Archival Content: 1999-2005
In many cities and states, laws and regulations make possession of syringes a crime and limit IDUs' ability to legally purchase syringes. As a result, IDUs who continue to inject often cannot follow prevention advice to use a sterile syringe for every injection. Several states also have restricted the funding or operation of syringe exchange programs (SEPs). On the federal level, funding to carry out any program of distributing sterile needles or syringes to IDUs has been prohibited by Congress since 1988.
As of 2004, injection drug use accounted for about one-fifth of all HIV infections and most hepatitis C infections in the United States.(1,2) Injection drug users (IDUs) become infected and transmit the viruses to others through sharing contaminated syringes and other drug injection equipment and through high-risk sexual behaviors. Women who become infected with HIV through sharing needles or having sex with an infected IDU can also transmit the virus to their babies before or during birth or through breastfeeding.
To effectively reduce the transmission of HIV and other blood-borne infections, programs must consider a comprehensive approach to working with IDUs. Such an approach incorporates a range of pragmatic strategies that address both drug use and sexual risk behaviors. One of the most important of these strategies is ensuring that IDUs who cannot or will not stop injecting drugs have access to sterile syringes. (See the related fact sheet Access to Sterile Syringes.) This strategy supports the "one-time-only use of sterile syringes" recommendation of several institutions and governmental bodies, including the U.S. Public Health Service.(3)
IDUs share syringes and injection equipment for multiple reasons, but primarily because of legal and regulatory barriers limiting access to sterile syringes and laws making possession of syringes a crime.
What Laws and Regulations Affect Illegal Injection Drug Use?
Several interrelated laws and regulations restrict IDUs’ ability or willingness to obtain and possess syringes:(4)
These laws and regulations are structural barriers that create a situation in which IDUs who continue to inject are advised to use only sterile syringes, but at the same time, are often prevented from carrying out this advice. Because holding on to or carrying syringes puts IDUs at risk of police searches, arrest, and criminal prosecution, they can be reluctant to participate in sterile syringe access or risk reduction initiatives such as syringe exchange or safe disposal programs.(6) (See the related fact sheet Syringe Disposal.) This environment may increase transmission risks because IDUs who are concerned about being arrested for obtaining or carrying syringes are more likely than other IDUs to share syringes and injection supplies.(7)
What Has Been Done to Address Structural Issues?
Several states have undertaken initiatives to change syringe laws and regulations:
Some states have reported a benefical public health impact. For example, after the partial repeal of syringe laws in Connecticut, pharmacies in that state began to sell nonprescription syringes.(9,13) As a result, more IDUs purchased syringes from pharmacies, syringe sharing decreased, and police reported fewer needle stick injuries.(8) Further, there is no evidence that ensuring access to sterile syringes increases the number of persons who inject or the number of injections.(14,15)
At the community level, both public health and law enforcement have strong interests that must be supported. Public health seeks to reduce drug use and blood-borne transmission of disease by helping individuals enter substance abuse treatment and change their risky sexual and drug-use behaviors. Law enforcement has an equally strong stake in preventing and punishing the distribution and sale of illicit drugs. State and local initiatives aimed at legal and regulatory reform need to find ways to strike a middle ground so that the interests of both are served. Such efforts include:
For More Information
Read A Comprehensive Approach: Preventing Blood-Borne Infections Among Injection Drug Users, which provides extensive background information on HIV and viral hepatitis infection in IDUs and on the legal, social, and policy environment. It also describes strategies and principles for addressing these issues.
1. Glynn M, Rhodes P. Estimated HIV prevalence in the United States at the end of 2003. 2005 National HIV Prevention Conference; June 12–15, 2005. Atlanta, GA. Abstract T1-B1101.
2. Centers for Disease Control and Prevention (CDC). Hepatitis C fact sheet. Accessed December 22, 2005 from http://www.cdc.gov/ncidod/diseases/hepatitis/c/fact.htm.
3. Centers for Disease Control and Prevention, Health Resources and Services Administration, National Institute on Drug Abuse and Substance Abuse and Mental Health Services Administration. HIV prevention bulletin: Medical advice for persons who inject illicit drugs. May 9, 1997.
4. Gostin LO. The legal environment impeding access to sterile syringes and needles: The conflict between law enforcement and public health. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology 1998;18(Suppl 1):S60-S70.
5. Burris S, Lurie P, Abrahamson D, Rich ID. Physician prescribing of sterile injection equipment to prevent HIV infection: time for action. Annals of Internal Medicine 2000; 133(3): 218-226.
6. Springer KW, Sterk CE, Jones TS, Friedman L. Syringe disposal options for injection drug users: A community-based perspective. Substance Use and Misuse 1999;34(13):1917-1934.
7. Bluthenthal RN, Kral AH, Erringer EA, Edlin BR. Drug paraphernalia laws and injection-related infectious disease risk among drug injectors. Journal of Drug Issues 1999;29(1):1-16.
8. Groseclose SL, Weinstein B, Jones TS, Valleroy LA, Fehrs LJ, Kassler WJ. Impact of increased legal access to needles and syringes on the practices of injecting-drug users and police officers— Connecticut, 1992-93. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology 1995;10:82-89.
9. Valleroy LA, Weinstein B, Jones TS, Groseclose SL, Rolfs RT, Kassler WJ. Impact of increased legal access to needles and syringes on community pharmacies needle and syringe sales— Connecticut, 1992-1993. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology 1995;10(1):73-81.
10. Beckett GA, Galena R, Shields D, Mills DA. Maine removed criminal penalties for syringe possession in 1997 after allowing sale of syringes without a prescription in 1993. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology 1998;18(Suppl 1):S145-S146.
11. Plevin L. State bill allows sale of syringes. Newsday. May 6, 2000. Page A03.
12. National Alliance of State and Territorial AIDS Directors. HIV prevention and access to sterile syringes. Joint letter issued by the American Medical Association, American Pharmaceutical Association, Association of State and Territorial Health Officials, National Association of Boards of Pharmacy, National Alliance of State and Territorial AIDS Directors. October 1999.
13. Wright-De Agüero L, Weinstein B, Jones TS, Miles J. Impact of the change in Connecticut syringe prescription laws on pharmacy sales and pharmacy managers’ practices. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology 1998;18(Suppl 1):S102-S110.
14. Normand J, Vlahov D, Moses LE, eds. Preventing HIV transmission: the role of sterile needles and bleach. Washington (DC): National Academy Press, 1995.
15. Needle RH, Coyle SL, Normand J, Lambert E, Cesari H. HIV prevention with drug-using populations—current status and future prospects: introduction and overview. Public Health Reports 1998;113(Suppl 1):4-18.
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