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I. SUMMARY

More than twenty years into the epidemic of human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS), injection drug use remains a major risk factor for HIV transmission in the United States and in many parts of the world. Despite the well documented effectiveness of syringe exchange programs and other measures that encourage the use of sterile injection equipment, these interventions in the United States are scattered, lack support, and in the worst cases are forbidden by law. Injection drug users who are denied access to sterile syringes often share and reuse syringes, placing themselves, their sex partners and their children at significant risk of HIV infection. Since the beginning of the AIDS epidemic, injection drug use has accounted for over a third of all reported AIDS cases in the United States and, according to recent surveys, continues to account for up to half of new HIV infections.

While the proper and consistent use of sterile syringes would all but eliminate this problem, syringes remain heavily regulated by an intricate body of state law. The United States Public Health Service counsels injection drug users to use a sterile syringe for every injection, and the Centers for Disease Control and Prevention (CDC) state that “for injection drug users who cannot or will not stop injecting drugs, using sterile needles and syringes only once remains the safest, most effective approach for limiting HIV transmission.” State laws, however, make unauthorized possession of sterile syringes a criminal offense. It is this discrepancy, and its impact on the prevention of a fatal and socially destructive disease, that this report seeks to address.

Programs that provide access to sterile syringes have been proven time and again to reduce HIV transmission without either encouraging drug use or increasing drug related crime. Syringe exchange, as well as similar measures such as nonprescription pharmacy sale of syringes, is an effective and life-saving health intervention. Yet syringe exchange is banned in much of the United States and, where it is allowed, is obstructed by laws forbidding the possession of drug paraphernalia. Other modes of syringe access, such as nonprescription pharmacy sale of syringes, are as of this writing forbidden in five states: California, Massachusetts, New Jersey, Delaware, and Pennsylvania. Almost all fifty states have enacted drug paraphernalia laws similar to model legislation written by the Drug Enforcement Agency in 1979 under President Jimmy Carter. Drug paraphernalia laws are encouraged by United Nations anti-drug conventions, which call on governments to take aggressive law enforcement measures against illicit drug use.

This report takes California as a case study of how the ideology of the “war on drugs” has trumped both reason and reality in the United States and violated the human right of injection drug users to take steps to protect their health. While syringe exchange services are legal in several California counties pursuant to the declaration of a local “state of emergency,” the unauthorized possession and distribution of hypodermic syringes is illegal statewide. Accordingly, this report documents cases of drug users being arrested, harassed, searched, and otherwise penalized based on possession of sterile syringes and other items obtained at legal syringe exchange programs. It also examines the situation of localities that have banned syringe exchange outright, forcing drug users to find syringes in trash cans, dumpsters, and “shooting galleries.” It documents cases of individuals who wish only to purchase sterile syringes at a pharmacy with their own money but are prevented from doing so by laws forbidding pharmacies from selling syringes without a prescription.

Syringe regulations in the United States reflect a gap between what is known about HIV prevention and what policy-makers choose to do about it. These regulations assume that deregulating syringes would encourage illegal drug use, even though this assumption has been refuted many times, including by government-funded studies. Over twenty years into the AIDS epidemic, it is not too late to deregulate syringes nationwide and stop consigning drug users to a preventable death. It is not too late to inject reason into the war on drugs.


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September 2003