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Risk Reduction Toolkit for Non-Prescription Syringe Sales in Community Pharmacies


Fast-Track proposals will not be accepted.
Number of anticipated awards: 1
Budget (total costs):
Phase I: up to $150,000 for up to 6 months
Persons who inject drugs (PWID) are at increased risk of acquiring HIV, hepatitis C virus (HCV), hepatitis B virus (HBV), and bacterial infections. Persons who inject drugs can substantially reduce their risk of getting and transmitting HIV, viral hepatitis and other blood borne infections by using a sterile needle and syringe for every injection. In many jurisdictions, persons who inject drugs can access sterile needles and syringes through syringe services programs (SSPs) and through pharmacies without a prescription ( ). The science shows that access to sterile syringes can reduce needle sharing and does not result in increased injection frequency, injection drug use, or unsafe disposal of syringes.
The National Alliance of State and Territorial AIDS Directors (NASTAD) and the Urban Coalition for HIV/AIDS Prevention Services (UCHAPS) published “Syringe Service Program Development and Implementation Guidelines for State and Local Health Departments” in 2012 ( ). These guidelines state that pharmacies and pharmacy organizations are a resource and strong ally for SSPs and describe a
“Pharmacy Distribution Model” and “Pharmacy Voucher Program” as service delivery models for SSPs. Pharmacists are
equipped to apply risk reduction strategies among PWID by selling non-prescription syringes, promoting safe injection practices, discussing safe syringe disposal, performing HIV and HCV testing, administering recommended immunizations (e.g., Tdap, hepatitis A, hepatitis B), providing counseling and education (e.g., sexually transmitted infections, HIV, HCV, HBV, substance abuse), assessing medications and adherence, and linking patients to appropriate healthcare. In addition, pharmacists counsel patients and family members on naloxone administration in order to address injection related opioid overdose concerns. A training program for implementation of a pharmacy-based statewide naloxone distribution program demonstrated that promotion and distribution of materials along with training resulted in increased dispensing of naloxone (Morton KJ, J Am Pharm Assoc 2017 )
Pharmacists are legally allowed to sell sterile needles and syringes in most areas of the United States; in fact, other than through SSPs, pharmacies are essentially the only option for a person to access a sterile syringe legally. As an example of the magnitude of the syringe sales in pharmacies, a 2015 survey of nearly 80% of the more than 1,000 community pharmacies in Massachusetts, where there is no limit on the number of syringes that can be sold, found that 97% of community pharmacies reported selling nonprescription syringes. They also reported median sales per store of 75 per week which translates into nearly 100,000 nonprescription syringes sold statewide per week (Stopka TJ, J Am Pharm Assoc 2017 ).

Syringe access programs provide a framework, typically developed by a state or local health department, within which nonprescription syringe sales (NPSS)-specific guidance for HIV prevention counselling, pharmacist and pharmacy staff education, syringe disposal or referrals are provided. To date, three states, Minnesota, New York and California have established pharmacy-based syringe access programs. These programs can serve as a model for the establishment of similar services in areas with injection drug use and low SSP coverage. However, in most pharmacies, NPSS is left to the discretion of the pharmacist. Education and tools are needed to support pharmacists in the delivery of risk reduction services to lower risk behaviors, facilitate safe disposal of syringes, and provide referrals for substance abuse treatment.
Project Goals
The primary goal of this project is to develop a toolkit for pharmacies to implement risk reduction services targeting PWID who access syringes through pharmacies. Pharmacists should be provided training and tools to implement pharmacy-based syringe programs and risk reduction services in order to improve the health of their local communities through the prevention of blood-borne pathogens, safe syringe disposal, testing for HIV and HCV with rapid point-of-care tests, linking to clinical care providers, mental health care providers, SUBSTANCE ABUSE PROVIDERS and other services. The training curriculum can be developed for on-line use or for in-person use (e.g. to be delivered at pharmacy conferences or meetings) and should be designed such that Continuing Pharmacy Education (CPE) accreditation can be attained by pharmacists and pharmacy technicians. The final development of the on-line or in-person training and accreditation can be secured during Phase II.
Phase I Activities and Expected Deliverables
Develop a prototype for a pharmacy-based syringe program and toolkit to implement risk reduction services for pharmacy-based risk reduction services associated with NPSS. Tools can include products that provide safer methods for injection and for safe syringe disposal. For example, risk reduction materials may include commercially available products provided to PWID such as alcohol swabs, sterile filters for needles, sterile ‘works,’ and a portable sharps container. The toolkit should include pamphlets that describe safe injection and safe syringe disposal and a list of referrals tailored to the local area developed in conjunction with the local health department. The toolkit should be packaged in a manner that facilitates distribution from the pharmacy either from a counter or a private consultation room. The toolkit should be designed so it will be affordable to potential customers which may include pharmacies, health departments, or commercial companies that sell sterile needles, sharps containers, or other products used for safe injections. The design may be tiered such that different customers may purchase individual components that meet their needs. The offeror may propose development of new materials to support safe injection, risk reduction, and safe syringe disposal (e.g., a new sterile filter to attach to commercially available syringes that will be easy to use and acceptable to PWID). The offeror should develop a training curriculum to implement a prototype for a platform for pharmacists and pharmacy staff to implement the toolkit for pharmacy-based risk reduction services associated with NPSS to PWID within the usual customary practice of their business process. The offeror should propose a pilot of the training curriculum and prototype in several pharmacies in one jurisdiction that would benefit from enhanced NPSS for PWID. The training and prototype should accommodate the laws and regulations for pharmacy syringe sales in that jurisdiction. The pilot should quantify the number of PWID clients served with the toolkit, numbers of syringes dispensed, and a variety of other metrics for monitoring and evaluation as outlined from the publication from the National Alliance of State and Territorial AIDS Directors (NASTAD) and the Urban Coalition for HIV/AIDS Prevention Services (UCHAPS) guidelines on “Syringe Service Program Development and Implementation Guidelines for State and Local Health Departments” ). Other metrics may be proposed as well.
If pharmacies are provided with toolkits, they can collaborate with state and local health departments, insurers, syringe-service programs, and other healthcare facilities to provide linkage and continuity of care, testing for blood-borne pathogens, and other risk reduction services for PWID in order to address public health concerns. Pharmacists can be a vital resource for prevention of transmission of blood-borne pathogens among PWID if they are given the appropriate tools.
Commercialization Potential

Pharmacists and pharmacy technicians can obtain proprietary continuing education and/or certificate programs that may be paid for by the individual pharmacist or technician or paid for by a pharmacy company.

Pharmacies, health departments, insurers or other organizations can purchase materials for a pharmacy-based syringe services program that may include web-based materials, printed materials, and a package of materials to be distributed along with syringes at the time of sale to support risk reduction (e.g., disposal container, alcohol swabs, materials needed for clean injections, sterile filters for needles).

Pharmacies, health departments, insurers or other organizations can purchase newly developed products to support safe injection (e.g., a new filter to attach to syringes).

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