To better understand the individual (e.g., attitudes and beliefs) and structural (e.g., laws and regulations) factors that influence and shape pharmacists’ decisions about selling syringes to injection drug users (IDUs).
Qualitative research.
Metropolitan Atlanta.
20 practicing pharmacists who work in or near areas of high drug use in Atlanta, and nine pharmacists who are considered leaders in their profession in Georgia.
Semistructured, in-depth interviews.
Individual and structural factors that influence pharmacists’ decisions about selling syringes to IDUs.
Pharmacists reported that they use their professional discretion in making syringe sale decisions and that these decisions are influenced by individuals factors such as their personal attitudes and beliefs about the nature and causes of drug use, and by structural factors such as the Georgia Board of Pharmacy regulation stating that syringes cannot be sold if they will be used for an “unlawful purpose.”
IDUs’ access to sterile syringes from pharmacies in Atlanta, would likely be increased by (1) providing practicing pharmacists with professional education programs that describe the broad professional support for IDU access to sterile syringes and why blood-borne infection prevention is a legitimate medical purpose for selling syringes and (2) removing or modifying the restrictive Board of Pharmacy regulation governing syringe sales.
To identify factors influencing pharmacists’ decisions about selling syringes to injection drug users (IDUs).
Audiotaped interviews.
Denver, Colorado.
Thirty-two pharmacists at 24 pharmacies.
One-hour semistructured interviews.
Practices regarding syringe sales to IDUs and factors influencing the practices.
Of the 32 pharmacists interviewed, 16 indicated that they sold syringes to all customers (“pro-sell”), 11 refused to sell unless shown proof of diabetic status (“no-sell”), and 5 were “undecided.” Several factors influenced the decision to sell. A perceived conflict between prevention of disease and prevention of drug abuse most clearly distinguished the three categories, with pro-sell pharmacists more likely than others to prioritize disease prevention and believe that syringe sales would not increase drug abuse. Business concerns, such as the effect of the presence of IDUs on other customers and the possibility of discarded syringes around the store, were especially prevalent among no-sell and undecided pharmacists. Seventeen pharmacists did not know about Colorado laws governing syringe sales. Four no-sell pharmacists used the laws to justify their decision not to sell, and two undecided pharmacists said they used the law when they did not want to sell syringes to IDU. All pharmacists supported syringe exchange programs.
One-half of the pharmacists sold syringes to IDUs, and several more indicated that they would do so if certain concerns were addressed. These data suggest that improved syringe disposal options, continuing education programs, and clarification of existing laws and regulations would encourage more pharmacists in Denver to sell syringes to IDUs.
To examine injection drug users (IDUs) opinions and behavior regarding purchase of sterile syringes from pharmacies.
Focus groups.
Urban and rural sites in Colorado, Connecticut, Kentucky, and Missouri.
Patients or Other Participants:
Eight focus groups, with 4 to 15 IDU participants per group.
Transcripts of focus group discussions were evaluated for common themes by the authors and through the use of the software program NUD*IST.
Knowledge of human immunodeficiency virus (HIV), pharmacy use, barriers to access from pharmacies, high-risk and risk-reducing behavior, and rural/urban difference.
Almost all participants knew the importance of using sterile syringes for disease prevention and reported buying syringes from pharmacies more than from any other source. Two IDUs believed pharmacists knew the syringes were being used for injecting drugs and perceived pharmacists’ sales of syringes to be an attempt to contribute to HIV prevention. Most IDUs reported that sterile syringes were relativity easy to buy from pharmacies, but most also reported barriers to access, such as having to buy in packs of 50 or 100, being made to sign a book, having to make up a story about being diabetic, or having the feeling that the pharmacists were demeaning them. While the majority of IDUs reported properly cleaning or not sharing syringes and safely disposing of them, others reported inadequate cleaning of syringes and instances of sharing syringes or of improper disposal. There were few differences in IDUs’ reported ability to buy syringes among states or between urban and rural sites, although the data suggest that IDUs could buy syringes more easily in the urban settings.
For the most part, participants understood the need for sterile syringes in order to protect themselves from HIV, hepatitis B virus, and hepatitis C virus and saw pharmacies as the best source of sterile syringes. Although these data are not generalizable, they suggest that pharmacists can and do serve as HIV-prevention service providers in their communities.
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