Estimated effect of US state syringe sale policy on source of last-used injection equipment

Abstract

Background: Many people who inject drugs (PWID) lack access to a new sterile syringe each time they inject, with increased risk of injection-related harms, including spread of communicable diseases. In the United States (US), restricted access is largely due to state laws and policies regulating syringe access. Our aim in this US-focused study is to estimate variations in syringe acquisition behavior in relation to state-level syringe sale policies, drawing upon self-identified PWID in a nationally representative sample survey.Methods: Estimates were obtained on the source of the last used syringe from participants of the National Survey on Drug Use and Health (NSDUH) years 2002-2011. States were classified as having restricted syringe policies if they had any restriction on the sale of syringes during the study period (e.g., required a prescription or limited the number being sold). Results:In states with unrestricted syringe sale policies, PWID were more likely to have obtained their most recently used syringe from a safe source (Difference (%) = 9.8, 95% CI: 1.9, 17.7). This difference was largely driven by a larger percent of injectors obtaining syringes from a pharmacy in unrestricted states (Difference = 20.4, 95% CI: 12.2, 28.6) but was partially offset by fewer injectors obtaining syringes from syringe exchange programs (Difference = −10.7, 95% CI: −16.1, −5.3). Conclusion:These new findings, taken with other evidence, should help promote removal of policy barriers that now thwart syringe acquisition from a safe source. We hope this additional evidence will provoke policy discussions and may influence regulations that promote public health and reduce the spread of communicable diseases.

Harm Reduction, By Mail: the Next Step in Promoting the Health of People Who Use Drugs

“…[ 46 ] Further, some states have regulations that make it difficult for syringes to be mailed, such as requiring onsite HIV and HCV testing, or limiting distribution to officially designated geographic areas [ 45 ]. In contrast, unrestrictive syringe policies are associated with increased acquisition of sterile syringe supplies [ 47 ]. For mail-delivery to be broadly expanded, participants must have confidence that they will not face prosecution or penalties for using these services.…”

Pharmacy Access to Sterile Injection Supplies for People Who Inject Drugs

“…5 Data analyzed from the National Survey on Drug Use and Health (2002 to 2011) showed that in states with unrestricted syringe retail sale policies, 66.3% of people who injected drugs reported their last syringe source was a pharmacy, compared with 45.9% in states restricting sales. 6 Removing legal barriers to retail sale of syringes and needles may not be sufficient because sales decisions are often left to a pharmacist's discretion, even in states allowing unrestricted sales. People who inject drugs commonly report feeling judged by pharmacy staff and being refused nonprescription purchase of injection supplies.…”

“…In 2017, at least 28 states had drug paraphernalia laws that referred to syringes or needles. 6 Such laws may deter people who inject drugs from visiting pharmacies to pur-chase supplies, even if these sales are permitted. Excluding procurement of sterile injection supplies at pharmacies from these laws might decrease fears of legal repercussions around such sales and increase the likelihood that people who inject drugs will obtain sterile injection supplies.…”

“…These laws can impede access to sterile injection supplies by, for example, requiring a prescription, imposing age restrictions, or capping the amount of syringes or needles that can be purchased . Data analyzed from the National Survey on Drug Use and Health (2002 to 2011) showed that in states with unrestricted syringe retail sale policies, 66.3% of people who injected drugs reported their last syringe source was a pharmacy, compared with 45.9% in states restricting sales …”

“…Drug paraphernalia laws can also impede over-the-counter sales of sterile injection supplies by placing people who inject drugs at risk for criminal charges. In 2017, at least 28 states had drug paraphernalia laws that referred to syringes or needles . Such laws may deter people who inject drugs from visiting pharmacies to purchase supplies, even if these sales are permitted.…”