Social justice for injection drug users: Public health policy implementation

Local public health departments (PHD) are traditionally responsible for implementing statewide legislation. In the case of expanding access to syringes for injection drug users (IDU) through non prescription syringe sales (NPSS) by pharmacies, implementation by PHD requires time, resources, stakeholder buy-in and political will. Five years after California legislation was passed to permit NPSS, only 15 of 61 counties have implemented programs, and 4 authorized local policies but did not recruit pharmacies. We assessed attitudes and perceptions about IDU behavior and about NPSS, and willingness to sell syringes among 123 pharmacists in 4 counties, and we interviewed 46 IDU recruited from syringe exchange programs (SEP) in these 4 counties. We also interviewed two elected/appointed officials in each the counties to determine their level of support or opposition. Seventy-two per cent of surveyed pharmacists were willing to sell syringes. We found statistically significant positive correlations between pharmacy willingness to sell syringes to IDU and the perception that doing so was effective public health policy. Eighty-two per cent of IDU interviewed would use pharmacies if it were legal to do so. Most of the elected/appointed officials indicated it was the role of the PHD to implement local policies; however, some were opposed to NPSS. Summary data were provided to each of the PHD in 2009; in two, NPSS programs were established as a result. This study highlights the value of sharing research data with PHD under study and using these data as leverage for public health policy implementation.