预测注射吸毒者的药店注射器销售：政策、实践和看法。
Predicting pharmacy syringe sales to people who inject drugs: Policy, practice and perceptions.
机构信息
Indiana University School of Public Health-Bloomington, 1025 E. 7th Street, Bloomington, IN 47405 USA; Rural Center for AIDS/STD Prevention, Indiana University, 1025 E. 7th Street, Bloomington, IN 47405 USA.
HIV Center for Clinical and Behavioral Studies, Columbia University Medical Center and New York Psychiatric Institute, 1051 Riverside Dr # 15, New York, NY 10032, USA; Social Intervention Group, Columbia University School of Social Work, 1255 Amsterdam Ave, New York, NY 10027, USA.
出版信息
Int J Drug Policy. 2018 Jun;56:46-53. doi: 10.1016/j.drugpo.2018.02.024. Epub 2018 Mar 17.
BACKGROUND
Pharmacies have much to contribute to the health of people who inject drugs (PWID) and to community efforts in HIV and hepatitis C (HCV) prevention through syringe access. However, little is known about what predicts pharmacy syringe sales without a prescription.
OBJECTIVE
To identify factors predicting pharmacy syringes sales to PWID.
METHODS
A hybrid staggered online survey of 298 Indiana community pharmacists occurred from July-September 2016 measuring pharmacy policy, practice, and pharmacist perceptions about syringe sales to PWID. Separate bivariate logistical regressions were followed by multivariable logistic regression to predict pharmacy syringe sales and pharmacist comfort dispensing syringes to PWID.
RESULTS
Half (50.5%) of Indiana pharmacies sold syringes without a prescription to PWID. Pharmacy syringe sales was strongly associated with pharmacist supportive beliefs about syringe access by PWID and their comfort level selling syringes to PWID. Notably, pharmacies located in communities with high rates of opioid overdose mortality were 56% less likely to sell syringes without a prescription than those in communities with lower rates. Pharmacist comfort dispensing syringes was associated with being male, working at a pharmacy that sold syringes to PWID and one that stocked naloxone, having been asked about syringe access by medical providers, and agreement that PWID should be able to buy syringes without a prescription.
CONCLUSIONS
As communities with high rates of opioid overdose mortality were less likely to have pharmacies that dispensed syringes to PWID, a concerted effort with these communities and their pharmacies should be made to understand opportunities to increase syringe access. Future studies should explore nuances between theoretical support for syringe access by PWID without a prescription and actual dispensing behaviors. Addressing potential policy conflicts and offering continuing education on non-prescription syringe distribution for pharmacists may improve comfort distributing syringes to PWID, and therefore increase pharmacy syringe sales.
背景
通过提供注射器，药店可以为注射毒品者（PWID）的健康以及艾滋病毒和丙型肝炎（HCV）预防的社区工作做出重大贡献。然而，对于哪些因素可以预测没有处方的药店注射器销售，人们知之甚少。
目的
确定预测药店向 PWID 销售注射器的因素。
方法
2016 年 7 月至 9 月，对印第安纳州的 298 名社区药剂师进行了混合式交错在线调查，调查内容包括药店政策、实践以及药剂师对向 PWID 销售注射器的看法。随后进行了单变量逻辑回归和多变量逻辑回归，以预测药店注射器销售和药剂师向 PWID 发放注射器的舒适度。
结果
印第安纳州有一半（50.5%）的药店向 PWID 销售没有处方的注射器。药店的注射器销售与药剂师对 PWID 获得注射器的支持性信念以及向 PWID 销售注射器的舒适度密切相关。值得注意的是，与死亡率较低的社区相比，位于阿片类药物过量死亡率较高的社区的药店销售没有处方的注射器的可能性低 56%。药剂师发放注射器的舒适度与以下因素相关：为男性、在销售注射器给 PWID 的药店工作、在库存纳洛酮的药店工作、曾被医疗服务提供者询问过注射器获取情况、以及认为 PWID 应该能够无需处方购买注射器。
结论
由于阿片类药物过量死亡率较高的社区的药店向 PWID 发放注射器的可能性较低，因此应与这些社区及其药店一起做出共同努力，以寻找增加注射器获取途径的机会。未来的研究应探讨理论上支持 PWID 无需处方获得注射器与实际发放行为之间的细微差别。解决潜在的政策冲突，并为药剂师提供有关非处方注射器分发的继续教育，可能会提高向 PWID 发放注射器的舒适度，从而增加药店的注射器销售。
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