Federal and State Reports Supporting Syringe Access

National Viral Hepatitis Action Plan – May 2011

On May 12, 2011, HHS issued Combating the Silent Epidemic of Viral Hepatitis: Action Plan for the Prevention, Care and Treatment of Viral Hepatitis which outlines actions, based on scientific evidence and extensive real-world experience that will serve as a roadmap for fighting chronic hepatitis B and C.

“Federal, state, and local agencies should expand programs to reduce the risk of hepatitis C virus infection through injection-drug use by providing comprehensive hepatitis C virus prevention programs. At a minimum, the programs should include access to sterile needle syringes and drug-preparation equipment because the shared use of these materials has been shown to lead to transmission of hepatitis C virus.” (pg 60)

Recommendations include: Coordinate federal, state, and local resources to expand and enhance IDU access to sterile syringes and hepatitis prevention interventions.

Access to syringe service programs through comprehensive, community- and pharmacy-based syringe programs can help prevent HBV and HCV infection in IDUs. In accordance with local laws, coordination of federal, state, and local resources will reduce barriers, maximize development of syringe service programs, and increase access to these programs. (page 44)

Federal Register/Vol. 76, No. 36/Wednesday, February 23, 2011/Notices

(US Department of Health and Human Services)

Syringe service programs (SSP) are widely considered to be an effective way of reducing HIV transmission among individuals who inject illicit drugs and there is ample evidence that SSPs also promote entry and retention into treatment (Hagan, McGough, Thiede, et al., 2000, Journal of Substance Abuse Treatment, 19, 247– 252). According to research that tracks individuals in treatment over extended periods of time, most people who get into and remain in treatment can reduce or stop using illegal or dangerous drugs. In addition to promoting entry to treatment, there are studies that document injection reductions for drug users who participate in SSPs. Hagan, et al., found that, not only were new SSP participants five times more likely to enter drug treatment than non-SSP participants, former SSP participants were more likely to report significant reduction in injection, to stop injecting altogether, and to remain in drug treatment. A summary of the research on SSPs is available at http:// www.samhsa.gov/ssp.

National HIV/AIDS Strategy - July, 2010

“President Obama committed to developing a National HIV/AIDS Strategy with three primary goals: 1) reducing the number of people who become infected with HIV, 2) increasing access to care and optimizing health outcomes for people living with HIV, and 3) reducing HIV-related health disparities.” (p vii)

"Access to sterile needles and syringes: Among injection drug users, sharing needles and other drug paraphernalia increases the risk of HIV infection. Several studies have found that providing sterilized equipment to injection drug users substantially reduces risk of HIV infection, increases the probability that they will initiate drug treatment, and does not increase drug use.” (pgs 15-16)

“Minimizing infections from injection drug use: Comprehensive, evidence-based drug prevention and treatment strategies have contributed to reducing HIV infections. In 1993, injection drug users comprised 31 percent of AIDS cases nationally compared to 17 percent by 2007. Studies show that comprehensive prevention and drug treatment programs, including needle exchange, have dramatically cut the number of new HIV infections among people who inject drugs by 80 percent since the mid-1990s.” (p 5)

 “Given limited resources and substantial needs in communities heavily impacted by HIV, behavioral interventions that can effectively reach large groups of individuals should be prioritized.”

California Adult Viral Hepatitis Prevention Strategic Plan – January 2010

(California Department of Public Health)

Under Recommendations and Action Steps:

 “Increase Access to Syringe Exchange and Harm Reduction Services:

a.    Leverage existing resources, including federal dollars when the federal syringe exchange funding ban is lifted, to increase access and other safe injection equipment….

b.    Encourage pharmacists… to participate in pharmacy syringe sale programs.

c.     Create and expand syringe exchange ….with the goal of every IDU having one sterile syringe per injection.

d.    Remove structural barriers to access to syringes and other safe drug-using equipment for IDUs…”

Report on Pilot:  An Evaluation of Over-the-Counter Sale of Sterile Syringes in California

 On July 17, 2010, the California Department of Public Health (CDPH) published a report to evaluate a pilot program allowing pharmacists to provide syringes to adults without a prescription, as is the practice in most U.S. states. Independent researchers from the University of California, RAND Corporation, and elsewhere collaborated with CDPH to evaluate the policy and write the report.

Key Findings:

1. Rate of syringe sharing among injection drug users (IDUs) is lower in cities and counties that authorized nonprescription syringe sale. More time will be needed to see a change in overall rates of HIV & hepatitis C, but risk of infection is much lower in cities and counties with safe, legal access to sterile syringes. (pp. 4-5)

2. No increase in rates of drug use. (p. 5)

3. No increase in the unsafe discard of syringes. Syringe waste near pharmacies remained rare.(p. 5)

4. No increase in rates of crime. (pp. 4-5)

5. No increase in the rate of accidental needle-stick injury to law enforcement. (p.5)

6. Pharmacy access may be reaching drug injectors not reached by syringe exchange programs (p. 45). Latino and white IDUs and amphetamine injectors were more likely to report pharmacies as a source of syringes than other groups. (p.85)

7. Requiring a local vote an expensive barrier to effective disease control: “Finding barriers such as lack of time, resources, and interest, but not lack of need for syringes, suggests that the two-step authorization process for legalizing OTC [over-the-counter] syringe sales (i.e., first on the county or city level and second on the pharmacy level) limited potential risk-reduction intentions of the legislation and deletion of this stipulation from a future bill could provide better access to this important prevention intervention. (p83-84) “Implementation barriers cited by LHJs [local health jurisdictions] suggest that leaving DPDP implementation to the discretion of local government entities could require more time and commitment than some already over-burdened health departments can handle. (p. 84)