Western Pa. pharmacists conflicted about '09 syringe law
Not long ago, the son of a longtime customer walked into Asti's South Hills Pharmacy in Castle Shannon to buy syringes typically used to inject insulin.
But owner and pharmacist Dan Asti could see track marks on the young man's arms, and although state law allows needle sales over the counter without a prescription, Asti suspected he would use them to inject heroin.
“He quoted the law at me, and I said, ‘I don't have to sell to you, but how can I help you?' ” Asti said. “He didn't want to be helped. ... That was a hard day.”
As a state House subcommittee holds a public hearing on Wednesday in Hempfield on heroin abuse, more pharmacists are weighing the 2009 law — enacted to slow the spread of HIV and hepatitis by making it easier for addicts to get sterile needles — against their consciences to keep from enabling drug abuse.
“It's not as easy a decision as you might think, from behind the counter,” said Chris Antypas, another pharmacist at Asti's.
“(By selling needles), you're aiding in drug abuse, but on the other hand it's a public health issue. If they're sharing or re-using needles, they have an increased risk of blood-transmitted diseases like hepatitis or HIV. ... Just because we don't sell them syringes, they're not going to stop and check into rehab right there.”
The Allegheny County Medical Examiner's Office reported at least 131 heroin-related deaths in 2012, up from 95 deaths in 2011 and 50 in 2010. Westmoreland County Coroner Kenneth A. Bacha logged 27 heroin-related deaths in 2012 and 22 this year — on pace to surpass last year's record, he said. That doesn't include deaths from other drugs used intravenously, Bacha said, such as crushed and injected Oxycontin.
Police and federal authorities recently broke up heroin distribution rings, arresting 29 alleged street-level dealers on Sept. 27 and 18 on Aug. 29.
Some pharmacists won't sell needles without a prescription or won't sell to first-time customers. Others sell syringes only by the box, hoping that the higher price tag compared to a single bag of syringes might discourage addicts.
“In general, we don't sell needles to people we don't know,” said Gerard O'Hare, owner and pharmacist at Jeffrey's Drug Store in Canonsburg. “We do sell some needles for cash, especially to pet owners who use it to inject their pets' insulin, but as weird as it seems anymore, when people are paying cash, you're already on alert.”
Among major chain pharmacies, Walgreens and Rite Aid say their pharmacies follow states' laws regarding needle sales; company representatives declined to comment on policies regarding suspected drug abusers.
“Our pharmacists are instructed to comply with the applicable state laws and regulations,” said Target spokeswoman Jessica Deede. “In regards to medical needles specifically, we trust and encourage our pharmacists to use their professional judgment.”
George Norkus, owner of Amsler Pharmacy in Allentown, said the advantage to owning his business is that he can set policies — and require a prescription for needles.
“When somebody comes in and wants just one syringe, they're likely to go out and share that syringe anyway,” Norkus said. He refers suspected addicts to the county's needle-exchange program.
Prevention Point Pittsburgh, a county-approved needle exchange, drug treatment and overdose prevention program, notes which pharmacies are willing to sell needles to drug users, in order to supplement Prevention Point's effort to get addicts to use clean needles, but does not keep data on how many places offer syringes for sale.
“There's tremendous variation because, with the change in regulation, there was no mandatory compliance,” said Renee Cox, executive director at Prevention Point. “With the increase in heroin use, we want pharmacists to take a role and be a part of disease prevention.”
Use of Prevention Point's needle-exchange programs dipped slightly when the law changed but since ticked upward, Cox said.
State law prohibiting the sale of drug paraphernalia specifically bans needles used to inject illegal drugs. But the state bulletin explaining over-the-counter syringe sales noted that someone's intent to use a needle for illegal drugs is what distinguishes illegal paraphernalia.
“Pharmacists cannot be held to reasonably know or believe that anyone purchasing needles and syringes without a prescription is using them to inject controlled substances,” the bulletin said.
Walt Lizza, pharmacist at Apothecare in Uniontown, said deciphering customers' intent is difficult, and figuring out who appears to be an intravenous drug user borders on profiling.
Public-health advocates, however, say hesitation by pharmacists and staff goes against the intent of the law. The Pennsylvania Department of Health's annual HIV/AIDS survey showed the number of HIV diagnoses statewide that resulted from intravenous drug use dropped from 224 in 2008 to 177 in 2009; it fell to 124 in 2010, and 96 in 2011 and 2012, though the survey noted the data for those years may be incomplete.
“Pharmacists can talk to other pharmacists, to help them see this law change as an opportunity,” Cox said.
“The whole point was to make syringe acquisition easier for drug users and prevent them from using used needles,” said Ronda Goldfein, executive director of the AIDS Law Project of Pennsylvania, one of the biggest backers of the 2009 change in the law. “Access to clean needles and syringes is important to preventing transmission of disease, maybe long enough for other programs to reach these people and help them with their addiction.”
Matthew Santoni is a Trib Total Media staff writer.