North Carolina is experiencing a health crisis related to rapidly rising rates of heroin and injection drug use. Heroin deaths in our state increased 565 percent from 2010 to 2014, and consequently acute hepatitis C cases spread through people sharing drug syringes nearly tripled. HIV cases acquired through injection drug use are rising as well.
Lack of access to sterile syringes is a significant driver of hepatitis C and HIV transmission, with over 50 percent of new hepatitis C cases and 8 percent of new HIV cases attributed to the practice of sharing syringes among people who inject drugs. Denying people access to syringes does not stop them from using drugs. Focus group interviews with drug users across the state have shown that a person suffering from severe opioid withdrawal symptoms will go to almost any lengths to take drugs to alleviate the pain, including scrounging for used syringes, sharing them with people whose HIV or hepatitis C status may be unknown or reusing an old syringe multiple times, leading to abscesses, collapsed veins and other complications that may require emergency room treatment.
North Carolina law allows pharmacies to sell syringeswithout a prescription but prohibits the sales if it is known they will be used for illicit drug purposes. The prohibition statute puts individual pharmacists in an ethically and legally gray area when a customer asks to purchase syringes without a prescription. The law does not define the burden of proof. That has led to a patchwork of pharmacy policies regarding syringe sales, leaving legitimate patients unable to obtain syringes without abridging their rights to privacy and self-determination.
These ad hoc policies further expose legitimate patients and users of illicit drugs to discriminatory practices: Studies show that blacks, Hispanics and men are less likely to be sold syringes than white or female customers. Additionally, a North Carolina study published by RTI International in 2009 demonstrated that black drug users were five times less likely to use pharmacies as a source for syringes than white drug users. Far from reducing drug abuse overall, this form of discrimination puts an undue burden on minorities for the risks associated with sharing or reusing needles.
As a pharmacist, I am deeply concerned by these problems. The human cost of drug abuse is intolerable – it is a disease, and people suffering from it deserve treatment. The financial cost to patients and society is high enough without also having to treat hepatitis C and HIV:
▪ New hepatitis C drugs: $188,859 per cure.
▪ A liver transplant: $577,000.
▪ Lifelong HIV therapy: $412,681
▪ A 10 pack of sterile syringes: $3.
Decades of empirical evidence on syringe access and injection drug use demonstrate that allowing drug users to purchase syringes decreases the likelihood that they will share unclean equipment, which lowers the transmission of HIV and hepatitis C substantially. Furthermore, providing syringes to drug users does not increase or encourage drug use. It simply ensures that fewer people will contract costly diseases.
565 The percentage increase in heroin deaths in N.C. from 2010 to 2014
$577,000 The average cost of a liver transplant
$3 The average cost of a 10 pack of syringes
Pharmacists in critical position
Pharmacists do not assume personal risk by selling syringes. A national search of reported cases found no instance in which a pharmacist had been prosecuted under a paraphernalia law or pharmacy regulation for selling a syringe that was later used to inject drugs. Additionally, scientific studies from other states have demonstrated that the proportion of improperly discarded syringes at or around pharmacies did not increase after pharmacists starting selling syringes regardless of their intended use.
The unrestricted sale of syringes is supported by the American Pharmacists Association, whose statement reads: “APhA encourages state legislatures and boards of pharmacy to revise laws and regulations to permit the unrestricted sale or distribution of sterile syringes and needles by or with the knowledge of a pharmacist in an effort to decrease the transmission of blood-borne diseases.” Likewise, a recent study of 146 pharmacies and staff reported that 87 percent of participating pharmacists support the unrestricted sale of syringes as a disease reduction method.
Pharmacists are in a critical position to help stop diseases from spreading and to refer people to appropriate treatment for substance abuse. Considering the devastating effects of increases in injection drug use, hepatitis C and HIV, as well as the financial toll on North Carolina Medicaid costs, we should play our part in combating this epidemic.
To me, that means two things: First, let the Board of Pharmacy, the North Carolina Association of Pharmacists and your elected representatives know that the law should be changed to allow the sale or distribution of syringes without restriction. Second, pharmacists should sell syringes to people who need them, no questions asked.
Brian N. Decker, PharmD, lives in Carrboro.