Encouraging Pharmacy Sale and Safe Disposal of Syringes in Seattle, Washington

Needle debris and discarded drug paraphernalia can pose risks to people who use drugs (PWUD) and other members of the community. The research question guiding our scoping review was, “What is the scope of literature around discussions of and interventions for needle debris associated with drug use in a community setting”?

The review was guided by the Joanna Briggs Institute methodology. Reporting was in accordance with the PRISMA scoping review extension. Searches in August of 2022 on Medline, CINAHL, PsycINFO, EMBASE, and Social Services Abstracts were completed. Quantitative and qualitative study designs were included. Grey literature was excluded. Extracted data included disposal initiatives and factors influencing disposal practices.

The databases combined search total was 3074. A total of 1115 duplicates were removed. Inclusion and exclusion criteria resulted in 72 studies full-text studies reviewed. Nineteen articles met all requirements. Studies from multiple continents resulted in similar themes. Two main themes were identified: needle disposal challenges for PWUD and disposal initiatives. Disposal challenges related to legal barriers and law enforcement influence, the varying definitions of ‘safe disposal’ and perspectives of PWUD. Disposal initiatives stemmed from community-based initiatives, pharmacy contributions and the perceptions and attitudes of community members.

Needle debris is a complex phenomenon highly impacted by the threat of persecution from law enforcement. PWUD need various disposal methods in proximity to their injecting location to avoid fear of prosecution from residual substances on the syringes.

California Senate Bill 41 (SB41), effective January 2012, is a human immunodeficiency virus/hepatitis C virus prevention measure designed to expand syringe access among injection drug users (IDUs) by allowing pharmacies to sell syringes without a prescription. This study assesses self-reported implementation of SB41 and characterizes barriers amenable to intervention.

Interviewer-administered survey.

Fresno and Kern Counties, CA. Pharmacists and other pharmacy staff (n = 404) at 212 pharmacies.

Self-reported nonprescription pharmacy sales to known or suspected IDUs.

Overall, 29.3% of participants said their pharmacy would sell nonprescription syringes to a known or suspected IDU, whereas a far higher proportion (79.3%) would sell nonprescription syringes to a person with diabetes. More than one-half said that their pharmacy requires nonprescription syringe purchasers to enter their signature and name and address in a log book although that is not required under SB41. Fewer than 2 out of 3 participants (61.1%) knew that it is legal to sell nonprescription syringes to IDUs. That knowledge, as well as having syringe sales practices based on both store policy and discretion, were positively associated with IDU syringe sales after controlling for other factors. Working at an independent pharmacy, agreeing that only people with “medical conditions” such as diabetes should be able to buy syringes, and viewing syringe sales to IDUs as “not good business” were independently but negatively associated with IDU syringe sales.

This study complements an earlier syringe purchase trial documenting low participation in voluntary nonprescription syringe sales under SB41 in Fresno and Kern Counties. In the absence of legislation requiring mandatory syringe sales, interventions should be developed to increase knowledge of the law and frame addiction as a medical condition, with a special focus on independent pharmacies. Informational interventions should stress the need to eliminate log book documentation requirements, which may serve as a barrier to IDU purchase.

To assess implementation of California Senate Bill SB41 in two inland California counties where prevalence of injection drug use is among the highest in the nation.

Syringe purchase trial.

Fresno and Kern counties, California.

All 248 community pharmacies in the counties.

Successful or unsuccessful syringe purchase attempt.

Only 52 (21.0%) syringe purchase attempts were successful. The proportion of successful attempts did not vary by county or by data collector ethnicity. The most common reasons for unsuccessful syringe purchase attempts were prescription requirements (45.7%), the requested syringe size was not available (10.7%), and the pharmacy did not sell syringes (9.7%). In addition, some syringe purchase attempts (4.1%) were unsuccessful because the data collector was asked to purchase more syringes than allowed by law. Although 80% and 78% of Fresno and Kern residents, respectively, live within a 5-minute drive of a community pharmacy, less than one-half live within a 5-minute drive of a community pharmacy that sold syringes.

SB41 has not resulted in broad pharmacy-based syringe access in California's inland counties, where a disproportionate number of cases of human immunodeficiency virus (HIV) infections are associated with injection drug use. Additional steps by legislative bodies, regulatory agencies, and professional organizations are needed to actively engage pharmacies in expanding nonprescription syringe sales to reduce HIV transmission among injection drug users.