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Table 2 Government laws and policies

From: Pharmacies as providers of expanded health services for people who inject drugs: a review of laws, policies, and barriers in six countries

Sites: Interventions: US (Boston) US (Providence) US (San Francisco) Canada (Vancouver) Mexico (Tijuana) Vietnam (Ha Giang) China (Xichang, Sichuan) Russia (St. Petersburg)
Needle & syringe sales/distribution MGL ch 94C, sec 27, 27A, 32 L: authorizes pharmacy sales without prescription at discretion to people 18 or older with no limits on quantity Pharmacies may sell at discretion; no limits on quantity. Non-prescription sales legal (up to 30) but requires local approval and pharmacist enrollment in disease prevention demonstration project (DPDP). Pharmacy sales legal. Sale at pharmacies without a prescription is legal. Retail non-prescription sale is legal; redemption of vouchers for free needles & syringes also legal. Non-prescription sale is legal. Non-prescription sale is legal; but pharmacies not required to stock.
Needle & syringe disposal MGL ch 111, sec 127A: prohibits improper disposal. There are no legal barriers to pharmacies collecting waste for proper disposal. No legal barrier to pharmacies maintaining sharps containers. Sharps must be disposed in approved container and transported to collection center; no legal barriers to sharps containers in pharmacies; information on safe disposal required to be provided with needle/syringe sales under DPDP; participating pharmacies must provide safedisposal options. No legal barriers to pharmacies collecting used needles/syringes. Any facilities (including pharmacies) that generate at least 25 kg of biologic/infectious waste per month are required to dispose of syringes and other sharps in a puncture-proof container. Unclear what rules apply to pharmacies generating less than 25 kg per month. Not provided for in Law on Pharmacy (2005); but Ordinance on Private Medical and Pharmaceutical Practice (Feb 25, 2003) authorizes those certified as private medical practitioners (including those with pharmacy degrees) to provide primary health care and HIV prevention services (Art. 18). Needle exchange and disposal center can be set up in local CDC, medical institutes or other locations. No legal barriers for pharmacies to provide sharps containers. Federal Law #128 (August 8, 2001) requires a license for collection, storage, or disposal of hazardous waste (including used needles & syringes).
HIV testing There is currently no standing order for pharmacists to conduct HIV testing. Pharmacies need CLIA waiver to offer finger prick testing. Persons with required training & certification may perform rapid HIV tests; regulations would need to be modified to allow pharmacies to draw blood, but not if testing was done by an outside organization. Provincial requirements for pre-/post-test counseling may constrain pharmacy-based testing. Cheek-swab tests possible but no blood may be drawn or handled at pharmacies. Not provided for in Law on Pharmacy (2005); may be permitted by Ordinance on Private Medical and Pharmaceutical Practice (Art. 18), if pharmacies can be considered medical establishments. Only local HIV/AIDS prevention agencies may do testing; pharmacies not included. Decree #1081 (December 22, 2011) on licensing of pharmacies does not allow pharmacies to conduct HIV testing; additional license for medical practice is required (FL #128 of August 08, 2011; Decree #30 of January 22, 2007).
HBV/other vaccination Critical adult vaccinations permitted by pharmacists following appropriate training. No legal barriers; other vaccinations already available in pharmacies. HBV vaccination required for children; Persons with required training and certification may provide vaccination. No legal barriers to pharmacies providing HBV or other vaccinations. However, it would require staff who have appropriate training, and adequate staffing levels. The law does not permit vaccinations at pharmacies unless the staff has the proper certification, such as a nursing degree. Not provided for in Law on Pharmacy (2005); may be permitted by Ordinance on Private Medical and Pharmaceutical Practice (Art. 18) if pharmacies can be considered medical establishments. Vaccination is not allowed in pharmacies. Vaccination requires licensed medical doctor, medical assistant, or nurse and infrastructure to store vaccine. Decree #1081 (December 22, 2011) on licensing of pharmacies does not allow pharmacies to provide vaccinations; additional license for medical practice is required (FL #128 of August 08, 2011; Decree #30 of January 22, 2007).
MMT/OST Federally regulated; methadone for drug treatment cannot be dispensed in pharmacies. Federally regulated; methadone for drug treatment cannot be dispensed in pharmacies. Office-based physicians can prescribe methadone and prescriptions are treated like any other but most pharmacies are not equipped to do daily dosing. Pharmacies can dispense methadone, but regulations restrict prescription. Methadone is a “Control 1” drug that requires a prescription limited to one-time administration, which effectively bars daily dosing, and “Control 1” drugs can only be handled by major medical institutions. Prohibited by Law on Pharmacy (2005) Article 26.2 because methadone is listed as a habit-forming drug, which pharmacies are prohibited from dispensing. Methadone is strictly controlled and can only be dispensed in government approved drug treatment centers. It cannot be dispensed in pharmacies. Methadone is included in List I of forbidden psychoactive agents (FL on narcotics and psychoactive agents of December 10, 1997).
Naloxone/overdose prevention/rescue Pharmacies may dispense through standing orders; training is needed on nasal delivery. Pharmacies may dispense through collaborative practice agreements Limited liability for licensed health providers prescribing and/or distributing naloxone. Regulatory barriers make naloxone unavailable to individuals through prescription. Pharmacies stock naloxone as a “Control 3” drug that requires a prescription that may be filled 3 times and expires in 6 months. Not provided for in Law on Pharmacy (2005); may be permitted by Ordinance on Private Medical and Pharmaceutical Practice (Art. 18), if pharmacies can be considered medical establishments. Naloxone can only be dispensed in medical facilities. Print materials on overdose prevention can be provided in pharmacies. Decree #2199-r (December 7, 2011): naloxone is on the list of vitally necessary and most essential medications; but only medical facilities are allowed to dispense and administer and to provide CPR if needed.
Abscess treatment Not currently available but no legal barriers to providing information. Pharmacies cannot provide medical or clinical care such as cutting and draining. Not currently available but no legal barriers to providing information. Pharmacies cannot provide medical or clinical care such as cutting and draining. No legal restrictions. No legal barriers. No legal barriers, but only minor wounds may be treated at a pharmacy. Perforation or cutting of any sort in order to treat an original wound not permitted. Not provided for in Law on Pharmacy (2005); may be permitted by Ordinance on Private Medical and Pharmaceutical Practice (Art. 18), if pharmacies can be considered medical establishments. Pharmacies can provide print materials only. Pharmacies can provide information and medications.
Brief counseling/materials No legal barriers except to substance abuse treatment counseling, which is covered by state regulations No legal barriers. No legal barriers; DPDP participating pharmacies required to provide health information with needle & syringe sales No legal barriers. No legal barriers. Should be permissible. Should be permissible. Pharmacies can provide such information.
Referrals No legal restrictions. No legal restrictions. No legal restrictions. No legal restrictions. No legal restrictions. No legal restrictions. No legal restrictions. No legal restrictions.