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

Background: There's limited information available about the range of harm reduction (HR) services provided by rural pharmacies.

Objective: 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.

Methods: 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.

Results: 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.

Conclusions: 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.