I had to present this topic recently in my Pharmacy law class as a debate. My team was agaist the sale of syringes OTC. This is our supporting arrgument and rebuttal:
Requiring prescriptions for syringes can:
improve patients overall health by encouraging routine doctors visits
promote an open trusting relationship between healthcare professionals and illicit drug users
ensure better education on appropriate use and disposal of syringes and needles
1. Straight Argument
a. Access
i. Strengths
1. Provides incentive for patients to utilize routine doctor visits.
a. According to the CDC, Diabetes is the 7th leading cause of death and is a gateway to other
Diseases including heart disease (leading cause of death) and stroke (3rd leading cause of death)
b. A 2011 study found in The Archives of Internal Medicine, indicated that diabetes patients who
visited a primary care provider every 1-2 weeks vs. 3-6 months achieved goal levels of
hemoglobin A1c (10 months vs. 53 months), BP (1 month vs. 14 months), and LDL-C (5 months
vs. 33 months) quicker than patients with irregular visits.
(
http://archinte.jamanetwork.com/article.aspx?articleid=1105940)
2. Promotes relationships between Intravenous Drug Users (IDUs) and medical professionals which could lead to renewed trust, additional health services and education, and entry into substance abuse programs.
a. A study published by the Journal of Urban Health: Bulletin of the New York Academy of
Medicine, discussed a program that permitted doctors to prescribe sterile syringes to IDUs.
Participants of the study received education on safer injection practices such as cleaning
injection site with alcohol, using a tourniquet, rotating injections sites and signs of abscesses,
cellulitis, and endocarditis. Also, participants received counseling on overdose prevention, safe
disposal of used syringes, and received a free biohazard bucket.
b. Patients received much-needed medical screenings including HIV, hepatitis, tuberculosis, and
syphilis. Also, patients could receive Hepatitis B vaccinations.
c. Overall, the syringe prescription program offered a hook into further medical care, encouraged
an ongoing relationship between the drug user and healthcare professional, and established a
basis for substance abuse treatment. (
http://www.springerlink.com/content/95qhr77n62353130/fulltext.pdf)
d. Because of the illicit nature of drug use, a tremendous amount of mistrust and fear on the part of IDUs often leads to poor interaction with the medical establishment. Prescription of syringes by a physician can serve as a tool for reaching out to a high-risk and often out-of-treatment population of drug users. It is a way for the health care community to tap into drug-using networks and bring those populations into a medical care system.
(
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1446672/ )
ii. Weaknesses
1. Requiring prescriptions for syringes does not guarantee patients will visit the doctor more frequently.
b. Cost
i. Strengths
1. Syringes, and other diabetic equipment, are covered under Medicaid Part D and would be provided at no cost to patients with a prescription.
2. According to Texas State Law, if the price of a drug to a patient is lower than the amount of the patient's co-payment under the patient's prescription drug insurance plan, the pharmacist shall offer the patient the option of paying for the drug at the lower price instead of paying the amount of the co-payment.
ii. Weaknesses
1. Patients are required to pay a dispensing fee on prescriptions which may elevate costs slightly over OTC pricing.
c. Quality
i. Strengths
1. Prescription syringes will increase interaction with pharmacy professionals who can provide education on proper use and disposal of syringes. Increased education can improve techniques, reduce needle sticks, and decrease hazardous events associated with improper disposal.
2. Proper education on hazards of reusing needles can reduce risk of infection in diabetic patients.
a. Patients who reuse needles when injecting insulin are at a greater risk of developing infections. (
http://jama.jamanetwork.com/article.aspx?articleid=360391#References)
3. Education on Silent Needle syndrome and proper disposal of syringes and needles can decrease silent needle events.
a. Silent Needle occurs when needles or fragments of needles silently penetrate the soft tissues and go unnoticed. They cause infection and injury. Educating diabetic patients can reduce these events. (
http://jama.jamanetwork.com/article.aspx?articleid=1030817 )
ii. Weaknesses
1. Silent Needle Syndrome is rare.
2. Rebuttal
a. In some areas, HIV is still on the rise, despite the programs.
i. A study in Vancouver from 2003 shows that although NEPs are in place there is an increasing prevalence of HIV. This is believed to be due to the fact that providing clean needles for those who participate only touches one facet of the epidemic when more thorough intervention including education for prevention and rehabilitation programs are not provided.
b. Statistics are not showing a strong utilization of OTC programs and users are still reusing needles.
i. A study in San Francisco from 1997-1999, shows that with all the NEPs in place of the 308 IDUs studied, roughly only 30% report actually utilizing the programs. Conversely, 50% admit to reusing needles and sharing with someone else.
c. A report by the CDC shows that 21.3 million dollars (16.8 of which was from the government) was spent on syringes for SEPs. Also, of the estimated 920 million-1.7 billion injections by IDUs per year in the US, 29.1 million syringes are exchanged (~1.7-3%).
d. A study done in Hartford, Connecticut from 1997 shows that 26 pharmacy managers reported an incidence with IDUs ranging from having to fill $0.50 orders for syringes during busy times, to being attacked with a syringe by an IDU. Out of the 25 pharmacies in Hartford only eight were willing to sell non-prescription syringes and within a years time, that number dropped to five.
e. There is a poor correlation between transmission of HIV/AIDS and IV drug use.
i. According to the CDC, Only 7% of male HIV contraction and 14% of female contraction is from IUD
3. Recommendations
a. We do not support the OTC supply of syringes which may be reused, thus defeating the purpose of the non-prescription regulation. If necessary, OTC syringes should only be supplied as the self-sheathing needles (with education on use) to prevent injuries and reuse among users.
i. Implementation of a safety re-sheathable winged steel needle substantially reduced injuries among healthcare workers performing vascular‐access procedures. The residual risk of injury associated with this device can be reduced further with increased compliance with proper activation procedures.
http://www.jstor.org/stable/10.1086/502174
