Providing Clean Syringes at Community Pharmacies: Stigma and Reality

The crackdown on opioid abuse has prompted increased heroin use in communities across the United States.

Heroin, which is easier to access and less expensive than prescription narcotics, has made a comeback as drug dealers cater to users who can no longer access prescription opioids. Illicit injection drugs, such as heroin, can spread blood-borne pathogens when delivered using a dirty needle. For that reason, public health officials are looking for harm-reduction strategies.

Syringe exchange programs run by public health officials are the most effective way to stem the spread of HIV and hepatitis C. However, communities stigmatize these programs, and local and state laws restrict them.

An alternative is the sale of nonprescription sterile syringes at community pharmacies. Pharmacies have trained professional staffs, are open long hours regularly, and are perceived as having less stigma with this process because they provide other products and services.

Government intervention can pave the way for pharmacists to dispense clean syringes. Sadly, some pharmacists circumvent it by establishing policies and practices that are stricter than those established by local and state law.

Now, an article published ahead-of-print in Drug and Alcohol Dependence suggests that education on barriers to nonprescription sterile syringe distribution, more open laws and pharmacy protocols, and decentralization of syringe dispersal will decrease the public health burden of dirty needles.

The researchers interviewed 71 retail pharmacists in California, Kansas, Mississippi, and New Jersey. A small subset of 17 pharmacists (approximately 24%) disclosed ethical reservations about providing nonprescription sterile syringes.

Incorporating dispensing into pharmacy training can abate pharmacist resistance to dispense nonprescription sterile syringes. Pharmacists are more receptive to dispensing syringes to injection drug users if they believe it’s part of their public health duty.

Pharmacies should be encouraged to avoid building additional access barriers into their practice. Some pharmacies set minimum syringe orders, demand prescriptions, or require that patients have an injected drug prescription at the store.

Increasing the number of dispensing facilities lessens pharmacist reluctance by making clean syringe activities routine and normal.

Pharmacists will encounter injection drug users requesting nonprescription sterile syringes as heroin use increases. The provision of clean syringes is a key public health tool, but it runs against some pharmacists’ moral beliefs and some pharmacies’ protocols.