The Legality of Prescribing and Dispensing Sterile Injection Equipment to IDUs to Prevent Disease Transmission

Explanation of table below

State Pres. law? Para. law? Comments Prescribing legal? Dispensing legal?
Y ? N Y ? N
AL   X   X       X  
AK     Local drug paraphernalia ordinances in several cities X     X    
AR   X   X       X  
AZ   X   X       X  
CA X X   X     X    
CO   X Paraphernalia law does not mention syringes; pharmacy law provides immunity to pharmacists filling valid prescriptions X     X    
CT X X Paraphernalia law excludes <31 syringes; prescription law excludes < 11 X     X    
DE X X Prescription law limits syringe possession to those for whom it is "necessary for the treatment of an injury, deformity or disease then suffered"     X     X
DC   X If authorized by commissioner of health under needle exchange law X       X  
FL X X Prescription required for sales to minors X       X  
GA   X Syringe sales require legitimate medical purpose but prescription not required X         X
HI   X 2001 legislation allows sale by physicians and pharmacists to IDUs until 2003 X     X    
ID   X   X       X  
IL X X   X     X    
IN   X Paraphernalia law exempts sellers of items "historically and customarily used in connection with the ... injecting ... of ... lawful substance[s]." X     X    
IA   X Paraphernalia law excludes syringes distributed for a "lawful purpose" X       X  
KS   X Case law narrowly interprets "legitimate medical purpose"     X     X
KY   X Syringe sale law places detailed restrictions on sales X       X  
LA   X Paraphernalia law explicitly excludes items distributed for medical use X     X    
ME X X Sale of <11 syringes unrestricted X     X    
MD   X Board of Pharmacy has implied pharmacist discretion extends to dispensing syringes to prevent disease X       X  
MA X X   X     X    
MI   X Dispensing legal if authorized for disease prevention purposes by any state or local agency X     X    
MN   X Sale of < 11 syringes unrestricted X     X    
MS   X   X       X  
MO   X   X       X  
MT   X Paraphernalia law exempts physicians & pharmacists X     X    
NE   X   X       X  
NV X X Prescription required except for insulin, asthma and other specified uses X     X    
NH X X Prescription law excludes <11 syringes for adults; paraphernalia law no longer applies to injection equipment. X     X    
NJ X X   X     X    
NM   X Pharmacy sales unrestricted X     X    
NY X X Prescription law excludes <11 syringes and paraphernalia law exempts syringes obtained pursuant to the prescription law. Commissioner of Health also has authority to authorize dispensing by prescription or otherwise. X     X    
NC   X   X       X  
ND   X   X       X  
OH   X Physicians and pharmacists exempt from paraphernalia law.   X     X  
OK   X     X     X  
OR   X Paraphernalia law excludes syringes X     X    
PA X X Prescription required for sale by pharmacy regulation X     X    
PR       X     X    
RI   X Paraphernalia law excludes injection equipment X     X    
SC   X Syringes separately regulated; paraphernalia law does not include "injection" or syringes, and does not apply to heroin use X     X    
SD   X   X       X  
TN   X Paraphernalia law exempts physicians & pharmacists; buyer must show "medical need" per pharmacy regulations X     X    
TX   X   X       X  
UT   X   X       X  
VT   X If authorized by commissioner of health under needle exchange law X       X  
VA X X Syringe law governs medical distribution and requires prescription for children under sixteen. X     X    
WA   X 2002 legislation legalizes pharmacy sale to IDUs 18 years old and older to prevent disease X     X    
WV   X Paraphernalia law allows sale by licensees such as pharmacists X     X    
WI   X Paraphernalia law excludes syringes X     X    
WY   X   X       X  
Total 13 50   48 2 2 28 21 3


Using standard legal research methods, the relevant statutes, regulations and court decisions in the fifty states, the District of Columbia, and Puerto Rico were collected and analyzed. The results are presented in the following table. Physician prescription of injection equipment to patients as a means of preventing disease transmission during drug use was clearly legal in 48 of the 52 jurisdictions, and dispensing the syringes in the pharmacy was clearly legal in 26. State law was considered to provide a reasonable claim to legality if it neither explicitly allowed nor forbade prescribing or dispensing, such that an attorney acting ethically and in good faith could argue that the practices were legal. Two states fell into this category with respect to prescribing, and 22 with respect to dispensing. Prescribing was only clearly prohibited by law in two jurisdictions; dispensing was clearly illegal in only four. The legalities of needle distribution through the health care system are thus quite different from those associated with lay distribution through needle exchanges or pharmacy sale without a prescription.

A web of state syringe prescription, drug paraphernalia, and pharmacy practice rules restrict the sale and possession of syringes and needles:

Syringe prescription laws (denoted Pres. law in table) require a prescription for the sale or possession of injection equipment. These laws were enacted to remedy the abuse of prescribing opiates like morphine during the late nineteenth and early twentieth centuries. Physician prescription practices, however, no longer contribute to illicit drug use since the medical profession is now subject to strict regulation.

Paraphernalia laws (denoted Para. law in table) were primarily enacted in the 1960s and 1970s to regulate the growth of the drug paraphernalia industry. These laws restricted the manufacture, sale, distribution, and possession of items like rolling papers, bongs, pipes, freebasing kits, and in some states, needles. In 1979, the Justice Department's Drug Enforcement Administration (DEA) promulgated the Model Drug Paraphernalia Act.