药房作为为注射吸毒者提供扩展医疗服务的提供者：六个国家的法律、政策及障碍综述
Pharmacies as providers of expanded health services for people who inject drugs: a review of laws, policies, and barriers in six countries.
作者信息
Hammett Theodore M, Phan Son, Gaggin Julia, Case Patricia, Zaller Nicholas, Lutnick Alexandra, Kral Alex H, Fedorova Ekaterina V, Heimer Robert, Small Will, Pollini Robin, Beletsky Leo, Latkin Carl, Des Jarlais Don C
机构信息
Abt Associates Inc,, Cambridge MA 02138, USA.
出版信息
BMC Health Serv Res. 2014 Jun 17;14:261. doi: 10.1186/1472-6963-14-261.
BACKGROUND
People who inject drugs (PWID) are underserved by health providers but pharmacies may be their most accessible care settings.
METHODS
Studies in the U.S., Russia, Vietnam, China, Canada and Mexico employed a three-level (macro-, meso-, and micro-) model to assess feasibility of expanded pharmacy services for PWID. Studies employed qualitative and quantitative interviews, review of legal and policy documents, and information on the knowledge, attitudes, and practices of key stakeholders.
RESULTS
Studies produced a mixed assessment of feasibility. Provision of information and referrals by pharmacies is permissible in all study sites and sale and safe disposal of needles/syringes by pharmacies is legal in almost all sites, although needle/syringe sales face challenges related to attitudes and practices of pharmacists, police, and other actors. Pharmacy provision of HIV testing, hepatitis vaccination, opioid substitution treatment, provision of naloxone for drug overdose, and abscess treatment, face more serious legal and policy barriers.
DISCUSSION
Challenges to expanded services for drug users in pharmacies exist at all three levels, especially the macro-level characterized by legal barriers and persistent stigmatization of PWID. Where deficiencies in laws, policies, and community attitudes block implementation, stakeholders should advocate for needed legal and policy changes and work to address community stigma and resistance. Laws and policies are only as good as their implementation, so attention is also needed to meso- and micro- levels. Policies, attitudes, and practices of police departments and pharmacy chains as well as knowledge, attitudes, and practices of individual PWID, individual pharmacies, and police officers should support rather than undermine positive laws and expanded services. Despite the challenges, pharmacies remain potentially important venues for delivering health services to PWID.
背景
注射吸毒者难以获得医疗服务提供者的充分服务，但药店可能是他们最容易获得医疗服务的场所。
方法
美国、俄罗斯、越南、中国、加拿大和墨西哥的研究采用了一个三级（宏观、中观和微观）模型，以评估为注射吸毒者扩大药店服务的可行性。研究采用了定性和定量访谈、法律和政策文件审查以及关键利益相关者的知识、态度和行为信息。
结果
研究对可行性的评估好坏参半。在所有研究地点，药店提供信息和转介服务都是允许的，并且在几乎所有地点，药店销售和安全处置针头/注射器都是合法的，尽管针头/注射器销售面临着与药剂师、警察和其他行为者的态度和行为相关的挑战。药店提供艾滋病毒检测、肝炎疫苗接种、阿片类药物替代治疗、提供用于药物过量的纳洛酮以及脓肿治疗，面临更严重的法律和政策障碍。
讨论
药店为吸毒者扩大服务的挑战存在于所有三个层面，尤其是以法律障碍和对注射吸毒者的持续污名化为特征的宏观层面。在法律、政策和社区态度的缺陷阻碍实施的地方，利益相关者应倡导必要的法律和政策变革，并努力消除社区的污名和抵制。法律和政策的效果取决于其实施情况，因此还需要关注中观和微观层面。警察部门和连锁药店的政策、态度和行为以及个体注射吸毒者、个体药店和警察的知识、态度和行为应支持而非破坏积极的法律和扩大的服务。尽管存在挑战，药店仍然可能是为注射吸毒者提供医疗服务的重要场所。
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