Laws prohibiting over-the-counter syringe sales to injection drug users: relations to population density, HIV prevalence, and HIV incidence

Friedman, Samuel R.; Perlis, Theresa; Jarlais, Don C. Des

doi:10.2105/ajph.91.5.791

Cited by 81 publications

(17 citation statements)

References 19 publications

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“…These findings could result from greater access to pharmacies that sell non-prescription syringes among PWID in San Francisco, which is consistent with other studies reporting associations between pharmacy use and lower rates of HIV and HCV infection, as well as lower rates of syringe sharing. 4,14–16 …”

Section: Discussionmentioning

confidence: 99%

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Effect of legal status of pharmacy syringe sales on syringe purchases by persons who inject drugs in San Francisco and San Diego, CA

Siddiqui

Armenta

Evans

et al. 2015

International Journal of Drug Policy

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Sharing blood-contaminated syringes is the main risk factor for acquiring and transmitting blood-borne infections among persons who inject drugs (PWID). To reduce this risk, in 2005, California enacted legislation allowing local health jurisdictions to legalize non-prescription syringe sales after approving a disease prevention demonstration project (DPDP). With San Francisco approving a DPDP immediately and San Diego never approving one, we compared PWID across cities for their use of pharmacies PWID to obtain syringes. PWID age 18–30 years old were recruited into separate studies in San Francisco (n=243) and San Diego (n=338) between 2008 and 2011. We used multivariable logistic regression to compare the proportions of PWID who obtained syringes from pharmacies by city while controlling for socio-demographics, injection practices and other risk behaviors. Overall, most PWID were white (71%), male (63%), and between the ages of 18–25 years (55%). Compared to San Francisco, a smaller proportion of PWID in San Diego had bought syringes from pharmacies in the prior three months (16.9% vs. 49.8%; p<0.001), which remained statistically significant after adjusting for socio-demographic and behavioral factors (adjusted odds ratio=4.45, 95% confidence interval: 2.98, 6.65). Use of pharmacies to obtain syringes was greater where it was legal to do so. Public health policy can influence HIV and hepatitis C associated risk among PWID; however, implementation of these policies is crucial for the benefits to be realized.

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Section: Discussionmentioning

confidence: 99%

“…Thus, pharmacies can be a viable source of sterile syringes for PWID due to the increased availability compared to syringe exchange programs; hence decreasing the HIV prevalence of those PWID who purchase syringes from a pharmacy. 4 …”

Section: Introductionmentioning

confidence: 99%

Effect of legal status of pharmacy syringe sales on syringe purchases by persons who inject drugs in San Francisco and San Diego, CA

Siddiqui

Armenta

Evans

et al. 2015

International Journal of Drug Policy

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“…We analyzed the predictors of PWID population prevalence (per 10,000 adult population), of HIV prevalence among PWID, and of HIV incidence among PWID. In one analysis, we showed that metropolitan areas in states with laws against over the counter purchase of syringes had higher HIV prevalence rates and incidence rates than those in states where syringes could be purchased (Friedman, Perlis, & Des Jarlais, 2001). In further analyses, we found that income inequality in a metropolitan area (as well as laws against syringe purchase) was positively associated with the population prevalence of PWID and with HIV prevalence rates among PWID (Friedman, Perlis, Lynch, & Des Jarlais, 2001).…”

Section: Findings From Five Analysesmentioning

confidence: 99%

Income inequality, drug-related arrests, and the health of people who inject drugs: Reflections on seventeen years of research

Friedman

Tempalski

Brady

et al. 2016

International Journal of Drug Policy

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This paper reviews and then discusses selected findings from a seventeen year study about the population prevalence of people who inject drugs (PWID) and of HIV prevalence and mortality among PWID in 96 large US metropolitan areas. Unlike most research, this study was conducted with the metropolitan area as the level of analysis. It found that metropolitan area measures of income inequality and of structural racism predicted all of these outcomes, and that rates of arrest for heroin and/or cocaine predicted HIV prevalence and mortality but did not predict changes in PWID population prevalence. Income inequality and measures of structural racism were associated with hard drug arrests or other properties of policing. These findings, whose limitations and implications for further research are discussed, suggest that efforts to respond to HIV and to drug injection should include supra-individual efforts to reduce both income inequality and racism. At a time when major social movements in many countries are trying to reduce inequality, racism and oppression (including reforming drug laws), these macro-social issues in public health should be both addressable and a priority in both research and action.

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“…14-25 Subsequently, pharmacy syringe sales have been associated with reduced injection mediated-risks 14,26-28 and reduced rates of HIV infection among PWID. 29-31 Non-prescription syringe sales offer the potential for enhancing syringe availability due to the broad distribution of pharmacies throughout most regions of the U.S. and up to 24 hours of operation, 27,32 but syringe sales rates can vary substantially, depending on local legislation and local pharmacy practice. 33 In many states, PWID recognize pharmacies as stable, safe and affordable sources of sterile syringes, 19,34,35 and other services, depending on the training level of the pharmacists.…”

Section: Introductionmentioning

confidence: 99%

Nonprescription naloxone and syringe sales in the midst of opioid overdose and hepatitis C virus epidemics: Massachusetts, 2015

Stopka¹,

Donahue²,

Hutcheson³

et al. 2017

Journal of the American Pharmacists Association

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Objectives To determine the prevalence of non-prescription naloxone and sterile syringe sales, factors associated with non-prescription sales, geospatial access to non-prescription naloxone and syringe selling pharmacies, and targets for potential interventions. Design Cross-sectional study. Setting and Participants Massachusetts has experienced steep increases in reported opioid overdoses and hepatitis C virus (HCV) cases in the past decade. Pharmacists have the potential to play a substantial role in increasing access to non-prescription naloxone and sterile syringes, which can reverse opioid overdoses and decrease HCV transmission, respectively. We completed brief telephone surveys with 809 of 1,042 retail pharmacies across Massachusetts (response rate=77.6%) during 2015 to assess experience with non-prescription sales of naloxone and sterile syringes. Outcome Measures Our primary outcomes were the stocking and selling of naloxone in the pharmacy (yes/no) for non-prescription sales, and non-prescription syringe sales (yes/no). We conducted multivariable regression analyses and created maps using a geographic information system (GIS) to identify factors associated with non-prescription sales of naloxone and sterile syringes, and to improve our understanding geospatial access to pharmacy-based naloxone and syringe sales. Results Over 97% of pharmacies reported selling sterile syringes without requiring a prescription and 45% of pharmacies reported stocking and selling naloxone. Factors associated with non-prescription sales included: hours of operation, experience with and interest in harm reduction activities, and presence in an opioid overdose hotspot. Geographic access to non-prescription sale of sterile syringes is wide-spread, while geospatial access to naloxone is more limited. Training to better understand the benefits, applications, and distribution needs of naloxone is of interest to surveyed pharmacists. Conclusion Access to sterile syringes through non-prescription sales is strong across Massachusetts and, while over 350 pharmacies (45%) reported stocking and selling naloxone to prevent opioid overdose deaths, there is much room for improvement in access, and training among pharmacy staff.

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Laws prohibiting over-the-counter syringe sales to injection drug users: relations to population density, HIV prevalence, and HIV incidence

Cited by 81 publications

References 19 publications

Effect of legal status of pharmacy syringe sales on syringe purchases by persons who inject drugs in San Francisco and San Diego, CA

Effect of legal status of pharmacy syringe sales on syringe purchases by persons who inject drugs in San Francisco and San Diego, CA

Income inequality, drug-related arrests, and the health of people who inject drugs: Reflections on seventeen years of research

Nonprescription naloxone and syringe sales in the midst of opioid overdose and hepatitis C virus epidemics: Massachusetts, 2015

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