Undercover Shoppers Experience Challenges in Accessing Legal, Clean OTC Needles in Arizona

Increased incidence of bloodborne pathogens, such as hepatitis and HIV, inspired public health strategy programs across the United States. Through the Occupational Safety and Health Administration (OSHA), education on pathogens and pathogen transmission prevention is required for all health care professionals.¹ Alongside OSHA, the CDC began the Syringe Service Program (SSP) to allow pharmacies to dispense clean needles over-the-counter (OTC), no matter the intended use.² Since its adoption, the SSP has reduced HIV and hepatitis incidences by 50%.²

In Arizona, investigators hired undercover shoppers to understand pharmacy dispensing patterns of safety syringes.³ When pharmacy staff questioned each patients’ purpose for purchase, the undercover patient would reply “to protect myself from HIV and hepatitis C.”³ Even with this response, only about 25% of pharmacies dispensed OTC safety syringes. Compared to other states with restrictions, Arizona has no specific regulations that restrict OTC safety syringe sales, so every store that participated was eligible to dispense them.³ These results prompted concern to investigators about the lack of preventative health care education nationwide.

In Arizona, investigators hired undercover shoppers to understand pharmacy dispensing patterns of safety syringes. Image Credit: © Sodapeaw - stock.adobe.com

Investigators discovered that pharmacy staff denied secret shoppers for subjective rationale: stigma, bias, and overall disapproval.3 In health care, subjective reasoning during patient treatment creates barriers to health equity. For patients to receive proper treatment, they will seek out higher risk alternatives to avoid mistreatment from health care professionals. By refusing service to customers seeking safety syringes, public health objectives to eliminate bloodborne pathogens will suffer, especially in high-risk populations such as people who inject illicit drugs.

Currently, most states permit the sales of OTC safety syringes. With this in mind, pharmacies have the tools to provide SSP, but do not have the education or support to effectively dispense syringes. The investigators concluded that advancement of bloodborne pathogen health policy can occur if³:

• State governments add new policies to ease syringe sales;
• Pharmacists avoid judging patients during syringe sales to minimize stigma;
• And pharmacy staff receive proper education.

With these changes, pharmacy professionals can better support patients who are seeking safe access to OTC clean needles, which will in turn help to decrease incidence of bloodborne pathogens, helping the country reach its public health goals.

About the Author

Dylan DeCandia, PharmD, RPh, is a community pharmacist at Franklyn’s Pharmacy in Ho-Ho-Kus, New Jersey.

REFERENCES

1. Syringe Services Program. The Centers for Disease Control and Prevention (CDC). August 7, 2023. Accessed May 22, 2024. https://www.cdc.gov/hiv/effective-interventions/prevent/syringe-services-programs/index.html
2. OSHA Bloodborne Pathogens Training Requirements. American Red Cross Training Services. Accessed May 22, 2024. https://www.redcross.org/take-a-class/first-aid/first-aid-training/osha-bloodborne-pathogen-training-requirements#:~:text=Basically%2C%20anyone%20who%20may%20come,OPIM%20in%20a%20lab%20setting
3. Russell DM, Meyerson BE, Mahoney AN, et al. Come back when you're infected: pharmacy access to sterile syringes in an Arizona Secret Shopper Study, 2023. February 22, 2024. Accessed May 22, 2024. doi:10.7759/cureus.51770