Contact: Prabhu Ponkshe, RWJF/SAPRP
Ellen Wilson, Burness Communications
FOR RELEASE: July 31, 2000; 5:00PM (EASTERN)
Physicians Can Legally Write Prescriptions for Sterile Needles
for Injection Drug Users in 48 states
New Study in Annals finds Pharmacies are "Clearly Legal" in
Fulfilling Prescriptions in 26 States
Washington, DC, July 31, 2000--The first thorough analysis of the legality of prescribing and dispensing syringes through the health care system finds that physicians in 48 states can legally write prescriptions for sterile injection equipment for injection drug users. For pharmacists in 26 states it is "clearly legal" to fill these prescriptions, while those in 22 states have "a reasonable claim to legality."
The study examines laws in all 50 states, the District of Columbia and Puerto Rico. It appears in the August 1, 2000 issue of the Annals of Internal Medicine and was written by a team of legal and medical experts.
Scott Burris of Temple University’s Beasley School of Law in Philadelphia, who was the lead author of the study, said, "In the past, physicians who wished to prescribe sterile syringes to drug users did not do so in part because of the perception that it would violate state and federal laws aimed at combating drug abuse, or result in a malpractice claim. Our analysis shows that, in most places, these concerns are unfounded."
Prescription of sterile injection equipment or needles for injection drug users is aimed at preventing the spread of HIV, hepatitis and other diseases, which the study claims has become a "medical necessity."
According to Burris, physician prescribing of syringes to drug injectors who are unable or unwilling to stop injecting is likely to be successful in 48 states, offering a new approach to HIV prevention among drug users. State, not federal, law determi nes under what conditions a syringe can be prescribed and a prescription filled.
"But what we have in this country today is a web of state-level syringe prescription, drug paraphernalia and pharmacy practice rules that restrict the sale and possession of injection equipment. These state-level laws and rules put far fewer rest rictions on physicians and pharmacists than they do on the lay people who generally operate needle exchanges," Burris said.
Syringe prescriptions/add one
The study reminds physicians that sterile syringes should be prescribed to drug users ideally in the context of overall substance abuse prevention and treatment, and that the goal should be to get the drug user to enter into a treatment program.
"We have successfully prescribed more than 18,000 syringes to over 200 drug users," said Josiah D. Rich, MD, MPH, of the Miriam Hospital at Brown University, a co-author of the study. "As a physician, I can help the patient get into drug treatment, vaccinate the patient against hepatitis B, offer HIV testing and counseling, and make sure the patient is as healthy as possible. In addition to providing legal access to sterile syringes, this is an opportunity to reach a medically under served population," Rich said.
According to Peter Lurie, MD, MPH, Deputy Director of Public Citizen’s Health Research Group and another of the study’s authors, more than half of all new HIV infections in the United States are related to injection drug use. "It is imperativ e to increase syringe availability to injection drug users. Physicians are ethically obligated to prevent the spread of disease among their patients and prescription of syringes by physicians can play a critical role in preventing new HIV infections," ; Lurie said. The Annals study cites recent medical evidence showing that providing safe injection equipment to injection drug users through needle exchanges has not increased drug abuse, has contributed to preventing HIV, and has shown to increase the number of drug users entering substance abuse treatment.
State law gives physicians the discretion to prescribe and pharmacists to sell devices like syringes for legitimate medical purposes such as preventing disease transmission. Using standard legal research techniques, the study classified prescribing or dispensing as "clearly legal" in states where no other laws curtailed this authority with respect to syringes, and "clearly illegal" in states where specific limitations did apply. States with syringe-related laws that could reasonabl y be interpreted either way were classified as having a "reasonable claim to legality."
In Ohio and Oklahoma, physicians have a reasonable claim to legality for prescribing sterile needles. Delaware and Kansas are the only two states in which it is "clearly illegal" for a physician to prescribe sterile needles. Those two states, along with Hawaii and Georgia, are the only 4 states that make it clearly illegal for pharmacies to sell prescribed syringes, according to Burris’ study.
In some of the 22 states where pharmacists have a reasonable claim to legality for fulfilling prescriptions, Burris found that state pharmacy boards had left the decision to the general discretion of the pharmacists.
Syringe prescriptions/ add two
In other states, the application of the relevant laws was open to dispute based on legislative intent, while others prohibited the filling of prescriptions if the pharmacist knew that the buyer intended to use the syringes for injecting illegal dru gs. In Burris’ opinion, a reasonable claim to legality should normally be enough to insulate a pharmacist from legal liability. According to the study, federal law enforcement officials have stated that federal drug laws do not authorize the Drug Enforcem ent Administration to second-guess the professional judgments of physicians or usurp the state function of defining proper health care practice.
The study acknowledged that some physicians and pharmacists may worry about malpractice liability should a patient or third party suffer injury from the syringe or the drugs injected with it. Although such risks can never be fully eliminated, Burris a nd his colleagues concluded that a malpractice action would be difficult for a drug-injecting patient to sustain for legal and practical reasons. Legally, the patient would have to prove that the injury, such as overdose or extended drug addiction, would not have happened had the physician not provided the needle. Moreover, the provision of the needle itself would have to be unreasonable in light of professional standards.
Detailed explanations of malpractice and ethical issues, and an analysis of the laws on syringe prescriptions in individual states, can be viewed at a web site created by Burris and his colleagues at Temple University. The web site (Editors: Web sit e is also embargoed for July 31, 2000, 5:00 Eastern) address is http://www.temple.edu/lawschool/aidspolicy
Miriam Hospital’s Rich, who has begun to make sterile injection equipment available to injection drug users in his clinic with the authorization of Rhode Island health authorities, has not encountered any legal or malpractice problems. Most of his pat ients are getting ongoing medical care and many have requested substance abuse treatment referrals.
The study is one of a number of recent important developments in disease prevention for drug users. At its June 2000 meeting, the American Medical Association adopted a resolution supporting "the ability of physicians to prescribe syringes and ne edles to patients with injection drug addiction, in conjunction with addiction counseling, in order to help prevent the transmission of contagious diseases." Since May, three states (New Hampshire, New York, and Rhode Island) have removed significan t legal restrictions on the possession of syringes.
The Substance Abuse Policy Research Program (SAPRP) of the Robert Wood Johnson Foundation (RWJF) funded the study. SAPRP is a $54 million initiative that examines public and private policies affecting alcohol, tobacco and illicit drugs.