Open Access Highly Accessed Open Badges Correspondence

Pharmacies as providers of expanded health services for people who inject drugs: a review of laws, policies, and barriers in six countries

Theodore M Hammett1*, Son Phan2, Julia Gaggin3, Patricia Case3, Nicholas Zaller4, Alexandra Lutnick5, Alex H Kral5, Ekaterina V Fedorova6, Robert Heimer7, Will Small89, Robin Pollini10, Leo Beletsky11, Carl Latkin12 and Don C Des Jarlais13

Author Affiliations

1 Abt Associates Inc., Cambridge MA 02138, USA

2 Abt Associates Inc., Bethesda MD 20814, USA

3 The Fenway Institute, Fenway Health, Boston MA 02215, USA

4 The Miriam Hospital, Center for AIDS Research, Providence RI 02906, USA

5 RTI International, San Francisco CA 94103, USA

6 The Biomedical Center, St. Petersburg 194044, Russia

7 Yale University School of Public Health, New Haven CT 06520, USA

8 British Columbia Centre for Excellence in HIV/AIDS, Vancouver BC V6Z 1Y6, Canada

9 Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada

10 Pacific Institute for Research and Evaluation, Calverton MD 20705, USA

11 Northeastern University School of Law & Bouvé College of Health Sciences, Boston MA 02144, USA

12 Johns Hopkins Bloomberg School of Public Health, Baltimore MD 21205, USA

13 Beth Israel Medical Center, New York NY 10038, USA

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BMC Health Services Research 2014, 14:261  doi:10.1186/1472-6963-14-261

Published: 17 June 2014



People who inject drugs (PWID) are underserved by health providers but pharmacies may be their most accessible care settings.


Studies in the U.S., Russia, Vietnam, China, Canada and Mexico employed a three-level (macro-, meso-, and micro-) model to assess feasibility of expanded pharmacy services for PWID. Studies employed qualitative and quantitative interviews, review of legal and policy documents, and information on the knowledge, attitudes, and practices of key stakeholders.


Studies produced a mixed assessment of feasibility. Provision of information and referrals by pharmacies is permissible in all study sites and sale and safe disposal of needles/syringes by pharmacies is legal in almost all sites, although needle/syringe sales face challenges related to attitudes and practices of pharmacists, police, and other actors. Pharmacy provision of HIV testing, hepatitis vaccination, opioid substitution treatment, provision of naloxone for drug overdose, and abscess treatment, face more serious legal and policy barriers.


Challenges to expanded services for drug users in pharmacies exist at all three levels, especially the macro-level characterized by legal barriers and persistent stigmatization of PWID. Where deficiencies in laws, policies, and community attitudes block implementation, stakeholders should advocate for needed legal and policy changes and work to address community stigma and resistance. Laws and policies are only as good as their implementation, so attention is also needed to meso- and micro- levels. Policies, attitudes, and practices of police departments and pharmacy chains as well as knowledge, attitudes, and practices of individual PWID, individual pharmacies, and police officers should support rather than undermine positive laws and expanded services. Despite the challenges, pharmacies remain potentially important venues for delivering health services to PWID.