California HIV/AIDS Research Program

Legislation permitting non-prescription syringe sales (NPSS) was passed in2004 in California as a structural intervention designed to expand access to syringes for injection drug users. As of December 2009, 19 of California’s 61 local health jurisdictions (LHJs) have approved policies to authorize pharmacies to sell nonprescription syringes. The legislation faces termination in 2010 if current evaluationefforts fail to demonstrate outcomes defined in the legislation. Using qualitative methods, we examined the systems and procedures associated with implementation; identified facilitators and barriers to implementation among 12 LHJs, and documented the role of public health in initiating and sustaining local programs. We identified consistent activities that led to policy implementation among LHJs and discovered several barriers that were associated with failure to implement local programs. Factors leading to NPSS were public health leadership; an inclusive planning process, marketing the program as a public health initiative; learning from others’ efforts, successes, andfailures; and identifying acceptable syringe disposal options in advance of programimplementation. Health departments that were confronted with political and moralarguments lost momentum and ultimately assigned a lower priority to the initiativeciting the loss of powerful public health advocates or a lack of human resources.Additional barriers were law enforcement, elected officials, and pharmacy opposition,and failure to resolve syringe disposal options to the satisfaction of importantstakeholders. The lessons learned in this study should provide useful guidance for the remaining LHJs in California without NPSS programs.