Burris, Scott

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Case Western Reserve University School of Law

Health Matrix: The Journal of Law-MedicineVolume 11 | Issue 12001Symposium: Legal and Ethical Issues of PhysicianPrescription and Pharmacy Sale of Syringes toPatients who Inject Illegal Drugs--Introduction:Ask, Tell, HelpScott BurrisFollow this and additional works at: https://scholarlycommons.law.case.edu/healthmatrixPart of the Health Law and Policy CommonsThis Symposium is brought to you for free and open access by the Student Journals at Case Western Reserve University School of Law ScholarlyCommons. It has been accepted for inclusion in Health Matrix: The Journal of Law-Medicine by an authorized administrator of Case Western ReserveUniversity School of Law Scholarly Commons.Recommended CitationScott Burris, Symposium: Legal and Ethical Issues of Physician Prescription and Pharmacy Sale of Syringes to Patients who Inject IllegalDrugs--Introduction: Ask, Tell, Help, 11 Health Matrix 1 (2001)Available at: https://scholarlycommons.law.case.edu/healthmatrix/vol11/iss1/3SYMPOSIUMLEGAL AND ETHICAL ISSUES OFPHYSICIAN PRESCRIPTION ANDPHARMACY SALE OF SYRINGESTO PATIENTS WHO INJECTILLEGAL DRUGSINTRODUCTION: ASK, TELL, HELPTO STATE THE OBVIOUS, our physicians matter to ourhealth. They diagnose and treat our ills, and can help us identifyand change behaviors that put our health at risk. Doctors can'tmake us eat better or smoke less, but study after study showsthat they can help patients live healthier just by showing interestand offering advice and information. At a social level, physi-cians can play an important role as patient advocates for betterhealth policies.Drug users often have doctors or see doctors, and need theirhelp. Drug use itself is a significant health issue. Although somedrug users can manage even long-term use of powerful drugslike heroin and cocaine, for many others drug use is a destruc-tive, chronic illness. All injection drug users face the risk ofHIV, hepatitis, serious bacterial infections, and overdose. Themedical needs of people who use drugs have been poorly servedin a "war on drugs" focused on punishment.Too often, drug users don't get the help they need fromtheir doctors. Between the stigma of drug use and the social andlegal complexities of our national response to the phenomenon,drug users and their doctors have tacitly applied a "Don't Ask,Don't Tell" policy in the medical encounter. As a result, drug-injecting patients are not necessarily identified as at risk for in-jection-related diseases, nor do physicians use their influence toHEALTH MATRIXhelp patients take better care of themselves by getting treatmentor using drugs more safely.The articles in this symposium address physician prescrip-tion of sterile needles and syringes as a means of improving thehealth of drug users and others whose health may indirectly beplaced at risk by injection-related disease. Burnis, Ng, and Luriereview state syringe and medical and pharmacy practice lawsand conclude that it is legal in most states for physicians to pre-scribe syringes, and for pharmacists to fill the prescriptions.Abrahamson finds no legal impediments in federal law, whileMehlman concludes that the intervention would raise no un-usual malpractice liability. Lazzarini's ethical analysis likewisecomes to the conclusion that ethics support the practice.Prescribing needles can help overcome the most immediatesource of disease risk for injection drug users: the reuse andsharing of needles arising from the users' inability to purchasenew, sterile ones. This is important, and may complement nee-dle exchange and deregulated pharmacy sales as a means ofgetting needles to those who need them to avoid transmitting oracquiring HIV or hepatitis. But as Rich and colleagues recountin their review of the nation's first syringe prescribing clinic,the most important result of the intervention may be the pro-found change in the doctor-patient relationship it creates. Dr.Rich found that having drug use out in the open, as it necessar-ily must be when the physician is offering to prescribe syringes,put an end to "Don't Ask, Don't Tell" in his clinic. Patients whohad concealed their drug use for years now sought his advice,received the care they needed, and assessed their need for drugtreatment. Formal evaluation will eventually provide some ob-jective data on whether eliminating stigma and dealing candidlywith drug use lead to better health outcomes, but Dr. Rich's ac-count leaves no doubt that offering to prescribe syringeschanged his relationships with his patients for the better.If prescribing syringes makes for a better physician-patientrelationship, it must be because the physician changes at least asmuch as the drug user. Physicians generally are uncomfortableabout discussing drug use with patients, and unsure about howto intervene when they detect it. These factors can be overcomewith reflection and a little study. The idea of prescribing sy-ringes is in this light less an end than a means to encouragephysicians to take more responsibility for addressing drug abuseamong their patients.(Vol. 1 1:1INTRODUCTIONAnd not just in their offices. The nation's drug policies aresadly out of tune with the needs of public health and people sickwith drug addiction. Physicians have played a role in articulat-ing a more therapeutic approach to drug use, but more physicianvoices are needed. Writing a needle prescription for a patientwho injects drugs and cannot or will not enter drug treatment isa small but decisive step on the journey to a world in whichpeople with drug problems are cured, not incarcerated.The syringe prescribing project was a group effort, andthanks are owed to many. The authors acknowledge funding andresearch support in their various articles. As a group, we aregrateful to Dean Robert Reinstein, Deborah Feldman, DorothyLee, and the faculty and staff of Temple University's BeasleySchool of Law, who supported the project in ways too numerousto enumerate. We thank Professor Maxwell Mehlman and thestaff of this journal for their unstinting efforts to bring these ar-ticles to press in a timely fashion. Jane Silver of the AmericanFoundation for AIDS Research, and the AIDS CoordinatingCommittee of the American Bar Association, under the chair-manship of Bob Stein, offered very helpful feedback on theproject at various stages. Dr. Steve Jones and Jennifer Taussigat the Centers for Disease Control and Prevention were ofenormous help to lawyers trying to understand the complexitiesof the public health science underlying the analysis, as wereKim Blankenship, Sarah Bray, Robert Heimer, and KavehKhoshnood at the Center for Interdisciplinary Research onAIDS at Yale. Finally, the project could not have been under-taken without a grant from the Substance Abuse Policy Re-search Program of the Robert Wood Johnson Foundation. Allthese people and organizations have helped us frame and an-swer the medical and legal questions surrounding syringe pre-scription, but the responsibility for the conclusions expressed inthe following articles is entirely the authors', and should not beattributed to any of those upon whose assistance we drew.Scott Burristt Professor, Beasley School of Law; Senior Associate, Johns Hopkins Schoolof Public Health and Associate Director, Center for Law and the Public's Health.20011

Symposium: Legal and Ethical Issues of Physician Prescription and Pharmacy Sale of Syringes to Patients who Inject Illegal Drugs--Introduction: Ask, Tell, Help

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Symposium: Legal and Ethical Issues of Physician Prescription and Pharmacy Sale of Syringes to Patients who Inject Illegal Drugs--Introduction: Ask, Tell, Help

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