Injection drug users (IDU) have three ways to get new, sterile syringes: 1) needle exchange, 2) physician prescription, and 3) pharmacy sales. Studies at Public Health show that despite large-scale needle exchange operations at 7 sites in King County, many IDU continue to share syringes. This is understandable. Needle exchange programs are limited to a few sites and hours and are sometimes under police watch, factors which can present barriers for IDU attempting to access new, sterile injection equipment. Physician prescribing has only recently been recommended and clarified to be legal in Washington State. Finally, many pharmacists are not yet sure of the legality of their selling to users without prescriptions. These factors can present barriers for IDU attempting to access sterile syringes.
FACTS
- 80-90% of King County IDU are already infected with hepatitis C virus (HCV), which countywide is now the main contributor to liver problems requiring transplants. HCV is so easily transmitted that many IDU become infected within the first few months after beginning injection drug use.
- 70% of King County IDU have evidence of exposure to hepatitis B (HBV), and some are chronically infected, adding to liver disease and transplantation needs.
- Over 50% of new HIV infections nationally are among IDU. HIV is fortunately less prevalent in King County IDU (about 3% infected). Given the high prevalence of HCV, HIV's potential for rapid spread, however, continues to be great.
- There are other serious and socially expensive complications stemming from the use of non-sterile injection equipment, including bacterial endocarditis.
LAW
Washington State does not require a prescription for retail purchase of syringes. However, current law (RCW 70.115.050) does stipulate that on the sale at retail of any syringe or other device used to inject drugs, "the retailer shall satisfy himself or herself that the device will be used for the legal use intended."
In the fall of 1999, after reviewing information from the Centers for Disease Control and Prevention, the Washington State Board of Pharmacy determined that legal use "includes the distribution of sterile hypodermic syringes and needles for the purpose of reducing the transmission of blood-borne diseases." In line with Washington State's drug paraphernalia law, the pharmacy board specified that pharmacy syringe sales should "be performed through public health and community-based HIV prevention programs."
In 2002, Washington State amended drug paraphernalia law to further clarify legal restrictions regarding syringes (RCW 69.50.4121 and 1998 c 317 s 1 and RCW 69.50.412 and 1981 c 48 s 2). The revised statute specifically exempts pharmacies from any penalties associated with syringe distribution. It also allows individuals over the age of 18 to possess sterile hypodermic syringes and needles for the purpose of reducing blood-borne diseases. Although pharmacists may now legally sell syringes, the pharmacy board continues to recommend that pharmacies partner with public health agencies for this activity.
CAMPAIGN
Based on this information and the 1999 Washington State Board of Pharmacy interpretation of syringe sales regulations, Public Health began collaborating in March, 2001 with King County retail pharmacists to increase syringe access. The purpose of the collaborations is to prevent the transmission of blood-borne infections and other medical complications of using non-sterile injection equipment. Fifteen retail pharmacies within King County have already become Public Health partners in these efforts. Locations range from Auburn to North Seattle.
Pharmacies are asked to voluntarily participate in selling sterile injection equipment. A memorandum of understanding is signed by both the pharmacy representative and the Public Health Director. This understanding recognizes the pharmacy as a "community partner" of Public Health to provide access to sterile syringes to protect individual and public health. With this understanding, Public Health agrees to provide:
- Written materials to each pharmacy for free distribution to customers.
- Free anonymous / confidential HIV and hepatitis counseling and testing at nearby sites.
- Free training for pharmacy staff on the prevention of HIV, hepatitis and other blood-borne infections.
Pharmacies agree to:
- Offer retail sales of sterile injection equipment to persons who use drugs by injection.
- Provide verbal and written information to customers concerning:
- The safe, legal, and free disposal of used needles/syringes.
- The prevention of disease, including HIV, hepatitis, and other blood-borne infections.
- The value and availability of drug/alcohol treatment.
- The value and availability of HIV counseling and testing.
- Request training, as necessary, from Public Health on the prevention of HIV, hepatitis and other blood-borne infections.
In addition to retail pharmacy collaborations:
- There are seven Needle Exchange sites within King County. These all provide a one-for-one exchange with no volume limit. The downtown Seattle needle exchange offers a medical clinic, HIV/STD testing as well as hepatitis screening and vaccination, and methadone vouchers for treatment.
- All three Public Health pharmacies now sell syringes to anyone requesting to purchase. No prescription is required, and individuals do not need to be registered Public Health patients.
- All Public Health clinics now accept used syringes for disposal.
Individuals can locate the nearest Needle Exchange, Public Health clinic or pharmacy or participating retail pharmacy nearest them by calling the HIV/STD Hotline at (206) 205-7837 or 1-800-678-1595.
Through these efforts, Public Health's goals are to prevent new bloodborne infections, reduce the negative consequences of injection drug use, facilitate entry into drug treatment, remove used syringes from circulation, and ensure their safe disposal.
Please assist Public Health to achieve these goals. For more information, contact Michael Hanrahan, campaign coordinator, at 206-205-5509 or Michael.Hanrahan@kingcounty.gov. This is an excellent opportunity for community pharmacies to continue to demonstrate their commitment to improving health care.
