title: Drug-related deaths and the sales of needles through pharmacies.
abstract: BACKGROUND
  Providing needles to people who inject drugs is a well-proven public health response to the transmission of HIV and other blood borne viruses. Despite over a quarter of a century of research, new concerns about potential unintended negative consequences of needle distribution continue to emerge. Specifically, a claim was recently made that the introduction of pharmacy sales of needles was followed by an increase in overdoses in pharmacy parking lots. If true, this would have serious implications for the design of needle access programs, particularly those involving pharmacy sales of needles.
  
  
  METHODS
  We examine spatial relationships between drug-related deaths and pharmacies in Los Angeles County (population 9.8 million) before and after the 2007 enactment of a California law allowing pharmacy sales of needles without a prescription. Seven thousand and forty-nine drugs related deaths occurred in Los Angeles county from 2000 to 2009 inclusive. Four thousand two hundred and seventy-five of these deaths could be geocoded, and were found to be clustered at the census tract level.
  
  
  RESULTS
  We used three methods to examine spatial relationships between overdose death locations and pharmacy locations for two years on either side of the enactment of the pharmacy sales law, and found no statistically significant changes. Among the 711 geocodable deaths occurring in the two years following the change in law, no death was found to occur within 50m of a pharmacy which sold needles.
  
  
  CONCLUSIONS
  These results are consistent with prior studies which suggest pharmacy sales of needles improve access to needles without causing increased harms to the surrounding community.
authors.affiliation: Division of Global Public Health, Department of Medicine, University of California, San Diego, San Diego, CA, USA. Electronic address: pdavidson@ucsd.edu.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Davidson
authors.affiliation: Department of Sociology, San Francisco State University, San Francisco, CA, USA.
authors.forename: Alexis
authors.initials: A
authors.lastname: Martinez
authors.affiliation: Urban Health Program, RTI International, San Francisco, CA, USA.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Lutnick
authors.affiliation: Urban Health Program, RTI International, San Francisco, CA, USA.
authors.forename: Alex H
authors.initials: AH
authors.lastname: Kral
authors.affiliation: Department of Preventive Medicine, Institute for Prevention Research, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
authors.forename: Ricky N
authors.initials: RN
authors.lastname: Bluthenthal
mesh_terms: D002140:California / Q000453:epidemiology; D003132:Commerce / Q000331:legislation & jurisprudence*; D062787:Drug Overdose / Q000401:mortality*; D005260:Female; D062306:Geography, Medical / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D009339:Needles / Q000009:adverse effects* / Q000706:statistics & numerical data; D010594:Pharmacies / Q000331:legislation & jurisprudence*; D055656:Prescriptions
keywords: HIV; Needle distribution; Overdose; People who inject drugs; Pharmacy