Pharmacist attitudes and provision of harm reduction services in North Carolina: an exploratory study

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Abstract

Background

Pharmacists are among the most accessible healthcare providers in the United States and uniquely positioned to provide harm reduction services. The availability of pharmacy-based harm reduction services and pharmacist attitudes toward delivering these services have been understudied to date. We examine North Carolina (NC) pharmacists’ experiences with and attitudes about harm reduction services and explore differences between rural and urban pharmacists.

Methods

A convenience sample of NC pharmacists participated in an anonymous, online survey regarding harm reduction services: non-prescription syringe sales; naloxone dispensing; and human immunodeficiency virus (HIV) and hepatitis C virus (HCV) screening. Urban–rural differences were analyzed using Pearson’s chi-square or Fisher’s exact tests. Open-ended responses were analyzed thematically.

Results

Three hundred pharmacists responded to the survey; 68 (23%) practiced in rural counties. Dispensing non-prescription syringes and naloxone at least occasionally was reported by 77% ( n = 231) and 88% ( n = 263) pharmacists, respectively. Pharmacy-delivered HIV or HCV screening was rare. Urban pharmacists dispensed naloxone more frequently than rural pharmacies ( p = 0.04). Only 52% of pharmacists agreed that persons who inject drugs should always be allowed to buy non-prescription syringes. Rural pharmacists’ attitudes toward harm reduction services for persons who inject drugs were statistically, though marginally, less supportive when compared to urban pharmacists’ attitudes. The most common barrier to non-prescription syringe access was requiring patients to provide proof of prescription injection medication use, which 21% of pharmacists reported was required by their pharmacy’s policy on non-prescription syringe sales.

Conclusions

Although most pharmacies distributed naloxone and sold non-prescription syringes, pharmacy store policies and personal beliefs inhibited naloxone and non-prescription syringe dispensing. NC community pharmacies infrequently offer HIV and HCV screening. Paired with disseminating the evidence of the positive impact of harm reduction on individual and public health outcomes to NC pharmacists, institutional and systems changes to practice and policy may be important to promote harm reduction service availability, particularly for rural NC residents.

Trial registration: N/A.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12954-021-00517-0.

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Most cited references 33

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Stigma at every turn: Health services experiences among people who inject drugs

Jennifer Syvertsen, Catherine Paquette, Robin A Pollini (2018)

Background People who inject drugs (PWID) encounter varying forms of stigma in health services contexts, which can contribute to adverse outcomes. We explored the lived experience of stigma among PWID to elucidate pathways by which stigma influences health care access and utilization. Methods We conducted 46 qualitative interviews with PWID in California’s Central Valley between March and December 2015, as part of a multi-phase, multi-method study examining implementation of a new pharmacy syringe access law. A “risk environment” framework guided our data collection and we used a deductive/inductive approach to analyze the qualitative data. Results Participants repeatedly cited the impact of stigma on syringe access, particularly in the context of meso-level pharmacist interactions. They described being denied syringe purchase as stigmatizing and embarrassing, and these experiences discouraged them from attempting to purchase syringes under the new pharmacy access law. Participants described feeling similarly stigmatized in their meso-level interactions with first responders and hospital staff, and associated this stigmatization with delayed and substandard medical care for overdoses and injection-related infections. Drug treatment was another area where stigma operated against PWID’s health interests; participants described macro-level public stigma towards methadone (e.g., equating methadone treatment with illicit drug use) as discouraging participation in this evidence-based treatment modality and justifying exclusion of methadone patients from recovery support services like sober living and Narcotics Anonymous. Conclusion Stigma played an undeniably important role in PWID’s experiences with health services access and utilization in the Central Valley. Our study illustrates the need to develop and test interventions that target drug use stigma at both structural and individual levels to minimize adverse effects on PWID health.

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Syringe Service Programs for Persons Who Inject Drugs in Urban, Suburban, and Rural Areas - United States, 2013.

Don Des Jarlais, Ann Nugent, Alisa Solberg … (2015)

Reducing human immunodeficiency virus (HIV) infection rates in persons who inject drugs (PWID) has been one of the major successes in HIV prevention in the United States. Estimated HIV incidence among PWID declined by approximately 80% during 1990-2006 (1). More recent data indicate that further reductions in HIV incidence are occurring in multiple areas (2). Research results for the effectiveness of risk reduction programs in preventing hepatitis C virus (HCV) infection among PWID (3) have not been as consistent as they have been for HIV; however, a marked decline in the incidence of HCV infection occurred during 1992-2005 in selected U.S. locations when targeted risk reduction efforts for the prevention of HIV were implemented (4). Because syringe service programs (SSPs)* have been one effective component of these risk reduction efforts for PWID (5), and because at least half of PWID are estimated to live outside major urban areas (6), a study was undertaken to characterize the current status of SSPs in the United States and determine whether urban, suburban, and rural SSPs differed. Data from a recent survey of SSPs(†) were analyzed to describe program characteristics (e.g., size, clients, and services), which were then compared by urban, suburban, and rural location. Substantially fewer SSPs were located in rural and suburban than in urban areas, and harm reduction services(§) were less available to PWID outside urban settings. Because increases in substance abuse treatment admissions for drug injection have been observed concurrently with increases in reported cases of acute HCV infection in rural and suburban areas (7), state and local jurisdictions could consider extending effective prevention programs, including SSPs, to populations of PWID in rural and suburban areas.

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A review of the efficacy and effectiveness of harm reduction strategies for alcohol, tobacco and illicit drugs.

Jacqui Cameron, Alison Ritter (2006)

Harm reduction is both a policy approach and used to describe a specific set of interventions. These interventions aim to reduce the harms associated with drug use. Employing a strict definition of harm reduction, evidence for the efficacy and effectiveness of alcohol, tobacco and illicit drug harm reduction interventions were reviewed. Systematic searches of the published literature were undertaken. Studies were included if they provided evaluation data (pre-post, or control group comparisons). More than 650 articles were included in the review. The majority of the literature concerned illicit drugs. For alcohol, harm reduction interventions to reduce road trauma are well-founded in evidence. Otherwise, there is limited research to support the efficacy and effectiveness of other alcohol harm reduction interventions. For tobacco, the area is controversial but promising new products that reduce the harms associated with smoking are being developed. In the area of illicit drugs there is solid efficacy, effectiveness and economic data to support needle syringe programmes and outreach programmes. There is limited published evidence to date for other harm reduction interventions such as non-injecting routes of administration, brief interventions and emerging positive evidence for supervised injecting facilities. There is sufficient evidence to support the wide-spread adoption of harm reduction interventions and to use harm reduction as an overarching policy approach in relation to illicit drugs. The same cannot be concluded for alcohol or tobacco. Research at a broad policy level is required, especially in light of the failure by many policy makers to adopt cost-effective harm reduction interventions.

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Author and article information

Contributors

Rachel A. Parry:

ORCID: http://orcid.org/0000-0001-6791-6468

rparry@unc.edu

Journal

Journal ID (nlm-ta): Harm Reduct J

Journal ID (iso-abbrev): Harm Reduct J

Title: Harm Reduction Journal

Publisher: BioMed Central (London )

ISSN (Electronic): 1477-7517

Publication date (Electronic): 8 July 2021

Publication date PMC-release: 8 July 2021

Publication date Collection: 2021

Volume: 18

Electronic Location Identifier: 70

Affiliations

[1 ]GRID grid.10698.36, ISNI 0000000122483208, UNC Eshelman School of Pharmacy, ; 201 Pharmacy Lane, CB 7355, Chapel Hill, NC 27599-7355 USA

[2 ]GRID grid.62562.35, ISNI 0000000100301493, RTI International, ; 3040 East Cornwallis Rd., PO Box 12194, Research Triangle Park, NC 27709-2194 USA

[3 ]GRID grid.10698.36, ISNI 0000000122483208, Institute for Global Health and Infectious Diseases, , University of North Carolina at Chapel Hill, ; 130 Mason Farm Rd, CB#7030, Chapel Hill, NC 27599-7030 USA

[4 ]GRID grid.10698.36, ISNI 0000000122483208, Division of Gastroenterology and Hepatology, Department of Medicine, , University of North Carolina at Chapel Hill, ; Chapel Hill, NC USA

Author information

Rachel A. Parry http://orcid.org/0000-0001-6791-6468

Article

Publisher ID: 517

DOI: 10.1186/s12954-021-00517-0

PMC ID: 8265050

PubMed ID: 34238306

SO-VID: 7cfe41b7-cee4-4d52-9b83-8c8068eec842

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 4 December 2020

Date accepted : 16 June 2021

Funding

Funded by: FundRef http://dx.doi.org/10.13039/100000026, National Institute on Drug Abuse;

Award ID: UG3DA044823

Award Recipient : William A. Zule

Custom metadata

ScienceOpen disciplines: Health & Social care

Keywords: harm reduction,substance abuse,intravenous,community pharmacy services,syringes,naloxone,hiv,hepatitis c

Data availability:

ScienceOpen disciplines: Health & Social care

Keywords: harm reduction, substance abuse, intravenous, community pharmacy services, syringes, naloxone, hiv, hepatitis c

Pharmacist attitudes and provision of harm reduction services in North Carolina: an exploratory study

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Tobacco Prevention & Cessation

Most cited references 33

Stigma at every turn: Health services experiences among people who inject drugs

Syringe Service Programs for Persons Who Inject Drugs in Urban, Suburban, and Rural Areas - United States, 2013.

A review of the efficacy and effectiveness of harm reduction strategies for alcohol, tobacco and illicit drugs.

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