Preventing HIV Transmission The Role of Sterile Needles and Bleach (1995) / Chapter Skim
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5 THE LEGAL ENVIRONMENT
5 THE LEGAL ENVIRONMENT
Pages 143-164
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From page 143... ...
drug control policies to provide a better understanding of why various legislative bodies of government (federal, state, and local) have enacted laws that directly contribute to the scarcity of .
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The primary intent of these criminal laws seems to have been to impact drug use by restricting and limiting the purchase of drug instrumentation and devices that facilitate drug use itself. For example, concerns regarding the sale of marijuana and other cannabinoids paraphernalia in "head shops" led to the enactment of many local and state drug paraphernalia laws (American Civil Liberties Union, 1994~.
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(For a detailed treatment and analysis of the history of drug policy in the United States, the reader is referred to the following publications: Courtwright, 1982, 1992; Morgan, 1981; Musto, 1 987, 1 99 1; and Reuter, 1 992.) Legislative/Statutory Environment Two categories of laws have been enacted that directly impact the availability of sterile syringes and other injection drug use paraphernalia: drug paraphernalia laws and prescription laws.
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Thus, state and local government authority to restrict individuals from manufacturing, selling, or using drug paraphernalia appears to be on firm constitutional footing. The prescription laws have also withstood constitutional challenges (People v.
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can be invoked only in situations that satisfy stringent criteria (e.g., no adequate alternative to avert the harm was available; see Gostin, 1993:53~; and · may not be a viable defense for the clients of needle exchange programs, i.e., injection drug users. The authority of public health officials to sanction needle exchange programs has sometimes been challenged.
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DO PARAPHERNALIA AND PRESCRIPTION LAWS CONTRIBUTE TO HIV TRANSMISSION? Contaminated needles and syringes are a primary mechanism for transmitting HIV among injection drug users.
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At first glance, it would appear that, given the misdemeanor offenses associated with conviction on paraphernalia possession in many states, such convictions would not constitute a serious deterrent to having injection drug users purchase sterile needles from pharmacies (it is legal to purchase them without a prescription in most states) to ensure that they have access to sterile equipment when they need to inject drugs.
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Koester's findings show that drug paraphernalia laws, at least in Denver, play a significant role in explaining the high-risk sharing behaviors among certain segments of the injection drug user community. In addition to Koester's ethnographic data, empirically derived descriptive data from large-scale studies provide indirect support for the negative impact of these laws on sharing behaviors (Des Jarlais and Friedman, 1992; Nelson et al., 1991)
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, which was enacted in May 1992 and became effective in July 1992 (Connecticut General Statutes, Sections 21 a-65, 21 a-240, 21 a-267, 1992~. The intent of these new statutes was to increase the availability of sterile injection equipment in an attempt to reduce the use of contaminated needles and syringes among the injection drug user community and, consequently, the rate of HIV transmission in the state.
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in terms of their reported estimated prevalence of injection drug use in their respective neighborhoods. That is, 75 percent of the managers in the largest cities reported that there were many injection drug users in their neighborhood, compared with 15 percent of all managers in other locations.
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Injection Drug Users' Behaviors The CDC project (Groseclose et al., in pressJ assessed injecting drug users' knowledge of the new laws, their needle and syringe purchasing practices, and their needle-sharing behaviors, both before and after the new laws were in effect. To do so, the investigators conducted two cross-sectional surveys of active injection drug users employing a structured interview format.
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as they relate to injection equipment. Moreover, CDC's monitoring of police harassment of injection drug users for possession of paraphernalia seems to reinforce the concern, voiced by participants at the panel's workshop (see Chapter 4)
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, requires immediate action to protect public health. In view of the hindering effects of paraphernalia and prescription laws on the prevention of HIV transmission, the panel urges that state prescription laws be repealed and that all paraphernalia laws be amended to allow for the possession of drug injection equipment.
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That is, amending paraphernalia and prescription laws would increase the availability of syringes and needles within a community but would not necessarily ensure that injection drug users have a sufficient supply of sterile equipment for each injection. Availability at the time of injection is more difficult to achieve (Bruneau, 1994~.
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were designed to decrease the prevalence of injection drug abuse, but they also inhibit users from carrying their own supply of needles and syringes and thus unwittingly contribute to the sharing of contaminated ones. · Laws requiring a prescription for the purchase of new needles and syringes (prescription laws)
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More accurate terminology used by injection drug users has been described in Koester (1994~; Carlson et al. (in press)
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Friedman, and W Hopkins 1985 Risk reduction for acquired immune deficiency syndrome among intravenous drug users.
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Copping, running and paraphernalia laws: Contextual variables and needle risk behavior among injection drug users in Denver. Forthcoming in Human Organiza tion 53(3)
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Friedland 1989 Risk factors for human immunodeficiency virus infection in intravenous drug users. New England Journal of Medicine 321(13)
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1993 Legislative Changes, The Connecticut Experience, Pharmacies. Presentation at Workshop on Needle Exchange and Bleach Distribution Programs, Baltimore, MD, September 28.
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