Syringe Access is an Important Public Health Measure: Chi-Square
Importance
Syringe exchange programs have proven to be an
effective public health intervention in reducing the
incidence of infectious disease among injection drug
users (IDUs). Pharmacies have the potential to play a
critical role in improving syringe access within
communities and reducing disease burden among
IDU populations. Ohio law states that pharmacists
may not sell or furnish non-prescription (NP)
syringes to customers who intend to use them for a
non-medical, illicit purpose. As injection drug use
continues to rise in the United States alongside
increased heroin use and addiction, it is important to
understand what role pharmacists have in harm
reduction.
Overall
% (n)
Syringe access is not an
important public health
measure
% (n=153)
Syringe access is an
important public
health measure
% (n=339)
P-Value
Willing to sell NP syringes to anyone
30.5 (157)
6.6 (10)
46.4 (141)
.001**
Willing to sell NP syringes to IDUs
30.0 (154)
4.7 (7)
46.6 (143)
.001**
Willing to provide info/resources to IDUs
73.7 (342)
45.1 (60)
86.4 (255)
.001**
Willing to provide prevention services to IDUs such as HIV and Hep
C testing
60.2 (265)
41.3 (55)
71.8 (196)
.001**
Willing to keep and maintain a sharps container
42.6 (189)
28.1 (41)
49.7 (148)
.001**
Received Syringe Access Training: Chi-Square
Overall
% (n)
Objective
This study surveyed Ohio licensed pharmacists in
order to:
1) identify what factors are associated with
pharmacist willingness to engage in harm
reduction interventions,
2) identify what factors are associated with greater
utilization of harm reduction strategies, and
3) explore pharmacists’ current understanding of
syringe access as a public health tool.
Never received HIV or
Hep C training
% (n=471)
Received either HIV or
Hep C training or both
% (n=87)
P-Value
37.2 (193)
38.5 (168)
30.1 (25)
0.146
In my opinion, selling NP syringes to IDUs will decrease HIV
transmission
70.0 (355)
70.0 (297)
70.7 (58)
.901
In my opinion, providing IDUs access to sterile syringes is an
important public health measure in preventing HIV and Hep C.
69.0 (339)
68.0 (278)
74.4 (61)
.251
Regardless of my pharmacy’s policy, I am willing to provide
prevention services to IDUs such as HIV and Hep C testing
60.2 (265)
57.6 (212)
73.6 (53)
.011*
The policies in my pharmacy allow for unrestricted
sales of NP syringes
40.7 (224)
• The belief that syringe access is an important public health measure is
associated with willingness to engage in harm reduction strategies.
Educational opportunities offered to Ohio pharmacists emphasizing
the importance of syringe access as a public health measure could
potentially result in greater willingness to engage in harm reduction
interventions within pharmacies.
• Study results also suggest that pharmacist syringe access behaviors
may decrease with greater exposure to community overdose fatality or
drug use, which illustrates the need for timely widespread education.
County of Employment: Chi-Square
Overall
% (n)
Of the 8,667 surveys distributed, 559 (6.4%) were completed and the
survey population was evenly distributed across gender, years of practice
and county of employment. Pharmacists stratified by the opinion that
syringe access is or is not an important public health measure statistically
differed regarding willingness to provide harm reduction services
(p=.001*) and the previous practice of harm reduction behaviors
(p=.001*). Only 15.6% or participants had ever received education
regarding the role of syringe access as a public health tool. Pharmacy
policies significantly differed in high incidence overdose fatality counties
versus low incidence overdose fatality counties (p= .032*). Furthermore,
pharmacist non-prescription syringe selling behavior significantly
differed in high and low incidence overdose fatality counties with regard
to how often pharmacists sold non-prescription syringes (p= .004) and
how often pharmacists refused to sell non-prescription syringes to
individuals believed to be injection drug users (p= .016*).
Conclusions
In my opinion, selling NP syringes to IDUs will increase drug
use
Design, Setting, & Participants
Surveys were distributed to Ohio licensed
pharmacists’ emails acquired from the Ohio
Pharmacy Board’s public database using Qualtrics
survey software. Survey questions were sampled
from previous studies, which included 33 close-ended
questions and space at the end of the survey for
comments. Data was analyzed using the statistical
software program SPSS. Frequencies were calculated
for survey responses in addition to Chi-Square
analyses to test group differences for categorical
variables. In addition, qualitative data was analyzed
from the comments section of the survey.
Results
<8-13.2 OD deaths per
100,000 per year
% (n=243)
13.3-30.4 OD deaths per
100,000 per year
% (n=314)
P-Value
45.8 (110)
36.7 (114)
.032*
• Create state-wide comprehensive pharmacy education regarding the
importance and effectiveness of syringe access to injection drug users.
• Encourage pharmacist engagement in the provision of essential
resources to injection drug users such as education, referrals,
HIV/Hepatitis C testing, etc.
During the past 3 months how often did you sell NP
syringes?
Never
36.3 (171)
33.2 (68)
38.6 (102)
.004*
A few times
39.3 (185)
35.1 (72)
42.8 (113)
.004*
At least 1 a month/wk
24.5 (115)
31.7 (65)
18.6 (49)
.004*
Always/most of the time
52.6 (227)
44.9 (84)
58.3 (141)
.016*
Sometimes
20.2 (87)
25.1 (47)
16.5 (40)
.016*
Never/rarely
27.1 (117)
29.9 (56)
25.2 (61)
.016*
How often do you refuse to sell NP syringes to those
customers you believe to be IDUs?
Suggestions
• Revise ORC 3719.17.2 to allow the sale and purchase of nonprescription syringes to injection drug users.