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Russell DM, Meyerson BE, Mahoney AN, Garnett I, Ferrell C, Newgass K, Agley JD, Crosby RA, Bentele KG, Vadiei N, Frank D, Linde-Krieger LB. Come back when you're infected: pharmacy access to sterile syringes in an Arizona Secret Shopper Study, 2023. Harm Reduct J 2024; 21:49. [PMID: 38388463 PMCID: PMC10885601 DOI: 10.1186/s12954-024-00943-w] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 01/22/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Pharmacies are critical healthcare partners in community efforts to eliminate bloodborne illnesses. Pharmacy sale of sterile syringes is central to this effort. METHODS A mixed methods "secret shopper" syringe purchase study was conducted in the fall of 2022 with 38 community pharmacies in Maricopa and Pima Counties, Arizona. Pharmacies were geomapped to within 2 miles of areas identified as having a potentially high volume of illicit drug commerce. Daytime venue sampling was used whereby separate investigators with lived/living drug use experience attempted to purchase syringes without a prescription. Investigator response when prompted for purchase rationale was "to protect myself from HIV and hepatitis C." A 24-item instrument measured sales outcome, pharmacy staff interaction (hostile/neutral/friendly), and the buyer's subjective experience. RESULTS Only 24.6% (n = 28) of 114 purchase attempts across the 38 pharmacies resulted in syringe sale. Less than one quarter (21.1%) of pharmacies always sold, while 44.7% never sold. Independent and food store pharmacies tended not to sell syringes. There emerged distinct pharmacy staff interactions characterized by body language, customer query, normalization or othering response, response to purchase request and closure. Pharmacy discretion and pharmacy policy not to sell syringes without a prescription limited sterile syringe access. Investigators reported frequent and adverse emotional impact due to pharmacy staff negative and stigmatizing interactions. CONCLUSIONS Pharmacies miss opportunities to advance efforts to eliminate bloodborne infections by stringent no-sale policy and discretion about syringe sale. State regulatory policy facilitating pharmacy syringe sales, limiting pharmacist discretion for syringe sales, and targeting pharmacy-staff level education may help advance the achievement of public health goals to eliminate bloodborne infections in Arizona.
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Affiliation(s)
- Danielle M Russell
- Arizona State University, Tempe, AZ, USA
- Harm Reduction Research Lab, University of Arizona College of Medicine-Tucson, Tucson, AZ, USA
- Drug Policy Research and Advocacy Board (DPRAB), University of Arizona, Tucson, AZ, USA
| | - Beth E Meyerson
- Harm Reduction Research Lab, University of Arizona College of Medicine-Tucson, Tucson, AZ, USA.
- Family and Community Medicine, College of Medicine, University of Arizona, Tucson, AZ, USA.
- Center for Comprehensive Pain and Addiction, University of Arizona Health Sciences, Tucson, AZ, USA.
| | - Arlene N Mahoney
- Harm Reduction Research Lab, University of Arizona College of Medicine-Tucson, Tucson, AZ, USA
- Southwest Recovery Alliance, Phoenix, AZ, USA
- Drug Policy Research and Advocacy Board (DPRAB), University of Arizona, Tucson, AZ, USA
| | - Irene Garnett
- Harm Reduction Research Lab, University of Arizona College of Medicine-Tucson, Tucson, AZ, USA
- Drug Policy Research and Advocacy Board (DPRAB), University of Arizona, Tucson, AZ, USA
- Center for Comprehensive Pain and Addiction, University of Arizona Health Sciences, Tucson, AZ, USA
| | - Chris Ferrell
- Drug Policy Research and Advocacy Board (DPRAB), University of Arizona, Tucson, AZ, USA
- CAN Community Health, Phoenix, AZ, USA
| | - Kylee Newgass
- Southwest Recovery Alliance, Phoenix, AZ, USA
- Drug Policy Research and Advocacy Board (DPRAB), University of Arizona, Tucson, AZ, USA
| | - Jon D Agley
- Harm Reduction Research Lab, University of Arizona College of Medicine-Tucson, Tucson, AZ, USA
- Indiana University School of Public Health-Bloomington, Bloomington, IN, USA
| | - Richard A Crosby
- Harm Reduction Research Lab, University of Arizona College of Medicine-Tucson, Tucson, AZ, USA
- University of Kentucky College of Public Health, Lexington, KY, USA
| | - Keith G Bentele
- Harm Reduction Research Lab, University of Arizona College of Medicine-Tucson, Tucson, AZ, USA
- Southwest Institute for Research On Women, University of Arizona, Tucson, AZ, USA
| | - Nina Vadiei
- Harm Reduction Research Lab, University of Arizona College of Medicine-Tucson, Tucson, AZ, USA
- College of Pharmacy, University of Arizona, Tucson, AZ, USA
| | - David Frank
- Harm Reduction Research Lab, University of Arizona College of Medicine-Tucson, Tucson, AZ, USA
- School of Global Public Health, New York University, New York, USA
| | - Linnea B Linde-Krieger
- Harm Reduction Research Lab, University of Arizona College of Medicine-Tucson, Tucson, AZ, USA
- Family and Community Medicine, College of Medicine, University of Arizona, Tucson, AZ, USA
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Meyerson BE, Treiber D, Brady BR, Newgass K, Bondurant K, Bentele KG, Samorano S, Arredondo C, Stavros N. Dialing for doctors: Secret shopper study of Arizona methadone and buprenorphine providers, 2022. J Subst Use Addict Treat 2024; 160:209306. [PMID: 38296033 DOI: 10.1016/j.josat.2024.209306] [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] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 11/30/2023] [Accepted: 01/24/2024] [Indexed: 02/06/2024]
Abstract
INTRODUCTION Methadone and buprenorphine are effective and safe treatments for opioid use disorder (OUD) and also reduce overdose and all-cause mortality. Identifying and reaching providers of medication for opioid use disorder (MOUD) has proven difficult for prospective patients and researchers. OBJECTIVES To assess the accuracy of government-maintained lists of Arizona (AZ) providers prescribing MOUD, and the extent to which these providers are accessible for treatment. METHODS A two-phase study used a listing of 2376 AZ MOUD providers obtained from the U.S. Drug Enforcement Administration and the Substance Abuse and Mental Health Services Administration. Phase 1 assessed the accuracy of the listing using internet confirmatory research from May-October 2022. Phase 2 used the resulting list of 838 providers to assess provider availability, type of MOUD treatment provided, and accepted payment through secret shopper calls between November 16 and 30, 2022. RESULTS Just over half (52.2 %, n = 1240) of providers were removed from the original listing during Phase 1. One quarter (25.9 %) were no longer in practice. Among the 833 eligible for the secret shopper Phase 2 study, 36.6 % (n = 307) were reached and identified as providing MOUD. A vast majority (88.1 %) of MOUD providers indicating treatment type were accepting new patients, however methadone was identified far more frequently than was likely permitted or provided for OUD. Providers were 5.5 times more likely to accept new patients if they accepted cash payment for services, and 4.9 times more likely if they accepted Medicaid. Rural areas remained underserved. CONCLUSIONS The active population of MOUD providers is far smaller than surmised. DEA and SAMHSA provider listings are not sufficiently accurate for survey research sampling. Other means of representative sampling will need to be devised, and trusted lists of providers for prospective patients should be promoted, publicly available, and regularly maintained for accuracy. Providers that offer treatment should assure that public-facing staff have basic information about the practice, the treatment offered, and conditions for taking new patients. Concerted efforts must assure rural access at the most local levels to reduce patient travel burden.
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Affiliation(s)
- B E Meyerson
- Harm Reduction Research Lab, University of Arizona College of Medicine-Tucson, AZ, United States of America; Department of Family and Community Medicine, University of Arizona College of Medicine, Tucson, AZ, United States of America; Comprehensive Center for Pain and Addiction, University of Arizona Health Sciences, Tucson, AZ, United States of America.
| | - D Treiber
- Sonoran Prevention Works, Phoenix, AZ, United States of America; Drug Policy Research and Advocacy Board, AZ, United States of America
| | - B R Brady
- Harm Reduction Research Lab, University of Arizona College of Medicine-Tucson, AZ, United States of America; Comprehensive Center for Pain and Addiction, University of Arizona Health Sciences, Tucson, AZ, United States of America; School of Interdisciplinary Health Programs, College of Health and Human Services, Western Michigan University, Kalamazoo, MI, United States of America
| | - K Newgass
- Harm Reduction Research Lab, University of Arizona College of Medicine-Tucson, AZ, United States of America; Southwest Recovery Alliance, Phoenix, AZ, United States of America; Drug Policy Research and Advocacy Board, AZ, United States of America
| | - K Bondurant
- Harm Reduction Research Lab, University of Arizona College of Medicine-Tucson, AZ, United States of America; Drug Policy Research and Advocacy Board, AZ, United States of America
| | - K G Bentele
- Harm Reduction Research Lab, University of Arizona College of Medicine-Tucson, AZ, United States of America; Southwest Institute for Research on Women, College of Social and Behavioral Sciences, University of Arizona, Tucson, AZ, United States of America
| | - S Samorano
- Harm Reduction Research Lab, University of Arizona College of Medicine-Tucson, AZ, United States of America; Drug Policy Research and Advocacy Board, AZ, United States of America
| | - C Arredondo
- Drug Policy Research and Advocacy Board, AZ, United States of America; El Rio Community Health Center, Tucson, AZ, United States of America
| | - N Stavros
- Drug Policy Research and Advocacy Board, AZ, United States of America; Community Medical Services, Phoenix, AZ, United States of America
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