Come back when you're infected: pharmacy access to sterile syringes in an Arizona Secret Shopper Study, 2023

Danielle M Russell; Beth E Meyerson; Arlene N Mahoney; Irene Garnett; Chris Ferrell; Kylee Newgass; Jon D Agley; Richard A Crosby; Keith G Bentele; Nina Vadiei; David Frank; Linnea B Linde-Krieger

doi:10.1186/s12954-024-00943-w

Come back when you're infected: pharmacy access to sterile syringes in an Arizona Secret Shopper Study, 2023

Harm Reduct J. 2024 Feb 22;21(1):49. doi: 10.1186/s12954-024-00943-w.

Authors

Danielle M Russell^{1

2

3}, Beth E Meyerson^{4

5

6}, Arlene N Mahoney^{2

7

3}, Irene Garnett^{2

3

8}, Chris Ferrell^{3

9}, Kylee Newgass^{7

3}, Jon D Agley^{2

10}, Richard A Crosby^{2

11}, Keith G Bentele^{2

12}, Nina Vadiei^{2

13}, David Frank^{2

14}, Linnea B Linde-Krieger^{2

15}

Affiliations

¹ Arizona State University, Tempe, AZ, USA.
² Harm Reduction Research Lab, University of Arizona College of Medicine-Tucson, Tucson, AZ, USA.
³ Drug Policy Research and Advocacy Board (DPRAB), University of Arizona, Tucson, AZ, USA.
⁴ Harm Reduction Research Lab, University of Arizona College of Medicine-Tucson, Tucson, AZ, USA. bmeyerson@arizona.edu.
⁵ Family and Community Medicine, College of Medicine, University of Arizona, Tucson, AZ, USA. bmeyerson@arizona.edu.
⁶ Center for Comprehensive Pain and Addiction, University of Arizona Health Sciences, Tucson, AZ, USA. bmeyerson@arizona.edu.
⁷ Southwest Recovery Alliance, Phoenix, AZ, USA.
⁸ Center for Comprehensive Pain and Addiction, University of Arizona Health Sciences, Tucson, AZ, USA.
⁹ CAN Community Health, Phoenix, AZ, USA.
¹⁰ Indiana University School of Public Health-Bloomington, Bloomington, IN, USA.
¹¹ University of Kentucky College of Public Health, Lexington, KY, USA.
¹² Southwest Institute for Research On Women, University of Arizona, Tucson, AZ, USA.
¹³ College of Pharmacy, University of Arizona, Tucson, AZ, USA.
¹⁴ School of Global Public Health, New York University, New York, USA.
¹⁵ Family and Community Medicine, College of Medicine, University of Arizona, Tucson, AZ, USA.

Abstract

Background: Pharmacies are critical healthcare partners in community efforts to eliminate bloodborne illnesses. Pharmacy sale of sterile syringes is central to this effort.

Methods: A mixed methods "secret shopper" syringe purchase study was conducted in the fall of 2022 with 38 community pharmacies in Maricopa and Pima Counties, Arizona. Pharmacies were geomapped to within 2 miles of areas identified as having a potentially high volume of illicit drug commerce. Daytime venue sampling was used whereby separate investigators with lived/living drug use experience attempted to purchase syringes without a prescription. Investigator response when prompted for purchase rationale was "to protect myself from HIV and hepatitis C." A 24-item instrument measured sales outcome, pharmacy staff interaction (hostile/neutral/friendly), and the buyer's subjective experience.

Results: Only 24.6% (n = 28) of 114 purchase attempts across the 38 pharmacies resulted in syringe sale. Less than one quarter (21.1%) of pharmacies always sold, while 44.7% never sold. Independent and food store pharmacies tended not to sell syringes. There emerged distinct pharmacy staff interactions characterized by body language, customer query, normalization or othering response, response to purchase request and closure. Pharmacy discretion and pharmacy policy not to sell syringes without a prescription limited sterile syringe access. Investigators reported frequent and adverse emotional impact due to pharmacy staff negative and stigmatizing interactions.

Conclusions: Pharmacies miss opportunities to advance efforts to eliminate bloodborne infections by stringent no-sale policy and discretion about syringe sale. State regulatory policy facilitating pharmacy syringe sales, limiting pharmacist discretion for syringe sales, and targeting pharmacy-staff level education may help advance the achievement of public health goals to eliminate bloodborne infections in Arizona.

Keywords: Community pharmacies; Delivery of health care; Evidence-based pharmacy practice; HIV infections; Hepatitis C; Public health; Syringes.

MeSH terms

Arizona
HIV Infections* / prevention & control
Humans
Pharmacies*
Pharmacy*
Substance Abuse, Intravenous*
Syringes