178093 3 Ps of Expanded Syringe Access in California: Public Health, Pharmacists and Policy Makers

Tuesday, October 28, 2008: 2:30 PM

Valerie J. Rose, DrPH, MPH , Policy and Evaluation Research, Public Health Foundation Enterprises, Inc. (PHFE), Oakland, CA
Glenn Backes, MSW, MPH , Public Policy Research, Safer Alternatives through Networking and Education (SANE), Sacramento, CA
Issues: Legislation permitting non-prescription sales of syringes was passed in 2004 in California as a structural intervention designed to expand access to syringes for injection drug users. To date, just 18 of the eligible 61 local health jurisdictions (LHJ) have implemented local programs. The legislation faces termination in 2010 if current evaluation efforts fail to demonstrate outcomes defined in the legislation.

Description: We examined the systems and procedures associated with implementation; and facilitators and barriers to implementation among 12 LHJ and documented the role of public health, pharmacies and policy makers in initiating, sustaining and evaluating local programs. Public health AIDS directors, syringe exchange program coordinators and elected or appointed officials were interviewed. We created an advocacy toolkit that included a “how to” tips booklet, innovative program materials, and sample policy language, then distributed it to LHJ without local programs and to selected activist and harm reduction organizations.

Lessons Learned: Among early adopters, implementation was associated with: 1) Leadership from the public health department and their collaborative partners; 2) direct public health contact with pharmacies; 3) sharps disposal decisions made in advance; 4) minimal evaluation requirements, and 5) policy makers familiar with the needle exchange debate. Vocal opposition from the DA, law enforcement or the Narcotics Association presented barriers to implementation. Furthermore, political authorization did not always result in implementation since public health departments did not consistently prioritize the intervention.

Recommendations: Create campaign to encourage non-adopters to initiate programs, increase advocacy, provide technical assistance, and disseminate evaluation results.

Learning Objectives:
By the end of the session, participants will be able to: 1)articulate the optimal components of an expanded syringe access program 2)describe five successful implementation strategies to establish expanded syringe access programs 3)list three common barriers to implementation of expanded syringe access programs 4)identify the necessary steps to create an expanded syringe access program in their health jurisdiction

Keywords: Injection Drug Users, Syringe Sources

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I was the principal investigator on a University of California funded study of the implementation processes among local health departments regarding expanded syringe access programs in California.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.