Intérêt d’un programme d’échange de seringues en pharmacie d’officine pour les usagers de drogues par voie intraveineuse

Abstract

To demonstrate that a syringe exchange program can reduce syringe re-use, to encourage HCV screening by injection drug users (IDUs), and to provide a new harm reduction tool through the pharmacy network. Staff at the volunteer pharmacies were trained before participating in this decentralized syringe exchange program based on making the Steribox (with its single-use Sterifilt filter) injection kit available free to IDUs. They were asked but not required to return used material to a waste container in the pharmacy. Pharmacists also informed them of the risk of HCV contamination and encouraged screening. The number of Steribox kits dispensed by the involved pharmacies quadrupled 6 months after the study began, although the number of IDUs using the pharmacy did not increase and kit sales in other local pharmacies did not decease. The disposal rate was almost 80%. The relationship between pharmacists and users clearly improved, and the dispensing of kits has become an opportunity for dialogue. Four participants who injected Subutex accepted referrals to a methadone maintenance treatment program and began treatment. The pharmacists demonstrated their ability to manage this new harm reduction tool. The 400% increase in the number of kits dispensed is an indicator of the effect of price on use of sterile injection material. Cost is undoubtedly a factor in syringe re-use. Paid syringes were reused nearly ten times each, compared with 4 times for the free ones. Appropriate disposal was a responsible act that most IDUs performed. The improvement of the relationship between IDUs and pharmacists increased the access of the former to the healthcare system and enhanced the local healthcare network. Referral to the methadone maintenance treatment program was an unexpected and happy result. The dialogue established around injection tools allowed the pharmacists to provide advice as they dispensed Sterifilt and to promote its use by IDUs.