Shifting the paradigm: physician-authorized, student-led efforts to provide harm reduction services amidst legislative opposition

Background For over 30 years, syringe services programs (SSPs) have served as an efficacious intervention for the prevention of HIV and Hepatitis C transmission among persons who use drugs. Despite a strong body of evidence for the effectiveness of SSPs as a preventative public health measure, numerous local and state governments in the United States continue to resist the establishment of new SSPs and aggressively pursue the closure of those already in operation. Commentary In Orange County, California, local officials have repeatedly mobilized in opposition of the establishment of syringe access – thereby hindering access to healthcare for thousands of predominantly unhoused individuals. The county was previously served by the Orange County Needle Exchange Program from 2016 until 2018 when a civil suit brought by the Orange County Board of Supervisors resulted in the closure of the program. For more than 2 years, persons who inject drugs in Orange County lacked reliable access to clean syringes, placing them at increased risk for contracting HIV and Hepatitis C. Here, we comment on the ongoing effort to restore syringe access in Orange County. This collaborative physician-directed endeavor has brought together students and community volunteers to provide vital harm reduction services to a remarkably underserved population. Since the reestablishment of syringe access in Orange County by the Harm Reduction Institute, new legal barriers have arisen including the passage of new municipal legislation banning the operation of syringe exchanges. We are well-equipped to overcome these obstacles. This work serves as an affirmation of assertions made by previous authors regarding the unique qualifications of medical & graduate students as effective harm reductionists. Conclusion Harm reduction services are vital to the health and well-being of people who use drugs. The provision of these services should not be impeded by legislative interference by municipal, county, or state governments.

Community Pharmacist Utilization of Legislation That Allows Impact on the Opioid Crisis in the State of Minnesota: A Mixed-Methods Approach

Background: As opioid overdose deaths climb, legislation supporting pharmacists in developing their role to address the crisis has expanded. Although Minnesota pharmacists are encouraged to utilize opiate antagonist, syringe access and authorized collector legislation, the use patterns of these tools are unknown. Methods: A mixed-methods approach was used to survey 8405 Minnesota-licensed pharmacists on their practices related to the opioid crisis. An analysis of community pharmacist utilization of opioid-related legislation was conducted. Results: The majority (88.64%) of respondents indicated that they had not dispensed naloxone in the past month using a protocol; 59.69% reported that they had not dispensed naloxone by any method in the past month. Over sixty percent (60.61%) of respondents agreed they are comfortable with dispensing syringes and would dispense noninsulin syringes in their pharmacy under the statewide Syringe Access Initiative; 25.86% reported that they are not comfortable dispensing syringes. The majority (78.64%) of respondents reported that they do not participate in collecting unwanted pharmaceuticals. Conclusion: While pharmacists have the potential to play a key role in efforts focused on addressing the opioid crisis through harm reduction strategies, this role and the use of supporting legislation is currently underutilized in the state of Minnesota.