Pharmacies as Providers of Expanded Health Services for People Who Inject Drugs: A Review of Laws, Policies, and Barriers in Six Countries

BMC Health Services Research, Vol. 14, Art. 261 (2014)

Northeastern University School of Law Research Paper No. 193-2014

12 Pages Posted: 13 Jul 2014  

Theodore M. Hammett

Abt Associates, Inc.

Son H. Phan

Abt Associates - Bethesda, MD

Julia Gaggin

The Fenway Institute, Fenway Health

Patricia Case

The Fenway Institute, Fenway Health

Nicholas Zaller

The Miriam Hospital, Center for AIDS Research

Alexandra Lutnick

Research Triangle Institute International, San Francisco CA

Alex H. Kral

The Biomedical Center

Ekaterina V. Fedorova

The Biomedical Center

Robert Heimer

Yale University - School of Public Health

Will Small

British Columbia Centre for Excellence in HIV/AIDS; Simon Fraser University (SFU) - Faculty of Health Sciences

Robin A. Pollini

Pacific Institute for Research and Evaluation (PIRE)

Leo Beletsky

Northeastern University - School of Law; Northeastern University - Bouvé College of Health Sciences

Carl Latkin

Johns Hopkins Bloomberg School of Public Health

Don C. Des Jarlais

Beth Israel Medical Center

Date Written: July 3, 2014

Abstract

Background: People who inject drugs (PWID) are underserved by health providers but pharmacies may be their most accessible care settings.

Methods: Studies in the U.S., Russia, Vietnam, China, Canada and Mexico employed a three-level (macro-, meso-, and micro-) model to assess feasibility of expanded pharmacy services for PWID. Studies employed qualitative and quantitative interviews, review of legal and policy documents, and information on the knowledge, attitudes, and practices of key stakeholders.

Results: Studies produced a mixed assessment of feasibility. Provision of information and referrals by pharmacies is permissible in all study sites and sale and safe disposal of needles/syringes by pharmacies is legal in almost all sites, although needle/syringe sales face challenges related to attitudes and practices of pharmacists, police, and other actors. Pharmacy provision of HIV testing, hepatitis vaccination, opioid substitution treatment, provision of naloxone for drug overdose, and abscess treatment, face more serious legal and policy barriers.

Discussion: Challenges to expanded services for drug users in pharmacies exist at all three levels, especially the macro-level characterized by legal barriers and persistent stigmatization of PWID. Where deficiencies in laws, policies, and community attitudes block implementation, stakeholders should advocate for needed legal and policy changes and work to address community stigma and resistance. Laws and policies are only as good as their implementation, so attention is also needed to meso- and micro- levels. Policies, attitudes, and practices of police departments and pharmacy chains as well as knowledge, attitudes, and practices of individual PWID, individual pharmacies, and police officers should support rather than undermine positive laws and expanded services. Despite the challenges, pharmacies remain potentially important venues for delivering health services to PWID.

Keywords: Pharmacies, Drug Users

Suggested Citation

Hammett, Theodore M. and Phan, Son H. and Gaggin, Julia and Case, Patricia and Zaller, Nicholas and Lutnick, Alexandra and Kral, Alex H. and Fedorova, Ekaterina V. and Heimer, Robert and Small, Will and Pollini, Robin A. and Beletsky, Leo and Latkin, Carl and Des Jarlais, Don C., Pharmacies as Providers of Expanded Health Services for People Who Inject Drugs: A Review of Laws, Policies, and Barriers in Six Countries (July 3, 2014). BMC Health Services Research, Vol. 14, Art. 261 (2014); Northeastern University School of Law Research Paper No. 193-2014. Available at SSRN: https://ssrn.com/abstract=2462125

Theodore M. Hammett (Contact Author)

Abt Associates, Inc. ( email )

55 Wheeler Street
Cambridge, MA 02138-1168
United States

Son H. Phan

Abt Associates - Bethesda, MD ( email )

4550 Montgomery Ave #800N
Bethesda, MD 20814
United States

Julia Gaggin

The Fenway Institute, Fenway Health ( email )

7 Haviland Street
4th Floor
Boston, MA 02215
United States

Patricia Case

The Fenway Institute, Fenway Health ( email )

800 Boylston Street
4th Floor
Boston, MA 02199
United States

Nicholas Zaller

The Miriam Hospital, Center for AIDS Research ( email )

164 Summit Avenue
Providence, RI 02906
United States

Alexandra Lutnick

Research Triangle Institute International, San Francisco CA ( email )

PO Box 12194
Research Triangle Park, NC 27709
United States

Alex H. Kral

The Biomedical Center ( email )

8 Viborgskaya St.
St. Petersburg, 194044
Russia

Ekaterina V. Fedorova

The Biomedical Center ( email )

8 Viborgskaya St.
St. Petersburg, 194044
Russia

Robert Heimer

Yale University - School of Public Health ( email )

PO Box 208034
60 College Street
New Haven, CT 06520-8034
United States

Will Small

British Columbia Centre for Excellence in HIV/AIDS ( email )

608 - 1081 Burrard Street
Vancouver, British Columbia V6Z 1Y6
Canada

Simon Fraser University (SFU) - Faculty of Health Sciences

8888 University Drive
Burnaby, British Columbia V5A 1S6
Canada

Robin A. Pollini

Pacific Institute for Research and Evaluation (PIRE) ( email )

11720 Beltsville Drive, Suite 900
Calverton, MD 20705
United States

Leo Beletsky

Northeastern University - School of Law; Northeastern University - Bouvé College of Health Sciences ( email )

400 Huntington Ave.
Boston, MA 02115
United States
617-373-5540 (Phone)

Carl Latkin

Johns Hopkins Bloomberg School of Public Health ( email )

615 North Wolfe Street
Baltimore, MD 21205
United States

Don C. Des Jarlais

Beth Israel Medical Center ( email )

Boston, MA 02115
United States

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