Physician Prescribing of Sterile Injection Equipment to Prevent HIV Infection: Time for Action [Burris S, et al. Ann Intern Med 2000; 133: 218]: This article addresses the issue of providing access to sterile injection equipment to injection drug users who cannot be rehabilitated as a method of preventing bloodborne infection, including HIV. The authors emphasize the important potential role of physicians and pharmacists in prescribing and dispensing such equipment, and they have analyzed laws in 50 states, DC and Puerto Rico to determine its legality. The results showed that physician prescription for injection equipment to patients as a means of preventing disease transmission is clearly legal in 48 of the 52 jurisdictions. States where this is illegal include Delaware and Kansas. States where there was "reasonable claim to legality" were Ohio and Oklahoma. Physician prescription for sterile equipment was legal in the other 48 jurisdictions. Pharmacy sale of prescribed syringes is illegal in Delaware, Kansas, Georgia and Hawaii (HI). A detailed analysis of each jurisdiction is available at: .
Comment: This is an infrequently discussed method for HIV risk reduction, which the authors rightfully note is a potentially important method to protect injection drug users, their sexual partners, and children from HIV and HCV transmission. It is noted that syringe prescription laws are commonly viewed as a great impediment to needle exchange programs, but most prescription laws simply require a prescription. With regard to ethics, the authors emphasize "the ethical principle of beneficence," which requires efforts by physicians to maximize benefits and minimize harm to patients. Prior studies have shown that injection drug users with diabetes in Baltimore were 2.5 times less likely to have HIV infection compared to injection drug users without diabetes, the implication being that access to sterile needles made the difference [JAMA 1991; 266: 2259]. One of the authors, who is from Providence, RI, began prescribing syringes in his clinic for about 180 injection drug users who have received prescriptions for 18,000 syringes; there have been no apparent problems. The authors urge physicians and pharmacists from states where paraphernalia laws or pharmacy regulations prohibit the dispensing of syringes to join efforts to change the rules. posted 8/11/2000