Pharmacy Voucher Program Organizations work with pharmacies by providing participants with vouchers redeemable for free syringes at participating pharmacies. Pharmacy voucher programs are especially useful in areas that have been unsuccessful in implementing SAPs but where over-the-counter sale of syringes without a prescription is permitted by law. Pharmacy voucher programs are also useful areas where drug use may be geographically distant and IDUs are unable to travel to the SAP.
In cases where pharmacy vouchers are used, SAPs may provide pharmacies with equipment and disposal services. Strengths
Limitations
• Mainstream location
• Pharmacists and pharmacy staff may hold pre-existing
• May have longer, more convenient hours • May be located closer to where injectors live or hang out
biases toward IDUs and selectively serve participants • IDUs may receive less individualized education, referrals and safer injection information • Pharmacies may be unwilling to dispose of used equipment • Pharmacies may have caps on the number of syringes per transaction • May be more difficult to provide injecting equipment other than syringes (cookers, cottons, water, ties, alcohol, etc)
Using Multiple Program Models Whenever resources allow, a multiple program model is often the most effective way to reach the greatest number of IDUs. Combining models, for example – one fixed site with a mobile van, or a mobile unit with peer-based walking delivery – literally works to “meet IDUs where they’re at” and increases the likelihood that syringes will reach even the “harder to reach” IDUs. In addition, multiple program models offer increased flexibility to direct resources to the most effective means on an as-needed basis, allowing programs to respond to shifts in behavior patterns among local IDUs. When using a multiple program models, it is important to be sure that all aspects of the program will be sustainable. Multi-approach models can require significant resources and demand more from staff. Nonetheless, for participants, the same standards of consistency will apply. If one aspect of the program loses credibility, it is possible that all aspects of the SAP will suffer. However, when well-executed and fully resourced, multi-approach services can be a valuable, comprehensive approach.
LEG A L I S S UES Although advocacy in many states has paved the way for successful syringe access, the legal landscape can be complicated and challenging to navigate. This section will outline some of the key considerations around legal issues when trying to implement syringe access. In particular, it is necessary to evaluate the legality of operating the SAP from a program perspective, as well as any legal implications for participants. Fear of drug use and drug users along with the impulse to regulate socially undesirable activities has led to sweeping restrictions on the possession, sale and distribution of needles and syringes which may be used for the injection of drugs. Public health imperatives and again, the work of activists, drug users and their allies, have successfully pushed for changes and an easing up of some legal restrictions on syringe access and possession over the years. In addition, the lifting of the federal ban on funding for SAPs in late 2009 offers a huge push for public health ideology -19-
