Temple University of the Commonwealth System of Higher Education

Beasley School of Law

Project on Harm Reduction in the Health Care System

Memorandum


Date: May 24, 1999

Subject: Prescribing and Dispensing Injection Equipment in New Jersey

INTRODUCTION

Numerous medical organizations and even the federal government itself now recommend that injection drug users employ a new, sterile syringe each time they inject.(1) Unfortunately, the number of sterile syringes required to follow this standard -- approximately 1 billion(2) -- exceeds the available supply by many millions. The continuing shortage of syringes contributes to the spread of HIV, and is thus a major health problem. Many commentators have suggested that the health care system can help increase access to safe injection equipment through prescription, pharmacy sales and other measures such as hospital or clinic-based needle exchange programs (NEPs).(3)

This Memorandum assesses the legality, under New Jersey law, of physician prescription and pharmacy sale of injection equipment to patients who are known to be injecting illegal drugs. It assumes that the ensuring a patient's access to sterile injection equipment is clinically effective and conducive to public health, is ethical, and constitutes only one facet of the care the patient is receiving from the physician. These assumptions are justified and discussed in two companion reports: Zita Lazzarini, Ethical Issues in Prescribing and Dispensing Syringes to Injection Drug Users, and Josiah Rich, Syringe Prescription in Rhode Island: A Case Study. The risk of malpractice liability is discussed in a third companion piece, Professional Liability in the Prescription and Dispensing of Sterile Injection Equipment to IDU Patients, by Maxwell Mehlman.

We conclude that physicians may legally prescribe and pharmacists may legally dispense syringes to injection drug users (IDUs) as a health care intervention to prevent a patient acquiring or transmitting HIV.

This Memorandum addresses the following specific questions:

1) May a physician legally prescribe sterile injection equipment to an IDU patient?

2) May a pharmacist legally fill such a prescription?

3) How might New Jersey law be changed or clarified to promote access to sterile injection equipment for IDUs through the health care system?

I. May a Physician Legally Prescribe Sterile Injection Equipment to an IDU Patient?

Answering this question requires a two-step analysis. We determine first whether prescription of sterile injection equipment is consistent with the general law governing medical practice. If so, we then ask whether any other law, such as a drug paraphernalia provision, prohibits prescription of syringes to an IDU patient. We begin with an overview of the regulatory environment.

A. The Regulatory Scheme

Professional Licensure Law

The practice of medicine in New Jersey is governed by N.J.S.A. § 45:9-1 et seq., with regulations found in chapter 35 of title 13 of the New Jersey Administrative Code. The Board of Medical Examiners has the authority to license physicians, N.J.S.A. § 45:9-6, and to punish licensed physicians who behave in ways that violate the law or beneath the standards of good faith and regular practice of medicine. See N.J.S.A. § 45:9-16. No provision of the medical practice act explicitly defines the basis or scope of the physician's general authority to prescribe, but the law has been interpreted to authorize the New Jersey Board of Medical Examiners to set limits on allowable prescription practices, either by enacting specific regulations banning certain prescription practices, Lemmon Company v. New Jersey State Board of Medical Examiners, 175 N.J. Super. 40, 417 A.2d 568, cert. denied 85 N.J. 148, 425 A.2d 299 (1980),(4) or through the disciplinary process.

The Board of Medical Examiners has issued regulations governing the prescription and dispensing of drugs and controlled substances. Both these terms are defined for purposes of these provisions in ways that exclude syringes.(5) Although they consequently do not actually govern syringe prescription, they set out standards and required practices that may be relevant by analogy:

A practitioner, acting within the scope of lawful practice and after an examination or evaluation of the patient's condition, may issue a written prescription for a drug to a patient, guardian or authorized representative in the form authorized by this section. The practitioner shall assure that appropriate follow-up is provided and that the effects of the drug are properly evaluated and integrated into the treatment plan for the patient.

N.J. A.C. §13:35-7.2(a); see also N.J.A.C. 8:65-7.4 (parallel controlled substances regulations).

(a) A practitioner shall not issue a prescription for a narcotic drug listed in any schedule which drug is intended for the purpose of "detoxification" or "maintenance treatment."

N.J.A.C. § 13:35-7.7.

The medical board may also punish physicians whose prescription practices constitute unprofessional conduct. Disciplinary actions of this sort most commonly arise in the case of prescription of controlled substances. These cases apply the familiar standard under which a prescription is valid if it is written for a legitimate medical purpose, in the normal course of professional practice. State v. Vaccaro, 142 N.J.Super. 167, 361 A.2d 47, cert. denied , 71 N.J. 518, 366 A.2d 674 (1976).

A separate provision of the "Professions and Occupations" title of the New Jersey Code, applicable to both physicians and pharmacists, was passed by the legislature to reemphasize the authority of professional licensing boards to punish practitioners who improperly prescribe or dispense controlled substances:

It shall be a valid ground for the refusal to grant, revocation or suspension of a license to practice a health care profession, subject to regulation in this State, including the practice of pharmacy, or for the refusal to admit to an examination a candidate for licensure, that the licensee has prescribed or dispensed a controlled dangerous substance or substances, as defined by the "New Jersey Controlled Dangerous Substances Act", (P.L.1970, c. 226) (C. 24:21- 1 et seq.), in an indiscriminate manner, or not in good faith, or without good cause, or where the licensee reasonably knows or should have known that the substance or substances prescribed are to be used for unauthorized or illicit consumption or distribution or that a substance or substances previously prescribed or dispensed were used by the patient for unauthorized or illicit consumption or distribution.

N.J.S.A. § 45: 1-13.

Controlled Substances Act Generally

The New Jersey Controlled Dangerous Substances Act, N.J.S.A. § 24:21-1 et seq., gives the Commissioner of Health the authority to establish rules and regulations governing the prescription and dispensing of controlled substances. N.J.S.A. § 24:21-9. These rules are found in chapter 65 of title 8 of the administrative code. As under the medical licensure law, the term "controlled substance" does not include a device such as a syringe, so the prescribing rules set out below are relevant only by analogy if at all.

(a) A prescription for a controlled substance to be effective must be issued for a legitimate medical purpose by an individual practitioner acting in the usual course of his professional practice. The responsibility for the proper prescribing and dispensing of controlled substances is upon the prescribing practitioner, but a corresponding responsibility rests with the pharmacist who fills the prescription. An order purporting to be a prescription issued not in the usual course of professional treatment or in legitimate and authorized research is not a prescription and the person knowingly filling such a purported prescription, as well as the person issuing it, shall be subject to the penalties provided for violations of the provisions of Law relating to controlled substances.

(b) A prescription may not be issued in order for an individual practitioner to obtain controlled substances for supplying the individual practitioner for the purpose of general dispensing to patients.

(c) A prescription may not be used for the dispensing of narcotic drugs listed in any schedule for "detoxification" or "maintenance treatment" as defined in N.J.A.C. 8:65-11.1.

N.J.A.C. 8:65-7.4.

Syringe Prescription Law

The Controlled Substances Act includes a specific provision requiring a prescription for the delivery or possession of a syringe:

a. No person shall sell, furnish, or give to any person or persons other than a duly licensed physician ... registered pharmacist ... an instrument commonly known as a hypodermic syringe, hypodermic needle or any instrument adapted for the use of controlled dangerous substances as defined in P.L.1970, c. 226 (C. 24:21-1 et seq.) by subcutaneous injections without a prescription of a duly licensed physician, dentist or veterinarian. Such prescription shall contain the name and address of the patient, the description of the instrument prescribed and the number of instruments prescribed.

b. Every person who disposes of, or sells, or furnishes, or gives away a hypodermic syringe or a hypodermic needle or an instrument adapted for the use of controlled dangerous substances by subcutaneous injections, upon the prescription of a duly licensed physician, dentist, or veterinarian, shall record the date of the sale or furnishing of the instrument. This prescription shall be retained on file for a period of two years and shall be open to inspection by any public officer or employee engaged in the enforcement of this section. A prescription filed in accordance with this section shall be sufficient authority, without the necessity of a renewal or reissuance, to permit subsequent sales or the furnishing of hypodermic syringes or hypodermic needles or instruments adapted for the use of controlled dangerous substances by subcutaneous injections to the person to whom the prescription was issued, for a period of one year from the date of its original issuance.

c. It shall be unlawful for any person or persons, except a duly licensed physician, ... to have under control or possess a hypodermic syringe, hypodermic needle or any other instrument adapted for the use of controlled dangerous substances by subcutaneous injections with intent to use such syringe, needle or instrument for such purpose, unless such possession be obtained upon a valid prescription form, and such use be authorized or directed by a duly licensed physician or veterinarian. For the purposes of this subsection, no such prescription shall be valid which has been outstanding for more than one year.

d. Any person who violates this section is guilty of a disorderly persons offense.

N.J. S.A. 24:21-51.

Drug Paraphernalia Law

Chapter 36 of the New Jersey Code of Criminal Justice is a comprehensive regulation of "drug paraphernalia." It was passed in its present form in 1987, and has the following principal elements:

The offense of distributing drug paraphernalia is set forth as follows:

It shall be unlawful for any person to distribute or dispense, or possess with intent to distribute or dispense, or manufacture with intent to distribute or dispense, drug paraphernalia, knowing that it will be used to plant, propagate, cultivate, grow, harvest, manufacture, compound, convert, produce, process, prepare, test, analyze, pack, repack, store, contain, conceal, ingest, inhale or otherwise introduce into the human body a controlled dangerous substance or controlled substance analog in violation of the provisions of chapter 35 of this title. Any person who violates this section commits a crime of the fourth degree.

N.J.S.A. § 2C:36-3.

This is the text of the syringe section:

Except as otherwise authorized by law, it shall be unlawful for a person to have under his control or possess with intent to use a hypodermic syringe, hypodermic needle or any other instrument adapted for the use of a controlled dangerous substance or a controlled substance analog as defined in chapter 35 of this title or to sell, furnish or give to any person such syringe, needle or instrument. Any person who violates this section is guilty of a disorderly persons offense.

N.J.S.A. § 2C:36-6.

B. Analysis

The first question is whether prescription of sterile injection equipment to IDUs is generally authorized under statutes governing medical practice. The syringe provision in the criminal code, N.J.S.A. § 2C:36-6, prohibits selling, furnishing or giving anyone a syringe "except as otherwise authorized by law," but does not indicate where such authorization might be found. The syringe prescription law, N.J.S.A. § 24:21-51, prohibits selling, furnishing or giving a syringe without a prescription to anyone other than a health care provider. This provision by its terms imposes no limits on a physician prescribing a syringe, and is premised on the legality of a physician writing such a prescription. Thus this section suggests that prescription is "otherwise authorized by law" within the meaning of § 2C:36-6, but itself provides that authorization only by implication. See State v. McCague, 314 N.J.Super. 254, 261 n.2, 714 A.2d 937, 941 n.2, cert. denied, 157 N.J. 542, 724 A.2d 802 (1998) ("The "[e]xcept as otherwise authorized by law" terminology refers to N.J.S.A. § 24:21-51, which provides that no person shall sell or give hypodermic syringes or needles to any person, other than certain designated medical professionals, without a prescription of a duly licensed physician, dentist or veterinarian, or possess such items without a prescription unless a designated medical professional.").

Having exhausted statutes explicitly discussing syringes, we must look to the general authority of physicians to prescribe. New Jersey law nowhere sets out in positive terms the extent or basis of the physician's general authority to write prescriptions for syringes or other devices. This authority is assumed, as an aspect of the professional practice of medicine. The law and regulations governing the prescription of controlled substances and drugs, however, set out the standards that would almost certainly be borrowed by courts in a syringe prescription case. Under these laws, a prescription is valid if it is written in good faith, for a legitimate medical purpose, in the normal course of professional practice. See State v. Vaccaro, 142 N.J.Super. 167, 361 A.2d 47 (A.D.1976), certification denied , 71 N.J. 518, 366 A.2d 674. A prescription for sterile injection equipment, issued to a patient who cannot or will not enter drug treatment, for the purpose of preventing the transmission of a serious communicable disease during injection, would seem to be well within the parameters of allowable discretion set by this standard.

No cases in New Jersey have assessed the legality of a syringe prescription, let alone one to an IDU. There is only one reported case of a physician being prosecuted for misprescribing controlled substances, and, as in other such prosecutions in other states, the physician defendant was accused of being virtually a drug pusher. The court in that case dismissed the claim that the "good faith" standard was too vague to properly guide a physician's conduct: " A physician who is honest and ethical, and dispenses the prohibited drugs in a good faith effort to treat and cure patients, has no fear of the criminal sanctions of the statute." Vaccaro, 142 N.J.Super. 167, 173, 361 A.2d 47, 50. In normal usage, "good faith" entails a genuine concern for the well-being of the patient and others who might be infected through sharing injection equipment with the patient, and conduct devoid of malice or deception. In determining whether a prescription arises within the usual course of professional practice, courts may consider such matters as whether a bona fide physician-patient relationship existed, whether other care was provided, whether proper records were kept of the encounter, whether the prescription was based on a proper history or individualized assessment of the patient's risk factors, efforts to provide other harm reducing services, follow up and so on. Both good faith and "usual course of practice" can be demonstrated from a physician's records, documenting the steps the physician has taken and future treatment plans.(6) See generally United States v. Moore, 423 U.S. 122, 142-43, 96 S.Ct. 335,345 ("The evidence presented at trial was sufficient for the jury to find that respondent's conduct exceeded the bounds of "professional practice."... [H]e gave inadequate physical examinations or none at all. He ignored the results of the tests he did make.... He did not regulate the dosage at all, prescribing as much and as frequently as the patient demanded. He did not charge for medical services rendered, but graduated his fee according to the number of tablets desired. In practical effect, he acted as a large-scale "pusher" not as a physician.") A physician who is providing syringes to a patient who cannot or will not enter drug treatment, and whose injection drug use places him at high risk of contracting or spreading a communicable disease, should have no difficulty satisfying these two prongs of the prescription standard.

On the final prong, there will certainly be some physicians who contend that prescribing injection equipment to an IDU patient is not a legitimate medical practice. Generally, however, courts in other jurisdictions applying this standard do not require unanimity. See, e.g., Glover v. Board of Medical Quality Assurance, 231 Cal.App.3d 203, 282 Cal.Rptr. 137 (1991); Commonwealth v. Salameh, 421 Pa.Super. 320, 324, 617 A.2d 1314, 1316 (1992) (prosecution must prove not simply that some physicians disagree with the practice at issue, but that "'no' responsible segment of the medical profession exists which accepts appellant's methods"). See generally S.E. Stone, The Investigation and Prosecution of Professional Practice Cases under the Controlled Substances Act: Introduction to Professional Practice Case Law. 21 Drug Enforcement 23 (1983). There is ample support for the position that prescribing sterile injection equipment comports with treatment principles accepted by a responsible segment of the medical profession. See Zita Lazzarini, Ethical Issues in Prescribing and Dispensing Syringes to Injection Drug Users, and Josiah Rich, Syringe Prescription in Rhode Island: A Case Study.

Conclusion: A prescription for sterile injection equipment to an IDU patient is consistent with the standard for a valid prescription under New Jersey laws governing the physician's authority to prescribe.

We turn now to the second question: Do any other laws prohibit physicians from prescribing sterile injection equipment to IDU patients? There are two main possibilities.

The provisions of N.J.S.A. § 45:1-13 authorize the denial, suspension or revocation of the license of any medical practitioner, including a physician, who prescribes or dispenses a controlled dangerous substance "in an indiscriminate manner, or not in good faith, or without good cause, or where the licensee reasonably knows or should have known that the substance or substances prescribed are to be used for unauthorized or illicit consumption or distribution or that a substance or substances previously prescribed or dispensed were used by the patient for unauthorized or illicit consumption or distribution." There are only three reported cases discussing this provision, none with a holding in point here. The statute may be raised by opponents of physician prescription as support for the argument that the legislature intended to prevent access to controlled substances for illicit use even when providing those substances for unquestionably legitimate medical purposes. By analogy, this would be offered as support for the proposition that the paraphernalia scheme should be read to bar any prescription or dispensing of needles to users, regardless of medical need.

The argument is one by analogy. Syringes are not classified as controlled substances. Indeed, both the medical practice and controlled substances act to which § 45:1-13 refers clearly exclude devices such as syringes from their definitions of controlled substances and drugs. By confining this provision to controlled substances, the legislature deliberately excluded other devices, such as syringes. Because the literal terms of the statute exclude syringes from coverage, the mere fact that the statute prohibits an arguably analogous act is insufficient to justify interpreting it to actually cover syringe prescription.(7)

A more serious possibility is the drug paraphernalia law. As we will discuss further in the pharmacy analysis below, we have concluded that the general drug paraphernalia provisions do not apply to syringes, which are instead regulated only in the sections of the drug paraphernalia law that explicitly mention them. For purposes of this portion of the analysis, however, we will assume that syringes are covered by both the syringe-specific and the general provisions of the drug paraphernalia law.

The syringe-specific paraphernalia provision makes it a crime to "sell, furnish or give" a syringe to any person "except as otherwise authorized by law." This memorandum has already concluded that syringe prescription is authorized within the laws governing medical practice and prescription generally (indeed, if it were not, this provision would prohibit possession or distribution of needles for any purpose). Even if syringe prescription were not authorized by law, a physician who writes a prescription does not "sell, furnish or give" a syringe to the patient. In the absence of a special definition in the statute, these words are given their ordinary meaning, which does not embrace facilitating the later purchase of a syringe by writing a prescription.

The result is the same if we assume that syringes fall under the prohibitions applicable to drug paraphernalia generally. The law makes it an offense to "for any person to distribute or dispense ... drug paraphernalia, knowing that it will be used to ... introduce into the human body a controlled dangerous substance or controlled substance analog in violation of the provisions of chapter 35 of this title." N.J.S.A. § 2C:36-3 (italics added). Again, neither the paraphernalia statute nor the general definition section of the crimes code, N.J.S.A. § 2C:1-14, provide definitions of the key italicized terms. The controlled substances act, which is the most relevant statute in the crimes code, states that "Distribute" means "to deliver other than by administering or dispensing a controlled dangerous substance or controlled substance analog." N.J. S.A. 2C:35-2. "Deliver" or "delivery" in turn "means the actual, constructive, or attempted transfer from one person to another of a controlled dangerous substance or controlled substance analog, whether or not there is an agency relationship." Id.(8) A physician who writes a prescription for an item is not actually transferring possession of that item to the patient, but merely providing the patient with instructions and authorization for the pharmacist who will transfer possession by dispensing the prescription.

Nor does the concept of a constructive delivery embrace the writing of a prescription. Constructive delivery logically requires actual or constructive possession of the item being delivered. See, e.g., Commonwealth v. Zimmerman, 3 D & C. 4ths 381, 385-85 (Common Pleas Lebanon Cty PA 1989). A physician writing a prescription to be filled at a pharmacy does not have actual or constructive possession of the syringe. Constructive possession has been defined to require "both the power and the intention at a given time to exercise control over a thing, either directly or through another person." State v. Montesano, 298 N.J.Super. 597, 613, 689 A.2d 1373, 1382, cert. denied, 150 N.J. 27, 695 A.2d 670 (1997); see also State v. Campisi, 42 N.J.Super. 138, 126 A.2d 17 (A.D.1956), reversed in part on other grounds, appeal dismissed in part, 23 N.J. 513, 129 A.2d 880. The authority to write a prescription for a syringe does not give the physician the ability to exercise control over it; like the patient, he would have to go to the pharmacy and purchase the syringe in order to possess it, and so cannot be said to constructively possess it.(9)

Conclusion: Writing a prescription for a syringe does not violate any New Jersey law. A physician may therefore legally prescribe injection equipment to an IDU patient.

II. Does Dispensing a Needle by a Pharmacist to an IDU Based on a Physician's Prescription Violate New Jersey's Drug Paraphernalia or Syringe Prescription Laws?

A. The Regulatory Scheme

Professional Licensure Law

The practice of pharmacy in New Jersey is governed by N.J.S.A. § 45:14-1 et seq. , with regulations found in chapter 39 of title 13 of the New Jersey Administrative Code. The Act vests in the State Board of Pharmacy power to adopt such regulations as are reasonably necessary to carry out the purposes of that Act.

Pharmacists are governed by the needle prescription provision, N.J. S.A. 24:21-51, described above. No other provisions of pharmacy law or regulations explicitly address syringes.

The disciplinary provisions of the pharmacy act and the code also authorize action against the license of a pharmacist who "has been adjudged guilty of violating any State or Federal law or any law of the District of Columbia or of any territory of the United States relating to the

practice of pharmacy, or relating to the dispensing of drugs, or has been convicted of a crime involving moral turpitude,... [or] is shown to be addicted to the use of narcotic drugs, or has been convicted of violating any law of this or any other state or of the United States relating to narcotic drugs." N.J.S.A. § 45:14-12; accord N.J.S.A. § 45: 1-13.. The Board can also punish "grossly unprofessional conduct," which is narrowly defined to cover pricing, advertising, and other general business practices but which the New Jersey Supreme Court has ruled can be interpreted by the board more broadly in particular cases. Matter of Heller, 73 N.J. 292, 374 A.2d 1191 (1977).

A pharmacist is authorized to dispense medications ordered by a valid prescription, and is ordinarily expected to do so in the absence of a good reason to refuse. Strauss S. The Pharmacist and the Law. Baltimore MD: Williams & Wilkins, 1980:29-31; Steven W. Huang, The Omnibus Reconciliation Act of 1990: Redefining Pharmacists' Legal Responsibilities, XXIV Am. J. L & Med. 417 (1998). The pharmacy regulations state that:

(a) The pharmacist shall have the right to refuse to fill a prescription if, in his or her professional judgment, the prescription is outside the scope of practice of the prescriber; or if the pharmacist has sufficient reason to question the validity of the prescription; or to protect the health and welfare of the patient.

N.J.A.C. 13:39-6.1.

Controlled Substance and Drug Paraphernalia Laws

The controlled substances and paraphernalia discussed in I.A. above are also applicable to pharmacists. The regulations for the Controlled Substances Act make clear that a pharmacist has an independent responsibility to ensure that controlled substances are properly prescribed: "The responsibility for the proper prescribing and dispensing of controlled substances is upon the prescribing practitioner, but a corresponding responsibility rests with the pharmacist who fills the prescription. An order purporting to be a prescription issued not in the usual course of professional treatment or in legitimate and authorized research is not a prescription and the person knowingly filling such a purported prescription, as well as the person issuing it, shall be subject to the penalties provided for violations of the provisions of Law relating to controlled substances." N.J.A.C. 8:65-7.4. The regulations also state that a "prescription for controlled substances may only be filled by a pharmacist acting in the usual course of his professional practice."N.J.A.C. 8:65-7.6.

B. Analysis

We have concluded above that a physician's prescription for sterile injection equipment, written under the factual conditions assumed for purposes of this Memorandum, is valid under New Jersey law. The syringe prescription statute does not set any additional substantive standards for a syringe prescription, but rather simply requires a prescription as a condition of sale. Ordinarily, the pharmacist is required to fill a valid prescription.(10) The regulatory exceptions related to prescriptions for controlled substances are not applicable. The next question is whether filling the prescription would be prohibited under any other provision of law.

Here the issue is, again, the paraphernalia law. The pharmacist is undoubtedly transferring the syringe, so if a syringe is drug paraphernalia in this situation, then the transfer is illegal. We thus come to the fundamental question of whether a syringe dispensed by a valid prescription, for legitimate medical reasons, falls within the definition of "drug paraphernalia" under New Jersey law. We conclude that it does not.

This conclusion depends upon reading the general paraphernalia statute, N.J.S.A. §§ 2C:36-1 to -7, to make a systematic distinction between drug paraphernalia generally and syringes. The language of the statute, as analyzed using the applicable techniques of interpretation, bespeaks a clear legislative intention to treat syringes differently from other items used to ingest drugs, and by its plain terms, the paraphernalia law does not prohibit heath care distribution of syringes authorized under the medical practice and syringe prescription laws.

In New Jersey, the cardinal rule of statutory construction is to effectuate the intent of the legislature. The traditional common-law rules of construction are guides to this end, but are not themselves rules of law to be applied rigidly for their own sake. The first and best guide to legislative intent is always the language of the statute itself. In ascertaining what the framers of legislators intended,

"we must first look at the evident wording of the statute to ascertain its plain meaning and intent." Renz v. Penn Cent. Corp., 87 N.J. 437, 440, 435 A.2d 540 (1981). Our duty is to apply the legislative intent as expressed in the statute's language, and we are not to presume that the Legislature intended something other than what it expressed by its plain language.

Toll Bros., Inc. v. West Windsor Tp., 312 N.J.Super. 540, 547, 712 A.2d 266, 270 (emphasis added), cert. denied, 157 N.J. 543, 724 A.2d 803 (1998). The plain text of the paraphernalia statute evinces and accomplishes the intent to regulate syringes separately from other items that can be used with illicit drugs, and not to include syringes in any substantive provision of the statute other than those in which they are explicitly named.

Interpretation of the paraphernalia act begins with the federal Model Drug Paraphernalia Act, upon which the New Jersey law was based. See The Town Tobacconist v. Kimmelman, 94 N.J. 85, 100; 462 A.2d 573 (N.J. 1983). A comparison of the two statutes' definitions of drug paraphernalia provides unmistakable evidence that the New Jersey legislature intended to exclude syringes from the general category of drug paraphernalia as defined in the statute. The Model Act includes two references to injection equipment, both italicized here:

The term 'drug paraphernalia' means all equipment, products and materials of any kind which are used, intended for use, or designed for use, in planting, propagating, cultivating, growing, harvesting, manufacturing, compounding, converting, producing, processing, preparing, testing, analyzing, packaging, repackaging, storing, containing, concealing, injecting, ingesting, inhaling, or otherwise introducing into the human body a controlled substance in violation of this Act (meaning the Controlled Substances Act of this State). It includes, but is not limited to:

(1) Kits used, intended for use, or designed for use in planting, propagating, cultivating, growing or harvesting of any species of plant which is a controlled substance or from which a controlled substance can be derived;

(2) Kits used, intended for use, or designed for use in manufacturing, compounding, converting, producing, processing, or preparing controlled substances;

(3) Isomerization devices used, intended for use, or designed for use in increasing the potency of any species of plant which is a controlled substance;

(4) Testing equipment used, intended for use, or designed for use in identifying or in analyzing the strength, effectiveness or purity of controlled substances;

(5) Scales and balances used, intended for use, or designed for use in weighing or measuring controlled substances;

(6) Diluents and adulterants, such as quinine hydrochloride, mannitol, mannite, dextrose and lactose, used, intended for use, or designed for use in cutting controlled substances;

(7) Separation gins and sifters used, intended for use, or designed for use in removing twigs and seeds from, or in otherwise cleaning or refining marihuana;

(8) Blenders, bowls, containers, spoons and mixing devices used, intended for use, or designed for use in compounding controlled substances;

(9) Capsules, balloons, envelopes and other containers used, intended for use, or designed for use in packaging small quantities of controlled substances;

(10) Containers and other objects used, intended for use, or designed for use in storing or concealing controlled substances;

(11) Hypodermic syringes, needles and other objects used, intended for use, or

(12) Objects used, intended for use, or designed for use in ingesting, inhaling, or otherwise introducing marihuana, cocaine, hashish, or hashish oil into the human body...

The Model Paraphernalia Act, reprinted in Annotation, Validity, under Federal Constitution, of So-called "Head Shop" Ordinances or Statutes, Prohibiting Manufacture and Sale of Drug Use Related Paraphernalia, 69 A.L.R. Fed. 15 (1984 & Supp. 1998) (italics added). Although the New Jersey Act is virtually identical to the Model Act, both references to injection equipment in the Model Act were omitted by the New Jersey legislators who drafted the state provision. The legislature deliberately diverged from the Model Act in this respect, a decision that makes perfect sense given a decision to exclude syringes from the general drug paraphernalia provisions, and which makes no sense if we assume that the legislature intended to include syringes within the general definition of drug paraphernalia.(11)

Comparison of the next two sections of the two acts demonstrates that the removal of references to injection from the state statute's general paraphernalia provisions was no accident. Apart from minor technical changes,(12) both the possession and distribution sections of the Model Act differ from their counterparts in the state law only in the exclusion of the word "inject" from the list of illegal uses knowledge of which satisfies the provisions' scienter requirements.

The very existence of section 2C:36-6 likewise manifests the intention to regulate syringes differently than other forms of drug paraphernalia. The Model Act, which explicitly defines paraphernalia to include syringes, has no separate provision for syringes. Of all the items that might fall under the general definition -- from cigarette papers, through paper clips, to gelatin capsules and glass vials -- only syringes are set apart in this statute for special treatment. This difference, moreover, is one of substance and not mere organization: the possession and distribution of injection equipment is a strict liability offense, while the general paraphernalia possession and distribution provisions impose a scienter requirement. Under both sections 2C:36-2 and -3, a violation occurs only when the possessor or distributor intends the item for one or more of the prohibited uses in the statute. Section 2C:36-6, by contrast, is an absolute ban on possession or distribution of any syringe "adapted for the use of a controlled dangerous substance." No knowledge or intent with respect to drug use is necessary to violate the provision. It is simply illegal to dispense or possess a syringe capable of injecting drugs for any purpose without a prescription. Thus section 2C:36-6 makes it illegal to sell a syringe without a prescription to a diabetic to inject insulin, even though such a sale would not violate section 2C:36-3 if it applied. The only exception to the strict prohibition of section 2C:36-6 is for syringes covered by a legitimate prescription. Unlike most other forms of drug paraphernalia, which the legislature did not wish to regulate in their conventional uses, syringes were intended to be totally regulated through the health care system.(13)

Finally, the statute's forfeiture provision, section 2C:36-7 treats paraphernalia and syringes as distinct, referring disjunctively to "[a]ny drug paraphernalia, hypodermic syringe or needle seized in violation of this chapter." If hypodermic syringes or needles were already included in the statute's definition of drug paraphernalia, then the separate reference to these items in the statute wold be mere surplusage. To so read a statute's language is to violate one of the most basic rules of statutory construction. See State v. Reynolds, 124 N.J. 559, 564, 592 A.2d 194, 196 (1991) ("A construction that will render any part of a statute inoperative, superfluous, or meaningless, is to be avoided."); Sutherland's Statutory Construction, Section 46.06.

Overall, the question of the statute's meaning on this issue is properly guided by the maxim, inclusio unius est exclusio alterius ("the inclusion of one is the exclusion of another") It is an accepted canon of statutory interpretation in New Jersey that "[w]here the Legislature has carefully employed a term in one place and excluded it in another, it should not be implied where excluded." See GE Solid State, Inc. v. Director, Div. of Taxation, 132 N.J. 298, 308, 625 A.2d 468 (1993); see also Sutherland's Statutory Construction, Section 47.24. In three separate sections of the paraphernalia statute, the legislature carefully excised references to syringes and injection from the Model Act it was adopting. In a fourth it added specific prohibitions applicable only to syringes, more stringent than those applied to drug paraphernalia generally. In a fifth, it referred to syringes and needles disjunctively from drug paraphernalia. No text could be clearer, and therefore no further discussion of the legislative intent is necessary or appropriate.(14)

A plain-text analysis of the statutory scheme shows that there is neither ambiguity nor conflict in the interpretation that distinguishes syringes from other forms of drug paraphernalia. This should dispose of any need to go beyond the text to extrinsic evidence of legislative intent. If such arguments arise, however, there is little support in the legislative history of the paraphernalia provision for the proposition that it was intended to govern physicians and pharmacists providing care consistent with professional standards. The paraphernalia law was passed in 1980, as part of a national trend, led by the federal government, to eliminate what had become a burgeoning commercial trade in the tools of drug use: By 1976, between fifteen and thirty thousand "head shops" did an annual three billion dollar business in such items as rolling papers, bongs and freebasing kits. See Kimmelman, supra; Lawrence O. Gostin & Zita Lazzarini, Prevention of HIV/AIDS Among Injection Drug Users: The Theory and Science of Public Health and Criminal Justice Approaches to Disease Prevention, 46 Emory L. J. 587, 611-12 (1997) (reviewing Congressional investigation of paraphernalia problem). Paraphernalia laws, including New Jersey's, were aimed at head shops, not doctors and pharmacists. The syringe prescription law, which had existed in substantially the same form since at least 1955, see 1955 N.J. Laws ch. 277, was incorporated into the overall scheme set out in title 24. See 1980 N.J. Laws ch. 133. In 1987, the legislature recodified the controlled substances and drug paraphernalia laws, creating the current chapters 35 and 36 of title 2C of the New Jersey Statutes. 1987 N.J. Laws ch. 106. At that time, the 1980 drug paraphernalia statute was moved to 2C, the current section 2C:36-6 was added, and the alternative reference to syringes was added to the seizure section, 2C:36-7. The legislature left intact the prior prescription law in title 24. This history demonstrates that the legislature never considered syringes to be covered under the general paraphernalia provision, but rather at every occasion treated the two categories as distinct.

Prosecutors have, as far as can be determined, themselves followed our interpretation of the statute in law enforcement practice. "An established usage in regard to the meaning and effect of a statute is a relevant and persuasive guide to its authoritative interpretation." Sutherland's Statutory Construction, Section 51.04. The drug paraphernalia and syringe prosecutions brought by New Jersey's Attorney General have arguably given rise to an "established usage" of these statutes. Both of New Jersey's major needle exchange prosecutions, State v. Sorge, 249 N.J. Super. 144; 591 A.2d 1382 (N.J. App.Div. 1991), and State v. McCague, 314 N.J.Super. 254, 714 A.2d 937 (1998), were brought under section 6, the syringe-specific provision, and not under the general drug paraphernalia prohibition of section 3.(15) The fact that prosecutors have used the syringe-specific law and not the broader drug paraphernalia law to prosecute these high profile needle exchange cases provides further support for the argument that the general drug paraphernalia law was not intended to apply to syringe possession and distribution.

Finally, the rules of lenity and strict construction of criminal statutes should operate to produce a judicial interpretation of the syringe control statutes that excludes syringes dispensed or prescribed for a legitimate medical purpose. In State v. Dixon,114 N.J. 111, 117, 553 A.2d 1, 4 (1989), the Supreme Court held:

Like the United States Supreme Court, "we adhere to the time-honored interpretive guideline that uncertainty concerning the ambit of criminal statutes should be resolved in favor of lenity." United States v. Kozminski, 487 U.S. 931, 108 S.Ct. 2751, 101 L.Ed.2d 788, 810 (1988) (citation omitted); see also State v. Valentin, 105 N.J. 14, 18, 519 A.2d 322 (1987) ("Penal laws cannot be extended by implication or intendment. Where more than one reasonable interpretation may be made, or where the language is ambiguous * * * the construction must be drawn against the state." (citation omitted)).

... In short, we should not be the ones to remold the statute when there is doubt about its application.

Conclusion: Dispensing sterile injection equipment by prescription to known IDUs probably does not violate New Jersey law.(16)

III. How Might New Jersey Law Be Changed or Clarified to Promote Access to Sterile Injection Equipment for IDUs Through the Health Care System?

This Memorandum has concluded that physicians may prescribe and pharmacists may dispense sterile injection equipment to IDUS as a health-care intervention to prevent the transmission of blood-borne pathogens. Nevertheless, several legal measures would add clarity to the legal situation or otherwise protect public health by enhancing access to safe injection equipment.

A. Changes in Statutes or Regulations

1. The legislature should amend the prescription and paraphernalia statutes to legalize the over-the-counter sale of injection equipment under all circumstances.

2. The Medical and Pharmacy Boards have the power to and should issue regulations explicitly stating that providing sterile injection equipment to IDU patients in order to prevent transmission of a serious communicable disease is an acceptable medical/pharmacy practice. See Lemmon Company v. New Jersey State Board of Medical Examiners,

3. The Pharmacy Board should require training in the theory and practice of harm reduction as part of mandated continuing education. N.J.S.A. § 45:14-11.11, 45:14-11.12.

4. Can the Secretary authorize exceptions?

B. Declaratory Judgment

Declaratory judgments are available to people whose contemplated conduct could subject them to criminal prosecution. The applicable statute is N.J.S.A. § 2A:16-53.

A person interested under a deed, will, written contract or other writing constituting a contract, or whose rights, status or other legal relations are affected by a statute, municipal ordinance, contract or franchise, may have determined any question of construction or validity arising under the instrument, statute, ordinance, contract or franchise and obtain a declaration of rights, status or other legal relations thereunder.

A brief review of the case law indicates that physicians or health care organizations that wished to prescribe injection equipment to IDU patients would have standing, along with dispensing pharmacists and the patients themselves, to sue a country prosecutor charged with the duty of enforcing the criminal law. In Keuper v. Wilson, 111 N.J.Super. 502, 507-07, 268 A.2d 760 (N.J. Super. Ch.1970), the Court explained:

The Uniform Declaratory Judgments Law has been increasingly used in this State to obtain a determination of the legality of a particular course of action rather than pursuing the course of action and risking criminal prosecution. E.g., Sanitary Vendors, Inc. v. Byrne, 40 N.J. 157, 190 A.2d 876 (1963); Lucky Calendar Co. v. Cohen, 19 N.J. 399, 117 A.2d 487 (1955), 20 N.J. 451, 120 A.2d 107 (1956); Thrillo, Inc. v. Scott, 15 N.J.Super. 124, 82 A.2d 903 (Cty.Ct.1951).

It appears from State v. Baird, 50 N.J. 376, 235 A.2d 673 (1967) that where there has been a determination under the Uniform Declaratory Judgments Law has a particular course of action would not be a violation of the criminal laws, such determination will be binding upon the prosecutor who was a party to the declaratory judgment action.

In another case, the court explained:

In this case there is a bona fide justiciable controversy as to the legal right of the plaintiff to engage in the kind of activity discussed herein....The duty of the defendant [county prosecutor] to prosecute violations of the criminal laws of this State within his county is clear, State v. Winne, 12 N.J. 152, 96 A.2d 63 (1953). Accordingly, there are present the necessary elements for a declaratory action, Borchard, Declaratory Judgments (2d ed. 1941), chapter II. The salutary purposes contemplated by the Declaratory Judgments Act, N.J.S. 2A:16--50 et seq., N.J.S.A., are clearly served when such conflicting interests are determined without the necessity of compelling the plaintiff to expose itself and its customer to the risk of criminal prosecution.

Lucky Calendar Co. v. Cohen, 19 N.J. 399, 408, 117 A.2d 487, 491(1955).

C. Attorney General's Opinion

The law department may issue attorney general's opinions under N.J.S.A.§ 52:17A-4, but not to individual citizen requesters.Attorney General opinions are considered persuasive authority for the New Jersey courts but are not binding.(17).

1. U.S. Public Health Service & Infectious Diseases Society of America, Guidelines for the Prevention of Opportunistic Infections in Persons Infected with Human Immunodeficiency Virus, 48(RR10) MMWR 1 (1999); U.S. Public Health Service, HIV Prevention Bulletin: Medical Advice for Persons Who Inject Illicit Drugs (May 8, 1997); accord J. Normand, D. Vlahov, & L. Moses eds. Preventing HIV Transmission: The Role of Sterile Needles and Bleach (1995) (National Academy of Sciences); Statements/Resolutions/Policies on Increased Access to Clean Needles and Syringes (collected at http://www.sfaf.org/prevention/needleexchange/statements.html); T. Stephen Jones and David Vlahov, Use of Sterile Syringes and Aseptic Drug Preparation Are Important Components of HIV Prevention Among Injection Drug Users, 18 J Acquir. Immune Defic. Syndr. S1 (Supp. 1, 1998).

2. Peter Lurie, T. Stephen Jones & J. Foley J, A Sterile Syringe for Every Drug User Injection: How Many Injections Take Place Annually, and How Might Pharmacists Contribute to Syringe Distribution? 18 J Acquir. Immune Defic. Syndr. S45 (Supp. 1, 1998).

3. Id.; Scott Burris, Peter Lurie, Daniel Abrahamson, and Josiah Rich, Physician Prescribing of Safe Injection Equipment to Prevent HIV Infection: Time for Action, __ Annals of Internal Medicine __ (2000); T. Stephen Jones, Should Pharmacists Sell Sterile Syringes to Injection Drug Users? 39 J Am Pharm Assoc 1 (1999); Alvin Novick, A Duty to Care: Sterile Injection Equipment and Illicit-drug Use, 11AIDS & Pub. Pol'y J. 63 (1996).

4. In a challenge to a regulation banning amphetamine prescription in New Jersey, the court affirmed that the board had broad power in determining the standards for physician prescription. Because the Board had statutory power to discipline doctors who prescribed amphetamines without good cause (N.J.S.A. § 45:1-13), it also had the power to define good cause. In proscribing amphetamine prescription altogether, the board was simply giving physicians advance notice of its standards for good cause. Thus, this prohibition was legal, even though federal law permitted the use of amphetamines for obesity treatment.

Also noteworthy were the Board's reasons for its amphetamine prohibition: to (1) provide needed uniformity in the prescribing practices of physicians throughout the state; (2) obviate the need for expert testimony in future prosecutions for indiscriminate dispensing of these drugs; (3) severely reduce black-market availability of amphetamines; and (4) reduce abuse of and addiction to amphetamines. Lemmon Company v. New Jersey State Board of Medical Examiners, 175 N.J. Super. 40, 417 A.2d 568 (N.J. App.Div. 1980).

Conceivably the Board could similarly prohibit the prescription of syringes to IDUs. Accordingly, education of the Board members may be warranted.

5. According to N.J.A.C. 13:35-7.1,

"Controlled substance" means a drug classified in any of the schedules (I through V) of the Controlled Dangerous Substances Act, N.J.S.A. § 24:21-5 to 24:21-8.1, recognized to have a potential for abuse or to lead to physical or psychological dependence.

...

"Drug" means any article recognized in the official United States Pharmacopoeia, official Homeopathic Pharmacopoeia of the United States or official National Formulary, or any supplement to those sources, including, but not limited to, a controlled substance, a prescription legend drug, an over- the-counter preparation, a vitamin or food supplement, or any compounded combination of any of the above or transdermal patch or strip, intended for use in the diagnosis, cure, mitigation, treatment or prevention of disease or medical condition in humans or intended to affect the structure or function of the human body. The term, as used in this subchapter, is synonymous with "medication" as used in N.J.S.A. § 45:9-22.11. "Drug," as used in this subchapter, does not mean a device or durable medical equipment.

6. New Jersey regulations governing the long-term prescription of controlled substances for pain illustrate the sort of documentation that would help demonstrate the validity of the care:

(a) When prescribing, dispensing or administering controlled substances, a practitioner shall ensure that a patient's medical history has been taken and physical examination accomplished, including an assessment of physical and psychological function, underlying or coexisting diseases or conditions, any history of substance abuse and the nature, frequency and severity of any pain. The medical record shall reflect:

1. A recognized medical indication for the use of the controlled substance;

...

(d) When controlled substances are continuously prescribed for management of pain for three months or more, the practitioner:

1. Shall review, at a minimum of every three months, the course of treatment, any new information about the etiology of the pain and the patient's progress toward treatment objectives;

2. Shall remain alert to problems associated with physical and psychological dependence; and

3. Shall periodically make reasonable efforts, unless clinically contraindicated, to either stop the use of the controlled substance, decrease the dosage, try other drugs such as nonsteroidal anti-inflammatories, or treatment modalities in an effort to reduce the potential for abuse or the development of physical or psychological dependence.

(e) If treatment objectives are not being met, the practitioner:

1. Shall assess the appropriateness of continued treatment with controlled substances or undertake a trial of other drugs or treatment modalities; and

2. Shall consider referring the patient for independent evaluation or treatment in order to achieve treatment objectives.

(f) A practitioner shall remain alert to the possibility that controlled substances may be misused or diverted. A practitioner managing pain in a patient with a history of substance abuse shall exercise extra care by way of monitoring, documentation and possible consultation with addiction medicine specialists, and should consider the use of an agreement between the practitioner and the patient concerning controlled substance use and consequences for misuse.

(g) The practitioner shall keep accurate and complete records including that information required by (a) above as well as:

1. The medical history and physical examination of the patient;

2. Other evaluations and consultations;

3. Treatment plan objectives;

4. Evidence of informed consent;

5. Treatments and drugs prescribed or provided, as in (a) above;

6. Any agreements with the patient; and

7. Periodic reviews conducted.

N.J.A.C. § 13:35-7.6.

7. The statute authorizes but does not mandate disciplinary action, and the regulations administering the prescription of controlled substances do not incorporate a prohibition against providing controlled substances to illicit users. N.J. Admin. Code tit. 8, § 8:65-7.4 (1996)(requiring only that a controlled substances prescription be issued "for a legitimate medical purpose by an individual practitioner acting in the usual course of his professional practice").

8. Under the Controlled Substances Act,

"Dispense" means to deliver a controlled dangerous substance or controlled substance analog to an ultimate user or research subject by or pursuant to the lawful order of a practitioner, including the prescribing, administering, packaging, labeling, or compounding necessary to prepare the substance for that delivery. "Dispenser" means a practitioner who dispenses.

NJSA § 2C:35-2.

9. Although a physician who prescribes a syringe does not physically provide a needle to the patient, and therefore could not be said to engage in conduct potentially covered by the paraphernalia statute, there is a risk that prescribing a syringe could be prosecuted as aiding and abetting a violation of the paraphernalia statute that would occur when the pharmacist dispensed the syringe, or for conspiracy to violate the paraphernalia statute. These charges are available to a motivated prosecutor. The risk to the physician is slight, however, for several reasons. Such a prosecution would be unusual: there is no reported case in New Jersey of a charge of aiding and abetting a paraphernalia violation, nor are either conspiracy or accomplice charges commonly deployed where the core offense is a misdemeanor. More importantly, both crimes depend upon the underlying illegality of providing sterile injection equipment by prescription. Our analysis suggests that this behavior is not a crime. With a valid prescription, a patient is not violating the paraphernalia law when he purchases the needle, and the physician, or pharmacist, cannot be his accomplice or co-conspirator.

10. A pharmacist presumably could refuse to fill a syringe prescription under N.J.A.C. 13:39-6.1 if he believed filling the prescription endangered the patient.

11. The state drafters made several other changes: they systematically removed the phrase "designed for use"; they added several references to "controlled substances analogs" to track prohibitions in New Jersey's Controlled Substances Act; and they removed two of the factors to be considered by courts in assessing whether an item was drug paraphernalia, both relating to the background and general business of the defendant.

12. In section 2C:36-3, the drafters declined to include the phrase "reasonably should know" in the scienter requirement for illegal distribution.

13. The Town Tobacconist v. Kimmelman, 94 N.J. 85, 100, 462 A.2d 573, 582-83 (N.J. 1983) provides further support. In that case, the Supreme Court, doing what it referred to as "judicial surgery," excised for interpretive purposes the "used or intended for use" phrase in the definition of drug paraphernalia in section 2C:36-1. Henceforth, the court held, the intent necessary for a violation would be that specified in the individual sections of the act. It follows that, where the act provides different states of mind for different sections, the legislature intended that the items covered be treated differently.

14. This interpretation also adheres to the general rule that "when there is a conflict between general and specific provisions of a statute, the specific provisions will control." Wilson v. Unsatisfied Claim and Judgment Fund Board, 109 N.J. 271; 536 A.2d 752 (N.J. 1988). In this instance, sections 2C:36-2 and -3 conflict with section -6 not only in the state of mind required for a violation but on the very question at issue here: the syringe-specific provision allows any sale of a syringe on valid prescription, even if the seller knows it will be used for illicit injection. Such a sale would be prohibited under the general paraphernalia provision.

15. In Sorge, the trial judge summarized the charges like this: "Charges were brought against some individuals for having ... the needles and some having both the needles and paraphernalia and some against only for paraphernalia." State v. Sigmon et al., No. V70 to V81, slip op. at 14 (Mun. Ct. Hudson Cty. November 6, 1991).

16. A contrary argument could be built on the premise that the paraphernalia law does not make a general distinction between syringes and other forms of paraphernalia. On that reading syringes are covered in all sections of the statute. Section 2C:36-6 prohibits sale or possession unless authorized by law. This exception refers both to the prescription statute and sections 2 and 3 of the paraphernalia law. Together, the three provisions create a regime in which no one may sell or possess a syringe without a prescription, but even a prescription does not authorize sale or possession for illicit injection. This interpretation will be offered in a garland of declarations about the war on drugs, and with citations espousing a "common sense" view of statutory interpretation: "The purpose of a statute should not be frustrated because of an unduly narrow interpretation. Cammarata v. Essex Cty. Park Comm'n, 26 N.J. 404, 140 A.2d 397 (1958). Statutory interpretation that would lead to an absurd result should be avoided. State v. Gill, 47 N.J. 441, 221 A.2d 521 (1966). The Legislature's plan for the statute must be read in its full light, with the primary concern being the fulfillment of its true purpose. State v. Gill, Supra." State v. K-Mart, 134 N.J.Super. 76, 84, 338 A.2d 230, 235 (1975). The purposes of both the syringe prescription statute and the paraphernalia statute were to reduce illicit drug use, a purpose that would be frustrated if physicians and pharmacists could provide injection equipment to IDUs.

This argument has several strengths. It is simple. It attributes to the legislature a categorical zero-tolerance approach to drug use. See Sorge, supra; McCague, supra. It effectively resolves the conflict posed by a valid prescription in the hands of a known drug user.

The argument suffers fundamental logical and technical weaknesses. As a logical matter, the premise that syringes are covered under the paraphernalia law begs the question, which is whether the legislature did in fact intend to do that or to treat syringes separately. As a matter of legal technique, the recourse to extrinsic evidence of legislative intent is not appropriate until an examination of the text fails to discern the statute's meaning. Despite its flaws, however, the argument remains formidable: we cannot count on judges' having the rigor or inclination to make a technically sound analysis leading to a result that goes counter to their intuitions.

17. As a rule, court decisions do not defer to such opinions on statutory construction but rather give an independent interpretation of the law in question. New Jersey v. Son, 179 N.J. Super. 549, 553-554, 432 A.2d 947, 949 (N.J. App. Div. 1981) However, if a statute is not amended after an Attorney General's opinion, the legislature's failure to act is factored into the court's construction. Id. at 553.