Abstract

BackgroundPharmacists 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.MethodsA 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.ResultsThree 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.ConclusionsAlthough 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.

Highlights

  • Pharmacists are among the most accessible healthcare providers in the United States and uniquely positioned to provide harm reduction services

  • Procedure An email was sent in May 2019 with a link to an anonymous, online survey to all pharmacists with an active license registered with the North Carolina State Board of Pharmacy (NCBOP) using the NCBOP listserv

  • Demographics The recruitment email was successfully delivered to 11,609 pharmacists on the NCBOP email listserv

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Summary

Introduction

Pharmacists are among the most accessible healthcare providers in the United States and uniquely positioned to provide harm reduction services. Pharmacists are important in rural areas where access to other healthcare professionals is limited [2] Given this accessibility, pharmacists are uniquely positioned to improve public health through offering harm reduction services. Harm reduction (HR) refers to a package of evidencebased interventions that help mitigate individual and community health risks associated with drug use. Such interventions include syringe exchanges, selling syringes without a prescription, dispensing naloxone (an opioid overdose reversal agent), and screening for human immunodeficiency virus (HIV) and hepatitis C virus (HCV). HR services have been found to be a cost-effective intervention to avert HIV and/or HCV infections [3]

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