Encouraging pharmacy sale and safe disposal of syringes in Seattle, Washington.

Abstract

In Seattle and King County, Washington, human immunodeficiency virus (HIV) seroprevalence among injection drug users (IDUs) has remained at 2% to 3% for more than 8 years.1 More than 80% of King County IDUs, however, are infected with the hepatitis C virus, and more than 20% of the uninfected become infected each year.1,2 These blood-borne infections mostly result from the reuse and shared use of drug injection equipment, including needles and syringes, drug cookers, water, and cotton filters.3 Access to sterile injection equipment is associated with lower frequency of unsafe injection practices and reduced risk of infection4–6 and does not appear to increase drug use by increasing injection frequency or the number of injectors.7–9 In 2001, King County syringe exchange programs (SEPs) exchanged more than 2 million syringes. Even with extensive SEP operations, some King County IDUs continue to share syringes. Approximately 62% of recently arrested IDUs revealed that they had injected with a syringe used by someone else in the previous 6 months,10 in part because of the limited hours, limited locations, and the lack of confidentiality of SEPs. Moreover, based on an estimated 15,000 IDUs in King County injecting 3 times per day, SEPs alone cannot provide the approximately 17 million syringes needed countywide per year so that IDUs would have access to a sterile syringe for every injection.1 Washington State syringe access laws and regulations were amended in the years 1999–2002.11 In 1999 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.” Based on the Washington Supreme Court’s interpretation of the 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.”12 In 2002, Washington State amended its 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 sale and allows individuals over the age of 18 to possess hypodermic syringes for the purpose of reducing blood-borne infections. Although pharmacists may now legally sell syringes, the pharmacy board continues to recommend that pharmacies enter into a programmatic relationship with public health agencies for this activity.