Pharmacists’ role in delivering harm reduction services
SIDCPharmacies play a major role in the provision of harm reduction services and advice worldwide. Community pharmacies are considered one of the most accessible service providers to People Who Use Drugs (PWUD). In many countries, People Who Inject Drugs (PWID) often access needles or syringes in pharmacies as a first place when they are unable to access a Needle and Syringes Program (NSP).
Research has shown that when harm reduction services are introduced into pharmacies, blood born infections and risky behaviors for PWID can decrease, early detection of sexually transmitted infections can increase, and help seeking behavior of PWUD increases. Increased referral to treatment or social centers has also been noted. However, the implementation of pharmacies-based harm reduction programs is still limited due to multiple challenges. Studies have shown that fear was a main barrier for needles distribution in pharmacies. Pharmacists feared harms to staff, increased criminality in the surrounding area, reduced clientele to PWID, disturbance of other non-PWID customers and increased inappropriate disposal of used needles in the neighboring area. Other reported challenges were also lack of time, lack of training and inappropriate or non-existent policy or protocol hindering the ability to sell needles without prescriptions or requesting to record the sales of similar products.
Harm reduction interventions have been available in Lebanon since more than 20 years, however, they remain limited and face multiple barriers that hinders their availability and accessibility. Funding has always been a main barrier for harm reduction services however, other barriers have also been noted. In an assessment done by the Ministry of Public Health in Lebanon, about the availability and accessibility of NSP services, PWIDs reported that clean syringes were difficult to access and one of the main reasons was that pharmacists refused to sell clean needles to PWID. They also reported facing stigma and discrimination from pharmacists and some of them were threatened to be reported to the police. Representatives from the Order of Pharmacists in Lebanon were also part of this assessment and requested “more awareness” on NSPs because pharmacists lack information about this topic. The same challenge was also reported by outreach workers and Civil Society Organizations (CSOs) focal points who mentioned that pharmacists were not cooperative with PWID and they try to avoid selling clean needles to them.
Based on the aforementioned situation, Soins Infirmiers et Developpement Communautaire (SIDC) with the support of the Middle East and North Africa Harm Reduction Association (MENAHRA) conducted consultation meetings with key stakeholders to provide an overview of pharmacists’ practices as well as pharmacists’ attitudes and identified barriers toward providing harm reduction services in addition to setting a list of recommendations to be adopted by main stakeholders to improve the situation.
