Last updated May 22, 2006.

Increasing sterile syringe availability through needle exchange programs, pharmacy sales, and physician prescription reduces needle sharing among injection drug users, which decreases transmission of HIV/AIDS and hepatitis.  Needle exchange programs and pharmacy sale of syringes have also been shown to increase safe disposal of used syringes.  In addition, these programs provide injection drug users with referrals to drug treatment, detoxification, social services, and primary health care.

Injection drug use is associated with a high risk of infection by blood-borne diseases such as HIV and hepatitis C.  Since the AIDS epidemic began, 34% of all reported cases in the United States have been among injection drug users and their sexual partners. Up to 75% of new AIDS cases among women and children are directly or indirectly a consequence of injection drug use. Zero-tolerance drug policies, which in many states criminalize both the possession of syringes and the distribution of sterile syringes, exacerbate the problem. These policies result in the re-use and sharing of contaminated syringes, spreading blood-borne diseases and creating poor health conditions.

People of color are disproportionately impacted by the lack of access to sterile syringes. In 2004, African Americans accounted for 43% of all people in the United States living with AIDS, although they only comprised approximately 13% of the U.S. population. Injection drug use was the second leading cause of HIV infection for African American women and the third leading cause of HIV for African American men.  Hispanics comprised over 20% of new AIDS cases in the United States. In 2002, 21% of the HIV/AIDS cases diagnosed among Hispanic males were attributed to injection drug use, and 17% of the HIV/AIDS cases among Hispanic women were due to injection drug use. 

Syringe availability is critical to saving lives and has been implemented in three primary ways:

Needle/Syringe Exchange Programs (NEPs) - These programs allow people to trade used syringes for sterile syringes. Numerous scientific studies as well as government-sponsored reports have shown that needle exchange programs reduce the spread of blood-borne diseases. Although many states and municipalities in the United States have taken steps to improve access to sterile syringes, the possession, distribution, and sale of syringes remain criminal offenses in much of the country.  The federal government, though one of the largest funders of AIDS prevention in the world, refuses to fund needle exchange programs. This forces many programs offering these crucial services to operate largely underground. There are currently 185 needle exchange programs operating in 36 states as well as Washington D.C., Puerto Rico, and Native American lands.  However, the legality of the programs often depends on a county-by-county certification of a State of Emergency that must be regularly renewed.

Under the aegis of the war on drugs, many government agencies and politicians have sought to eliminate needle exchanges for drug users, through both legal and illegal means. While some law enforcement agencies recognize the benefits of needle exchange programs, there are numerous cases of police harassment of both needle exchange workers and clients. Litigation on behalf of needle exchange program clients in Bridgeport, CT successfully challenged such police harassment, but it has since resumed.  In Massachusetts, local police forces have continued to arrest needle exchange participants despite a statewide public health initiative allowing pilot programs in certain cities.

New Jersey is another state that has faced significant challenges to syringe access.  With the fifth highest number of adult HIV cases, the third highest number of pediatric HIV cases and the highest proportion of women infected with HIV in the nation, New Jersey is in the midst of a public health crisis. Although 45% of all HIV infections in New Jersey were caused by sharing contaminated syringes, New Jersey is one of only two states that do not allow any form of sterile syringe access for injection drug users. 

Drug Policy Alliance New Jersey has been fighting to address the issue in the State Capitol, city councils, and courts since 2002, and has created the Campaign for a Healthier New Jersey to advocate for access through syringe exchange programs as well as non-prescription pharmacy sale of syringes. The Campaign, which supports bills in the State Senate and Assembly, works with a coalition of partners including the Medical Society of New Jersey, the New Jersey State Nurses Association, and the Black Ministers Council of New Jersey. Yet, in spite of substantial support for the Campaign, passage of the legislation has been blocked by unsupportive legislators. Drug Policy Alliance New Jersey continues the fight, and intends to see the legislation enacted as law.

Pharmacy Sale of Syringes - Non-prescription, over-the-counter sale of syringes has recently expanded to include almost all of the United States. Only four states (Delaware, Massachusetts, Pennsylvania, and New Jersey) still require prescriptions to purchase syringes. States have taken several different approaches to revising their policies so that syringes can be sold without a prescription, including exempting syringes from paraphernalia laws and broadening language in laws related to medical need. Studies from the first states that allowed non-prescription pharmacy sales show that the practice has had a significant impact on needle sharing trends. For example, since Connecticut reformed its drug paraphernalia and prescription laws to allow pharmacy sales in 1992, needle sharing among injection drug users dropped by 40%.

In 2004, California joined the list of states allowing nonprescription syringe sales when Governor Arnold Schwarzenegger signed SB 1159 (Vasconcellos) into law.  California now permits over-the-counter sales of up to 10 syringes in counties and cities that elect to participate in the statewide Disease Prevention Demonstration Project. Since the enactment of SB 1159, 14 counties (Los Angeles, Santa Barbara, San Francisco, Contra Costa, Yuba, Marin, Santa Cruz, Alameda, Yolo, San Mateo, Solano, Sonoma, Humboldt, and Santa Clara) and 3 cities (Los Angeles, West Hollywood, and San Francisco) have authorized non-prescription syringe sales.

Physician Prescription of Syringes - Another means of increasing access to sterile syringes is permitting doctors to prescribe syringes to their patients. This would appear to be uncontroversial given the role of doctors in preventing disease transmission, but few states currently allow the practice. Drug Policy Alliance has taken a lead role in providing the legal analysis to support efforts to increase the ability of doctors to prescribe syringes nationwide. Physician prescription of syringes, much like needle exchange programs, can provide a vehicle through which injection drug users can access health care services and referrals to drug treatment programs.