Southwest Institute for Research on Women, University of Arizona, 925 N. Tyndall Ave, Tucson, AZ, 85719, USA.
Rural Center for AIDS/STD Prevention, Indiana University School of Public Health-Bloomington, Bloomington, IN, 47405, USA.
Harm Reduct J. 2019 Sep 18;16(1):57. doi: 10.1186/s12954-019-0327-1.
Community pharmacies are important for health access by rural populations and those who do not have optimum access to the health system, because they provide myriad health services and are found in most communities. This includes the sale of non-prescription syringes, a practice that is legal in the USA in all but two states. However, people who inject drugs (PWID) face significant barriers accessing sterile syringes, particularly in states without laws allowing syringe services programming. To our knowledge, no recent studies of pharmacy-based syringe purchase experience have been conducted in communities that are both rural and urban, and none in the Southwestern US. This study seeks to understand the experience of retail pharmacy syringe purchase in Arizona by PWID.
An interview study was conducted between August and December 2018 with 37 people living in 3 rural and 2 urban Arizona counties who identified as current or former users of injection drugs. Coding was both a priori and emergent, focusing on syringe access through pharmacies, pharmacy experiences generally, experiences of stigma, and recommendations for harm reduction services delivered by pharmacies.
All participants reported being refused syringe purchase at pharmacies. Six themes emerged about syringe purchase: (1) experience of stigma and judgment by pharmacy staff, (2) feelings of internalized stigma, (3) inconsistent sales outcomes at the same pharmacy or pharmacy chain, (4) pharmacies as last resort for syringes, (5) fear of arrest for syringe possession, and (6) health risks resulting from syringe refusal.
Non-prescription syringe sales in community pharmacies are a missed opportunity to improve the health of PWID by reducing syringe sharing and reuse. Yet, current pharmacy syringe sales refusal and stigmatization by staff suggest that pharmacy-level interventions will be necessary to impact pharmacy practice. Lack of access to sterile syringes reinforces health risk behaviors among PWID. Retail syringe sales at pharmacies remain an important, yet barrier-laden, element of a comprehensive public health response to reduce HIV and hepatitis C among PWID. Future studies should test multilevel evidence-based interventions to decrease staff discrimination and stigma and increase syringe sales.
社区药店对于农村地区人群和那些无法充分利用卫生系统的人群来说，是获得健康的重要途径，因为它们提供了无数的卫生服务，并且在大多数社区都能找到。这包括销售非处方注射器，在美国，除了两个州之外，这种做法在其他所有州都是合法的。然而，注射毒品者（PWID）在获得无菌注射器方面面临着巨大的障碍，特别是在没有允许注射器服务项目立法的州。据我们所知，在美国西南部，最近没有在农村和城市社区进行基于药店的注射器购买经验的研究，也没有在该地区进行研究。本研究旨在了解亚利桑那州农村和城市社区中 PWID 对零售药店购买注射器的体验。
2018 年 8 月至 12 月期间，对居住在亚利桑那州 3 个农村和 2 个城市县的 37 名目前或曾经使用过注射毒品的人进行了访谈研究。编码既采用了先验法，也采用了新兴法，重点关注通过药店获得注射器、一般的药店体验、污名化体验以及对药店提供的减少伤害服务的建议。
所有参与者都报告说在药店购买注射器时被拒绝。有六个主题出现：（1）药店员工的污名化和判断带来的体验，（2）内化的污名化感受，（3）在同一家药店或连锁药店的销售结果不一致，（4）药店是购买注射器的最后选择，（5）因持有注射器而被捕的恐惧，（6）因拒绝注射器而导致的健康风险。
非处方注射器在社区药店的销售是改善 PWID 健康状况的一个错失的机会，因为这可以减少注射器共享和重复使用。然而，目前药店拒绝和员工污名化表明，需要采取药店层面的干预措施来影响药店的实践。无法获得无菌注射器加强了 PWID 的健康风险行为。零售药店的注射器销售仍然是减少 HIV 和丙型肝炎在 PWID 中传播的全面公共卫生应对措施的一个重要且充满障碍的要素。未来的研究应该测试多层次的循证干预措施，以减少员工歧视和污名化，并增加注射器销售。
