California Pharmacies Aren't Expanding Syringe Sales to Reduce HIV Spread

Although retail pharmacists in California are permitted to sell nonprescription syringes under legislative efforts to prevent HIV transmission among injection drug users (IDUs), recent research uncovered that many pharmacies still limit syringe access.

A team of researchers from the Pacific Institute for Research and Evaluation in Beltsville, Maryland, and Northeastern University in Boston, Massachusetts, analyzed the implementation of California Senate Bill 41 (SB41) in 2 rural counties where the prevalence of injection drug use is among the highest in the nation and a disproportionate number of HIV/AIDS cases are associated with such injection drug use.

Since SB41 became effective in January 2012, all licensed pharmacists in California have been able to legally sell ≤30 nonprescription syringes to all individuals aged ≥18 years. The law has also decriminalized the possession of ≤30 syringes obtained from an authorized source.

In their study, researchers attempted to purchase syringes at 248 licensed pharmacies in Fresno and Kern Counties between April 2013 and July 2013. The researchers utilized 4 trained data collectors who were instructed to purchase syringes using protocol adapted from prior studies.

About 1 in 5 purchase attempts was successful, with no significant difference seen between the 2 counties. The data collectors were often asked for a prescription (21.4%), and 30.2% of the time, they were queried about the reason for their syringe purchase. The purchasers were also asked whether they were diabetic and/or had proof of diabetes (19.8%) and whether they were customers on file with the pharmacy (5.2%). Additionally, during 10.9% of their attempts, the data collectors were told that the minimum purchase quantity was 100 syringes.

Failed purchase attempts were mostly attributed to not having a prescription (45.7%), not having the syringe type or size in stock (10.7%), being told that the pharmacy did not sell syringes (9.7%), and the buyer not providing a reason for the purchase (8.2%). In about one-third of the failed attempts, the data collectors were asked about their diabetes status.

“Even where syringes were successfully purchased, data collectors were asked why they wanted the syringe and for other personal information (e.g., name, phone number, address, signature), even though there is no legal or regulatory basis for doing so,” the study authors wrote.

Alarmingly, just 4 of the 52 pharmacies that sold syringes provided HIV prevention and referral information required by SB41, the researchers uncovered.

“Nonprescription syringe sales present an invaluable opportunity to engage IDUs in conversation and information exchange regarding individual and community health,” the researchers concluded. “…Additional steps by legislative bodies, regulatory agencies, and professional organizations are needed to actively engage pharmacies in expanding nonprescription syringe sales to reduce HIV transmission among IDUs.”