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U.S. Department of Health and Human Services

Archival Content: 1999-2005

Letters about Injection Drug Users and HIV Prevention Issues

Washington State Dept of Health
Washington State Pharmacy Assoc. Seattle & King County Public Health

July 17, 2002

HIV and Hepatitis Prevention: Access to Sterile Syringes

Dear Colleague:

The Washington State Board of Pharmacy, the Washington State Pharmacy Association and Public Health - Seattle & King County seek pharmacists to help prevent the transmission of HIV, hepatitis, and other blood-borne infections among injection drug users (IDU) by selling new, sterile syringes. Injection drug use currently accounts for one-third of all new U.S. AIDS cases and approximately 60% of hepatitis C virus (HCV) infections. HCV is the major cause of end-stage liver disease and need for transplantation and is a major cause of hepatocellular carcinoma. Nationally, 50% of new HIV infections occur among IDU and their sex partners. In King County, where most studies involving IDU are conducted in Washington State, only 3% of IDU are HIV infected thanks to needle exchange and other prevention efforts. Given that 86% of King County IDU are infected with HCV, however, HIV's potential for rapid spread continues to be great. Statewide HIV and HCV data for IDU are not available. However, it is estimated that over 60% of IDU across Washington State have HCV.

The United States Public Health Service is one of several institutions recommending that drug users who continue to inject use a new, sterile syringe for every injection to prevent the transmission of blood-borne pathogens. Research continues to show that access to sterile injection equipment is associated with reduced risk of infection and lower frequency of unsafe injection practices. And, increased access to sterile equipment does not increase drug use. The Centers for Disease Control and Prevention (CDC) recognizes pharmacies as critically important in helping IDU reduce their risks of acquiring and transmitting bloodborne viruses. The CDC strongly promotes increased access to sterile syringes through pharmacy sales.

Current Washington State law (RCW 70.115.050) stipulates that on the sale at retail of any syringe or other device used to inject drugs, "the retailer shall satisfy himself or herself that the device will be used for the legal use intended."

In the fall of 1999, after reviewing information from the Centers for Disease Control and Prevention and an interpretation of drug paraphernalia laws by the Washington State Supreme Court, the Washington State Board of Pharmacy determined that legal use includes the distribution of sterile hypodermic syringes and needles for the purpose of reducing the transmission of blood-borne diseases. On March 28, 2002, Governor Locke signed into law House Bill 1759 which allows for the sale of hypodermic needles and syringes to reduce the transmission of blood-borne diseases. This revised drug paraphernalia legislation (RCW 69.50.4121 and 1998 c 317 s 1 and RCW 69.50.412 and 1981 c 48 s 2) specifically

exempts pharmacies from any penalties associated with syringe distribution. It also allows individuals over the age of 18 to possess sterile hypodermic syringes and needles for the purpose of reducing blood-borne diseases.

To facilitate access to education and screening for HIV and hepatitis as well as public health services such as drug and alcohol treatment, the Washington State Board of Pharmacy recommends that pharmacies partner with public health agencies for syringe sales.

Some counties have already initiated partnership efforts; in other counties, implementation of the new laws are still in the planning stages. Pharmacists can take a leadership role in implementing the new regulations across Washington State. Please contact your local health jurisdiction to inquire about syringe sales guidance and to request assistance.

For more information, please contact the following staff members of the organizations issuing this letter:

Organization Contact
WA State Board of Pharmacy Don Williams
WA State Pharmacy Association Rod Shafer
Public Health - Seattle - King County Robert Marks

This is an excellent opportunity for community pharmacies to continue to demonstrate their commitment to improving health care. With your help, we can prevent new blood-borne infections, reduce the negative consequences of injection drug use and facilitate entry into drug treatment. Together we can protect the health of all Washington State residents and communities.


Don Williams, RPh, FASHP
Executive Director
Washington State Board of Pharmacy

Rod Shafer
Chief Executive Officer
Washington State Pharmacy Association

Alonzo Plough, Ph.D., MPH
Director and Health Officer
Public Health - Seattle - King County

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