With this in mind, Dr. Nick Hagemeier, an associate professor at East Tennessee State University’s Bill Gatton College of Pharmacy, started researching the role of community pharmacies serving as points of intervention to stop the spread of the diseases.
Coincidentally, his research began two weeks before Dec. 1, World AIDS Day.
He said the goal of the research is simple — to figure out what the current landscape for selling syringes in pharmacies is by interviewing pharmacists and gauging their perceptions and analyzing their practices.
Many pharmacies can only sell syringes upon proof of medical need. In metro areas across the country, however, the definition of what constitutes a medical need has been broadened to prevent addicts from sharing needles and transmitting diseases.
“How do you interpret that (rule) as a pharmacist? Some would say that means a diagnosis of something like diabetes, but proof of medical need could be prevention of hepatitis C and HIV,” Hagemeier said.
Joining him in this research is Dr. Kelly Foster, an assistant professor in ETSU’s Department of Sociology and Anthropology, and Dr. Karilynn Dowling, a pharmacy colleague. Through qualitative and quantitative research, their aim is to evaluate pharmacists’ syringe dispensing knowledge and behaviors across Tennessee, Virginia and North Carolina.
“We’re not trying to persuade pharmacies to do anything, we’re just trying to understand why they do what they do,” he said of the study. “We’re trying to figure out what’s feasible, and what the current landscape looks like when it comes to selling syringes.”
Results obtained through the study will be used to develop grant proposals for a national study exploring these questions. Through this grant-funded research, Hagemeier said he hopes to gain a deeper understanding of what pharmacists can do to reduce the drug-related spread of HIV and hepatitis C.
“Pharmacists are the most accessible health care provider, and I’m convinced we have a role to play,” he said. “We’re just working to figure out how we can best fill that role in this region.
“Given significant variation in state statutes and regulations, we anticipate significant variation in perceptions and behaviors. We also anticipate variation in pharmacists’ knowledge about the legality of dispensing syringes and knowledge of harm reduction approaches.”
Though syringe exchange programs have been effective in some areas in reducing the spread of diseases, little is known about how similar programs would work in rural areas. Eventually, researchers will be able explore this topic more.
The question is whether non-metro community pharmacists in places like Southern and Central Appalachia would and could serve as effective access points.
Hagemeier said this “would be a tough sell” in a conservative area like Northeast Tennessee.
“Harm reduction isn’t like world peace. It isn’t a topic that’s easy for everyone to support. However, with injection drug use a growing public health concern in South Central Appalachia, we have to establish harm-reduction strategies for HCV and HIV prevention in rural areas,” Hagemeier said in a recent ETSU press release. “We are hopeful this research will help move us closer to that goal.”
Understanding more about stigmas and perceptions, according to Hagemeier, could help pharmacists throughout the region play a crucial role in preventing diseases associated with injection drug abuse.
“It all depends on your definition of success. If your definition is that they are all sober and abstinent, that’s one thing,” he said. “Another definition is that we prevented the transmission of HIV or hepatitis C.”
With intravenous drug abuse remaining a regional epidemic, the risk of spreading these diseases — as well as increasing dual infection rates — is a real danger.
“It only takes one person, and if they have a network where they share syringes, it can spread rapidly,” he said.