Primary and Secondary Analysis of Local Elected Officials’ Decisions to Support or Oppose Pharmacy Sale of Syringes in California

Abstract

Under California law, local governments may authorize pharmacies within their jurisdictions to sell ten or fewer syringes to an adult without prescription, proof of identity, or proof of medical need. Local governments may simultaneously exempt adults from prosecution for violation of state drug paraphernalia codes for possession of ten or fewer syringes for personal use. Both of these provisions are temporary and sunset on December 31, 2010, unless subsequent state legislation amends that date. The objective of our study was to ascertain how and why local policymakers made their decisions regarding non-prescription syringe sale (NPSS). We examined influences on their decisions, including specific messengers and the arguments that were most salient to their decision making. We selected jurisdictions that were geographically representative of California counties; those with and without syringe exchange programs, and those that had passed or rejected NPSS. We conducted nine semi-structured interviews in five jurisdictions. To enrich primary data collection, we analyzed secondary data by reviewing audio, video, and written transcripts of public hearings and newspaper coverage in five jurisdictions, including three jurisdictions without primary interview data. Among proponents of NPSS, we identified common themes, including: (1) public health research provided conclusive evidence for reduction in HIV and hepatitis transmission without problems of crime, drug use, or unsafe discard of syringes; (2) the local health officer was the key to influencing local policymakers; (3) recall of prior debates over syringe exchange served to inform their decision making; and (4) a lack of local opposition or controversy. Common concerns among opponents of NPSS included: (1) that there would be an increase in unsafe discard of syringes; (2) loss of an important law enforcement tool; (3) that drug users were incapable of desired behavior change; and (4) that research was inconclusive, or proved that syringe access would not work in reducing rates of disease. Themes held in common by proponents and opponents of NPSS were identified as well. Syringe access through NPSS is in fact supported by a robust body of public health research and is considered an important component of a comprehensive strategy to reduce HIV and hepatitis transmission. Our study highlights the importance of understanding the perspectives of elected officials in order to ameliorate their concerns without undermining the public health goal of reducing death, disease, and suffering in at-risk communities.

Predictors of historical change in drug treatment coverage among people who inject drugs in 90 large metropolitan areas in the USA, 1993–2007

“…Further, when SSPs were proposed and/or established in various cities of the US, opponents often rallied around the watchword that treatment was what was needed and that syringe exchange was a diversion of resources from treatment [43,44,47,48,[82][83][84] Even still, SSPs are banned in 15 states (see https://www. vox.com/science-and-health/2018/6/22/17493030/needleexchanges-ban-state-map On the one hand, despite the claims of critics of SSPs (i.e, public injecting, inappropriate disposal of used syringes, mortality of drug use and associated illegal activity) [43,[84][85][86][87][88], the presence of a syringe exchange was not associated with decreases in treatment coverage. Need had only a weak relationship with treatment coverage, and changes in need were not associated with changes in coverage.…”

The Scatter Factor Signaling Pathways as Therapeutic Associated Target in Cancer Treatment

“…The majority of kinase inhibitors form hydrogen bonds to residues in the hinge region thus targeting the ATP binding site of the kinase. These inhibitors are known as type I or type II inhibitors depending on whether they bind to the kinase active conformation (with a phosphorylated A-loop) or an inactive conformation [79,80]. To date more than 70 patent applications on c-Met inhibitors are published.…”

Extent and patterns of community collaboration in local health departments: An exploratory survey

“…Collaboration between elected officials and LHDs was found extremely important in making decisions regarding pharmacy sales of syringes in California [32]. Kennedy reported that higher LHD performance was associated with the perceived support by elected officials [33].…”

“…Elected officials are often responsible for making political and public health decisions, thus, their role and influence on public health activities may be important [ 31 ]. Collaboration between elected officials and LHDs was found extremely important in making decisions regarding pharmacy sales of syringes in California [ 32 ]. Kennedy reported that higher LHD performance was associated with the perceived support by elected officials [ 33 ].…”