Question about hypodermic needle/syringe laws in Texas

[crossurfingers]

Can anyone point me in the direction of where this is? I've looked in the law book for the boards and even online at the state board of pharmacy's website but I have had no luck. I've been told that they need proof of insulin use in their medication profile, but I would like to see the law myself regarding quantities we are allowed to sell, if we need to ID, age restrictions, etc.

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[MountainPharmD]

Can anyone point me in the direction of where this is? I've looked in the law book for the boards and even online at the state board of pharmacy's website but I have had no luck. I've been told that they need proof of insulin use in their medication profile, but I would like to see the law myself regarding quantities we are allowed to sell, if we need to ID, age restrictions, etc.

You have had no luck because there is no law. Syringes are OTC and can be sold to anyone without restrictions. You have encountered something pharmacists are famous for...making up fake laws to justify their actions. Happens all the time.

 

[BidingMyTime]

I'm surprised pharmacists are still trying to deny drug users syringes. This was a big ethical concern when I went to school....the idea being not to encourage drug use. However information on AIDS was just starting to come out. Now, it's pretty much accepted that society wants drug users to have access to clean syringes, to prevent the devastation & costs that come with HIV/AIDS. This is why some places even have free syringe giveaways. I think it's...I don't know the right word, I guess uneducated, for a pharmacist to make up a law about someone having to "prove" they are on insulin (some insulins are OTC, so if a state did have a law like that, a drug user might circumvent it by just buying insulin with his syringes, so what would the point be?)

 

[ACE Rx]

No laws exist in Texas regarding syringes. It is up to either your company's policy or your own personal judgement when deciding whether or not to dispense syringes.

 

[Rxnupe]

Can anyone point me in the direction of where this is? I've looked in the law book for the boards and even online at the state board of pharmacy's website but I have had no luck. I've been told that they need proof of insulin use in their medication profile, but I would like to see the law myself regarding quantities we are allowed to sell, if we need to ID, age restrictions, etc.

No law exist, but trust me that won't get you off the hook- if you have a case where you know the person is a heroine addict/junkie and you sell them syringes and they shoot up and kill themselves you could be liable.
Now, check the law- you actually can LOAN on control medications with the exception of C2's but how many pharmacist will loan on controls???? I think it's a crazy idea to sell syringes to addicts just to stop the spread of AIDS- almost as crazy- as selling a gun to a felon who is about to rob a bank and give the money to the poor.
There's a reason why Syringes are kept behind the counter- if your company has a policy where they want you to sell syringes to anyone for any reason- than have the store place all syringes on the OTC First Aid or Diabetic aisle.

Also, remember Texas has a lot of Pill Mills- if you have 5 people come up to your pharmacy all with cocktail prescriptions from the same MD- if you call the MD and he says go ahead and fill them- don't think the DEA or TXBOP would give you a pass- bottom line it's your license that's on the line- so make the best judgement.

 

[CUninja]

Please give us all examples of cases where pharmacists have been held liable for a drug user's overdose because they sold said user a syringe.

This is not at all the same thing as selling a gun to a felon, which is not only clearly illegal, but also very dangerous.

If you feel like refusing to sell syringes to IV drug users helps you sleep at night, by all means go ahead and do so. MountainPharmD is completely right on this one...if you feel the need to make up a rule to follow...fine...but don't expect any of the rest of us to follow it...

 

[Rxnupe]

Please give us all examples of cases where pharmacists have been held liable for a drug user's overdose because they sold said user a syringe.

This is not at all the same thing as selling a gun to a felon, which is not only clearly illegal, but also very dangerous.

If you feel like refusing to sell syringes to IV drug users helps you sleep at night, by all means go ahead and do so. MountainPharmD is completely right on this one...if you feel the need to make up a rule to follow...fine...but don't expect any of the rest of us to follow it...

The operative word is "could" -if you think there's not a lawyer that would take a case where a person OD'ed by using a syringe purchased from a pharmacy without question than you need a reality. I personally know of a civil lawsuit where a Pharmacist misfilled a prescription and nearly a year later the person died, but it had nothing to do with the misfill- yet the family sued the Pharmacist and the Company in a civil lawsuit- I can't give you the details , but the case is still pending.
If that were the case what's the difference between selling a syringe to someone who you know is a drug user and filling a prescription from a pill mill.

Also can you name me one major Retail chain that keeps syringes outside of the pharmacy???? Remember there are no laws that state that syringes must be kept in the pharmacy like PSE products. Hmmm I wonder why they keep them behind the counter and not OTC in the aisles?????

 

[BidingMyTime]

Also can you name me one major Retail chain that keeps syringes outside of the pharmacy???? Remember there are no laws that state that syringes must be kept in the pharmacy like PSE products. Hmmm I wonder why they keep them behind the counter and not OTC in the aisles?????

Well, to clarify, that is in your state. In Illinois, for example, syringes are OTC, but are regulated and similar to PSE, there are quantity limits and one must be over the age of 18. Keeping the syringes behind the counter is necessary to meet the laws requirements. In addition, syringes had previously been RX only in Illinois, the law was changed specifically in order to provide illegal drug users with access to clean needles.

I realize you are in Texas, so your law & your legal concerns may be different. I just want to point out that the situation is different in other states, with at least one state-Illinois, specifically allowing the sale of OTC syringes in an effort to combat HIV/AIDS. I'm sure people can and have been sued for anything, but I can't imagine a lawsuit against a pharmacist selling OTC syringes would go very far, since the law was written to provide illegal drug users with clean syringes.

I might also point out that other OTC items, blood glucose strips, DXM products, etc. are often kept behind the counter, not because of a law that requires them to, but because they are a highly shoplifted item too. Undoubtedly, syringes would also be a highly shoplifted item, for the same reason that DXM is, so it makes sense to keep syringes behind the counter, regardless of any legal issues.

 

[Rxnupe]

Well, to clarify, that is in your state. In Illinois, for example, syringes are OTC, but are regulated and similar to PSE, there are quantity limits and one must be over the age of 18. Keeping the syringes behind the counter is necessary to meet the laws requirements. In addition, syringes had previously been RX only in Illinois, the law was changed specifically in order to provide illegal drug users with access to clean needles.

I realize you are in Texas, so your law & your legal concerns may be different. I just want to point out that the situation is different in other states, with at least one state-Illinois, specifically allowing the sale of OTC syringes in an effort to combat HIV/AIDS. I'm sure people can and have been sued for anything, but I can't imagine a lawsuit against a pharmacist selling OTC syringes would go very far, since the law was written to provide illegal drug users with clean syringes.

I might also point out that other OTC items, blood glucose strips, DXM products, etc. are often kept behind the counter, not because of a law that requires them to, but because they are a highly shoplifted item too. Undoubtedly, syringes would also be a highly shoplifted item, for the same reason that DXM is, so it makes sense to keep syringes behind the counter, regardless of any legal issues.

That is not the main reason why they are kept behind the counter- Syringes at most cost 30 dollars for a box of 100- We have Diabetes Meters that cost 80 that are kept on the OTC aisle and I work in a high theft area. If Illinois has that law that's fine, but Texas has no such law and until they do, I personally do not sell them without proof f need or use.

 

[CUninja]

May it possibly be because they don't want them to be stolen? Or may it also possibly be because they are filled pursuant to a prescription so often that it just makes sense to have them in the pharmacy?

Plastic syringes have been around for at least 35 years in the US and the fact that you can't find a single lawsuit where a pharmacist has been held liable for selling syringes to a drug user should tell you something.

The fact that you personally know of a civil lawsuit against a pharmacist that has nothing to do with the topic at hand is irrelevant. Medical professionals, including pharmacists, are sued and held liable all the time for malpractice....just none where the selling of syringes OTC is involved.

 

[Rxnupe]

May it possibly be because they don't want them to be stolen? Or may it also possibly be because they are filled pursuant to a prescription so often that it just makes sense to have them in the pharmacy?

Plastic syringes have been around for at least 35 years in the US and the fact that you can't find a single lawsuit where a pharmacist has been held liable for selling syringes to a drug user should tell you something.

The fact that you personally know of a civil lawsuit against a pharmacist that has nothing to do with the topic at hand is irrelevant. Medical professionals, including pharmacists, are sued and held liable all the time for malpractice....just none where the selling of syringes OTC is involved.

The bottom line is if the OP is comfortable with selling to anyone than he/she can- if a Pharmacist wants to accept prescriptions from Pill Mills than so be it.
There are Pill Mills in a lot of states where even if you call and verify the Rx they will tell you tat they seen the patient even though you know deep down that person more than likely is not getting the med for medical purposes- are you telling me if 10 people came to your pharmacy with cocktail prescriptions that you will fill each and everyone with no question? I work in Dallas and often we get people who bring control medication prescriptions from Houston which is give or take 4 hours away or roughly 240 miles.

The pharmacist at my store and other chains refuse to fill them- of course there's no law that says prescriptions from Houston can't be filled in Dallas or another city, but if you think the DEA will pat you on the back and won't say anything if they see a trail of prescriptions(Control) from Houston being filled in Dallas than you are nuts.
Is there a written law in Florida or any state that says you can only fill or order a certain amount of C2's? If not then why did the 2 CVS's in Florida get in trouble- couldn't the pharmacists have said well we were just ordering enough to take care of our clients??? No, playing ignorant and dumb does not work or get you off the hook in Texas.

If a person wants to sell syringes to any Joe/Jane that asks for them than go right ahead- again it's your license.

 

[Rxnupe]

May it possibly be because they don't want them to be stolen? Or may it also possibly be because they are filled pursuant to a prescription so often that it just makes sense to have them in the pharmacy?

Plastic syringes have been around for at least 35 years in the US and the fact that you can't find a single lawsuit where a pharmacist has been held liable for selling syringes to a drug user should tell you something.

The fact that you personally know of a civil lawsuit against a pharmacist that has nothing to do with the topic at hand is irrelevant. Medical professionals, including pharmacists, are sued and held liable all the time for malpractice....just none where the selling of syringes OTC is involved.

Read this article:http://www.cdc.gov/idu/facts/aed_idu_phar.pdf

Here is some of the article copied and pasted:

What Laws and Regulations Affect Pharmacy Sales?
A number of laws, regulations, and pharmacy practice policies effectively restrict
pharmacy sales of sterile syringes to IDUs.(5) For example, 47 states plus the
District of Columbia and the Virgin Islands have drug paraphernalia laws that
criminalize the sale and possession of syringes if it is known that they may be used
to inject illegal drugs. Eight states and the Virgin Islands also have laws requiring
individuals to have a valid medical prescription to purchase syringes. (See the
related fact sheet, State and Local Policies Regarding IDUs' Access to Sterile
Syringes.
In addition, 23 states have pharmacy regulations or practice guidelines that restrict
pharmacists from selling sterile syringes to IDUs or that impose additional
requirements on customers who wish to purchase syringes. Some pharmacy chains
and individually-owned pharmacies also have policies that restrict over-the-counter
sales of syringes.(6)
Many individual pharmacists are also reluctant to sell sterile syringes to IDUs even
where such sales are legal.(7,8,9) This reluctance stems from negative feelings
toward IDUs, disapproval of injection drug use, concerns about unsafe disposal of
used syringes, and concerns about safety and crime. Many pharmacists follow
procedures that make it more difficult for IDUs to buy syringes, such as asking for
photo identification, requiring the name and address of the customer, asking for
confirmation of diabetic status, asking the customer to explain why they need to buy
the syringes, or selling only to individuals who are known to the pharmacist.(7,8)



What I highlighted in RED is reason enough for me not to sell syringes to anyone.

 

[Rxnupe]

To the OP here's a site which will tell you each states rules/laws if any of syringes:
http://www.temple.edu/lawschool/phrhcs/map.htm

 

[CUninja]

I am very much aware that in Texas, there is no law regarding syringe sales. That is confirmed by the link that was posted.

Let me highlight a different part of the very same article in red...

What Laws and Regulations Affect Pharmacy Sales?
A number of laws, regulations, and pharmacy practice policies effectively restrict
pharmacy sales of sterile syringes to IDUs.(5) For example, 47 states plus the
District of Columbia and the Virgin Islands have drug paraphernalia laws that
criminalize the sale and possession of syringes if it is known that they may be used
to inject illegal drugs. Eight states and the Virgin Islands also have laws requiring
individuals to have a valid medical prescription to purchase syringes. (See the
related fact sheet, State and Local Policies Regarding IDUs’ Access to Sterile
Syringes.
In addition, 23 states have pharmacy regulations or practice guidelines that restrict
pharmacists from selling sterile syringes to IDUs or that impose additional
requirements on customers who wish to purchase syringes. Some pharmacy chains
and individually-owned pharmacies also have policies that restrict over-the-counter
sales of syringes.(6)
Many individual pharmacists are also reluctant to sell sterile syringes to IDUs even
where such sales are legal. (7,8,9) This reluctance stems from negative feelings
toward IDUs, disapproval of injection drug use, concerns about unsafe disposal of
used syringes, and concerns about safety and crime. Many pharmacists follow
procedures that make it more difficult for IDUs to buy syringes, such as asking for
photo identification, requiring the name and address of the customer, asking for
confirmation of diabetic status, asking the customer to explain why they need to buy
the syringes, or selling only to individuals who are known to the pharmacist.(7,8)

For the portion in green, I implore you to look up the literature which this sentence references. It is a free article: Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology 1998;18 (Suppl 1):S60-S70

On page S63, "Pharmacists retain considerable discretion in deciding whether they will sell injection equipment and to whom they will sell. This leads to wide variations in the willingness of pharmacists to sell syringes. Biases toward, for example, racial minorities, young people, or the homeless can limit the opportunities for IDUs to purchase syringes at pharmacies."

Any reference to pill mills, is again, irrelevant to the discussion. We are talking about the OTC sale of syringes, not the filling of controlled medications where the validity of a prescription is in question.

I will cede to you that under Texas law, you DO have the right to restrict access to syringes, just as I have the right to sell them to those who ask for them.

I have no way of positively knowing whether someone is an IDU, short of them shooting up inside my pharmacy. My own opinion is that I am applying my own biases/prejudices by restricting access to those who I don't positively know are an IDU.

Please don't take this as a character assassination. I do think it is good to have a debate about a gray area in which both sides are able to state their beliefs and supporting information.

 

[browneyes021]

LIABILITY FOR PRESCRIBING INTRAVENOUS INJECTION EQUIPMENT TO IV DRUG USERS

http://web.ebscohost.com/ehost/deta...ta=JnNpdGU9ZWhvc3QtbGl2ZQ==#db=f5h&AN=4847308

One question is whether physicians who engage in this behavior, as well as pharmacists who fill the prescriptions, face a significant threat of malpractice liability if the IV drug user or someone else, perhaps an innocent bystander, is harmed as a result of the prescribed equipment. No such cases have been reported, perhaps because the practice is not yet frequent. For the reasons explained in the analysis that follows, it is unlikely that any malpractice suits would be brought successfully in the future.

One further point at the outset: The physician or pharmacist who chooses not to provide access to IV equipment because of fears of malpractice liability also must consider the possibility of being liable if the drug user is harmed by that decision, such as by becoming infected with HIV through needle sharing. In other words, the potential liability for providing IV equipment must be compared, not with the absence of liability altogether, but with the risk of liability created by not providing access to the IV equipment. (The only way to avoid any risk of liability whatsoever might be to refrain from creating patient-physician relationships with persons who might be IV drug users, which may be difficult to accomplish for a number of reasons that are beyond the scope of this paper, not the least of which is the limited degree to which physicians in managed care plans can refuse to take on specific patients from among the pool of enrollees.)

B. Injury
In order to hold someone liable for malpractice, the plaintiff must demonstrate that he or she has been injured. In the case of a physician or pharmacist who provided access to IV equipment to a drug user, several possible injuries are foreseeable:

The plaintiff might allege that, as a result of being given access to the IV equipment, he or she had continued to abuse IV drugs and, as a result, had been harmed by the effects of the drugs (such as by becoming addicted). (Implicit in this allegation is the questionable causal proposition that, if the person had not been given access to the equipment by the defendant, he or she would not have continued to use the drugs.)

The plaintiff (or a family member) might allege that, as a result of being given access to the IV equipment, the drug user overdosed and was killed or injured. (Implicit in this allegation is the questionable causal proposition that, if the person had not been given access to the equipment, he or she would not have overdosed.)

The plaintiff might allege that he or she had been harmed (such as by becoming infected, continuing to abuse IV drugs, or overdosing) as a result of using the IV equipment that had been prescribed, although it had not been prescribed for the plaintiff. For example, the plaintiff could have obtained the equipment from the person for whom it had been prescribed. (Again, the plaintiff implicitly would be maintaining that the harm would not have occurred had the IV equipment not been prescribed.)

Finally, the plaintiff could be a non-IV drug user who alleges injury as the result of coming into contact with the equipment, such as becoming infected following a needle stick. Such a plaintiff might be a law enforcement officer, a garbage collector, a health care worker, or an innocent "bystander" like a curious child who finds the paraphernalia lying in the street. Even if the plaintiff had not actually become infected, he or she might seek damages for the fear of becoming infected as a result of the exposure to the risk.

Even though these injuries arguably are foreseeable, a plaintiff would have a difficult time prevailing on the injury issue. For one thing, he or she would have to persuade the judge or jury not only that he or she had been injured, but that the injury resulted from the IV equipment that had been prescribed, rather than from other IV equipment. This may be extremely difficult to prove, since the prescribed equipment is not likely to bear any physical marks that would distinguish it from other IV equipment that was obtained illegally.

In addition, the plaintiff would have to show that the injury sustained was not outweighed by any benefits accruing to him or her as a result of the IV equipment having been prescribed. This is the legal doctrine of "offset."[2] The defendant could argue that, even though the plaintiff had been injured, the injury was offset by the benefit of the reduction in the risk of infection achieved by prescribing the IV equipment. (Even if the court felt that the risks of the injury that occurred were not out-weighed completely by the reduction in the risk of infection, the magnitude of the harm that occurred, and hence the damages to be awarded, would be reduced by the value of the benefit that was conferred.[3])

Finally, most courts refuse to permit damages to be awarded merely for being afraid of becoming infected, unless the individual actually was exposed to an infectious agent, such as HIV.[4]


I couldn't find anything more up to date besides this article, which was published in 2001. If anyone can find a more updated article with relevant information regarding cases where pharmacists have been sued for giving syringes to individuals who they were not aware were drug abusers, can they post it here? I don't feel it's one duty to judge a person as an IVDA or not when you don't have concrete proof of it and as the article states it could go both ways for selling or not selling a syringe to an individual if they overdose if you use the arguement of not selling to someone because you think they are using it for illegal substances.

 

[BenJammin]

When there is negligence, there is liability. How am I negligent for selling syringes to someone who doesn't flat out tell me that they're going to use it to get high? I'm not. Just like a Wal-Mart employee isn't liable for damages you caused to yourself by buying a two liter of soda, emptying it out, and using it to make meth. Get real.

 

[Rxnupe]

I am very much aware that in Texas, there is no law regarding syringe sales. That is confirmed by the link that was posted.

Let me highlight a different part of the very same article in red...

What Laws and Regulations Affect Pharmacy Sales?
A number of laws, regulations, and pharmacy practice policies effectively restrict
pharmacy sales of sterile syringes to IDUs.(5) For example, 47 states plus the
District of Columbia and the Virgin Islands have drug paraphernalia laws that
criminalize the sale and possession of syringes if it is known that they may be used
to inject illegal drugs. Eight states and the Virgin Islands also have laws requiring
individuals to have a valid medical prescription to purchase syringes. (See the
related fact sheet, State and Local Policies Regarding IDUs' Access to Sterile
Syringes.
In addition, 23 states have pharmacy regulations or practice guidelines that restrict
pharmacists from selling sterile syringes to IDUs or that impose additional
requirements on customers who wish to purchase syringes. Some pharmacy chains
and individually-owned pharmacies also have policies that restrict over-the-counter
sales of syringes.(6)
Many individual pharmacists are also reluctant to sell sterile syringes to IDUs even
where such sales are legal. (7,8,9) This reluctance stems from negative feelings
toward IDUs, disapproval of injection drug use, concerns about unsafe disposal of
used syringes, and concerns about safety and crime. Many pharmacists follow
procedures that make it more difficult for IDUs to buy syringes, such as asking for
photo identification, requiring the name and address of the customer, asking for
confirmation of diabetic status, asking the customer to explain why they need to buy
the syringes, or selling only to individuals who are known to the pharmacist.(7,8)

For the portion in green, I implore you to look up the literature which this sentence references. It is a free article: Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology 1998;18 (Suppl 1):S60-S70

On page S63, "Pharmacists retain considerable discretion in deciding whether they will sell injection equipment and to whom they will sell. This leads to wide variations in the willingness of pharmacists to sell syringes. Biases toward, for example, racial minorities, young people, or the homeless can limit the opportunities for IDUs to purchase syringes at pharmacies."

Any reference to pill mills, is again, irrelevant to the discussion. We are talking about the OTC sale of syringes, not the filling of controlled medications where the validity of a prescription is in question.

I will cede to you that under Texas law, you DO have the right to restrict access to syringes, just as I have the right to sell them to those who ask for them.

I have no way of positively knowing whether someone is an IDU, short of them shooting up inside my pharmacy. My own opinion is that I am applying my own biases/prejudices by restricting access to those who I don't positively know are an IDU.

Please don't take this as a character assassination. I do think it is good to have a debate about a gray area in which both sides are able to state their beliefs and supporting information.

Where did I EVER mention that you or the OP had no right or sell syringes- again it's your license- do what you want. Are you also going to loan on controls- if you are a Pharmacist in Texas technically you can loan on controls except C2's.
Also when customers leave a dentist and they have a prescription for an antibiotic and a pain medication and the the customer just want the pain med I guess you allow them to just get the pain- even though majority of Pharmacist do not allow the person to only get the pain medications- keep in mind there's no law that says you must get both.
Bottom line I and I assume many other Pharmacist took an oath to save peoples lives- if you are a pharmacist that openly sells syringes to someone whom you highly suspect is going to "shoot" up with heroine or meth than maybe you need to re-think the oath you were supposed to upheld. If you are a pharmacist in Texas please send me your location and I will be glad to send all the addicts to your store to purchase syringes.

 

[BidingMyTime]

When there is negligence, there is liability. How am I negligent for selling syringes to someone who doesn't flat out tell me that they're going to use it to get high? I'm not. Just like a Wal-Mart employee isn't liable for damages you caused to yourself by buying a two liter of soda, emptying it out, and using it to make meth. Get real.

Exactly. It doesn't mean that somebody can't sue for any lame reason, but proving negligence/liability is something else.

The article posted above that pharmacists could potentially be sued for syringes/injectables prescribed (it doesn't note any difference between people getting the syringes/injectables OTC or RX), but that could come back for any drug. A fentanyl patch thrown loosely in the garbage that someone's dog gets into, a prescription med that a child gets into, a child-bearing age woman who partners with a guy on some tetratrogenic drug.

Personally, I think it is wise for every pharamcist to carry liability insurance, because anyone can sue about anything. Working in the health care field in any aspect carries a risk of liability. I just don't see where there is any more risk of someone being sued for selling OTC syringes, then selling RX syringes or any other drug.

 

[BidingMyTime]

Bottom line I and I assume many other Pharmacist took an oath to save peoples lives- if you are a pharmacist that openly sells syringes to someone whom you highly suspect is going to "shoot" up with heroine or meth than maybe you need to re-think the oath you were supposed to upheld.

I resent the implication that pharmacists who sell OTC syringes are not upholding their oath to save lives. As has already been explained, there are many pharmacists who believe that saving lives part applies to making sure that clean syringes are available for those who are going to inject drugs no matter what. Refusing to sell syringes to someone, is not going to stop them from shooting up, it just ups the risk that they will shoot up someone else's syringe and get hepatitis or HIV or who knows what else. Drug addiction is expensive enough for society, but a chronic condition like HIV is a lot more expensive to society.....there are limited health care dollars, and when medicaid/medicare must spend to take care of someone with HIV, that is less money available to spend somewhere else. If your ethics lead you to a different conclusion, that is fine, but you should realize that other pharmacist's ethics will lead them to the conclusion that selling OTC syringes is the correct thing to do.

As for filling emergency supplies on controll's....I'm not sure what this has to do with the selling OTC syringes, but IL law states emergency supplies are only for "maintenance" meds, I would be surprised if TX law states otherwise. How many controll's are maintenance meds? Certainly the most common, Vicodin, Tyl #3, Ambien are not maintenance meds. Controlled or not, I would have no problem giving phenobarbital being used for seizure control to a regular customer--as it was clearly a maintenance medicine. Within the law, I will do what is in the patient's best interest

As for the customer who only wants the pain medicine, and not the antibiotic....the problem is that its not in their best health interest to only get the pain medicine and not the antibiotic. It's not because I'm trying to be the drug police...it's because whether cost or other issues are the reason, from a health point, the antibiotic needs to be the first priority.

I feel all else being equal, clean syringes are in a patient's best interest. I really don't understand why you would feel otherwise.
I

 

[CUninja]

I resent the implication that pharmacists who sell OTC syringes are not upholding their oath to save lives. As has already been explained, there are many pharmacists who believe that saving lives part applies to making sure that clean syringes are available for those who are going to inject drugs no matter what. Refusing to sell syringes to someone, is not going to stop them from shooting up, it just ups the risk that they will shoot up someone else's syringe and get hepatitis or HIV or who knows what else. Drug addiction is expensive enough for society, but a chronic condition like HIV is a lot more expensive to society.....there are limited health care dollars, and when medicaid/medicare must spend to take care of someone with HIV, that is less money available to spend somewhere else. If your ethics lead you to a different conclusion, that is fine, but you should realize that other pharmacist's ethics will lead them to the conclusion that selling OTC syringes is the correct thing to do.

As for filling emergency supplies on controll's....I'm not sure what this has to do with the selling OTC syringes, but IL law states emergency supplies are only for "maintenance" meds, I would be surprised if TX law states otherwise. How many controll's are maintenance meds? Certainly the most common, Vicodin, Tyl #3, Ambien are not maintenance meds. Controlled or not, I would have no problem giving phenobarbital being used for seizure control to a regular customer--as it was clearly a maintenance medicine. Within the law, I will do what is in the patient's best interest

As for the customer who only wants the pain medicine, and not the antibiotic....the problem is that its not in their best health interest to only get the pain medicine and not the antibiotic. It's not because I'm trying to be the drug police...it's because whether cost or other issues are the reason, from a health point, the antibiotic needs to be the first priority.

I feel all else being equal, clean syringes are in a patient's best interest. I really don't understand why you would feel otherwise.
I

Rxnupe is correct that you can loan controls in TX, minus C2's. There is no compelling public interest for a pharmacist to loan controls as there is for the OTC sale of syringes (prevention of communicable disease.) This is another gray area...where it is legal to do something but also legal not to do it.

I agree with BidingMyTime's ethical conclusion of OTC syringe sales. It is a gray area and I respect that Rxnupe has come to a different conclusion than mine.

 

[Rxnupe]

Rxnupe is correct that you can loan controls in TX, minus C2's. There is no compelling public interest for a pharmacist to loan controls as there is for the OTC sale of syringes (prevention of communicable disease.) This is another gray area...where it is legal to do something but also legal not to do it.

I agree with BidingMyTime's ethical conclusion of OTC syringe sales. It is a gray area and I respect that Rxnupe has come to a different conclusion than mine.

Yes neither of us is right or wrong but I always feel the pharmacy as a whole should come to an agreement- I have worked at stores where it's ok with one pharmacist and not ok with another pharmacist so the customer is a bit confused. At my location, no pharmacist sells the unless they have reasonable belief that the person is a diabetic. I never loan on Controls unless it's phenobarbital but I would if it were for example a chemo patient or person I know who is going through some serious pain and has a history of not abusing meds.

 

[All4MyDaughter]

Yes neither of us is right or wrong but I always feel the pharmacy as a whole should come to an agreement- I have worked at stores where it's ok with one pharmacist and not ok with another pharmacist so the customer is a bit confused. At my location, no pharmacist sells the unless they have reasonable belief that the person is a diabetic. I never loan on Controls unless it's phenobarbital but I would if it were for example a chemo patient or person I know who is going through some serious pain and has a history of not abusing meds.

So there are no legit reasons someone could need a syringe other than diabetes? FAIL.

 

[cycloketocaine]

So there are no legit reasons someone could need a syringe other than diabetes? FAIL.

Somebody forgot to tell my ileum that I won't be able to get B12 cause that's no excuse to buy syringes.

 

[All4MyDaughter]

Somebody forgot to tell my ileum that I won't be able to get B12 cause that's no excuse to buy syringes.

I don't want to hear about any wussies who need allergy shots either!

 

[browneyes021]

I don't want to hear about any wussies who need allergy shots either!

What about those men who need their testosterone shots?

 

[browneyes021]

My question with this entire debate (and it probably needs a TX lawyer familiar with health care liability) is would one be held liable in a state where no law exists allowing pharmacists to sell syringes to an individual regardless of their legitimate medical need for this medical device if the pharmacist claims they were acting in the best intention of the public by protecying an individual from contracting HIV or hepatitis vs one who would not sell syringes on the basis of protecting the public from using drugs or those customers from coming in contact with reckless drug abuser who dispose their needles anywhere? From that last statement, I am asking which is seen as keeping the public safer (I may have the wrong wording here). Is it that other states get around the 'legitimate medical need' part by decriminalizing syringes as not part of drug paraphernalia or the IVDAs themselves?

 

[All4MyDaughter]

My question with this entire debate (and it probably needs a TX lawyer familiar with health care liability) is would one be held liable in a state where no law exists allowing pharmacists to sell syringes to an individual regardless of their legitimate medical need for this medical device if the pharmacist claims they were acting in the best intention of the public by protecying an individual from contracting HIV or hepatitis vs one who would not sell syringes on the basis of protecting the public from using drugs or those customers from coming in contact with reckless drug abuser who dispose their needles anywhere? From that last statement, I am asking which is seen as keeping the public safer (I may have the wrong wording here). Is it that other states get around the 'legitimate medical need' part by decriminalizing syringes as not part of drug paraphernalia or the IVDAs themselves?

Here is the best way to shield oneself from liability:

Patient - I need to buy some syringes
Pharmacist/Tech/Cashier - OK. That's five bucks.
Patient - Thanks

If I understand TX law, it's OK to sell them without questioning the patient. To prevent liability, that is what I would do. Pharmacists who start asking 10001 questions or putting patients through some kind of "needs test" to make sure they are using the syringes appropriately are ESTABLISHING some sort of duty and liability where none exists (under the law). I think that's dumb and unnecessary.

 

[Ackj]

Here is the best way to shield oneself from liability:

Patient - I need to buy some syringes
Pharmacist/Tech/Cashier - OK. That's five bucks.
Patient - Thanks

If I understand TX law, it's OK to sell them without questioning the patient. To prevent liability, that is what I would do. Pharmacists who start asking 10001 questions or putting patients through some kind of "needs test" to make sure they are using the syringes appropriately are ESTABLISHING some sort of duty and liability where none exists (under the law). I think that's dumb and unnecessary.

If you're charging that much for syringes, they're definitely re-using them, rather than getting clean ones for each hit, er... medical administration. I really hope that was a made up number for example.

 

[All4MyDaughter]

If you're charging that much for syringes, they're definitely re-using them, rather than getting clean ones for each hit, er... medical administration. I really hope that was a made up number for example.

You'll notice my scenario doesn't specify how many syringes were purchased... but a box of BD syringes is about 30 bucks retail. So I don't think my number (which WAS made up) is totally unreasonable.

 

[MountainPharmD]

So there are no legit reasons someone could need a syringe other than diabetes? FAIL.

Epic fail for Rxnupe and the syringe police.

 

[Ackj]

You'll notice my scenario doesn't specify how many syringes were purchased... but a box of BD syringes is about 30 bucks retail. So I don't think my number (which WAS made up) is totally unreasonable.

I forget it's a state law that limits how many you can buy. A 10 pack (max for our ESAP) for $5 is pricey. If your state doesn't limit it, then a box of 100 for $5 is pretty slick. Today I sold a box of 100 for $23 I believe, patient with a diabetic doggie and rx from DVM. I suspected it was a forged RX since the dog didn't fail metformin yet, but I filled it anyway.

 

[MountainPharmD]

I forget it's a state law that limits how many you can buy. A 10 pack (max for our ESAP) for $5 is pricey. If your state doesn't limit it, then a box of 100 for $5 is pretty slick. Today I sold a box of 100 for $23 I believe, patient with a diabetic doggie and rx from DVM. I suspected it was a forged RX since the dog didn't fail metformin yet, but I filled it anyway.

I would have denied the prior auth for that....

 

[BidingMyTime]

Today I sold a box of 100 for $23 I believe, patient with a diabetic doggie and rx from DVM. I suspected it was a forged RX since the dog didn't fail metformin yet, but I filled it anyway.

How reckless! What if it had been an undercover police dog? Don't you care about your license and liability? And that's the best case scenario, worst case, all the druggie dogs in town are going to be buying up all your syringes leaving poor diabetic children sick and dying because they have no way to inject their insulin. How could you not think of the children?

 

[Rxnupe]

Epic fail for Rxnupe and the syringe police.

How is the an Epic fail- every person who I or my techs have encountered the customer always says: "I need or my mom needs to take an insulin shot and we need such and such needle.... again the customer has set themselves up for failure by telling us they are taking or someone they know is about to take an insulin shot- and if we don't have records of the person on their grandmother/mother etc in our records than it doesn't get sold- they are welcome to go 5 blocks down the street and ask WAGS- whom I know has the same policy.
MPD I am still waiting for the data that shows Mail Order has great customer satisfaction!!!!

 

[Rxnupe]

So there are no legit reasons someone could need a syringe other than diabetes? FAIL.

Of course there is a legit reason and sometimes we have customers who bring proof of what they are about to inject- but the fact of the matter is the customers are telling us they are "diabetic" or they are purchasing needles for someone who is Diabetic- so sorry to bust your bubble but no Fail here.

I guess if 5 people who are all know each other and they come to your pharmacy each to purchase the max amount of PSE- I guess we need to pull the "dumb" card and just assume they all have sinus issues and couldn't possibly be doing anything "illegal"?

 

[MountainPharmD]

MPD I am still waiting for the data that shows Mail Order has great customer satisfaction!!!!

Why? Did I ever say I would produce any?

I said mail order was a cheaper, more efficient and cost effective way to fill maintance prescriptions.

I did post a link to a survey that showed CVS has its lowest customer staisfaction rating in 7 years and dropped 2% last year putting them behind the customer service powerhouses of Walgreens and Rite-Aid. Seriously lower ratings than Walgeens and Rit-Aid?

 

[rxlea]

Wait! I thought you two made up Mountain/rxnupe.. What happened to burying the hatchet?

I'm disappointed in y'all.

 

[MountainPharmD]

Wait! I thought you two made up Mountain/rxnupe.. What happened to burying the hatchet?

I'm disappointed in y'all.

We did! I am just giving him some ****! Its all in good!

Maybe the stress of retail pharmacy is getting to him.

 

[Drgdoc]

Can anyone point me in the direction of where this is? I've looked in the law book for the boards and even online at the state board of pharmacy's website but I have had no luck. I've been told that they need proof of insulin use in their medication profile, but I would like to see the law myself regarding quantities we are allowed to sell, if we need to ID, age restrictions, etc.

HEALTH AND SAFETY CODE

TITLE 6. FOOD, DRUGS, ALCOHOL, AND HAZARDOUS SUBSTANCES

SUBTITLE C. SUBSTANCE ABUSE REGULATION AND CRIMES

CHAPTER 481. TEXAS CONTROLLED SUBSTANCES ACT

(17) "Drug paraphernalia" means equipment, a product, or material that is used or intended for use in planting, propagating, cultivating, growing, harvesting, manufacturing, compounding, converting, producing, processing, preparing, testing, analyzing, packaging, repackaging, storing, containing, or concealing a controlled substance in violation of this chapter or in injecting, ingesting, inhaling, or otherwise introducing into the human body a controlled substance in violation of this chapter. The term includes (A-L):

K: a hypodermic syringe, needle, or other object used or intended for use in parenterally injecting a controlled substance into the human body;

Sec. 481.125. OFFENSE: POSSESSION OR DELIVERY OF DRUG PARAPHERNALIA.

(b) A person commits an offense if the person knowingly or intentionally delivers, possesses with intent to deliver, or manufactures with intent to deliver drug paraphernalia knowing that the person who receives or who is intended to receive the drug paraphernalia intends that it be used to plant, propagate, cultivate, grow, harvest, manufacture, compound, convert, produce, process, prepare, test, analyze, pack, repack, store, contain, or conceal a controlled substance in violation of this chapter or to inject, ingest, inhale, or otherwise introduce into the human body a controlled substance in violation of this chapter.

 

[CUpharmD2013]

Pretty sure they needed the answer to this question 4 years ago, but welcome to the community.

 

[Humble Sloth]

HEALTH AND SAFETY CODE

TITLE 6. FOOD, DRUGS, ALCOHOL, AND HAZARDOUS SUBSTANCES

SUBTITLE C. SUBSTANCE ABUSE REGULATION AND CRIMES

CHAPTER 481. TEXAS CONTROLLED SUBSTANCES ACT

(17) "Drug paraphernalia" means equipment, a product, or material that is used or intended for use in planting, propagating, cultivating, growing, harvesting, manufacturing, compounding, converting, producing, processing, preparing, testing, analyzing, packaging, repackaging, storing, containing, or concealing a controlled substance in violation of this chapter or in injecting, ingesting, inhaling, or otherwise introducing into the human body a controlled substance in violation of this chapter. The term includes (A-L):

K: a hypodermic syringe, needle, or other object used or intended for use in parenterally injecting a controlled substance into the human body;

Sec. 481.125. OFFENSE: POSSESSION OR DELIVERY OF DRUG PARAPHERNALIA.

(b) A person commits an offense if the person knowingly or intentionally delivers, possesses with intent to deliver, or manufactures with intent to deliver drug paraphernalia knowing that the person who receives or who is intended to receive the drug paraphernalia intends that it be used to plant, propagate, cultivate, grow, harvest, manufacture, compound, convert, produce, process, prepare, test, analyze, pack, repack, store, contain, or conceal a controlled substance in violation of this chapter or to inject, ingest, inhale, or otherwise introduce into the human body a controlled substance in violation of this chapter.

Sec. 19.05. CRIMINALLY NEGLIGENT HOMICIDE. (a) A person commits an offense if he causes the death of an individual by criminal negligence.

(b) An offense under this section is a state jail felony.

If you are morally okay with forcing drug users to share needles and propagate the spread of Hepatitis, HIV and other deadly viral diseases in your community feel free to refuse to distribute syringes. Using religious nut-job reasoning to hurt mentally sick people and your community is not okay.

 

[J6x]

I am very much aware that in Texas, there is no law regarding syringe sales. That is confirmed by the link that was posted.

Let me highlight a different part of the very same article in red...

What Laws and Regulations Affect Pharmacy Sales?
A number of laws, regulations, and pharmacy practice policies effectively restrict
pharmacy sales of sterile syringes to IDUs.(5) For example, 47 states plus the
District of Columbia and the Virgin Islands have drug paraphernalia laws that
criminalize the sale and possession of syringes if it is known that they may be used
to inject illegal drugs. Eight states and the Virgin Islands also have laws requiring
individuals to have a valid medical prescription to purchase syringes. (See the
related fact sheet, State and Local Policies Regarding IDUs’ Access to Sterile
Syringes.
In addition, 23 states have pharmacy regulations or practice guidelines that restrict
pharmacists from selling sterile syringes to IDUs or that impose additional
requirements on customers who wish to purchase syringes. Some pharmacy chains
and individually-owned pharmacies also have policies that restrict over-the-counter
sales of syringes.(6)
Many individual pharmacists are also reluctant to sell sterile syringes to IDUs even
where such sales are legal. (7,8,9) This reluctance stems from negative feelings
toward IDUs, disapproval of injection drug use, concerns about unsafe disposal of
used syringes, and concerns about safety and crime. Many pharmacists follow
procedures that make it more difficult for IDUs to buy syringes, such as asking for
photo identification, requiring the name and address of the customer, asking for
confirmation of diabetic status, asking the customer to explain why they need to buy
the syringes, or selling only to individuals who are known to the pharmacist.(7,8)

For the portion in green, I implore you to look up the literature which this sentence references. It is a free article: Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology 1998;18 (Suppl 1):S60-S70

On page S63, "Pharmacists retain considerable discretion in deciding whether they will sell injection equipment and to whom they will sell. This leads to wide variations in the willingness of pharmacists to sell syringes. Biases toward, for example, racial minorities, young people, or the homeless can limit the opportunities for IDUs to purchase syringes at pharmacies."

Any reference to pill mills, is again, irrelevant to the discussion. We are talking about the OTC sale of syringes, not the filling of controlled medications where the validity of a prescription is in question.

I will cede to you that under Texas law, you DO have the right to restrict access to syringes, just as I have the right to sell them to those who ask for them.

I have no way of positively knowing whether someone is an IDU, short of them shooting up inside my pharmacy. My own opinion is that I am applying my own biases/prejudices by restricting access to those who I don't positively know are an IDU.

Please don't take this as a character assassination. I do think it is good to have a debate about a gray area in which both sides are able to state their beliefs and supporting information.

 

[J6x]

I am not a med student. I use syringes to he high and I live in Texas. In the past I could always walk into CVS Pharmacy and purchase a bag of points with no problem until one day they suddenly had a change of heart. Now they want my diabetes status or I'm refused. It wasn't long after this started that I contracted HIV by sharing a used syringe. It's true, we make our own decisions and live with the consequences. Even with that said if it ha been easy to buy sterile syringes as the law supports then it is extremely likely that I would not be infected today. I'm not blaming the pharmacy or pharmacist for my choices, but as an addict I can tell you hands down that as long as pharmacies are making it difficult to maintain a safe level of IV drug use (yeah I know how that sounds) sooner or later an addict will make the decision to get high using a dirty needle and bam, infected. I've been shooting you for 10 years now and was infected about 3 years ago. It sets me out if my skin when refused the sake of clean points knowing that the law is on my side, and with good reason.

 

[Humble Sloth]

I am not a med student. I use syringes to he high and I live in Texas. In the past I could always walk into CVS Pharmacy and purchase a bag of points with no problem until one day they suddenly had a change of heart. Now they want my diabetes status or I'm refused. It wasn't long after this started that I contracted HIV by sharing a used syringe. It's true, we make our own decisions and live with the consequences. Even with that said if it ha been easy to buy sterile syringes as the law supports then it is extremely likely that I would not be infected today. I'm not blaming the pharmacy or pharmacist for my choices, but as an addict I can tell you hands down that as long as pharmacies are making it difficult to maintain a safe level of IV drug use (yeah I know how that sounds) sooner or later an addict will make the decision to get high using a dirty needle and bam, infected. I've been shooting you for 10 years now and was infected about 3 years ago. It sets me out if my skin when refused the sake of clean points knowing that the law is on my side, and with good reason.

Eventually your HIV will find it's way to the individual that made that decision to refuse to distribute clean needles to addicts. Or more likely someone that individual cares about. This is how karma and the world works. Hate breeds hate. ---- that cesspool known as Texas. With oil dropping fast it won't be long to it returns to being a desert wasteland. It's already one of the poorest states and has one of the lowest GDPs per capita in the nation.

 

[CetiAlphaFive]

I only ever refused to sell syringes because it became a safety issue for my techs and patients.
I think that anyone who makes up a fake law to justify their decision is absolutely doing the wrong thing.
I've seen them when they end up in the hospital with horrible infections.
It's sad and unnecessary.

This is yet another public health burden placed on pharmacists that should not be.
There should be a national program that provides free syringes to facilities that would be equipped to provide them to anyone that requests them.

We became known as the easiest spot to purchase them in the city.
We started having belligerent, altered individuals shoving their way through the line at the pick up window. I had to tell a guy with a swastika on his forehead that he needed to be more than 0.09" away from the teenage girl in front of him.

Like I said, this is just another issue pharmacists have been burdened with that we're not equipped to handle.

However, if I can safely provide them with clean syringes, I will.
Every time.

Eventually your HIV will find it's way to the individual that made that decision to refuse to distribute clean needles to addicts. Or more likely someone that individual cares about. This is how karma and the world works. Hate breeds hate. ---- that cesspool known as Texas. With oil dropping fast it won't be long to it returns to being a desert wasteland. It's already one of the poorest states and has one of the lowest GDPs per capita in the nation.

Does posting blatant lies make you feel better about living in the most financially and racially segregated, socially unequal hipsterpocalypse of a city?

 

[TX Tacmed]

No law exist, but trust me that won't get you off the hook- if you have a case where you know the person is a heroine addict/junkie and you sell them syringes and they shoot up and kill themselves you could be liable.
Now, check the law- you actually can LOAN on control medications with the exception of C2's but how many pharmacist will loan on controls???? I think it's a crazy idea to sell syringes to addicts just to stop the spread of AIDS- almost as crazy- as selling a gun to a felon who is about to rob a bank and give the money to the poor.
There's a reason why Syringes are kept behind the counter- if your company has a policy where they want you to sell syringes to anyone for any reason- than have the store place all syringes on the OTC First Aid or Diabetic aisle.

Also, remember Texas has a lot of Pill Mills- if you have 5 people come up to your pharmacy all with cocktail prescriptions from the same MD- if you call the MD and he says go ahead and fill them- don't think the DEA or TXBOP would give you a pass- bottom line it's your license that's on the line- so make the best judgement.

Just curious on this, but do you think that an attorney won't come after you for refusing to sell insulin syringes to an actual diabetic patient who ends up in DKA or dies from complications of not being able to obtain required items for a medication required to sustain life because of a general opinion you made of this person. I'm in EMS & Law Enforcement and I would much rather a pharmacist take a chance & sell the syringes to a potential junkie than deprive someone who truly needs the syringes to sustain life. I think there would be a huge case of liability for negligence if a diabetic suffered illness or death from refusal.

 

[sosoo]

......... Today I sold a box of 100 for $23 I believe, patient with a diabetic doggie and rx from DVM. I suspected it was a forged RX since the dog didn't fail metformin yet, but I filled it anyway.

why would the dog need to pass/fail metformin if it has diabetes? just because the dog didn't have metformin you suspect it's a forged Rx? if the dog is on insulin, it doesn't occur to you that the dog has type 1 diabetes? metformin is not indicated for type 1?

 

[CetiAlphaFive]

Just curious on this, but do you think that an attorney won't come after you for refusing to sell insulin syringes to an actual diabetic patient who ends up in DKA or dies from complications of not being able to obtain required items for a medication required to sustain life because of a general opinion you made of this person. I'm in EMS & Law Enforcement and I would much rather a pharmacist take a chance & sell the syringes to a potential junkie than deprive someone who truly needs the syringes to sustain life. I think there would be a huge case of liability for negligence if a diabetic suffered illness or death from refusal.

Yes, everyone with a brain thinks that because we do not have a duty to provide anyone with anything.
The pharmacy is not an emergency room.

why would the dog need to pass/fail metformin if it has diabetes? just because the dog didn't have metformin you suspect it's a forged Rx? if the dog is on insulin, it doesn't occur to you that the dog has type 1 diabetes? metformin is not indicated for type 1?

Hahahahahah, bro. Are you kidding?

 

[sosoo]

Hahahahahah, bro. Are you kidding?

what are you dumbfounded about this time? he thinks the RX is forged just because the dog was not on metformin? metformin is for type 2 and the dog is type 1.

 

[BenJammin]

Just curious on this, but do you think that an attorney won't come after you for refusing to sell insulin syringes to an actual diabetic patient who ends up in DKA or dies from complications of not being able to obtain required items for a medication required to sustain life because of a general opinion you made of this person. I'm in EMS & Law Enforcement and I would much rather a pharmacist take a chance & sell the syringes to a potential junkie than deprive someone who truly needs the syringes to sustain life. I think there would be a huge case of liability for negligence if a diabetic suffered illness or death from refusal.

For there to be liability there must be a breach of duty that was violated. Pharmacists do not have any duty to sell syringes. You can't sue for negligence when they're acting in the normal course of business