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Irwin AN, Gray M, Ventricelli D, Boggis JS, Bratberg J, Floyd AS, Silcox J, Hartung DM, Green TC. "I go out of my way to give them an extra smile now:" A study of pharmacists who participated in Respond to Prevent, a community pharmacy intervention to accelerate provision of harm reduction materials. Res Social Adm Pharm 2024; 20:512-519. [PMID: 38395644 PMCID: PMC10981567 DOI: 10.1016/j.sapharm.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 02/03/2024] [Accepted: 02/04/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Community pharmacies are well-positioned to improve the health of people with opioid use disorder and who use drugs by providing naloxone and other essential public health supplies. Respond to Prevent (R2P) is a clinical trial which sought to accelerate provision of harm reduction materials through a multicomponent intervention that included in-store materials, online training, and academic detailing. OBJECTIVES The objective of this study was to explore pharmacists' attitudes, knowledge, and experiences in providing naloxone, dispensing buprenorphine, and selling nonprescription syringes following participation in the R2P program. METHODS Two online asynchronous focus groups were conducted with community-based chain pharmacists across Massachusetts, New Hampshire, Oregon, and Washington who had participated in the R2P program. Participants accessed an online repository of group interview items and responded to questions over a short period. Each pharmacist participated anonymously for approximately 30 min over 2 ½ days. Pharmacists answered questions on experiences with pharmacy-based harm reduction care and R2P intervention implementation barriers and facilitators. Qualitative data analysis was conducted by a multidisciplinary team using an immersion-crystallization approach. RESULTS A total of 32 pharmacists participated in the two focus groups. Most participants were female (n = 18, 56%), non-Hispanic (n = 29, 91%), and white (n = 17, 53%). Four major themes were identified related to (1) addressing bias and stigma toward people with opioid use disorder and who use drugs, (2) familiarity and comfort with naloxone provision, (3) perspective and practice shifts in nonprescription syringe sales, (4) structural challenges to harm reduction care in the pharmacy. CONCLUSIONS Community pharmacists across the four states identified attitudes, knowledge, and experiences that create barriers to providing care to people with opioid use disorder and who use drugs. R2P approaches and tools were effective at reducing stigma and changing attitudes but were less effective at addressing structural challenges from the pharmacists' perspective.
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Affiliation(s)
- Adriane N Irwin
- Department of Pharmacy Practice, Oregon State University College of Pharmacy, Corvallis, OR, USA
| | | | - Daniel Ventricelli
- Indivior, Inc., North Chesterfield, VA, USA; Department of Clinical Pharmacy, Philadelphia College of Pharmacy at University of the Sciences, Philadelphia, PA, USA
| | - Jesse S Boggis
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA; Opioid Policy Research Collaborative, Heller School for Social Policy & Management at Brandeis University, Waltham, MA, USA
| | - Jeffrey Bratberg
- Department of Pharmacy Practice and Clinical Research, University of Rhode Island College of Pharmacy, Kingston, RI, USA
| | - Anthony S Floyd
- Department of Psychiatry and Behavioral Sciences, Addictions, Drug & Alcohol Institute, University of Washington School of Medicine, Seattle, WA, USA
| | - Joseph Silcox
- Opioid Policy Research Collaborative, Heller School for Social Policy & Management at Brandeis University, Waltham, MA, USA; Department of Sociology, University of Massachusetts, Boston, MA, USA
| | - Daniel M Hartung
- Department of Pharmacy Practice, Oregon State University College of Pharmacy, Corvallis, OR, USA
| | - Traci C Green
- Opioid Policy Research Collaborative, Heller School for Social Policy & Management at Brandeis University, Waltham, MA, USA; Departments of Emergency Medicine and Epidemiology, Brown Schools of Medicine and Public Health, Providence, RI, USA.
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Gionfriddo MR, Owens KM, Leist SE, Schrum LT, Covvey JR. Attitudes, beliefs, knowledge, and practices for over-the-counter syringe sales in community pharmacies: A systematic review. J Am Pharm Assoc (2003) 2023; 63:1472-1489.e3. [PMID: 37429389 DOI: 10.1016/j.japh.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/02/2023] [Accepted: 07/06/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND Community pharmacies are an important resource for people who inject drugs (PWID) to purchase over-the-counter (OTC) syringes. Access to sterile injection equipment can reduce the transmission of blood-borne illnesses. However, pharmacists and their staff ultimately use discretion over sales. OBJECTIVE To identify staff attitudes, beliefs, knowledge, and practices in the sale of OTC syringes in community pharmacies. METHODS This systematic review was reported according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and registered with PROSPERO (CRD42022363040). We systematically searched PubMed, Embase, and Scopus from inception to September 2022. The review included peer-reviewed empirical studies regarding OTC syringe sales among community pharmacy staff (pharmacists, interns, and technicians). We screened records and extracted data using a predefined data extraction form. Findings were narratively synthesized, and critical appraisal was conducted using the Mixed Methods Appraisal Tool. RESULTS A total of 1895 potentially relevant articles were identified, and 35 were included. Most studies (23; 63.9%) were cross-sectional descriptive designs. All studies included pharmacists, with seven (19.4%) also including technicians, two (5.6%) including interns, and four (11.1%) including other staff. Studies found relatively high support among respondents for harm reduction-related services within community pharmacies, but less common reports of staff engaging in said services themselves. When studies investigated the perceived positive or negative impacts of OTC syringe sales, prevention of blood-borne illness was widely understood as a benefit, while improper syringe disposal and safety of the pharmacy and its staff commonly reported as concerns. Stigmatizing attitudes/beliefs toward PWID were prevalent across studies. CONCLUSION Community pharmacy staff report knowledge regarding the benefits of OTC syringes, but personal attitudes/beliefs heavily influence decisions to engage in sales. Despite support for various syringe-related harm reduction activities, offerings of services were less likely due to concerns around PWID.
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Bin Raja Ghazilla RA, Azuddin M, Bin Ahmad Hairuddin MKF, Risdiana N. An analysis of the effect of syringe barrel volume on performance and user perception. Medicine (Baltimore) 2023; 102:e33983. [PMID: 37335669 DOI: 10.1097/md.0000000000033983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
In the market, there are many types and shapes of syringes. One of the groupings of syringe types is based on barrel volume. The shape of the product design affects performance and user perception. The aim of this study is to investigate the effect of barrel volume on its performance and user perception. We performed analysis following international organization for standardization 7886 procedures on syringe with 1 mL, 3 mL, 5 mL, and 10 mL volume. In addition, a user perception test was conducted on 29 respondents using a questionnaire with the Likert chart method. This study indicates that the bigger the syringe volume, the larger the dead space and the force to operate the piston are. A larger syringe volume also raises the volume that changes due to the plunger position increase. Meanwhile, the barrel volume does not affect water and water leakage, as we did not observe any leak during the syringe tests in our experiment. In addition, the user perception test shows that the barrel's length influences the ease of device control during the injection. The volume of the barrel negatively correlated with its effect to the environment. The safety features of all syringes are similar except for the 3 mL syringe, which has a value of 0.1 points difference to other syringes.
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Affiliation(s)
| | - M Azuddin
- CPDM, Department of Mechanical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Nurvita Risdiana
- Department of Mental Health Nursing, School of Nursing, Universitas Muhammadiyah Yogyakarta, Daerah Istimewa Yogyakarta, Indonesia
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Chatterjee A, Bannister M, Hill LG, Davis CS. Prescribing Syringes to People Who Inject Drugs: Advancing Harm Reduction in Primary Care. J Gen Intern Med 2023; 38:1980-1983. [PMID: 37020124 PMCID: PMC10271981 DOI: 10.1007/s11606-023-08183-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 03/20/2023] [Indexed: 04/07/2023]
Abstract
Access to new syringes can reduce the risk of HIV and hepatitis C transmission, skin and soft tissue infections, and infectious endocarditis for people who inject drugs (PWID). Syringe service programs (SSPs) and other harm reduction programs are a good source of syringes. However, they are sometimes not accessible due to limited hours, geographic barriers, and other factors. In this perspective, we argue that when PWID faces barriers to syringes physicians and other providers should prescribe, and pharmacists should dispense, syringes to decrease health risks associated with syringe re-use. This strategy is endorsed by professional organizations and is legally permissible in most states. Such prescribing has numerous benefits, including insurance coverage of the cost of syringes and the sense of legitimacy conveyed by a prescription. We discuss these benefits as well as the legality of prescribing and dispensing syringes and address practical considerations such as type of syringe, quantity, and relevant diagnostic codes, if required. In the face of an unprecedented overdose crisis with many associated health harms, we also make the case for advocacy to change state and federal laws to make access to prescribed syringes uniform, smooth, and universal as part of a suite of harm reduction efforts.
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Affiliation(s)
- Avik Chatterjee
- Boston Health Care for the Homeless Program, Boston, MA, USA.
- Boston Medical Center, Boston, MA, USA.
- Boston University School of Medicine, Boston, MA, USA.
| | | | - Lucas G Hill
- The University of Texas at Austin College of Pharmacy, Austin, TX, USA
| | - Corey S Davis
- Network for Public Health Law, Edina, MN, USA
- NYU Grossman School of Medicine, New York City, NY, USA
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Krisdiyanto, Bin Raja Ghazilla RA, Azuddin M, Bin Ahmad Hairuddin MKF, Muflikhun MA, Risdiana N, Afifuddin E. The hypodermic syringe performance based on the ISO 7886-1:2017: A narrative review. Medicine (Baltimore) 2022; 101:e31812. [PMID: 36626504 PMCID: PMC9750608 DOI: 10.1097/md.0000000000031812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
A syringe is used to inject fluid or medicine into the patient's soft tissue. The main components of the syringe were the needle, barrel, and plunger. The use of syringes in the medical world is relatively high, and especially since the COVID-19 pandemic, the use of hypodermic syringes increased sharply due to vaccination. The syringe used must be effective and of good quality, so the International Organization for Standardization (ISO) has published test procedures and minimum specifications for hypodermic syringes. The performance of the syringe can be observed from the dead space, force piston operation, water and air leakage, and fitting position of the plunger in the barrel. This review shows that most researchers use the weighing method to measure the dead space, although some use other methods. The researchers found that most of the products met the minimum specifications of the ISO, and that the dimensions and shape of the syringe affected the dead space. Researchers have not examined other performance measures recommended by the ISO. Researchers have focused more on force injection than force piston operation, leakage after injection or back spray than air and water leakage, and reduction the friction of the plunger without considering the fitting position of the plunger in the barrel.
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Affiliation(s)
- Krisdiyanto
- CPDM, Department of Mechanical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
- Mechanical Engineering Department, Faculty of Engineering, Universitas Muhammadiyah Yogyakarta, Yogyakarta, Indonesia
| | | | - M. Azuddin
- CPDM, Department of Mechanical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Muhammad Akhsin Muflikhun
- Mechanical and Industrial Engineering Department, Faculty of Engineering, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Nurvita Risdiana
- Department of Mental Health Nursing, School of Nursing, Universitas Muhammadiyah Yogyakarta, Yogyakarta, Indonesia
| | - Eki Afifuddin
- Mechanical and Industrial Engineering Department, Faculty of Engineering, Universitas Gadjah Mada, Yogyakarta, Indonesia
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Lai RK, Friedson KE, Reveles KR, Bhakta K, Gonzales G, Hill LG, Evoy KE. Naloxone Accessibility Without an Outside Prescription from U.S. Community Pharmacies: A Systematic Review. J Am Pharm Assoc (2003) 2022; 62:1725-1740. [DOI: 10.1016/j.japh.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 07/19/2022] [Accepted: 07/20/2022] [Indexed: 10/16/2022]
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Fadanelli M, Cooper HLF, Freeman PR, Ballard AM, Ibragimov U, Young AM. A qualitative study on pharmacy policies toward over-the-counter syringe sales in a rural epicenter of US drug-related epidemics. Harm Reduct J 2022; 19:1. [PMID: 34996466 PMCID: PMC8742380 DOI: 10.1186/s12954-021-00569-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 11/08/2021] [Indexed: 11/10/2022] Open
Abstract
Background Expanding access to sterile syringes in rural areas is vital, as injection-related epidemics expand beyond metropolitan areas globally. While pharmacies have potential to be an easily accessible source of sterile syringes, research in cities has identified moral, legal and ethical barriers that preclude over-the-counter (OTC) sales to people who inject drugs (PWID). The current study builds on prior urban-based research by elucidating (1) pharmacy OTC policies and (2) pharmacists’ rationale for, and barriers and facilitators to, OTC syringe sales in a US rural area hard hit by drug-related epidemics. Methods We conducted 14 semi-structured interviews with pharmacists recruited from two Eastern Kentucky health districts. Interview domains included experiences with, and attitudes toward, selling OTC syringes to PWID. Constructivist grounded theory methods were used to analyze verbatim transcripts. Results Most pharmacists operated “restrictive OTC” pharmacies (n = 8), where patients were required to have a prescription or proof of medical need to purchase a syringe. The remainder (n = 6) operated “open OTC” pharmacies, which allowed OTC syringe sales to most patients. Both groups believed their pharmacy policies protected their community and pharmacy from further drug-related harm, but diverging policies emerged because of stigma toward PWID, perceptions of Kentucky law, and belief OTC syringe sales were harmful rather than protective to the community. Conclusion Our results suggest that restrictive OTC pharmacy policies are rooted in stigmatizing views of PWID. Anti-stigma education about substance use disorder (SUD), human immunodeficiency virus (HIV), and Hepatitis C (HCV) is likely needed to truly shift restrictive pharmacy policy.
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Affiliation(s)
- Monica Fadanelli
- Emory University Rollins School of Public Health, 1518 Clifton Rd, Atlanta, GA, 30322, USA.
| | - Hannah L F Cooper
- Emory University Rollins School of Public Health, 1518 Clifton Rd, Atlanta, GA, 30322, USA
| | | | - April M Ballard
- Emory University Rollins School of Public Health, 1518 Clifton Rd, Atlanta, GA, 30322, USA
| | - Umed Ibragimov
- Emory University Rollins School of Public Health, 1518 Clifton Rd, Atlanta, GA, 30322, USA
| | - April M Young
- University of Kentucky College of Public Health, Lexington, KY, USA
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