Access to syringes at pharmacies (ASAP): Preliminary impact of a pharmacy-level intervention

BACKGROUND: Community pharmacies are important access points for services to reduce bloodborne illnesses like HIV and Hepatitis C. However multiple barriers limit pharmacy provision of these services, including stigma toward people who use drugs and staff discomfort with harm reduction practices. OBJECTIVE: This study evaluated a pharmacy-level intervention called ASAP (Access to Syringes at Pharmacies) designed to increase nonprescription syringe sales and reduce stigma. METHODS: A one-armed pilot study was conducted with 18 staff of three community pharmacies located in three different Arizona counties from January-April 2022. Data were collected through monthly surveys measuring staff comfort with selected harm reduction practices and stigma toward people who use drugs. Ecological momentary assessment tracked dispensing behaviors. Linear mixed effects models with bootstrapping analyzed changes over time. RESULTS: All three pharmacies reported selling syringes without a prescription during the study period, with variation in number of sales events between the pharmacies. The number of pharmacy staff who reported "always" dispensing syringes without a prescription increased from 44.4% at baseline to 77.8% by study end. Comfort with harm reduction practices increased significantly immediately following training (β = 0.39). Stigma scores decreased significantly both immediately post-training (β = -0.41) and at study end (β = -0.34). Throughout the intervention, higher stigma scores were consistently associated with lower likelihood of syringe dispensing (r > -0.45). CONCLUSIONS: The ASAP intervention provides reason for optimism for effective pharmacy-based education to increase nonstigmatized syringe dispensing to reduce bloodborne illnesses and infections. Future studies should evaluate ASAP in a larger, controlled trial across diverse pharmacy settings to establish causal relationships and optimize implementation strategies.