THE LEGAL ENVIRONMENT IMPEDING ACCESS TO STERILE SYRINGES AND NEEDLES- THE CONFLICT BETWEEN LAW-ENFORCEMENT AND PUBLIC-HEALTH

This article examines the legal environment for programs to prevent tr ansmission of HN and other blood-borne diseases among injection drug u sers (IDUs). Cost-effective public health programs often have question able legal authority, and health professionals, community activists, a nd IDUs may be subject to arrest and prosecution. Legal impediments to the sale and distribution of syringes exist in every state: 47 states have drug paraphernalia statutes, 8 states have syringe prescription statutes, and 23 states have pharmacy regulations or practice guidelin es. The Mail Order Drug Paraphernalia Act permits federal enforcement against individuals who knowingly sell or distribute syringes to IDUs. Congress has prohibited the use of federal funds for syringe exchange programs (SEPs). Legal restrictions on access to sterile syringes pre sent formidable obstacles to public health prevention. These restricti ons render it much more difficult for pharmacists to sell syringes ove r the counter or for physicians to prescribe syringes, create a chilli ng effect on IDUs seeking to comply with medical advice and protect th emselves and their partners from disease, and place significant obstac les on the lawful establishment and operation of SEPs. Public health a uthorities have only sometimes creatively circumvented legal restricti ons through judicial declarations of lawfulness, municipal declaration s of a ''state of emergency,'' and by use of the ''necessity'' defense . I recommend repeal of syringe prescription statutes and reform of dr ug paraphernalia statutes and pharmacy regulations.