In clarifying that position, it was stated that, if pharmacies were turned into collection sites for dirty needles by encouraging injection drug users to exchange their needles in drugstores, adverse consequences could result because of reduced quality of services provided to other customers. That is, other customers would not receive the needed medical and prescription-related information they have come to expect. Moreover, the retailer representative pointed out that liability concerns arise from having to adhere to rules and regulations set forth by the Drug Enforcement Agency (DEA), the Environmental Protection Agency (EPA), the Food and Drug Administration (FDA), and the Occupational Safety and Health Administration (OSHA), as well as state and local health departments.

For example, OSHA adopted the blood-borne pathogen standard in December 1991. This consists of a comprehensive set of requirements with which an employer must comply to protect employees from exposure to blood-borne pathogens in the workplace. The standards include, among other things, a workplace evaluation for hazard potential, a written plan for treatment and follow-up, and other record-keeping requirements.

If pharmacies were to serve as exchange sites, employees would be placed at potential risk of occupational exposure to blood-borne pathogens. OSHA standards would require that all staff be properly trained on how to handle the contaminated needles. With regard to the economic implications of having pharmacy-based needle exchange programs, it was noted that the costs associated with complying with federal and state regulations would be substantial. This would not include the potential adverse effect of these programs on profit margins caused by increased thefts.

The representative from the American Pharmaceutical Association, whose membership numbers 40,000 professionals, stated that the association has an official policy statement that supports needle exchange programs as part of a comprehensive approach to HIV infection. This approach also includes outreach, counseling, treatment, and community involvement in decisions about how the program should be implemented. Moreover, it is the association's view that pharmacists are in a unique position as health care professionals in communities to play an important role in prevention efforts by expanding sales of needles, by serving as distribution sites for needle exchange (after the appropriate amendments to state and federal laws are made), or both. The association recognizes that not all pharmacists would be willing to participate in such efforts, but it believes that some would, and that a significant impact could be made even if a small proportion of pharmacies participate.

The discussion that followed the workshop presentations by health care professionals raised important issues regarding the professional discretion of individual pharmacists in the 41 states in which there are no prescription laws to determine whether to sell needles to individual customers. In states



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