New Connecticut Laws to Improve Access to Needles and Syringes: What is Their Impact?

Introduction

Human immunodeficiency virus (HIV) can be transmitted among injecting-drug users (IDUs) through the multi-person use (sharing) of HIV-contaminated needles and syringes. Increasing IDUs' access to and use of sterile needles and syringes may reduce HIV transmission. To help reduce IDUs' use of HIV-contaminated needles and syringes, Connecticut enacted new laws that took effect on July 1, 1992. One of the new laws permits, but does not require, pharmacists to sell up to 10 needles and syringes to individuals who do not have medical prescriptions. Another new law makes it legal for individuals to possess up to 10 clean needles and syringes. Prior to this, purchase and possession of needles and syringes without a prescription had been illegal in Connecticut. From July 1, 1992 through June 30, 1993, we conducted an evaluation to determine whether the changes in the needle prescription and drug paraphernalia laws were associated with changes in pharmacies' needle and syringe sales practices and needle and syringe sales, IDUs' needle and syringe-related purchasing and usage, and police officers' practices and risk of needlestick injuries.

Evaluation Findings

• Through a surveillance system monitoring needle and syringe sales at selected Connecticut pharmacies, we found that most, but not all, pharmacies sold nonprescription needles and syringes after the new laws.
• In pharmacies in neighborhoods where there was a high prevalence of injecting drug use, numbers of nonprescription needles and syringes sold and needle and syringe transactions increased steadily from July 1992 through June 1993.
• The percentage of IDUs who were aware of both new laws increased during the first 12 months after the new laws. Nine to 12 months after the new laws, over two-thirds of the IDUs interviewed knew about both new laws.
• After the new laws went into effect, IDUs reported more pharmacy purchasing of needles and syringes and less street purchasing. And, there was a shift from street purchasing to pharmacy purchasing as the most frequently reported source of needles and syringes.
• The percentage of IDUs who reported sharing needles and syringes decreased after the new laws.
• While law enforcement officers in Hartford were less likely to arrest persons for paraphernalia possession after the new laws were enacted, there was no difference in the percentage of IDUs who reported that they were hassled by police for possession of clean needles and syringes.
• And, while IDUs reported changes in needle and syringe possession, Occupational Safety and Health Administration reports of needlestick injuries among Hartford police decreased after the new laws.

Policy Recommendations

As a first step, state and local public health officials, in collaboration with law enforcement officers, addiction services personnel, pharmacy and medical associations, and members of affected communities should review the laws limiting access to sterile needles and syringes in their jurisdictions.

Our data suggest that once legal restrictions on the purchase and possession of needles and syringes are removed, pharmacies will sell nonprescription needles and syringes, and IDUs will shift their needle and syringe purchasing from illegal "street" sources to pharmacies and reduce their needle sharing behaviors.

Therefore, policy-makers should consider:

• the repeal of needle prescription laws—allowing increased availability of sterile needles and syringes, and
• the modification of drug paraphernalia laws—specifically, decriminalizing the possession of needles and syringes.

The pivotal role of pharmacists and police officers in increased sterile needle and syringe availability for IDUs who will not or cannot stop injecting must be emphasized. Pharmacists and police officers should be brought into the discussions of this public health action and should be encouraged to take a more active public health role.

Public health officials should work with IDUs, pharmacists, and police officers to determine their needs and concerns related to HIV infection, addictions, and access to sterile needles and syringes and should educate them as necessary.

Knowledge of the new laws among IDUs was not complete. We would recommend that IDUs be given more information about what the new laws allow in practical terms.

Comment

We recognize that increasing sterile needle and syringe availability for IDUs who cannot or will not enter drug treatment programs requires the consideration of a variety of options including increased pharmacy sales and needle exchange programs. However, among these options, pharmacy sale of sterile needles and syringes offers an intervention that can be implemented with minimal, or no, public funding.

We recognize that HIV prevention efforts directed toward injecting-drug users must be comprehensive and should include drug treatment, and addiction and risk reduction counseling, in addition to the specific interventions to increase IDUs' access to and ability to possess sterile needles and syringes.