BACKGROUND: Pharmacists provide a broad range of harm reduction services, with service uptake often influenced by state-based policies. This study aimed to map the provision of harm reduction services and determine predictors of increased uptake among community pharmacies.

METHODS: An anonymous online survey of Australian community pharmacists collected data on pharmacist and pharmacy characteristics and the provision of harm reduction services, and explored pharmacy-level characteristics associated with the provision of greater harm reduction services.

RESULTS: The sample comprised 730 pharmacists. Harm reduction service provision included take-home naloxone (73.2%, n = 730), needle and syringe programs (51.5%, n = 643), opioid agonist treatment (46.2%, n = 686) and supplying hepatitis C (55.0%, n = 660) and HIV medications (66.8%, n = 656). Jurisdictional variability was observed. For example, on-site administration of long-acting injectable buprenorphine ranged from 2.9% in Victoria to 12.7% in New South Wales, while needle and syringe programs ranged from 35.0% (New South Wales) to 82.1% (Western Australia). Pharmacies in less densely populated states (Queensland (Adjusted odds ratio (aOR): 2.80, 95% confidence intervals (CI): 1.85-4.24) and Western Australia (aOR 2.72, 95%CI 1.65-4.50)) had significantly higher odds of providing a broader range of harm reduction services, compared to New South Wales (Australia's most populous state), as were pharmacies located outside of capital cities (aOR 1.48, 95%CI 1.10-2.03).

CONCLUSIONS: Australian community pharmacies demonstrate high engagement with harm reduction services, despite jurisdictional differences for some services. Financially incentivised policies appeared to facilitate uptake. Findings highlight the role of enablers in pharmacy-based harm reduction and offer insights to expand uptake, locally and internationally.