Pharmacists Provide Harm Reduction Services to Patients With Substance Use Disorder

My son, Philip, who is 36 years old, is married with 2 daughters. He has type 1 diabetes and has used an insulin pump since he was 17 years old. Nine years ago, he lived in Pittsburgh, Pennsylvania, working for an app development company where he biked to work. One day while I was working on the bench, I got a call from Phil, who sounded distressed.

Our whole country needs to do better in providing harm reduction services, including naloxone and syringe service programs. | Image Credit: Kzenon - stock.adobe.com

He said, “Hey, Dad, I’m in a jam. I changed my cannula this morning on my pump, and it is clogged now. My blood sugar is trending up, and I’m afraid to try to bike home. I stopped at the local drug store chain near work and asked to buy a couple of insulin syringes so I could pull some NovoLog from my reservoir until I can get home and get a new set. The pharmacist refused, saying they only sell syringes by the entire box of 100. Dad, I’d never use up a whole box. The pharmacist said that is their policy. Could you give them a call?”

Pennsylvania law permits pharmacists to dispense syringes without a prescription at their discretion. I explained Phil’s situation to the pharmacist, who agreed to sell him a 10-pack of insulin syringes. I was disappointed with the pharmacist’s actions; they should have asked to see his insulin pump or checked his hemoglobin A_1c level to confirm he needed the syringes for diabetes.

I have talked to numerous patients with substance use disorder who have requested syringes. With one patient, I got into a deep discussion about injection drug use, and he shared with me, “A heroin addict won’t stop using heroin just because he doesn’t have a clean needle. He will just use a dirty one.”

By not selling these patients clean needles, we are not stopping their injection drug use. We are opening them up to diseases such as hepatitis B, hepatitis C, and HIV.

The term harm reduction accurately describes the goal of providing syringes to patients in need. A couple of years ago, a patient came to the pharmacy I was staffing and asked for diabetic needles. Giving her the benefit of the doubt, I asked what brand and what volume to ensure accurate dosing if she was on insulin. She hesitated, and I took her into our immunization room. She admitted she was using them for injection drug use, and I gave her 5 syringes we were using for COVID-19 vaccine injections that were provided by the government. She was most grateful and assured me she was going to seek help the next day.

With approval from the owner, I collected over 1000 syringes and needles left over from COVID-19 vaccine administrations at the pharmacy and took them to the Milan Puskar Health Right in Morgantown, West Virginia. Health Right is a free clinic for low-income, uninsured, or underinsured residents of West Virginia. The clinic has a staff of 30 people and over 200 volunteers, providing more than 28,000 patient encounters and dispensing millions of dollars’ worth of free medications annually. In 2023, they distributed 360,000 syringes and needles through their syringe service program.

Under Pennsylvania law, possession of drug paraphernalia is prohibited. Drug paraphernalia includes all equipment, products, and materials of any kind intended for manufacturing, using, or storing controlled substances. Possession of drug paraphernalia in Pennsylvania constitutes an ungraded misdemeanor offense. The potential penalties include up to 1 year in jail and fines up to $2500, which was not a risk I was willing to take.

I contacted Carla Sofronski, director of the Pennsylvania Harm Reduction Network, and she informed me that this legislation addressing syringe service programs has been delayed for at least 15 years. The latest bill is currently in the House Judiciary Committee of the US House of Representatives. Pennsylvania ranks ninth in the country for new HIV infections.

The CDC has identified numerous hot spots for bloodborne diseases, and they are not in Pittsburgh and Philadelphia, as one might expect because they are major cities, but in Altoona, Harrisburg, and other smaller towns in Central Pennsylvania. Pittsburgh and Philadelphia enacted ordinances many years ago at the height of the HIV epidemic that still permit syringe service programs.

Pennsylvania needs to do better. Our whole country needs to do better in providing harm reduction services, including naloxone (Narcan) and syringe service programs. For now, pharmacists need to be proactive in helping these patients and supporting our local harm reduction networks.

To read these stories and more, download the PDF of the Drug Topics May/June issue here.

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