 0507, La Jolla, CA 92093, USA.
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Cooper HLF, Bossak BH, Tempalski B, Friedman SR, Des Jarlais DC. Temporal trends in spatial access to pharmacies that sell over-the-counter syringes in New York City health districts: relationship to local racial/ethnic composition and need. J Urban Health 2009; 86:929-45. [PMID: 19911283 PMCID: PMC2791821 DOI: 10.1007/s11524-009-9399-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Pharmacies that sell over-the-counter (OTC) syringes are a major source of sterile syringes for injection drug users in cities and states where such sales are legal. In these cities and states, however, black injectors are markedly less likely to acquire syringes from pharmacies than white injectors. The present analysis documents spatial and temporal trends in OTC pharmacy access in New York City health districts over time (2001-2006) and investigates whether these trends are related to district racial/ethnic composition and to local need for OTC pharmacies. For each year of the study period, we used kernel density estimation methods to characterize spatial access to OTC pharmacies within each health district. Higher values on this measure indicate better access to these pharmacies. "Need" was operationalized using two different measures: the number of newly diagnosed injection-related AIDS cases per 10,000 residents (averaged across 1999-2001), and the number of drug-related hospital discharges per 10,000 residents (averaged across 1999-2001). District sociodemographic characteristics were assessed using 2000 US decennial census data. We used hierarchical linear models (HLM) for descriptive and inferential analyses and investigated whether the relationship between need and temporal trajectories in the Expanded Syringe Access Demonstration Program access varied by district racial/ethnic composition, controlling for district poverty rates. HLM analyses indicate that the mean spatial access to OTC pharmacies across New York City health districts was 12.71 in 2001 and increased linearly by 1.32 units annually thereafter. Temporal trajectories in spatial access to OTC pharmacies depended on both need and racial/ethnic composition. Within high-need districts, OTC pharmacy access was twice as high in 2001 and increased three times faster annually, in districts with higher proportions of non-Hispanic white residents than in districts with low proportions of these residents. In low-need districts, "whiter" districts had substantially greater baseline access to OTC pharmacies than districts with low proportions of non-Hispanic white residents. Access remained stable thereafter in low-need districts, regardless of racial/ethnic composition. Conclusions were consistent across both measures of "need" and persisted after controlling for local poverty rates. In both high- and low-need districts, spatial access to OTC pharmacies was greater in "Whiter" districts in 2001; in high-need districts, access also increased more rapidly over time in "whiter" districts. Ensuring equitable spatial access to OTC pharmacies may reduce injection-related HIV transmission overall and reduce racial/ethnic disparities in HIV incidence among injectors.
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Affiliation(s)
- Hannah L F Cooper
- Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
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Pollini RA, Brouwer KC, Lozada RM, Ramos R, Cruz MF, Magis-Rodriguez C, Case P, Burris S, Pu M, Frost SDW, Palinkas LA, Miller C, Strathdee SA. Syringe possession arrests are associated with receptive syringe sharing in two Mexico-US border cities. Addiction 2008; 103:101-8. [PMID: 18028520 PMCID: PMC2214830 DOI: 10.1111/j.1360-0443.2007.02051.x] [Citation(s) in RCA: 109] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS To identify factors associated with receptive syringe sharing among injection drug users (IDUs) and elucidate the association between syringe possession arrests and syringe sharing. DESIGN Cross-sectional study. SETTING Mexican border cities of Tijuana, Baja California and Ciudad Juarez, Chihuahua. PARTICIPANTS IDUs in Tijuana (n = 222) and Ciudad Juarez (n = 206) were recruited using respondent-driven sampling (RDS). IDUs were > or = 18 years and had injected illicit drugs in the past month. MEASUREMENTS An interviewer-administered survey was used to collect quantitative data on socio-demographic, behavioral and contextual characteristics, including self-reported syringe sharing and arrests for syringe possession. Associations with receptive syringe sharing were investigated using logistic regression with RDS adjustment. FINDINGS Overall, 48% of participants reported ever being arrested for carrying an unused/sterile syringe, even though syringe purchase and possession is legal in Mexico. Arrest for possessing unused/sterile syringes was associated independently with receptive syringe sharing [adjusted odds ratio (AOR) = 2.05; 95% confidence interval (CI): 1.26, 3.35], as was injecting in a shooting gallery (AOR = 3.60; 95% CI: 2.21, 5.87), injecting in the street (AOR = 2.05; 95% CI: 1.18, 3.54) and injecting methamphetamine (AOR = 2.77; 95% CI: 1.41, 5.47) or cocaine (AOR = 1.96; 95% CI: 1.15, 3.36). More than half of participants (57%) had been arrested for possessing a used syringe; in a second model, arrest for used syringe possession was also associated independently with receptive sharing (AOR = 2.87; 95% CI: 1.76, 4.69). CONCLUSIONS We documented high levels of syringe-related arrests in two Mexican-US border cities and an independent association between these arrests and risky injection practices. Public health collaborations with law enforcement to modify the risk environment in which drug use occurs are essential to facilitate safer injection practices.
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Affiliation(s)
| | | | | | - Rebeca Ramos
- United States-Mexico Border Health Association, USA
| | | | | | | | | | - Minya Pu
- School of Medicine, University of California San Diego, USA
| | | | - Lawrence A. Palinkas
- School of Medicine, University of California San Diego, USA,University of Southern California, USA
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Bluthenthal RN, Ridgeway G, Schell T, Anderson R, Flynn NM, Kral AH. Examination of the association between syringe exchange program (SEP) dispensation policy and SEP client-level syringe coverage among injection drug users. Addiction 2007; 102:638-46. [PMID: 17286637 DOI: 10.1111/j.1360-0443.2006.01741.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To determine whether syringe exchange programs' (SEPs) dispensation policy is associated with syringe coverage among SEP clients. DESIGN Cross-sectional samples of SEPs and their clients. SETTING SEPs in California, USA. PARTICIPANTS Twenty-four SEPs and their injection drug using (IDU) clients (n = 1576). MEASUREMENTS Clients were classified as having adequate syringe coverage if they received at least as many syringes from the SEP as their self-reported injections in the last 30 days. SEPs were classified based on their syringe dispensation policy. Dispensation schemes ranging from least restrictive to most are: unlimited needs-based distribution; unlimited one-for-one exchange plus a few additional syringes; per visit limited one-for-one plus a few additional syringes; unlimited one-for-one exchange; and per visit limited one-for-one exchange. FINDINGS Adequate syringe coverage among SEP clients by dispensation policy is as follows: unlimited needs-based distribution = 61%; unlimited one-for-one plus = 50%; limited one-for-one plus = 41%; unlimited one-for-one = 42%; and limited one-for-one = 26%. In multivariate analysis, adequate syringe coverage was significantly higher for all dispensation policies compared to per visit limited one-for-one exchange. Using propensity scoring methods, we compared syringe coverage by dispensation policies while controlling for client-level differences. Providing additional syringes above one-for-one exchange (50% versus 38%, P = 0.009) and unlimited exchange (42% versus 27%, P = 0.05) generally resulted in more clients having adequate syringe coverage compared to one-for-one exchange and per visit limits. CONCLUSION Providing less restrictive syringe dispensation is associated with increased prevalence of adequate syringe coverage among clients. SEPs should adopt syringe dispensation policies that provide IDUs sufficient syringes to attain adequate syringe coverage.
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Affiliation(s)
- Ricky N Bluthenthal
- Health Program and Drug Policy Research Center, RAND Corporation, 1776 Main Street, Santa Monica, CA 90407, USA.
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Stoltz JA, Wood E, Small W, Li K, Tyndall M, Montaner J, Kerr T. Changes in injecting practices associated with the use of a medically supervised safer injection facility. J Public Health (Oxf) 2007; 29:35-9. [PMID: 17229788 DOI: 10.1093/pubmed/fdl090] [Citation(s) in RCA: 116] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Injection drug users (IDUs) are vulnerable to serious health complications resulting from unsafe injection practices. We examined whether the use of a supervised safer injection facility (SIF) promoted change in injecting practices among a representative sample of 760 IDUs who use a SIF in Vancouver, Canada. Consistent SIF use was compared with inconsistent use on a number of self-reported changes in injecting practice variables. More consistent SIF use is associated with positive changes in injecting practices, including less reuse of syringes, use of sterile water, swabbing injection sites, cooking/filtering drugs, less rushed injections, safe syringe disposal and less public injecting.
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Affiliation(s)
- Jo-Anne Stoltz
- Clinical Activities, British Columbia Centre of Excellence in HIV/AIDS, University of British Columbia, Vancouver, Canada.
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Parviz S, Fatmi Z, Altaf A, McCormick JB, Fischer-Hoch S, Rahbar M, Luby S. Background demographics and risk behaviors of injecting drug users in Karachi, Pakistan. Int J Infect Dis 2006; 10:364-71. [PMID: 16793307 DOI: 10.1016/j.ijid.2005.07.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2005] [Revised: 06/28/2005] [Accepted: 07/08/2005] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To find the prevalence of HIV infection and risk behaviors among injecting drug users (IDUs) in Karachi, Pakistan. DESIGN A cross-sectional study of IDUs conducted in Karachi, Pakistan from February through June 1996. RESULTS Of the 242 IDUs, 11 (4%) refused HIV testing. One (0.4%; 95% confidence interval (CI) = 0.37-0.48%) was HIV positive. All subjects were male. Over the past 6 months 47% had engaged in receptive needle sharing, 38% had perceived a change in their social network, 22% had had sexual intercourse, of whom only 7% always used condoms, and none had washed their needles with bleach. Younger age (28 vs. 31 years; p = 0.01), younger age at first injection (25 vs. 28 years; p = 0.001), fewer years of schooling (3 vs. 5 years; p = 0.001), lower monthly income (70 dollars vs. 80 dollars; p = 0.03), inhaling fumes of heroin from a foil in the year before injecting (OR = 4.8; CI = 2.2-10.3), injecting first time with heroin (OR = 3.6; CI = 1.2-12.6), having a temporary job (OR = 2.5; CI = 1.2-5.2), and a perceived change in one's social network (OR = 4.4; CI = 2.4-7.9) were all associated with receptive needle sharing. IDUs who knew about HIV spread through contaminated needles were less likely to share (OR = 0.4; CI 0.2-0.8). In the final logistic regression model receptive needle sharing was associated with inhaling of fumes of heroin on a foil in the year prior to injecting (adjusted OR = 5.6; CI = 2.6-12.0), a perceived change in one's social network (adjusted OR = 4.0; CI = 2.2-7.4), and inversely associated with age at first time of injection (beta = -0.07; p = 0.002). CONCLUSION Background HIV prevalence was low among IDUs in Karachi despite high-risk behavior in 1996. In order to control HIV transmission among IDUs in Pakistan, continual HIV surveillance with well-coordinated and effective HIV risk reduction, and drug demand reduction programs need to be implemented among drug users.
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Affiliation(s)
- Shehzad Parviz
- Community Health Sciences Department, The Aga Khan University, Karachi, Pakistan.
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Abstract
Although much of the debate surrounding the distribution of sterile syringes to injection drug users (IDUs) has focused on needle exchange programs (NEPs), IDUs acquire their syringes from three major sources: NEPs, pharmacies, and secondary exchangers or needle sellers. The purpose of the present study is to examine types and frequencies of social interactions among drug injectors who sell needles, most of which come from NEPs, compared with individuals who do not sell needles. Specifically, we compared engagement in drug-related behaviors, roles in the drug economy, and social network membership. Data were collected as part of the SHIELD study, an HIV prevention intervention targeted at drug users and their social networks (n=910) from February 2001 through September 2003 in Baltimore, Maryland (USA). In this sample, 56 participants reported selling needles. Needle sellers had higher levels of engagement in drug-related social interactions, including using drugs with others, giving or receiving drugs from others, and buying drugs with other users. Participants who sold needles had a significantly higher number of roles in the drug economy. Also, they had more social network members who were injectors, with whom they talked about risky drug behaviors, gave needles to, and shared cookers and bleach with. Compared with nonselling injectors, needle sellers engage in HIV risk-related behaviors, such as injecting daily and sharing injection equipment, more frequently. The study's findings may be useful to determine whether secondary exchangers should be targeted for HIV prevention activities both to reduce their own risk and to diffuse risk reduction information throughout the drug using community.
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Affiliation(s)
- Carl A Latkin
- Faculty of Social and Behavioral Sciences, Department of Health Policy and Management, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD 21205, USA.
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Pouget ER, Deren S, Fuller CM, Blaney S, McMahon JM, Kang SY, Tortu S, Andia JF, Des Jarlais DC, Vlahov D. Receptive Syringe Sharing Among Injection Drug Users in Harlem and the Bronx During the New York State Expanded Syringe Access Demonstration Program. J Acquir Immune Defic Syndr 2005; 39:471-7. [PMID: 16010172 DOI: 10.1097/01.qai.0000152395.82885.c0] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Effective on January 1, 2001, New York State enacted the Expanded Syringe Access Demonstration Program (ESAP), which allows syringes to be sold in pharmacies without a prescription or dispensed through doctors, hospitals, and clinics to persons 18 years of age or older and permits the possession of those syringes for the purposes of injecting drugs. OBJECTIVE To assess changes in receptive syringe sharing since the inception of the ESAP. METHODS Sociodemographic characteristics and syringe use data regarding the last injection episode were combined from 3 projects (n = 1181) recruiting injection drug users in ongoing studies in Harlem and the Bronx in New York City from January 2001 through June 2003. These data were analyzed as serial cross sections by calendar quarter. RESULTS Receptive sharing decreased significantly over time, from 13.4% in the first quarter to 3.6% in the last quarter. Obtaining the last injection syringe from an ESAP source (mostly pharmacies) increased significantly over time, from 7.5% in the first quarter to 25.0% in the last quarter. In multiple logistic regression analysis, variables that were significantly associated with less receptive sharing were syringe exchange and ESAP syringe source as well as time since ESAP inception. Female gender and white race/ethnicity were significantly associated with greater receptive sharing. CONCLUSIONS The increase in the use of pharmacies and other ESAP syringe sources in this sample has been accompanied by a decline in receptive sharing.
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Affiliation(s)
- Enrique R Pouget
- National Development and Research Institutes, Inc., New York, NY 10010, USA,
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Kerr T, Small W, Wood E. The public health and social impacts of drug market enforcement: A review of the evidence. International Journal of Drug Policy 2005. [DOI: 10.1016/j.drugpo.2005.04.005] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Golub ET, Bareta JC, Mehta SH, McCall LD, Vlahov D, Strathdee SA. Correlates of unsafe syringe acquisition and disposal among injection drug users in Baltimore, Maryland. Subst Use Misuse 2005; 40:1751-64. [PMID: 16419554 DOI: 10.1080/10826080500259513] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Because multi-person syringe use is the most common vehicle for HIV and hepatitis C virus transmission among injection drug users (IDUs), safe sources of sterile syringes and safe methods of disposal are necessary to curb these epidemics. We examined syringe acquisition and disposal in a cohort of IDUs in Baltimore. Between January 1, 1998 and December 31, 2001, 1034 participants reported on syringe acquisition at 3492 visits, and 953 reported on disposal at 2569 visits. Participants were 69.9% male, 93.9% African-American, and median age was 44. Syringes were acquired exclusively from unsafe sources at 32.3% of visits, while exclusively unsafe disposal was reported at 59.3% of visits. Significant correlates of unsafe acquisition were: attending shooting galleries, anonymous sex, sharing needles, smoking crack, and emergency room visits. Significant correlates of unsafe disposal were: injecting speedball, no methadone treatment, acquiring safely, and frequent injection. Having a primary source of medical care was associated with safe acquisition, but unsafe disposal. IDUs continue to acquire safely but dispose unsafely, especially among those with a primary source of care; this suggests that messages about safe disposal are not being disseminated as widely as those about acquisition. These data suggest the need for a more active program involving pharmacists, an expanded syringe access program, and better efforts to enhance safe disposal.
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Affiliation(s)
- Elizabeth T Golub
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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26
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Compton WM, Horton JC, Cottler LB, Booth R, Leukefeld CG, Singer M, Cunningham-Williams R, Reich W, Fortuin Corsi K, Staton M, Fink JL, Stopka TJ, Spitznagel EL. A multistate trial of pharmacy syringe purchase. J Urban Health 2004; 81:661-70. [PMID: 15466847 PMCID: PMC3455919 DOI: 10.1093/jurban/jth149] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Pharmacies are a potential site for access to sterile syringes as a means for preventing human immunodeficiency virus (HIV), but the type and extent of their utility is uncertain. To examine pharmacy syringe purchase, we conducted a standardized, multistate study in urban and rural areas of four states in which attempts to purchase syringes were documented. Of 1,600 overall purchase attempts, 35% were refused. Colorado (25%) and Connecticut (28%) had significantly lower rates of refusal than Kentucky (41%) and Missouri (47%). Furthermore, urban settings had higher rates of refusal (40%) than rural settings (31%, P < .01). Race and gender did not have a consistent impact on rates of refusal. Despite potential advantages of pharmacies as sites for access to sterile syringes, pharmacy purchase of syringes faces significant obstacles in terms of the practices in different jurisdictions.
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Affiliation(s)
- Wilson M Compton
- National Institute on Drug Abuse, 6001 Executive Boulevard, MSC 9589, Bethesda, MD 20892-9589, USA.
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Abstract
AIM Better sterile syringe access should be associated with a lower likelihood of syringe re-use and receptive syringe sharing, although few empirical studies have examined gradients in syringe access using both individual and ecological data. In this study, we compare syringe re-use and receptive syringe sharing among injection drug users (IDUs) with syringe exchange program (SEP) and legal over-the-counter pharmacy access with limits on syringes that can be purchased, exchanged or possessed to IDUs with no pharmacy sales but unlimited syringe access through SEPs. We address three questions: (1) Does residing in an area with no legal syringe possession increase the likelihood of police contact related to possessing drug paraphernalia? (2) Among direct SEP users, is use of more permissive SEPs associated with less likelihood of syringe re-use and receptive syringe sharing? (3) Among non-SEP users, is residing in an area with pharmacy access associated with lower likelihood of syringe re-use and receptive syringe sharing? DESIGN Quantitative survey of IDUs recruited from SEPs, subject nomination and outreach methods. Multivariate analyses compared police contact, syringe re-use and receptive syringe sharing among IDUs recruited in three cities. FINDINGS In multivariate analyses, we found that police contact was associated independently with residing in the area with no legal possession of syringes; among SEP users, those with access to SEPs without limits had lower syringe re-use but not lower syringe sharing; and that among non-SEP users, no significant differences in injection risk were observed among IDUs with and without pharmacy access to syringes. CONCLUSION We found that greater legal access to syringes, if accompanied by limits on the number of syringes that can be exchanged, purchased and possessed, may not have the intended impacts on injection-related infectious disease risk among IDUs.
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Affiliation(s)
- Ricky N Bluthenthal
- Health Program and Drug Policy Research Center, RAND, Santa Monica, CA 90407-2138, USA.
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Burris S, Blankenship KM, Donoghoe M, Sherman S, Vernick JS, Case P, Lazzarini Z, Koester S. Addressing the "risk environment" for injection drug users: the mysterious case of the missing cop. Milbank Q 2004; 82:125-56. [PMID: 15016246 PMCID: PMC2690204 DOI: 10.1111/j.0887-378x.2004.00304.x] [Citation(s) in RCA: 177] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Ecological models of the determinants of health and the consequent importance of structural interventions have been widely accepted, but using these models in research and practice has been challenging. Examining the role of criminal law enforcement in the "risk environment" of injection drug users (IDUs) provides an opportunity to apply structural thinking to the health problems associated with drug use. This article reviews international evidence that laws and law enforcement practices influence IDU risk. It argues that more research is needed at four levels--laws; management of law enforcement agencies; knowledge, attitudes, beliefs, and practices of frontline officers; and attitudes and experiences of IDUs--and that such research can be the basis of interventions within law enforcement to enhance IDU health.
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Affiliation(s)
- Scott Burris
- Temple University, Beasley School of Law, Philadelphia, PA 19122, USA.
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Recommendations for incorporating human immunodeficiency virus (HIV) prevention into the medical care of persons living with HIV. Clin Infect Dis. 2004;38:104-121. [PMID: 14679456 DOI: 10.1086/380131] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2003] [Accepted: 09/05/2003] [Indexed: 01/14/2023] Open
Abstract
The estimated number of annual new human immunodeficiency virus (HIV) infections in the United States has remained at 40,000 for >10 years. Reducing the rate of transmission will require new strategies, including emphasis on prevention of transmission by HIV-infected persons. Medical care providers can affect HIV transmission by screening HIV-infected patients for risk behaviors, communicating prevention messages, discussing sexual and drug-use behaviors, reinforcing changes to safer behavior, referring patients for services such as substance abuse treatment, facilitating partner counseling and referral, and identifying and treating other sexually transmitted diseases. The Centers for Disease Control and Prevention (CDC), the Health Resources and Services Administration (HRSA), the National Institutes of Health (NIH), and the HIV Medicine Association (HIVMA) of the Infectious Diseases Society of America (IDSA) have recently collaborated to develop evidence-based recommendations for incorporating HIV prevention into the medical care of persons living with HIV. This article summarizes key aspects of the recommendations.
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Fisher DG, Fenaughty AM, Cagle HH, Reynolds GL. Injection drug users’ use of pharmacies for purchasing needles in Anchorage, Alaska. International Journal of Drug Policy 2003; 14:381-7. [DOI: 10.1016/s0955-3959(03)00138-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Stancliff S, Agins B, Rich JD, Burris S. Syringe access for the prevention of blood borne infections among injection drug users. BMC Public Health 2003; 3:37. [PMID: 14633286 PMCID: PMC317318 DOI: 10.1186/1471-2458-3-37] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2003] [Accepted: 11/21/2003] [Indexed: 11/24/2022] Open
Abstract
Background Approximately one-third of acquired immunodeficiency syndrome cases in the United States are associated with the practice of sharing of injection equipment and are preventable through the once-only use of syringes, needles and other injection equipment. Discussion Sterile syringes may be obtained legally by 4 methods depending on the state. They may be purchased over the counter, prescribed, obtained at syringe exchange programs or furnished by authorized agencies. Each of these avenues has advantages and disadvantages; therefore, legal access through all means is the most likely way to promote the use of sterile syringes. Summary By assisting illicit drug injectors to obtain sterile syringes the primary care provider is able to reduce the incidence of blood borne infections, and educate patients about safe syringe disposal. The provider is also able to initiate discussion about drug use in a nonjudgmental manner and to offer care to patients who are not yet ready to consider drug treatment.
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Affiliation(s)
- Sharon Stancliff
- AIDS Institute, New York State Department of Health, 5 Penn Plaza, 1Floor, New York, New York 10001, USA
| | - Bruce Agins
- AIDS Institute, New York State Department of Health, 5 Penn Plaza, 1Floor, New York, New York 10001, USA
| | - Josiah D Rich
- The Miriam Hospital,164 Summit Avenue, Providence, RI 02906, USA
| | - Scott Burris
- Temple University Beasley School of Law, 1719 N Broad Street Philadelphia, PA 19122, USA
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Affiliation(s)
- T Stephen Jones
- Division of HIV/AIDS Prevention, Intervention, Research, and Support, National Center for HIV, STD & TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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Burris S, Welsh J, Ng M, Li M, Ditzler A. State syringe and drug possession laws potentially influencing safe syringe disposal by injection drug users. J Am Pharm Assoc (Wash) 2002; 42:S94-8. [PMID: 12489625 DOI: 10.1331/1086-5802.42.0.s94.burris] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To review state laws and judicial decisions for potential barriers to proper syringe disposal by injection drug users (IDUs). DESIGN Using standard legal research methods, this study reviewed drug paraphernalia, syringe prescription, drug possession, and syringe exchange laws and relevant case decisions in 59 jurisdictions. MAIN OUTCOME MEASURES Drug paraphernalia, syringe prescription, and drug possession laws. RESULTS Drug paraphernalia laws prohibit all possession of syringes by IDUs in 31 jurisdictions. Syringe prescription laws prohibit possession in 7 jurisdictions. In 53 jurisdictions, IDUs may be subject to prosecution for the possession of drug residue in used syringes. Only two states (HI, RI) have no legal barriers to safe syringe disposal by IDUs. Sixteen jurisdictions that have tried to expand syringe access for IDUs by authorizing SEPs or by deregulating pharmacy sale of syringes continue to have criminal law provisions that could pose barriers to proper disposal. CONCLUSION IDUs are a significant source of syringes disposed of outside the health care system. Involving IDUs in safe community sharps disposal programs is an important public health goal, but may be frustrated by legal barriers. Although this study looked only at law on the books, and not law as actually applied, ethnographic and survey research indicates that criminal laws do influence the syringe possession behavior of IDUs. The findings of this study suggest that syringe and drug possession laws could deter IDUs from participating in safe syringe disposal programs.
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Affiliation(s)
- Scott Burris
- Temple University, Beasley School of Law, Philadelphia, PA 19122, USA.
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Des Jarlais DC, McKnight C, Friedmann P. Legal syringe purchases by injection drug users, Brooklyn and Queens, New York City, 2000-2001. J Am Pharm Assoc (Wash) 2002; 42:S73-6. [PMID: 12489620 DOI: 10.1331/1086-5802.42.0.s73.de] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To assess preliminary results of the Expanded Syringe Access Demonstration Program (ESAP) in New York City. DESIGN Temporal trends of pharmacy use among injection drug users (IDUs) in Brooklyn and Queens were analyzed from December 2000 through December 2001. SETTING Brooklyn and Queens, New York City. PARTIPANTS: IDUs. MAIN OUTCOME MEASURES Attempts to purchase syringes from pharmacies and success in doing so. RESULTS Of the 1,072 IDUs interviewed from December 2000 through December 2001, the majority were daily heroin injectors, but there was also substantial speedball and cocaine injection. There was a clear increase over time in both the percentage of subjects who attempted to purchase syringes in pharmacies and in the percentage who successfully purchased syringes. Among IDUs interviewed 4 or more months after ESAP began, large majorities of those who attempted to purchase syringes were successful in doing so. No differences in use of ESAP by IDUs were identified in Brooklyn versus Queens: 27% of IDUs interviewed in Queens reported that they had attempted to purchase syringes in pharmacies versus 28% in Brooklyn. Persons who reported injecting on a daily or more frequent basis were more likely to have attempted pharmacy purchases than persons who reported injecting less frequently, 32% versus 21%. CONCLUSIONS The ESAP program has led to an increase in the use of pharmacies as sources of sterile injection equipment among IDUs in New York City. The extent to which pharmacies become an important source of sterile injection equipment and the effect of legal pharmacy sales on risk behaviors for human immunodeficiency virus (HIV) infection remain to be determined.
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Affiliation(s)
- Don C Des Jarlais
- Baron Edmond de Rothschild Chemical Dependency Institute, Beth Israel Medical Center, New York, NY 10003, USA.
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Novotny GA, Cotton-Oldenburg NU, Bond B, Tracy B. The Minnesota Pharmacy Syringe Access Initiative: a successful statewide program to increase injection drug user access to sterile syringes. J Am Pharm Assoc (Wash) 2002; 42:S21-2. [PMID: 12489606 DOI: 10.1331/1086-5802.42.0.s21.novotny] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Gary A Novotny
- Health Education and Risk Reduction Unit, STD and HIV Section, Minnesota Department of Health, Minneapolis 55440, USA.
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