Comparing pharmacy and drug service needle and syringe programmes

In 2019-20, Megan Coakley was an MSc student in Public Health at the University of Bristol. For her dissertation, she worked with ARC West’s Dr Jo Kesten to reuse data from our research into needle and syringe programmes and low dead space injecting equipment. In this blog she describes what she discovered.

My background is working in drug services and housing, but in 2019 I followed my interest in strategic and systemic changes to drug policy by completing an MSc in Public Health at the University of Bristol. During the course, my practical experience as a frontline worker was consolidated with research from a variety of public health disciplines.

For my dissertation, I wanted to focus on the experiences of people who inject drugs. Jo Kesten and Matt Hickman became my supervisors for the project. They had completed primary research on low dead space syringes in needle and syringe programmes (NSPs), interviewing 36 staff and volunteers at Bristol Drugs Project, Developing Health and Independence and local pharmacies.

Having worked as a frontline drugs worker, I was attracted to the project as I had observed the successes and the barriers in the system first-hand. I have seen NSPs hand out life saving Naloxone, reduce the rate of blood borne viruses though clean equipment, testing and vaccination, and link people to other essential services, such as housing or dental. I was pleased to link this all together and analyse service users’ experiences, with the aim to improve services in the future.

For my project, I explored the same data set as the low dead space syringes in NSPs project, but with a different lens. I looked to explore and compare the mechanisms of delivery of different NSPs, reasons for choice, describe the type of information people seek and receive, and compare the experiences of different sources of harm reduction and advice.

I wanted to build on the findings of previous research, exploring the differences between pharmacy and drug service NSPs, including operation and what harm reduction advice is given.

I used NVIVO to complete a reflexive thematic analysis on the interviews, picking out key themes according to my research questions. It was difficult to narrow down to a small number of themes because of the wide variety of topics discussed. Also, the interview questions were designed for the previous study, so some answers didn’t fully link to my research questions and were harder to code.

My frontline experience meant I had a solid understanding (from a staff perspective) of experiences of drug services, but this was the first time I’d considered them as research rather than at an anecdotal level.

Despite these challenges, I developed four key themes:

1. Accessibility and convenience: many people who inject drugs used the NSP closest to them, especially if it was walking distance. However, barriers to accessibility included fear of stigma.
2. Training: pharmacy workers had less time for harm reduction work than drug services staff. Staff in drug services received considerable training, but there is a gap in this experience for pharmacy staff.
3. Building relationships: drug service staff work hard to build relationships with service users, but pharmacy NSPs are far more transactional.
4. Harm reduction practice: drug services ask more questions, use a database to build information and provide a variety of equipment, whereas pharmacies tend to only do an exchange of one pack of equipment and give limited harm reduction advice.

This research shows there is a missed opportunity to provide pharmacy workers with further training so they can deliver high quality harm reduction interventions. However, many people who inject drugs preferred the discretion and speed of pharmacy interactions, so these interventions would have to be appropriately tailored so people continue to use the service.

Many people who inject drugs don’t attend drugs services so pharmacy and peer discussion could be the only way they hear vital information, for example, about a bad batch of heroin. This research has identified a gap in policy and I hope it will be built on in future.