According to the Institute of Medicine of the National Academy of Sciences:
For injection drug users who cannot or will not stop injecting drugs, the once-only use of sterile needles and syringes remains the safest, most effective approach for limiting HIV transmission.(1)
Many states have drug paraphernalia laws that limit possession of sterile syringes.(2) For state by state details, see the website of the Project on Harm Reduction in the Health Care System, Beasley School of Law, Temple University.
Pharmacy sales of sterile syringes
Pharmacies are a critical element in efforts to help people who inject drugs reduce their risk of acquiring and transmitting HIV and other blood-borne viruses.
Recognizing the key role of pharmacy sales of syringes, the American Medical Association, the American Pharmaceutical Association, the Association of State and Territorial Health Officials, the National Association of Boards of Pharmacy, and the National Alliance of State and Territorial AIDS Directors issued a joint letter in October 1999 urging state leaders in medicine, pharmacy and public health to coordinate their actions to improve the access of people who inject drugs to sterile syringes through pharmacy sales.(3)
California, Delaware, Illinois, Massachusetts, New Hampshire and New Jersey are the only remaining states with syringe prescription laws. But other states still restrict pharmacy sale of syringes through pharmaceutical board regulations. The restrictive situations in all these states need reform.(4)
Pharmacy sale of syringes is very cost-effective as an HIV prevention technique; it costs the taxpayers nothing.
Even when syringe sale by pharmacies is legal, discrimination by pharmacies can play a role in preventing African Americans from getting access to sterile needles. There is evidence from St. Louis, for example, that drugstores will not always sell syringes to African Americans even when the sale of syringes is legal.(5)
Physician prescription of sterile syringes
Because physicians are key gatekeepers to syringe access, efforts to encourage them to prescribe syringes to people who inject drugs will help ensure that those who continue to inject can legally obtain sterile syringes. Involving physicians also illustrates the medical rationale for increasing injecting drug user's access -- that improving access to sterile syringes has a legitimate medical purpose in preventing disease.
Physician prescription of injection equipment is legal in 48 of the 52 jurisdictions (it is illegal in Delaware and Kansas). In two other jurisdictions (Ohio and Oklahoma) physicians have a "reasonable claim to legality." This means that the laws in that jurisdiction neither explicitly allow nor forbid prescribing or dispensing, so that an attorney "acting ethically and in good faith" could argue that the practice was legal.
It is also legal for pharmacists to fill prescriptions in 26 states (it is illegal only in Delaware, Kansas, Georgia, and Hawaii). In 22 other jurisdictions they have a "reasonable claim to legality."(6)
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Footnotes
(1) N. Abdala, P.C. Stephens, B.P Griffith, and Robert Heimer. 1999. "Survival of HIV-1 in syringes." Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology. vol. 20. no.1. pages 73-80.
(2) Centers for Disease Control and Prevention. 2002. Access to sterile syringes. January. 4 pages. Centers for Disease Control and Prevention. Policy efforts to increase IDUs access to sterile syringes. January. 4 pages. See also the website of the Substance Abuse Policy Research Program for a report on Syringe Access Laws in the United States as of November 30, 2002.
(3) American Medical Association the American Pharmaceutical Association, the Association of State and Territorial Health Officials, the National Association of Boards of Pharmacy, and the National Alliance of State and Territorial AIDS Directors. 1999. HIV prevention and access to sterile syringes. (Only in Adobe Acrobat). October. 2 pages. See also Centers for Disease Control and Prevention. 2002. Pharmacy sales of syringes. January. 4 pages.
(4) 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. pp.53-62. See also U.S. Conference of Mayors AIDS Information Exchange, "The Role of Pharmacies in Preventing HIV Among Injection Drug Users, December 1999. 12 pages.
(5) William Compton III, L. B. Cottler, S. H. Decker, et al. 1992. "Legal needle buying in St. Louis, American Journal of Public Health. vol. 82. pages 595-596.
(6) Centers for Disease Control and Prevention. 2002. "Physician prescription of sterile syringes to injection drug users." February. 3 pages. See also the website of the Project on Harm Reduction in the Health Care System, Beasley School of Law, Temple University.
For a list of other materials used on this website, see References.