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January 1, 1997, Vol 277, No. 1 >
ARTICLE | January 1, 1997

Prevention of HIV/AIDS and Other Blood-Borne Diseases Among Injection Drug Users: Title and subTitle BreakA National Survey on the Regulation of Syringes and Needles FREE

Lawrence O. Gostin, JD; Zita Lazzarini, JD, MPH; T. Stephen Jones, MD, MPH; Kathleen Flaherty, JD
[+] Author Affiliations

The views expressed herein are those of the authors and do not necessarily reflect the official policy of the US Department of Health and Human Services, the Carter Presidential Center, the Centers for Disease Control and Prevention, or the cosponsors of the consultation held at the Carter Presidential Center.

Corresponding author: Lawrence Gostin, JD, Georgetown University Law Center, 600 New Jersey Ave NW, Washington, DC 20001 (e-mail: gostin@law.georgetown.edu).

Health Law and Ethics section editors: Lawrence O. Gostin, JD, Georgetown/ Johns Hopkins University Program on Law and Public Health, Washington, DC, and Baltimore, Md; Helene M. Cole, MD, Contributing Editor, JAMA.


JAMA. 1997;277(1):53-62. doi:10.1001/jama.1997.03540250061033
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References

We report the results of a survey of laws and regulations governing the sale and possession of needles and syringes in the United States and its territories and discuss legal and public health proposals to increase the availability of sterile syringes, as a human immunodeficiency virus (HIV) transmission prevention measure, for persons who continue to inject drugs. Every state, the District of Columbia (DC), and the Virgin Islands (VI) have enacted state or local laws or regulations that restrict the sale, distribution, or possession of syringes. Drug paraphernalia laws prohibiting the sale, distribution, and/or possession of syringes known to be used to introduce illicit drugs into the body exist in 47 states, DC, and VI. Syringe prescription laws prohibiting the sale, distribution, and possession of syringes without a valid medical prescription exist in 8 states and VI. Pharmacy regulations or practice guidelines restrict access to syringes in 23 states. We discuss the following legal and public health approaches to improve the availability of sterile syringes to prevent bloodborne disease among injection drug users: (1) clarify the legitimate medical purpose of sterile syringes for the prevention of HIV and other blood-borne infections; (2) modify drug paraphernalia laws to exclude syringes; (3) repeal syringe prescription laws; (4) repeal pharmacy regulations and practice guidelines restricting the sale of sterile syringes; (5) promote professional training of pharmacists, other health professionals, and law enforcement officers about the prevention of blood-borne infections; (6) permit local discretion in establishing syringe exchange programs; and (7) design community programs for safe syringe disposal.

REFERENCES

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2 +
Turner C, Miller H, Moses L. AIDS: Sexual Behavior and Intravenous Drug Use . Washington, DC: National Academy Press; 1989;.
3 +
Centers for Disease Control.  Human immunodeficiency virus infection in the United States: a review of current knowledge . MMWR Morb Mortal Wkly Rep . 1987;;36( (suppl 5-6) ):1-48.
4 +
Garfein RS, Vlahov D, Galai N, et al.  Viral infections in short-term injection drug users: the prevalence of the hepatitis C, hepatitis B, human immunodeficiency, and human T-lymphotrophic viruses . Am J Public Health . 1996;;86:655-661.
5 +
Cherubin CE, Sapira JD.  The medical complications of drug addiction and the medical assessment of the IV drug user: twenty-five years later . Ann Intern Med . 1993;;119:1017-1028.
6 +
Hagan H, Reid T, Des Jarlais D, et al.  The incidence of HBV infection and syringe exchange programs . JAMA . 1991;;266:1646-1647.
7 +
Alter MJ.  Epidemiology of hepatitis C in the West . Semin Liver Dis . 1995;;15:5-14.
8 +
Rice DP, Kelman S, Miller LS.  Estimates of economic costs of alcohol and drug abuse and mental illness, 1985 and 1988 . Public Health Rep . 1991;;106:280-292.
9 +
Centers for Disease Control and Prevention.  First 500,000 AIDS cases— United States, 1995 . MMWR Morb Mortal Wkly Rep . 1995;;44:849-853.
10 +
Centers for Disease Control and Prevention. HIV/AIDS Surveillance Report, 1995 . Atlanta, Ga: US Dept of Health and Human Services, Public Health Service; 1996;.
11 +
Normand J, Vlahov D, Moses LE, eds. Preventing HIV Transmission: The Role of Sterile Needles and Bleach . Washington, DC: National Academy Press; 1995;.
12 +
Hahn RA, Onorato IM, Jones S, Dougherty J.  Prevalence of HIV infection among intravenous drug users in the United States . JAMA . 1989;;261:2677-2684.
13 +
Prevots DR, Allen DM, Lehman JS, et al.  Trends in HIV seroprevalence among injection drug users entering drug treatment centers, United States, 1988-1993 . Am J Epidemiol . 1996;;143:733-742.
14 +
Allen DM, Onorato IM, Green TA.  HIV infection in intravenous drug users entering drug treatment, United States, 1988-1989 . Am J Public Health . 1992;;82:541-546.
15 +
Des Jarlais DC, Friedman SR, Novick DM, et al.  HIV-1 infection among intravenous drug users in Manhattan, New York City, from 1977 through 1987 . JAMA . 1989;;261:1008-1012.
16 +
Newmeyer JA.  The prevalence of drug use in San Francisco in 1987 . J Psychoactive Drugs . 1988;;20:185-189.
17 +
Chaisson R, Moss A, Onishi R, et al.  Human immunodeficiency virus infection in heterosexual intravenous drug users in San Francisco . Am J Public Health . 1987;;77:169-172.
18 +
Centers for Disease Control and Prevention.  AIDS associated with injectingdrug use—United States, 1995 . MMWR Morb Mortal Wkly Rep . 1996;;45:392-398.
19 +
Paone D, Caloir S, Des Jarlais DC.  Sex, drugs, and syringe exchange in New York City: women's experiences . J Am Wom Assoc . 1995;;50:109-114.
20 +
Holmberg SD.  The estimated prevalence and incidence of HIV in 96 large US metropolitan areas . Am J Public Health . 1996;;86:642-654.
21 +
Friedland GH, Klein RS.  Transmission of the human immunodeficiency virus . N Engl J Med . 1987;;317:1125-1135.
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Des Jarlais DC, Friedman SK.  The psychology of preventing AIDS among intravenous drug users . Am Psychologist . 1988;;43:865-869.
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Black JL, Dolan MP, Deford HA, et al.  Sharing of needles among users of intravenous drugs . N Engl J Med . 1986;;314:446-447.
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Magura S, Grossman J1, Lipton DS, et al.  Determinants of needle sharing among intravenous drug users . Am J Public Health . 1989;;79:459-462.
30 +
Koester S, Booth R, Wiebel W.  The risk of HIV transmission from sharing water, drug-mixing containers, and cotton filters among intravenous drug users . Int J Drug Policy . 1990;;1:28-30.
31 +
Celentano DD, Vlahov D, Cohn S, et al.  Risk factors for shooting gallery use and cessation among intravenous drug users . Am J Public Health . 1991;;81:1291-1295.
32 +
Koester SK.  Copping, running, and paraphernalia laws: contextual variables and needle risk behavior among injection drug users in Denver . Hum Organization . 1994;;53:287-295.
33 +
Heimer R, Kaplan EH, O'Keefe E, et al.  Three years of needle exchange in New Haven: what have we learned? AIDS Public Policy J . 1994;;9:59-74.
34 +
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Geiger v City of Eagan, 618 F2d 26 (8th Cir 1980).
39 +
Village of Hoffman Estates v Flipside, Hoffman Estates, Inc, 455 US 489, reh'g denied, 456 US 950 (1982).
40 +
Garner v White, 726 F2d 1274 (8th Cir 1984).
41 +
Camille Corp v Phares, 705 F2d 223 (7th Cir 1983).
42 +
See, eg, Neb Code 28-439(3).
43 +
Spokane County Health District v Brockett, 839 P2d 324 (Wash 1992).
44 +
Dougal v County of Suffolk, 477 NYS2d 381 (App Div 1984)
45 +
affd, 481 NE2d 254 (NY 1985).
46 +
Gless v City of New York, 483 NYS2d 715 (App Div)
47 +
affd, 481 NE2d 254 (NY 1985).
48 +
21 USC §857
49 +
reenacted 21 USC §863 (1990).
50 +
Mail Order Drug Paraphernalia Control Act, 1986: Hearings on HR 1625 Before the Subcommittee on Crime of the House Committee on the Judiciary, 99th Cong, 2nd Sess, 1986:16 (testimony of Joyce Nalepka, president of the National Federation of Parents for a Drug-Free Youth).
51 +
Posters 'N' Things Ltd v United States, 114 S Ct 1747
52 +
reh'g denied, 114 S Ct 2771 (1994).
53 +
Pascal C.  Intravenous drug abuse and AIDS transmission: federal and state laws regulating needle availability . In: Battjes RJ, Pickens RW, eds. Needle Sharing Among Intravenous Drug Abusers: National and International Perspectives . Rockville, Md: National Institute on Drug Abuse; 1988;. NIDA monograph No. 80.
54 +
United States v 57,261 Items of Drug Paraphernalia, 869 F2d 955 (6th Cir)
55 +
cert denied, 493 US 933 (1989).
56 +
United States v Murphy, 977 F2d 503 (10th Cir 1992).
57 +
People v Saul, 176 NYS2d 405 (Columbia County Ct 1958).
58 +
People v Strong, 365 NYS2d 310 (4th Dept 1975)
59 +
affd, 366 NE2d 867 (NY 1977).
60 +
People v Bellfield, 230 NYS2d 79 (Sup Ct 1961)
61 +
affd, 183 NE2d 230 (NY 1962).
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Dyton v State, 250 A2d 383 (Del 1969).
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Musto DF. The American Disease: Origins of Narcotic Control . New York, NY: Oxford University Press; 1987;.
64 +
Fernando MD. AIDS and Intravenous Drug Use: The Influence of Morality, Politics, Social Science, and Race in the Making of a Tragedy . Westport, Conn: Praeger; 1993;:44, 55.
65 +
CA, DE, IL, MA, NH, NJ, NY, RI, VI.
66 +
CA, CT, DE, IL, MA, NV, NH, NJ, NY, OH, RI, VA.
67 +
Case No. 1640, accusation against SAV-ON-DRUGS (decision effective March 4, 1994).
68 +
CA, CT, DE, GA, IN, KY, MD, MA, MN, MO, NV, NJ, NY, ND, OH, PA, SC, TN, VT, VA, WV, WI, WY.
69 +
GA, IN, KY, MD, MN, MO, NV, ND, OH, PA, SC, TN, VT, VA, WV, WI, WY.
70 +
GA, IN, KY, MD, NV, OH, PA, SC, TN, VA, WV.
71 +
AR, CA, CT, DC, IL, IN, KY, MD, MA, NH, NJ, NY, OH, RI, SC, VA, VI, WV.
72 +
CA, CT, DE, KY, ND, OH, RI, VI.
73 +
Compton WM, Cottler LB, Decker SH, et al.  Legal needle buying in St. Louis . Am J Public Health . 1992;;82:595-596.
74 +
CA, DE, FL, IL, MA, NH, NJ, NY, PA, RI, VI.
75 +
DC, GA, IN, KY, MD, MI, MS, MO, NV, OH, SC, TN, TX, VA, WA, WV.
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Des Jarlais DC, Friedman SR, Southern JL, et al.  Continuity and change within an HIV epidemic: injecting drug users in New York City, 1984-1992 . JAMA . 1994;;271;121-127.
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Gleghorn AA, Jones TS, Doherty M, et al.  Acquisition and use of needles and syringes by injecting drug users in Baltimore, Maryland . J Acquir Immune Defic Syndr Hum Retrovirol . 1995;;10:97-103.
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Nelson KE, Vlahov D, Cohn S, et al.  Human immunodeflciency virus infection in diabetic intravenous drug users . JAMA . 1991;;266:2259-2261.
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Singer M, Weeks MR, Himmelgreen D.  Sale and exchange of syringes . J Acquir Immune Defic Syndr Hum Retrovirol . 1995;;10:104.
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Groseclose SL, Weinstein B, Jones TS, et al.  Impact of increased legal access to needles and syringes on practices of injecting-drug users and police officers—Connecticut, 1992-1993 . J Acquir Immune Defic Syndr Hum Retrovirol . 1995;;10:82-89.
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Lurie P, Reingold AL, Bowser B, et al. The Public Health Impact of Needle Exchange Programs in the United States and Abroad . San Francisco: University of California, Institute for Health Policy Studies; 1993;:vol 1.
82 +
In response to the survey, Boise, Idaho, Boston and Cambridge, Mass, and the state of New Jersey reported arrests and/or convictions for possession of drug paraphernalia or syringes.
83 +
Stryker J.  IV drug use and AIDS: public policies and dirty needles . J Health Policy Politics Law . 1989;;14:719-740.
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Grund J-PC, Heckathorn DD, Broadhead RS, Anthony DL.  In Eastern Connecticut, IDUs purchase syringes from pharmacies but don't carry syringes . J Acquir Immune Defic Syndr Hum Retrovirol . 1995;;10:104-105.
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Feldman HIV, Biernacki P.  The ethnography of needle sharing among intravenous drug users and implications for public policies and intervention strategies . In: Battjes RI, Pickens RW, eds. Needle Sharing Among Intravenous Drug Abusers: National and International Perspectives . Rockville, Md: National Institute on Drug Abuse; 1988;:28-39. NIDA Monograph No. 80.
86 +
Valleroy LA, Weinstein B, Jones TS, et al.  Impact of increased legal access to needles and syringes on community pharmacies' needle and syringe sales— Connecticut, 1992-1993 . J Acquir Immune Defic Syndr Hum Retrovirol . 1995;;10:73-81.
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Croatto JP, Ewart FJ, Hage BH, et al.  The role of the pharmacist in preventing a 'second wave' of the HIV epidemic among IV drug users . Aust J Pharm . 1987;;68:602-604.
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Ettelson R.  Sell needles and syringes to IV drug abusers? Pharm Times . 1991;;57:107-114.
90 +
Compton WM III, Cottler LB, Decker SH, et al.  Legal needle buying in St. Louis . Am J Public Health . 1992;;82:595-596.
91 +
Zellmer WA.  Pharmacist involvement in needle exchange programs . Am Pharm . 1994;;34( (9) ):48-51.
92 +
People v Lipton, 429 NE2d 1059 (NY 1981).
93 +
People v Goldberg, 369 NYS2d 989 (Sup Ct 1975).
94 +
People v Lonergan, 267 Cal Rptr 887 (Ct App)
95 +
review denied, 1990 Cal LEXIS 2801 (Cal June 27, 1990).
96 +
Perzik v Superior Court, 4 Cal Rptr 2d 1 (Ct App 1991).
97 +
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99 +
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100 +
Hartgers C, Buning ED, van Santen GW, Vester AD, Coutinho RA.  The impact of the needle and syringe-exchange programme in Amsterdam in injecting risk behavior . J Acquir Immune Defic Syndr . 1989;;3:571-576.
101 +
Ljunberg B, Christensson B, Tuning K, et al.  HIV prevention among injecting drug users: three years' experience from a syringe exchange program in Sweden . J Acquir Immune Defic Syndr . 1991;;4:890-895.
102 +
Burris S, Finucane D, Gallagher H, Grace J.  The legal strategies used in operating syringe exchange programs in the United States . Am J Public Health . 1996;;86:1161-1166.
103 +
Spokane County Health District v Brockett, 839 P2d 324 (Wash 1992).
104 +
Allen v City of Tacoma, No. 89-2-09067-3 (Wash Super Ct, Pierce County, May 9, 1990).
105 +
Clark C.  Grand jury calls for needle exchange . San Diego Union-Tribune . (June 29) , 1994;:B1.
106 +
Hoge P.  Needle laws force a political balancing act . Sacramento Bee . (December 5) , 1994;:A1.
107 +
Cheevers J.  Needle exchanges battle AIDS and the law; addicts spread HIV by sharing contaminated syringes . Los Angeles Times . (January 9) ,1995;:A1.
108 +
Commonwealth v Parker, No. 89-0123 (Boston Mun Crim Ct January 23, 1991) (Order and Findings); Bench Ruling No. 89-01213, January 9,1990 (defendant acquitted).
109 +
State v Sorge, 591 A2d 1382 (NJ Super Ct Law Div 1991) (necessity defense unsuccessful, conviction upheld).
110 +
People v Bordowitz, 588 NYS2d 507 (Crim Ct 1991) (defendants acquitted).
111 +
Commonwealth v Leno, 616 NE2d 453 (Mass 1993) (necessity defense not allowed, conviction upheld).
112 +
Gostin LO.  Law and policy . In: Stryker J, Smith MD, eds. Dimensions of HIV Prevention: Needle Exchange . Menlo Park, Calif: Henry J Kaiser Family Foundation; 1993;.
113 +
National Commission on AIDS. The Twin Epidemics of Substance Use and HIV . Washington, DC: Presidential Commission on AIDS; 1991;.
114 +
American Medical Association. House of Delegates Resolution 405 (I-96): Intravenous drug use, syringes, substance abuse treatment, and HIV prevention . Chicago, Ill: American Medical Association; 1996;.
115 +
Committee on Medicine and Law. Legalization of Non-Prescription Sale of Hypodermic Needles: A Response to the AIDS Crisis . New York, NY: Association of the Bar of the City of New York; 1986;.
116 +
ABA AIDS Coordinating Committee. AIDS: The Legal Issues . Washington, DC: American Bar Association; 1988;.
117 +
Des Jarlais DC, Hopkins W.  'Free' needles for intravenous drug users at risk for AIDS: current developments in New York City . N Engl J Med . 1985;;313:1476.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Gostin LO.  The interconnected epidemics of drug dependency and AIDS . Harvard CR-CL Law Rev . 1991;;26:113-184.
2 +
Turner C, Miller H, Moses L. AIDS: Sexual Behavior and Intravenous Drug Use . Washington, DC: National Academy Press; 1989;.
3 +
Centers for Disease Control.  Human immunodeficiency virus infection in the United States: a review of current knowledge . MMWR Morb Mortal Wkly Rep . 1987;;36( (suppl 5-6) ):1-48.
4 +
Garfein RS, Vlahov D, Galai N, et al.  Viral infections in short-term injection drug users: the prevalence of the hepatitis C, hepatitis B, human immunodeficiency, and human T-lymphotrophic viruses . Am J Public Health . 1996;;86:655-661.
5 +
Cherubin CE, Sapira JD.  The medical complications of drug addiction and the medical assessment of the IV drug user: twenty-five years later . Ann Intern Med . 1993;;119:1017-1028.
6 +
Hagan H, Reid T, Des Jarlais D, et al.  The incidence of HBV infection and syringe exchange programs . JAMA . 1991;;266:1646-1647.
7 +
Alter MJ.  Epidemiology of hepatitis C in the West . Semin Liver Dis . 1995;;15:5-14.
8 +
Rice DP, Kelman S, Miller LS.  Estimates of economic costs of alcohol and drug abuse and mental illness, 1985 and 1988 . Public Health Rep . 1991;;106:280-292.
9 +
Centers for Disease Control and Prevention.  First 500,000 AIDS cases— United States, 1995 . MMWR Morb Mortal Wkly Rep . 1995;;44:849-853.
10 +
Centers for Disease Control and Prevention. HIV/AIDS Surveillance Report, 1995 . Atlanta, Ga: US Dept of Health and Human Services, Public Health Service; 1996;.
11 +
Normand J, Vlahov D, Moses LE, eds. Preventing HIV Transmission: The Role of Sterile Needles and Bleach . Washington, DC: National Academy Press; 1995;.
12 +
Hahn RA, Onorato IM, Jones S, Dougherty J.  Prevalence of HIV infection among intravenous drug users in the United States . JAMA . 1989;;261:2677-2684.
13 +
Prevots DR, Allen DM, Lehman JS, et al.  Trends in HIV seroprevalence among injection drug users entering drug treatment centers, United States, 1988-1993 . Am J Epidemiol . 1996;;143:733-742.
14 +
Allen DM, Onorato IM, Green TA.  HIV infection in intravenous drug users entering drug treatment, United States, 1988-1989 . Am J Public Health . 1992;;82:541-546.
15 +
Des Jarlais DC, Friedman SR, Novick DM, et al.  HIV-1 infection among intravenous drug users in Manhattan, New York City, from 1977 through 1987 . JAMA . 1989;;261:1008-1012.
16 +
Newmeyer JA.  The prevalence of drug use in San Francisco in 1987 . J Psychoactive Drugs . 1988;;20:185-189.
17 +
Chaisson R, Moss A, Onishi R, et al.  Human immunodeficiency virus infection in heterosexual intravenous drug users in San Francisco . Am J Public Health . 1987;;77:169-172.
18 +
Centers for Disease Control and Prevention.  AIDS associated with injectingdrug use—United States, 1995 . MMWR Morb Mortal Wkly Rep . 1996;;45:392-398.
19 +
Paone D, Caloir S, Des Jarlais DC.  Sex, drugs, and syringe exchange in New York City: women's experiences . J Am Wom Assoc . 1995;;50:109-114.
20 +
Holmberg SD.  The estimated prevalence and incidence of HIV in 96 large US metropolitan areas . Am J Public Health . 1996;;86:642-654.
21 +
Friedland GH, Klein RS.  Transmission of the human immunodeficiency virus . N Engl J Med . 1987;;317:1125-1135.
22 +
Haverkos HIV, Jones TS.  HIV, drug-use paraphernalia, and bleach . J Acquir Immune Defic Syndr . 1994;;7:741-742.
23 +
US Preventive Services Task Force. Guide to Clinical Preventive Services . 2nd ed. Baltimore, Md: Williams & Wilkins; 1996;.
24 +
Centers for Disease Control and Prevention.  Improper infection control practices during employee vaccination programs—District of Columbia and Pennsylvania, 1993 . MMWR Morb Mortal Wkly Rep . 1993;;42:969-971.
25 +
American Medical Association. A Physician Guide to HIV Prevention . Chicago, Ill: American Medical Association; 1996;.
26 +
Des Jarlais DC, Friedman SK.  The psychology of preventing AIDS among intravenous drug users . Am Psychologist . 1988;;43:865-869.
27 +
Donoghoe MC, Stimson GV, Dolan K, et al.  Changes in HIV risk behavior in clients of syringe-exchange schemes in England and Scotland . AIDS . 1989;;3:267-272.
28 +
Black JL, Dolan MP, Deford HA, et al.  Sharing of needles among users of intravenous drugs . N Engl J Med . 1986;;314:446-447.
29 +
Magura S, Grossman J1, Lipton DS, et al.  Determinants of needle sharing among intravenous drug users . Am J Public Health . 1989;;79:459-462.
30 +
Koester S, Booth R, Wiebel W.  The risk of HIV transmission from sharing water, drug-mixing containers, and cotton filters among intravenous drug users . Int J Drug Policy . 1990;;1:28-30.
31 +
Celentano DD, Vlahov D, Cohn S, et al.  Risk factors for shooting gallery use and cessation among intravenous drug users . Am J Public Health . 1991;;81:1291-1295.
32 +
Koester SK.  Copping, running, and paraphernalia laws: contextual variables and needle risk behavior among injection drug users in Denver . Hum Organization . 1994;;53:287-295.
33 +
Heimer R, Kaplan EH, O'Keefe E, et al.  Three years of needle exchange in New Haven: what have we learned? AIDS Public Policy J . 1994;;9:59-74.
34 +
Veal GR.  The Model Drug Paraphernalia Act: can we outlaw head shops— and should we? Georgia Law Rev . 1981;;16:137-169.
35 +
Drug Paraphernalia: Hearing Before the House Select Committee on Narcotics Abuse and Control, 96th Cong, 1st Sess, 1979:79 (testimony of Dan Leonard, staff investigator for the House Select Committee on Narcotics Abuse and Control).
36 +
Mid-Atlantic Accessories Trade Ass'n v Maryland, 500 Supp 834, 841 (D Md 1980).
37 +
McKoy v United States (Case 2), 263 A2d 649 (DC 1970).
38 +
Geiger v City of Eagan, 618 F2d 26 (8th Cir 1980).
39 +
Village of Hoffman Estates v Flipside, Hoffman Estates, Inc, 455 US 489, reh'g denied, 456 US 950 (1982).
40 +
Garner v White, 726 F2d 1274 (8th Cir 1984).
41 +
Camille Corp v Phares, 705 F2d 223 (7th Cir 1983).
42 +
See, eg, Neb Code 28-439(3).
43 +
Spokane County Health District v Brockett, 839 P2d 324 (Wash 1992).
44 +
Dougal v County of Suffolk, 477 NYS2d 381 (App Div 1984)
45 +
affd, 481 NE2d 254 (NY 1985).
46 +
Gless v City of New York, 483 NYS2d 715 (App Div)
47 +
affd, 481 NE2d 254 (NY 1985).
48 +
21 USC §857
49 +
reenacted 21 USC §863 (1990).
50 +
Mail Order Drug Paraphernalia Control Act, 1986: Hearings on HR 1625 Before the Subcommittee on Crime of the House Committee on the Judiciary, 99th Cong, 2nd Sess, 1986:16 (testimony of Joyce Nalepka, president of the National Federation of Parents for a Drug-Free Youth).
51 +
Posters 'N' Things Ltd v United States, 114 S Ct 1747
52 +
reh'g denied, 114 S Ct 2771 (1994).
53 +
Pascal C.  Intravenous drug abuse and AIDS transmission: federal and state laws regulating needle availability . In: Battjes RJ, Pickens RW, eds. Needle Sharing Among Intravenous Drug Abusers: National and International Perspectives . Rockville, Md: National Institute on Drug Abuse; 1988;. NIDA monograph No. 80.
54 +
United States v 57,261 Items of Drug Paraphernalia, 869 F2d 955 (6th Cir)
55 +
cert denied, 493 US 933 (1989).
56 +
United States v Murphy, 977 F2d 503 (10th Cir 1992).
57 +
People v Saul, 176 NYS2d 405 (Columbia County Ct 1958).
58 +
People v Strong, 365 NYS2d 310 (4th Dept 1975)
59 +
affd, 366 NE2d 867 (NY 1977).
60 +
People v Bellfield, 230 NYS2d 79 (Sup Ct 1961)
61 +
affd, 183 NE2d 230 (NY 1962).
62 +
Dyton v State, 250 A2d 383 (Del 1969).
63 +
Musto DF. The American Disease: Origins of Narcotic Control . New York, NY: Oxford University Press; 1987;.
64 +
Fernando MD. AIDS and Intravenous Drug Use: The Influence of Morality, Politics, Social Science, and Race in the Making of a Tragedy . Westport, Conn: Praeger; 1993;:44, 55.
65 +
CA, DE, IL, MA, NH, NJ, NY, RI, VI.
66 +
CA, CT, DE, IL, MA, NV, NH, NJ, NY, OH, RI, VA.
67 +
Case No. 1640, accusation against SAV-ON-DRUGS (decision effective March 4, 1994).
68 +
CA, CT, DE, GA, IN, KY, MD, MA, MN, MO, NV, NJ, NY, ND, OH, PA, SC, TN, VT, VA, WV, WI, WY.
69 +
GA, IN, KY, MD, MN, MO, NV, ND, OH, PA, SC, TN, VT, VA, WV, WI, WY.
70 +
GA, IN, KY, MD, NV, OH, PA, SC, TN, VA, WV.
71 +
AR, CA, CT, DC, IL, IN, KY, MD, MA, NH, NJ, NY, OH, RI, SC, VA, VI, WV.
72 +
CA, CT, DE, KY, ND, OH, RI, VI.
73 +
Compton WM, Cottler LB, Decker SH, et al.  Legal needle buying in St. Louis . Am J Public Health . 1992;;82:595-596.
74 +
CA, DE, FL, IL, MA, NH, NJ, NY, PA, RI, VI.
75 +
DC, GA, IN, KY, MD, MI, MS, MO, NV, OH, SC, TN, TX, VA, WA, WV.
76 +
Des Jarlais DC, Friedman SR, Southern JL, et al.  Continuity and change within an HIV epidemic: injecting drug users in New York City, 1984-1992 . JAMA . 1994;;271;121-127.
77 +
Gleghorn AA, Jones TS, Doherty M, et al.  Acquisition and use of needles and syringes by injecting drug users in Baltimore, Maryland . J Acquir Immune Defic Syndr Hum Retrovirol . 1995;;10:97-103.
78 +
Nelson KE, Vlahov D, Cohn S, et al.  Human immunodeflciency virus infection in diabetic intravenous drug users . JAMA . 1991;;266:2259-2261.
79 +
Singer M, Weeks MR, Himmelgreen D.  Sale and exchange of syringes . J Acquir Immune Defic Syndr Hum Retrovirol . 1995;;10:104.
80 +
Groseclose SL, Weinstein B, Jones TS, et al.  Impact of increased legal access to needles and syringes on practices of injecting-drug users and police officers—Connecticut, 1992-1993 . J Acquir Immune Defic Syndr Hum Retrovirol . 1995;;10:82-89.
81 +
Lurie P, Reingold AL, Bowser B, et al. The Public Health Impact of Needle Exchange Programs in the United States and Abroad . San Francisco: University of California, Institute for Health Policy Studies; 1993;:vol 1.
82 +
In response to the survey, Boise, Idaho, Boston and Cambridge, Mass, and the state of New Jersey reported arrests and/or convictions for possession of drug paraphernalia or syringes.
83 +
Stryker J.  IV drug use and AIDS: public policies and dirty needles . J Health Policy Politics Law . 1989;;14:719-740.
84 +
Grund J-PC, Heckathorn DD, Broadhead RS, Anthony DL.  In Eastern Connecticut, IDUs purchase syringes from pharmacies but don't carry syringes . J Acquir Immune Defic Syndr Hum Retrovirol . 1995;;10:104-105.
85 +
Feldman HIV, Biernacki P.  The ethnography of needle sharing among intravenous drug users and implications for public policies and intervention strategies . In: Battjes RI, Pickens RW, eds. Needle Sharing Among Intravenous Drug Abusers: National and International Perspectives . Rockville, Md: National Institute on Drug Abuse; 1988;:28-39. NIDA Monograph No. 80.
86 +
Valleroy LA, Weinstein B, Jones TS, et al.  Impact of increased legal access to needles and syringes on community pharmacies' needle and syringe sales— Connecticut, 1992-1993 . J Acquir Immune Defic Syndr Hum Retrovirol . 1995;;10:73-81.
87 +
Croatto JP, Ewart FJ, Hage BH, et al.  The role of the pharmacist in preventing a 'second wave' of the HIV epidemic among IV drug users . Aust J Pharm . 1987;;68:602-604.
88 +
Glantz A, Byrne C, Jackson P.  Role of community pharmacies in prevention of AIDS among injecting drug misusers: findings of a survey in England and Wales . BMJ . 1989;;299:1076-1079.
89 +
Ettelson R.  Sell needles and syringes to IV drug abusers? Pharm Times . 1991;;57:107-114.
90 +
Compton WM III, Cottler LB, Decker SH, et al.  Legal needle buying in St. Louis . Am J Public Health . 1992;;82:595-596.
91 +
Zellmer WA.  Pharmacist involvement in needle exchange programs . Am Pharm . 1994;;34( (9) ):48-51.
92 +
People v Lipton, 429 NE2d 1059 (NY 1981).
93 +
People v Goldberg, 369 NYS2d 989 (Sup Ct 1975).
94 +
People v Lonergan, 267 Cal Rptr 887 (Ct App)
95 +
review denied, 1990 Cal LEXIS 2801 (Cal June 27, 1990).
96 +
Perzik v Superior Court, 4 Cal Rptr 2d 1 (Ct App 1991).
97 +
Bruneau J, Franco E, Lamothe F, et al. Increased HIV seroprevalence and seroincidence associated with participation in needle exchange program: unexpected findings from the Saint-Luc cohort study in Montreal. In: Proceedings and abstracts from the XI International Conference on AIDS; July 1996; Vancouver, British Columbia. Abstract Tu.C.323.
98 +
Watters JK.  Syringe and needle exchange as HIV/AIDS prevention for injection drug users . JAMA . 1994;;271:115-120.
99 +
Kaplan EH, Heimer K.  HIV prevalence among intravenous drug users: model-based estimates from New Haven's legal needle exchange . J Acquir Immune Defic Syndr . 1992;;5:163-169.
100 +
Hartgers C, Buning ED, van Santen GW, Vester AD, Coutinho RA.  The impact of the needle and syringe-exchange programme in Amsterdam in injecting risk behavior . J Acquir Immune Defic Syndr . 1989;;3:571-576.
101 +
Ljunberg B, Christensson B, Tuning K, et al.  HIV prevention among injecting drug users: three years' experience from a syringe exchange program in Sweden . J Acquir Immune Defic Syndr . 1991;;4:890-895.
102 +
Burris S, Finucane D, Gallagher H, Grace J.  The legal strategies used in operating syringe exchange programs in the United States . Am J Public Health . 1996;;86:1161-1166.
103 +
Spokane County Health District v Brockett, 839 P2d 324 (Wash 1992).
104 +
Allen v City of Tacoma, No. 89-2-09067-3 (Wash Super Ct, Pierce County, May 9, 1990).
105 +
Clark C.  Grand jury calls for needle exchange . San Diego Union-Tribune . (June 29) , 1994;:B1.
106 +
Hoge P.  Needle laws force a political balancing act . Sacramento Bee . (December 5) , 1994;:A1.
107 +
Cheevers J.  Needle exchanges battle AIDS and the law; addicts spread HIV by sharing contaminated syringes . Los Angeles Times . (January 9) ,1995;:A1.
108 +
Commonwealth v Parker, No. 89-0123 (Boston Mun Crim Ct January 23, 1991) (Order and Findings); Bench Ruling No. 89-01213, January 9,1990 (defendant acquitted).
109 +
State v Sorge, 591 A2d 1382 (NJ Super Ct Law Div 1991) (necessity defense unsuccessful, conviction upheld).
110 +
People v Bordowitz, 588 NYS2d 507 (Crim Ct 1991) (defendants acquitted).
111 +
Commonwealth v Leno, 616 NE2d 453 (Mass 1993) (necessity defense not allowed, conviction upheld).
112 +
Gostin LO.  Law and policy . In: Stryker J, Smith MD, eds. Dimensions of HIV Prevention: Needle Exchange . Menlo Park, Calif: Henry J Kaiser Family Foundation; 1993;.
113 +
National Commission on AIDS. The Twin Epidemics of Substance Use and HIV . Washington, DC: Presidential Commission on AIDS; 1991;.
114 +
American Medical Association. House of Delegates Resolution 405 (I-96): Intravenous drug use, syringes, substance abuse treatment, and HIV prevention . Chicago, Ill: American Medical Association; 1996;.
115 +
Committee on Medicine and Law. Legalization of Non-Prescription Sale of Hypodermic Needles: A Response to the AIDS Crisis . New York, NY: Association of the Bar of the City of New York; 1986;.
116 +
ABA AIDS Coordinating Committee. AIDS: The Legal Issues . Washington, DC: American Bar Association; 1988;.
117 +
Des Jarlais DC, Hopkins W.  'Free' needles for intravenous drug users at risk for AIDS: current developments in New York City . N Engl J Med . 1985;;313:1476.

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