Deregulation of Hypodermic Needles and Syringes as a Public Health Measure

HIV, Hepatitis and other infections spread through the use of unsterile injection equipment pose a major health threat in the United States, causing thousands of deaths and millions of dollars in preventable health care expenditures every year. The victims include not only drug users themselves, but also indirectly their sex partners and their children, whose infections at birth can be attributed to drug use.

Scarcity of clean needles for injection drug users (IDUs) is one of the main causes of the problem. Scarcity of needles is, in turn, almost entirely the result of public policy. Drug paraphernalia, needle prescription and pharmacy practice laws and regulations were intended to make it difficult for IDUs to purchase syringes, and have done so. These rules, and the steps police take to enforce them, often make IDUs who have needles reluctant to carry them for fear of arrest. Public health dictates reducing or eliminating legal barriers to syringe access.

Over the past decade, the main intervention to increase IDU access to sterile syringes was needle exchange. Needle exchange programs distribute new syringes to people who bring back used ones and also normally provide an array of health and social services, including access to drug treatment. Although by 1997, more than 130 needle exchanges were distributing over 17 million needles, needle exchange was growing increasingly controversial. Critics questioned the effectiveness of needle exchange and contended that giving needles to IDUs, especially with government money, sent a message that drug use was acceptable. Research has established that needle exchange programs can help control HIV and do not encourage drug use, but it has also become clear that needle exchange is not a panacea: other avenues of syringe access, particularly non-prescription pharmacy sales, are also needed to make it possible for IDUs to inject only with sterile syringes.

The year 2000 saw the crystallization of a new trend in needle policy: deregulation. New York and New Hampshire both passed legislation allowing the unrestricted sale of ten or fewer syringes in pharmacies, and Rhode Island deregulated syringe sales altogether. This action brought to nine the number of states that unambiguously allow IDUs to buy and possess sterile syringes. Deregulation avoids some of the political and public health problems of needle exchange: it vastly increases the sources for syringes, but eliminates the "endorsement" that may be perceived when government pays the bill. Deregulation, however, brings to a head the ultimate conflict between disease prevention and traditional policies aimed at restricting access to the tools of illegal drug use.

Legislators across the nation are now facing this conflict. This report lays out the medical facts and legal developments behind the deregulation of syringes. It describes three approaches states have taken to syringe deregulation:

• complete deregulation (lifting all significant restrictions on sale and possession of syringes)
• unrestricted pharmacy sales (lifting restrictions on possession but confining sales to pharmacies)
• "ten and under" (unrestricted sale and possession of a specified number of syringes).

The American Bar Association supports the elimination of legal barriers to syringe exchange programs. With this Report, the AIDS Coordinating Committee aims to provide policy-makers and the public the basic legal and medical information necessary for thoughtful consideration of the issues.