title: Pharmacies as providers of expanded health services for people who inject drugs: a review of laws, policies, and barriers in six countries.
abstract: BACKGROUND
  People who inject drugs (PWID) are underserved by health providers but pharmacies may be their most accessible care settings.
  
  
  METHODS
  Studies in the U.S., Russia, Vietnam, China, Canada and Mexico employed a three-level (macro-, meso-, and micro-) model to assess feasibility of expanded pharmacy services for PWID. Studies employed qualitative and quantitative interviews, review of legal and policy documents, and information on the knowledge, attitudes, and practices of key stakeholders.
  
  
  RESULTS
  Studies produced a mixed assessment of feasibility. Provision of information and referrals by pharmacies is permissible in all study sites and sale and safe disposal of needles/syringes by pharmacies is legal in almost all sites, although needle/syringe sales face challenges related to attitudes and practices of pharmacists, police, and other actors. Pharmacy provision of HIV testing, hepatitis vaccination, opioid substitution treatment, provision of naloxone for drug overdose, and abscess treatment, face more serious legal and policy barriers.
  
  
  CONCLUSIONS
  Challenges to expanded services for drug users in pharmacies exist at all three levels, especially the macro-level characterized by legal barriers and persistent stigmatization of PWID. Where deficiencies in laws, policies, and community attitudes block implementation, stakeholders should advocate for needed legal and policy changes and work to address community stigma and resistance. Laws and policies are only as good as their implementation, so attention is also needed to meso- and micro- levels. Policies, attitudes, and practices of police departments and pharmacy chains as well as knowledge, attitudes, and practices of individual PWID, individual pharmacies, and police officers should support rather than undermine positive laws and expanded services. Despite the challenges, pharmacies remain potentially important venues for delivering health services to PWID.
authors.affiliation: Abt Associates Inc,, Cambridge MA 02138, USA. ted_hammett@abtassoc.com.
authors.forename: Theodore M
authors.initials: TM
authors.lastname: Hammett
authors.forename: Son
authors.initials: S
authors.lastname: Phan
authors.forename: Julia
authors.initials: J
authors.lastname: Gaggin
authors.forename: Patricia
authors.initials: P
authors.lastname: Case
authors.forename: Nicholas
authors.initials: N
authors.lastname: Zaller
authors.forename: Alexandra
authors.initials: A
authors.lastname: Lutnick
authors.forename: Alex H
authors.initials: AH
authors.lastname: Kral
authors.forename: Ekaterina V
authors.initials: EV
authors.lastname: Fedorova
authors.forename: Robert
authors.initials: R
authors.lastname: Heimer
authors.forename: Will
authors.initials: W
authors.lastname: Small
authors.forename: Robin
authors.initials: R
authors.lastname: Pollini
authors.forename: Leo
authors.initials: L
authors.lastname: Beletsky
authors.forename: Carl
authors.initials: C
authors.lastname: Latkin
authors.forename: Don C
authors.initials: DC
authors.lastname: Des Jarlais
mesh_terms: D002681:China; D005240:Feasibility Studies; D007722:Health Knowledge, Attitudes, Practice; D006291:Health Policy; D006297:Health Services Accessibility / Q000331:legislation & jurisprudence*; D006801:Humans; D009656:North America; D010593:Pharmaceutical Services / Q000331:legislation & jurisprudence*; D036301:Qualitative Research; D012426:Russia; D015819:Substance Abuse, Intravenous; D014744:Vietnam