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

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.