title: Nonprescription syringe sales: Resistant pharmacists' attitudes and practices.
abstract: To examine barriers to nonprescription syringe sales (NPSS) in pharmacies by examining resistant pharmacists' willingness to provide syringes to people who inject drugs (PWID) and their current practices for provision or refusal.
  
  
  
  Qualitative, semi-structured, in-depth interviews with community pharmacists in California, Kansas, Mississippi, and New Jersey. Participants include seventeen community pharmacists who expressed ethical concerns about providing syringes drawn from a larger sample of 71 community pharmacists participating in a study of ethical decision-making. Analysis captures pharmacists' descriptions of their experiences providing syringes to suspected PWID.
  
  
  
  Pharmacists who identified syringes as a key ethical issue exhibited significant ambivalence about providing syringes to PWID. Most of these pharmacists were aware of harm reduction logics, but endorsed them to varying degrees. Moral concerns about supplying PWID with syringes were mediated by law and organizational policy. Many pharmacists who considered syringes an ethical challenge allayed their concerns by creating informal policy and engaging in deterrence practices designed to dissuade PWID from coming to the pharmacy.
  
  
  
  As heroin abuse rates continue to rise, pharmacists are undoubtedly integral allies in the fight to prevent the spread of communicable diseases like HIV/AIDS and Hepatitis C. Education should be aimed at identifying barriers to NPSS resulting from resistant pharmacists' attitudes and practices. Increased education paired with favorable law and organizational policy and decentralization of syringe provision could increase access to clean needles and decrease public health risks.
authors.affiliation: Saint Louis University, Department of Sociology & Anthropology, Saint Louis University, 1921 Morrissey Hall, Saint Louis, MO 63108, United States. Electronic address: Chiarello@slu.edu.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Chiarello
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003132:Commerce / Q000191:economics* / Q000331:legislation & jurisprudence; D003157:Community Pharmacy Services / Q000191:economics* / Q000331:legislation & jurisprudence; D005260:Female; D040261:Harm Reduction; D007722:Health Knowledge, Attitudes, Practice; D006526:Hepatitis C / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D008297:Male; D004366:Nonprescription Drugs / Q000008:administration & dosage; D010595:Pharmacists / Q000191:economics* / Q000331:legislation & jurisprudence / Q000523:psychology*; D015819:Substance Abuse, Intravenous / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control; D013594:Syringes / Q000191:economics*
chemical_list: D004366:Nonprescription Drugs
keywords: Behavior; HIV/AIDS; Heroin; Nonprescription syringe sales; Pharmacist; Qualitative research