Availability of and attitudes towards harm reduction services: a rural pharmacy perspective

There's limited information available about the range of harm reduction (HR) services provided by rural pharmacies. This study’s objectives are to describe the types of HR services offered by rural pharmacies and examine pharmacists’ attitudes and willingness to offer those services. A cross-sectional online survey was sent to pharmacists who are members of a practice-based research network for rural community pharmacies. Pharmacists reported the frequency to which their pharmacy engage in as well as their willingness to offer the following HR services: naloxone dispensing; buprenorphine dispensing; point of care testing for human immunodeficiency virus (HIV) and Hepatitis C (HCV); and non-prescription syringe (NPS) sales. Also, pharmacists' knowledge and willingness to sell drug test strips and attitudes towards people who inject drugs (PWID) were assessed. Descriptive statistics were calculated. A total of 61 pharmacists completed the survey (completion rate= 45.2%). Most reported dispensing naloxone 2-3 times per month (90.2%), and a third dispensed buprenorphine daily (32.8%). Only one pharmacy offered HIV testing, and none offered HCV testing. Most pharmacies (65.6%) had a policy regarding the sale of NPS, with 21.3% reporting they never dispense non-prescription syringes. Many pharmacists were willing to sell fentanyl test strips (67.2%) and xylazine test strips (50.8%). Pharmacists’ most negative attitudes related to believing PWID customers make other customers feel uncomfortable and that providers keep patients on buprenorphine for too long. Many rural community pharmacists engage in HR services and are willing to offer more. However, stigmatizing attitudes highlight the need for pharmacy-focused HR training to reduce stigma and increase knowledge. •Most pharmacists surveyed dispense buprenorphine on a daily (n=20, 32.8%) or weekly (n=22, 36.1%) basis.•Although most rural community pharmacists do not offer HIV testing, HCV testing, or sell drug test strips, many are interested in learning more about these harm reduction activities.•Stigma toward people who inject drugs may factor into the store-level policies regarding nonprescription syringe sales.