Nonprescription Sale of Syringes in Pharmacies
As of January 1, 2015, licensed pharmacists may sell hypodermic needles and syringes to adults age 18 and older without a prescription in order to reduce the spread of blood-borne diseases. Lack of access to new, sterile injection equipment is one of the primary risk factors that leads to syringe sharing, which puts people who inject drugs at high risk for HIV and HCV, as well as for hepatitis B infections.
Nonprescription Syringe Sale (NPSS) Toolkit: Materials for Pharmacists, Health Departments and Customers
The NPSS Toolkit is a compilation of resources designed to help public health agencies expand NPSS in their jurisdictions. The toolkit includes the information pharmacies need in order to start offering syringes for sale without a prescription. The toolkit's documents may be used in training, academic detailing, and planning activities, and serve as quick reference resources for public health and pharmacy staff.
Fact Sheets - Short documents addressing fundamentals
Tools for Educators – Briefing documents for educators, as well as for pharmacists and pharmacy staff
Research Summaries – One-page summaries of journal articles
Journal Articles – Research that provides insight into pharmacists' attitudes and practices. Included here is a sample of some of the peer-reviewed literature on NPSS. Important note: California law has changed as of January 1, 2015. Articles about California pharmacies written prior to that time will include references to prior practices, such as limits on the number of syringes that can be sold, that have been eliminated and are no longer in state statute.
Additional Toolkits and Resources
- List of pharmacy schools in California – Many health departments in the U.S. have worked closely schools of pharmacy to broaden local participation in non-prescription syringe sale, as well as other public health interventions such as naloxone prescription and HIV and HCV medication adherence.
- HIV Testing in Retail Pharmacy Settings - This free training opportunity from CDC provides pharmacists and pharmacy staff the skills necessary to conduct a complete HIV testing session using one rapid test technology with control solutions. This training teaches CDC's Six-Step HIV Testing Protocol and reviews considerations for implementing HIV testing in pharmacy settings. It includes a 60-minute e-Learning pre-course module and 4.5 hours of classroom training.
- Project Inform's website hosts additional information for pharmacists and customers.
Key Provisions of California Law
Adults age 18 and older may possess needles and syringes acquired from a pharmacy, physician or authorized syringe exchange program. There is no limit on the number of needles and syringes that pharmacies may sell to a customer, and no limit on the number an adult can purchase and possess.
Pharmacies that sell syringes without a prescription must store needles and syringes behind counter and must:
- Provide for safe disposal of needles and syringes by choosing one or more of the following options:
- selling or furnishing sharps containers, and/or
- selling or furnishing mail-back sharps containers, and/or
- providing on-site sharps collection and disposal;
- Provide written information or verbal counseling to customers at the time of sale on how to:
- access treatment for substance use disorder,
- access testing and treatment for HIV and HCV, and
- safely dispose of sharps waste. The CDPH Patient Information Sheet (DOC) provides this information in English and in Spanish (DOC).
Needle and Syringe Disposal
Used needles, syringes and lancets ("sharps") from individuals are termed "home-generated" medical waste by California law, and are not regulated as "medical waste," which is generated on site by medical providers.
Businesses and facilities that take back home-generated sharps waste can be found through:
California law related to sharps waste disposal
California law does not require pharmacies to take back sharps waste from individuals; although some local (cities and county) ordinances in California do require pharmacies to take back sharps waste. (Information about these city and county ordinances can be found by visiting the CalRecycle website.)
Business and Professions (B&P) Code Section 4146 permits pharmacies to accept the return of needles and syringes from the public if contained in a sharps container, which is defined in H&S Code Section 117750 as "a rigid puncture-resistant container that, when sealed, is leak resistant and cannot be reopened without great difficulty."
B&P Code 4145.5 requires syringe services programs and pharmacies that sell or provide nonprescription syringes to also provide consumers with one or more of three disposal options: 1) onsite disposal, 2) provision of sharps containers that meet applicable state and federal standards, and/or 3) provision of mail-back sharps containers.
Health and Safety (H&S) Code Section 118286 prohibits individuals from discarding home-generated sharps waste in home or business recycling or waste containers.
H&S Code Section 118286 also requires that home-generated sharps waste be transported only in a sharps container or other container approved by the applicable enforcement agency, which may be either the state or a local government agency.
Two state agencies provide guidance on home-generated sharps waste disposal. CalRecycle's Sharps Waste Disposal page is a valuable resource both for individuals who use sharps and must dispose of them properly, and for counties, cities and businesses working to comply with sharps disposal law.
The California Department of Public Health (CDPH) has the authority to approve locations as points of consolidation for the collection of home-generated sharps waste, which, after collection, are transported and treated as medical waste. CDPH's Medical Waste Management Program provides support and oversight to home-generated sharps consolidation points located in 25 counties and one city. The CDPH website includes locations of home-generated sharps waste disposal sites throughout the state, as well as information on who to contact in each county for further information on home-generated sharps waste disposal.