Stakeholder Analysis of Pharmacy Sales of Syringes

Valerie J. Rose, Public Health Foundation Enterprises, Inc.
Basic-Applied Clinical

Scientific Abstract: Access to syringes through pharmacies is an important structural HIV intervention that should be implemented throughout California as part of a comprehensive harm reduction strategy which also includes syringe exchange programs. Syringe access through pharmacy sales took effect in January 2005 under California Senate Bill (SB) 1159, and was designed to curb the transmission of HIV and hepatitis C (HCV) among injection drug users (IDUs) and their sexual and syringe sharing partners. The legislation allows pharmacies to sell or furnish up to 10 syringes without a prescription to individuals 18 years of age and older in any of California's 61 health jurisdictions if they approve local legislation, and if pharmacies agree to enroll in a demonstration project with the local health department. Expanded syringe access programs can be effective motivators of injection cessation, unsafe syringe sharing, increased safe disposal of syringes and enhanced participation in harm reduction or drug treatment programs. With just 3 years remaining before SB1159 terminates in 2010, the majority of California counties have not established any form of syringe exchange or syringe access program. The California Department of Health Services/Office of AIDS (DHS/OA) was mandated by the legislation to implement or support evaluation studies. The proposed pilot study is designed to address several evaluation criteria required by the legislation in four counties that early on adopted local legislation, but failed to implement pharmacy access programs. The specific aims of the pilot study are to: 1) assess the attitudes of pharmacists regarding the sale of syringes to IDUs; 2) explore unmet needs among pharmacists with respect to legislative requirements of SB1159; 3) assess the perceptions of IDUs regarding pharmacies as an alternative source for sterile syringes; 4) assess key stakeholders' opinions about the failure to establish local programs; 5) provide policy recommendations that can be used to stimulate the creation of additional programs, and 6) provide timely data to support the public health impact of pharmacy access programs in California. The proposed study will explore the underpinning rationale for the delay in implementation from the perspective of key stakeholders (e.g., policy makers, health department staff, and law enforcement) in Humboldt, San Mateo, Santa Cruz and San Luis Obispo Counties using personal interview methods. Surveys will assess pharmacists' attitudes and intentions and will document the perceptions of IDUs about pharmacies as an alternative to syringe exchange programs. The results of the study may encourage these four and other health departments throughout California to establish pharmacy access programs. The recommendations may also serve as the foundation for re-authorization language to continue SB1159 beyond 2010. The proposed study provides a unique opportunity for California policymakers. Until research documents whether or not pharmacies are willing to collaborate with health departments to sell syringes, and until the intended beneficiaries of the program (i.e., IDUs) express their intentions, health departments across California may continue to erroneously assume political or pharmacy opposition and by default, allow SB1159 to terminate. Most importantly, IDUs will be at increased risk for HIV and HCV acquisition and transmission if their options for sterile syringes are limited.