title: Adverse event associated with a change in nonprescription syringe sale policy.
abstract: OBJECTIVE
  To report and describe the possible correlation of a change in syringe sale policy at a community pharmacy with an adverse clinical outcome.
  
  
  METHODS
  Providence, RI, in summer 2009.
  
  
  METHODS
  27-year-old white woman with a long-standing history of chronic relapsing opiate addiction and human immunodeficiency virus (HIV)/hepatitis C virus (HCV) coinfection.
  
  
  METHODS
  The patient presented to the hospital emergency department with 5 days of severe diffuse pain, swelling in her hands and feet, and several days of rigors with fevers, sweats, and chills. She was diagnosed with sepsis resulting from a disseminated methicillin-resistant Staphylococcus aureus (MRSA) infection. The patient was treated with intravenous antibiotics, neurosurgical drainage of an epidural abscess, intensive care unit care for 1 week, and acute hospitalization for 8 weeks.
  
  
  METHODS
  Not applicable.
  
  
  RESULTS
  A few weeks before the patient was hospitalized, pharmacists at her local neighborhood pharmacy decided to stop selling syringes in packages of 10. Instead, syringes were sold at a minimum quantity of 100. The patient did not know where to obtain sterile syringes and began reusing syringes.
  
  
  CONCLUSIONS
  The patient introduced pathogenic bacteria from her skin into her bloodstream through unsafe injection practices. The change in syringe sale policy at her local pharmacy likely inadvertently contributed to this severe and life-threatening situation. Consideration of the implications of syringe sale policy must include an understanding of the barriers that influence individual pharmacist's decisions regarding particular store policies that affect over-the-counter syringe sales. Legalized sale of nonprescription syringes in community pharmacies alone is not enough to curb the epidemic of unsafe injection practices in the United States. All medical risks that are inherent in the use of unsafe syringes, including blood-borne viral pathogens (e.g., HIV, HCV) and bacterial infections (e.g., MRSA), should be considered.
authors.affiliation: Warren Alpert School of Medicine, Brown University, Providence, RI, USA. nzaller@lifespan.org
authors.forename: Nickolas D
authors.initials: ND
authors.lastname: Zaller
authors.forename: Michael A
authors.initials: MA
authors.lastname: Yokell
authors.forename: Alexandra
authors.initials: A
authors.lastname: Jeronimo
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Bratberg
authors.forename: Patricia
authors.initials: P
authors.lastname: Case
authors.forename: Josiah D
authors.initials: JD
authors.lastname: Rich
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003132:Commerce; D004866:Equipment Contamination; D005260:Female; D015658:HIV Infections / Q000150:complications; D007722:Health Knowledge, Attitudes, Practice; D019698:Hepatitis C, Chronic / Q000150:complications; D006801:Humans; D016106:Methicillin Resistance; D055624:Methicillin-Resistant Staphylococcus aureus; D010594:Pharmacies / Q000191:economics*; D057766:Policy; D055656:Prescriptions; D013203:Staphylococcal Infections / Q000150:complications / Q000635:transmission*; D015819:Substance Abuse, Intravenous / Q000150:complications*; D013594:Syringes / Q000191:economics*