Nonprescription sales of syringes in pharmacies are being met with some enthusiasm, some resistance, and a tinge of stigma. But they offer an accessible, affordable, reliable way to lower the risks of HIV/AIDS and infectious hepatitis, and, if managed well, they can help control health care costs and save lives.
Some people sincerely question the wisdom of selling syringes (cylinders with hollow needles attached) to people who inject drugs (PWIDs). They see it as granting permission to continue misuse. Others think that people who misuse drugs “should suffer the consequences.” Those consequences are substantial; they include blood-borne infections and painful illnesses. As the data below show, they also include soaring medical costs—clearly impacting society as well.
Greatly boosting the medical costs are the sheer numbers involved. CDC data show that at least 3.5 million people in the U.S. are infected with hepatitis C virus (HCV). The C. Everett Koop Institute estimates the total lifetime costs for those currently infected with HCV could reach $9 billion. But if 80% develop chronic liver disease, the total costs over a lifetime would be “a staggering $360 billion in today’s dollars.” Adding medical costs, and all costs for other types of infectious hepatitis, along with costs for HIV/AIDS, boosts total expenditures to unbelievable levels.
Beyond those costs are other serious consequences that cannot be measured—broken ties with loved ones, untimely tragedies. Most of us know of a young person who had much to offer, but instead tragically succumbed to a drug overdose.
Stigma: The Not-So-Good News
Local stigma is a common problem, and California is no exception. California pharmacies have been selling nonprescription syringes since 2012—and The New York Times has identified areas where PWIDs face severely limited treatment options. An official blames local stigma— “county supervisors who don’t want a treatment program located in their area.”
Syringes for Diabetic Patients—But Not for PWIDs
A study in the International Journal of Drug Policy points to areas of stigma in California’s Central Valley. A purchase trial found that only one in five PWIDs were able to buy syringes, despite legalization. The study also found that only about 29% of pharmacists and staff would sell to PWIDs—but 79% would sell to patients with diabetes.
Pharmacists turned down people they thought might be PWIDs, based on appearance. Some participants donned conservative clothes and covered their injection scars, but were refused syringes nevertheless. Their attempts to buy, they said, were “embarrassing and stigmatizing,” and “forced them to ‘out’ themselves as drug users.” Some PWIDs who heard these reports didn’t even bother to try purchasing syringes.
Stigma is no stranger to people taking methadone, participants learned. Methadone treatment was even “more stigmatized than injecting drugs,” they said, noting that many local sober living homes barred methadone patients.
Amanda, a study participant, said:
. . . if you get on methadone, you are just as bad as any junkie heroin addict, so you might as well just do the heroin because then nobody knows you are at a methadone clinic . . .
[We] hated people who were on methadone and talked crap about them, because, for whatever reason, we thought we were so much better.
Amanda and her husband eventually enrolled in methadone treatment, but she wished they’d done so sooner, instead of letting their daughter live elsewhere, “because she had heroin addicts her whole life as parents.”
What motivates some PWIDs to head for a pharmacy to purchase syringes, instead of sharing or reusing syringes on hand—their own, or others’—as many PWIDs do?
Perhaps they are aware of their risks, and ready to accept advice and help. Some may be standing on the brink—almost ready for treatment—waiting for someone to offer a hand.
Enter the pharmacist. He or she is among the most trusted and knowledgeable sources patients approach for health care information.
In some states it’s standard to require pharmacists to provide information to people buying syringes. Pharmacists in California are called upon to offer guidance about testing and treatment for HIV and hepatitis, and to provide safe disposal of sharps. Some pharmacy programs give links to support groups and detailed help about entering treatment programs.
To date, more than half the states offer nonprescription sales of syringes in pharmacies. Some states have a counseling agreement resembling California’s.
The Bottom Line
The pharmacy staff’s interactions with customers can have far-reaching effects. Pharmacists who are nonjudgmental and understanding can do much more than provide helpful information and safe syringes; they can help PWIDs take those difficult first steps, perhaps even opening the door to treatment.
A Note To Our Readers—
This article certainly isn’t meant to encourage readers to use illicit drugs. But we do want to spread the word that, for drug users not in treatment, access to clean syringes can lower the risk of contracting or spreading HIV and viral hepatitis. Moreover, the opportunity to contact a pharmacist or other health care provider for advice may increase the likelihood that a person who is using drugs will consider treatment.
Sue Emerson, Publisher, Addiction Treatment
Edlin BR, Eckhardt BJ, Shu MA, et al. Toward a more accurate estimate of the prevalence of hepatitis C in the United States. Hepatology. 2015;62(5):1353-1363. (Free PMC Article.) doi: 10.1002/hep.27978.
The C. Everett Koop Institute. Dartmouth Medical School. Hepatitis C: The Facts: The Epidemic: Associated Health Costs—United States. http://www.epidemic.org/thefacts/theEpidemic/USHealthCareCosts.
Del Real JA. Needle by needle, a heroin crisis grips California’s rural north. The New York Times. May 8, 2018. https://www.nytimes.com/2018/05/08/us/california-heroin-opioid.html.
Paquette CE, Syvertsen JL, Pollini RA. Stigma at every turn: Health services experiences among people who inject drugs. Int J Drug Policy. 2018;(57)104-
Meyerson BE, Davis A, Agley JD, et al. Predicting pharmacy syringe sales to people who inject drugs: Policy, practice and perceptions. Int J Drug Policy. 2018;56:46-53.
HIV and Injection Drug Use. National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. November 2016. https://www.cdc.gov/hiv/pdf/risk/cdc-hiv-idu-fact-sheet.pdf.