The path of reform

The numerous state and local laws and regulations that limit access to sterile needles were put in place just as the not-yet-understood HIV/AIDS epidemic was beginning to spread across the United States.  With no scientific studies to support their thinking, lawmakers merely assumed that if access to syringes were limited, injecting drug use would be reduced.⁽¹⁾

This assumption proved tragically wrong.  Limiting access to sterile needles did reduce the supply of sterile needles, but it did not reduce injecting drug use.  Injecting drug use continued apace as users shared needles and their HIV and other blood-borne infections.

The all-too-slow process of reform

Elimination of the barriers to accessing sterile needles is coming all too slowly.  The first wave of reform in any city or state often occurs as a few activists, concerned with saving lives right now, set up a needle exchange, giving out sterile needles and collecting used ones.⁽²⁾  This direct action cuts through restrictive laws and regulations.  But it is risky and requires courage.  The activists see themselves as public health workers; some police, prosecutors, elected officials, and community members see them as criminals. 

In the second wave of reform, activists in a particular city gain local support, and the local legal situation is reconfigured to give the needle exchange staff and participants protection from arrest for needle possession.  In the most successful instances of reform, such as in the states of Connecticut, Hawaii, and New Mexico, the state government, through its health department, begins running needle exchanges and expands service to other areas of the state where it is needed.

The third wave of reform involves changing laws and regulations so that pharmacists can sell syringes without a prescription.  To be effective, the pharmacy effort has to include educational programs to inform pharmacists of the public health importance of over-the-counter sales of syringes.  Care also must be taken that syringes are sold without regard to race or ethnicity.  A St. Louis study, for example, found that several pharmacies were willing to sell syringes to whites but not to African Americans.⁽³⁾

In the year 2000, New Hampshire, New York and Rhode Island reformed their laws, making it possible for pharmacies to sell without a prescription.  California, Delaware, Illinois, Massachusetts, Nevada, New Jersey, and Pennsylvania are the only remaining states with severely restrictive syringe prescription laws or regulations. 

A fourth wave of reform, just beginning, is physician prescription of syringes.  Prescribing syringes to prevent the spread of HIV is a legitimate medical purpose.  The relevant governing bodies in Rhode Island have recognized this to be the case, and some injecting drug users in that state are now able to get syringes by prescription from their doctor.

A final wave of reform involves changing the laws governing drug paraphernalia.  This reform is completed in only nine states (Alaska, Connecticut, Georgia, Maine, Minnesota, New Hampshire, New York, Oregon, and Wisconsin).  Laws prohibiting possession of sterile needles and other related safe injection equipment (such as cookers and cotton) need to be removed from all the state and local drug paraphernalia laws.  Anything less will continue the spread of HIV and other blood-borne diseases.  

Footnotes

(1) Lawrence O. Gostin, Zita Lazzarine, T. Stephen Jones, and Kathleen Flaherty, "Prevention of HIV/AIDS and Other Blood-Borne Diseases Among Injection Drug Users: A National Survey on the Regulation of Syringes and Needles," Journal of the American Medical Association, January 1, 1997, vol. 277, pages 53-62.

(2) The overview of the process of needle access reform is based on Dr. Dawn Day's numerous conversations with leaders in the needle exchange movement.  The information on the legal situation in particular states with regard to prescription laws or paraphernalia laws is taken from Scott Burris, Peter Lurie, Daniel Abrahamson, and Josiah D. Rich, "Physician Prescribing of Sterile Injection Equipment to Prevent HIV Infection: Time for Action," Annals of Internal Medicine, August 2000, vol. 133, pages 218-226.  The information on the physician prescription experience in Rhode Island is taken from Josiah D. Rich, "Physician Syringe Prescription to Prevent HIV in Rhode Island," presentation at the North American Syringe Exchange Convention, Portland, Oregon, April 2000.  For more information on physician prescription of syringes, see also the website of the Project on Harm Reduction in the Health Care System, Beasley School of Law, Temple University.

(3) W. M. Compton, L. B. Cottler, S. H. Decker, and others, "Legal Needle Buying in St. Louis," American Journal of Public Health, 1992, vol. 82, no. 4, pages 595-596. Another study found that when the state closed the local needle exchange, the pharmacists in the area who previously had been selling needles over the counter began refusing to sell syringes without a prescription. Robert S. Broadhead, Yael van Hulst, and Douglas D. Heckathorn, "The Impact of a Needle Exchange's Closure," Public Health Reports, September/October 1999, vol. 114, pages 439-447.

For a list of other materials used on this website, see References.