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A Legal Analysis of Prescribing and Dispensing Sterile Injection Equipment to Patients Who Use Illegal Drugs

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Project Summary:

Public health authorities and professional organizations recommend that intravenous drug users ("IDUs") use a new, sterile syringe for each injection. The importance of this behavior is emphasized by extensive data demonstrating the health risks of unsterile injection. Although ensuring access to sterile injection equipment for IDU patients who cannot or will not end their drug use is now clinically and ethically indicated, physicians and pharmacists face both real and perceived constraints in the form of state and federal laws restricting access to injection equipment. These laws have hampered the development of needle exchange programs, and do impose some limits on provision of needles through the health care system. The fact that providing syringes to patients is medically appropriate does, however, have significant legal implications for physicians and pharmacists that have not been fully explored. This project will present the public health, clinical and ethical case for prescribing and dispensing sterile injection equipment as part of a comprehensive harm reducing approach to preventing and caring for disease among IDUs. Guided by a panel of experts, the project will address basic clinical questions for physicians prescribing injection equipment. It will closely examine the drug laws of the fifty states in light of the latest medical and public health data, paying special attention to significant, but often overlooked, variations among state laws of similar general type. Based on preliminary research, the project is expected to show: 1.that physicians have a reasonable legal basis for prescribing syringes in most or all states; and 2.that pharmacists in some states may legally fill these prescriptions even though they know the patient will use them for drug injection. The project will specify, for each state: The legality of physicians prescribing and pharmacists dispensing sterile injection equipment when clinically appropriate; The legal barriers to prescribing and dispensing, if any, in each state's law; Methods for clarifying law, such as medical or pharmacy board ruling, attorney general's opinion, and declaratory judgment; and Amendments to law or regulations required to eliminate legal barriers to prescribing or dispensing sterile injection equipment in the health care system. The project will promote better access for IDUs to sterile injection equipment, and help deepen and broaden the political debate over needle access. It will show that some physicians can undertake the provision of injection equipment at little or no legal risk. It will emphasize the role of the health care professions in improving health care, including needle access, for IDU patients, and identify concrete strategies for physicians and pharmacists who feel obliged by their ethical and clinical values to pursue clarification or changes in the law.

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