- Are syringes legal in Tennessee?
- Pharmacies and syringe access in Tennessee
- Benefits of syringe access
- Basics of Tennessee’s Syringe Services Programs
- Expanding syringe access in Tennessee
- Syringes are legal to possess in Tennessee. On their own, syringes are 100% legal in the Volunteer State, even without a prescription. However, syringes can be considered drug paraphernalia. Certain factors can increase the likelihood of being charged with Possession of Drug Paraphernalia for having syringes.
- Two Tennessee laws offer limited immunity from Possession of Drug Paraphernalia charges. The Drug Paraphernalia Immunity Law (T.C.A. § 40-7-124) and the Safe Syringe Act (T.C.A. § 68-1-136) both protect people who inject drugs (PWID) who get caught with syringes from catching Possession of Drug Paraphernalia charges.
- Pharmacies don’t need prescriptions to dispense syringes in Tennessee. However, many pharmacists refuse to sell syringes without prescriptions, thinking that helping PWID access syringes increases drug use and disease transmission. Pharmacists also avoid dispensing syringes to suspected PWID out of fear that PWID will ruin other customers’ shopping experiences, vandalize the pharmacy itself, or shoplift. Further, many pharmacists aren’t aware of their states’ syringe laws, making them feel uncomfortable dispensing syringes.
- PWID in Tennessee rarely source syringes from pharmacies. Instead, the black market — often taking the form of fellow drug users, dealers, and diabetic friends and family members — remains the leading form of syringe access in Tennessee. Black-market syringe access has several drawbacks, including unguaranteed syringe sterility, a lack of consistency and reliability, and exaggerated prices; these factors encourage syringe reuse and sharing, and are thereby associated with higher rates of HIV/HCV transmission and soft tissue damage (e.g., scarring, abscesses, infections).
- Still, other syringe access methods are available to PWID in Tennessee. Syringe Services Programs offer reliable syringe access to PWID; sadly, only nine of Tennessee’s 95 counties host SSPs. Online syringe access is a promising legal, reliable alternative for PWID who live in low- to no-access areas, yet barriers like poor understanding of syringe laws and lack of internet proficiency lead to underutilization.
- In closure, we recommend several feasible, reasonable ways to expand syringe access in Tennessee. These include modifying application and operational requirements for SSPs, encouraging and/or incentivizing pharmacies to sell syringes without prescriptions, requiring health departments to offer syringe exchange, educating law enforcement about syringe possession laws, and legalizing (or, if not, decriminalizing) syringe possession.
Are syringes legal in Tennessee?
Short answer: Yes, syringes are legal in Tennessee, even without a prescription. They only become illegal if you intend on using them to inject drugs.
Many PWID are unclear about the legal status of syringes in Tennessee, thereby directly encouraging hazardous behaviors including but not limited to unsafe syringe disposal and hiding syringes from law enforcement if apprehended, increasing risks of occupational needlestick injury. In turn, the unclear legal status of syringes breeds an environment in which syringe reuse, syringe sharing, and poor injection practice seem more prevalent.
In Tennessee, syringes are legal as long as you don’t plan on using them to inject drugs. You don’t need a prescription to possess them. However, in practice, some Tennesseans get arrested for syringe possession under questionable circumstances. While every case differs and every law enforcement officer (LEO) uses different judgment, here are some factors that influence whether law enforcement (LE) charges someone with syringes with Possession of Drug Paraphernalia (T.C.A. § 39-17-425):
- Are you found with drugs? PDP charges = more likely.
- Do you admit to using drugs when asked by LE? PDP charges = more likely.
- Is other drug paraphernalia present? PDP charges = more likely.
- Are your syringes used? PDP charges = more likely.
- Are your syringes in their original packaging? PDP charges = less likely.
- Do you inform LEO of the Drug Paraphernalia Immunity Law? PDP charges = less likely.
- Are you calm and polite? PDP charges = less likely.
- Other factors, including but not limited to race, ethnicity, income, wealth, social status, vehicle make and model, and local reputation also play a role.
Tennessee is home to two laws that give PWID limited immunity from Possession of Drug Paraphernalia charges insofar as syringes are concerned:
Tennessee’s Drug Paraphernalia Immunity Law is a 2015 state law that protects people with syringes from being charged with or prosecuted for Possession of Drug Paraphernalia, a Class A misdemeanor punishable by up to 11 months, 29 days in jail and $2,500 in fines. PWID benefit from this law as long as they tell police they have syringes before a search is executed (see picture below).
Syringe Services Programs also provide limited immunity from drug paraphernalia charges. As described in T.C.A. § 68-1-136(c)(2)(A), SSP participants have immunity from Possession of Drug Paraphernalia charges while “engaged in the exchange or in transit to or from the exchange” (see picture below).
Pharmacies and syringe access in Tennessee
Many pharmacists hold negative attitudes toward providing syringe access to PWID. These “no-sell” pharmacists seem to be in the majority here in Tennessee. “No-sell” pharmacists share various concerns about providing syringe access to PWID. One study on pharmacists’ attitudes and concerns regarding syringe sales to PWID lists these common (yet largely unfounded) concerns:
- Disease transmission and drug use. Many pharmacists think that selling syringes to PWID increases HIV and viral hepatitis transmission risks and leads to drug abuse.
- Fact: Increasing over-the-counter access to sterile syringes prevents the spread of HCV/HIV.
- Business woes. Pharmacists may think PWID are untrustworthy, more likely to shoplift and vandalize stores, and leave behind used syringes in bathrooms or parking lots. Pharmacists also worry how other customers might interpret their decisions to sell syringes to PWID.
- Fact: Syringe-friendly pharmacists help facilitate safe syringe disposal.
- Fact: Negative encounters between PWID and pharmacists occur infrequently.
- Uncertain legal status of syringe sales. Some pharmacists aren’t aware of their states’ laws on syringe sales. These pharmacists often take the safe route and refuse to sell syringes without prescriptions.
How pharmacy syringe access plays out in practice:
Pharmacies in Tennessee can sell syringes to adults without prescriptions. Individually, pharmacists have discretion over whether they sell syringes to customers on a case-by-case basis. Pharmacists may face pressure from management to refuse customers’ syringe requests without prescriptions. In practice, it seems true that most Tennessee pharmacists won’t sell syringes to customers without prescriptions.
When it comes to sourcing syringes from pharmacies, Tennesseans who inject drugs fall into three categories:
- PWID who have attempted purchase at several pharmacies.
- PWID who have attempted purchase at one pharmacy.
- PWID who haven’t bothered attempting purchase at any pharmacies.
Across the Volunteer State, PWID who attempt to purchase syringes from pharmacies widely report bad experiences. While attempting syringe purchase from multiple pharmacies carries no criminal punishment, practical penalties remain: namely, humiliation and reputation damage. These two prohibitive factors leave most Tennesseans who inject drugs in Categories 2 and 3 — having not explored community pharmacies as syringe access points.
If not pharmacies, where do PWID get syringes in Tennessee?
Even though pharmacies aren’t a viable syringe access point for Tennesseans who inject drugs, several other syringe access options exist:
1. Syringe Services Programs
As of July 2022, the Volunteer State is home to seven organizations that run 15 state-approved syringe exchanges, officially known as Syringe Services Programs by the Tennessee Department of Health (TDoH).
Currently, SSPs are present in just nine counties across the state. This is an improvement of 50% in just short of 18 months when, in early 2021, just six counties were represented by SSPs. Still, nine of 95 total counties is a horrifically small coverage area.
2. Online syringe access
Online syringe access providers belong to three categories: medical supply retailers (e.g., Amazon), mail-based harm reduction supply distributors (e.g., NEXT Distro), and online pharmacies (e.g, Naloxone Exchange).
Most Tennesseans who inject drugs aren’t aware of online syringe access. Even after learning about it, many PWID remain apprehensive to the idea. Improving access to introductory guides like “Practical Advice for Buying Syringes Online,” a resource of ours, may assuage the many concerns of PWID re: sourcing clean sharps online.
Barriers to online syringe access may include:
- Lesser internet access in rural areas
- Some online medical suppliers require prescriptions to send syringes to Tennessee
- Customers must have at least one online payment option
- PWID worry their housemates might intercept their packages
- They also worry that retailers might fail to ship syringes discreetly
- Some drug users have concerns about “ending up on a list”
3. Black-market syringe access
Most Tennesseans who inject drugs exclusively source syringes from the black market.
The “black market” doesn’t consist of a mysterious cabal of masked henchmen; rather, the “black market” simply refers to a broad, relationship-based network of people who buy, sell, and facilitate the sale of illegal, unregulated goods. Common sources of black-market syringe access include fellow drug users, dealers, and diabetic family members and friends.
No matter the exact source, black-market syringe access has several drawbacks:
- Syringe sterility can never be guaranteed. Because the black market isn’t regulated, government agencies and industry watchdogs can’t oversee the trade of syringes. Unregulated vendors are rarely as reliable as regulated vendors — syringes may have been mishandled or previously used by other PWID. This increases the risk of blood-borne disease transmission, a risk that doesn’t exist with legitimately-sourced syringes.
- Black-market syringe access isn’t consistent or reliable. Pharmacies, medical supply stores, SSPs, and mail-based harm reduction supply distributors are all extremely reliable and guarantee the sterility of syringes. On the black market, syringes are always in limited quantities, leading PWID to reuse and share them.
- Syringes are far more expensive on the black market. When bought from pharmacies or online medical supply retailers, syringes cost around $15 to $20 per box of 100, or 15¢-20¢/syringe. SSPs offer syringes for free. On the black market, syringes cost anywhere from $1-$5/syringe.
Summary — Where do people actually get syringes?
In order of popularity, here’s where Tennessee’s drug-injecting residents currently source syringes from:
- Black market. (Worst option)
- The most popular source of syringes for Tennesseans who inject drugs, this underground marketplace includes people who use or sell drugs, sex workers, and diabetic family members and friends.
- SSPs. (Best option)
- SSPs are much-needed public health programs, but most communities don’t have them. They also link people who inject drugs to other much-needed resources that they otherwise might not have access to, including education about safer drug use.
- Online syringe access.
- Although more people should buy syringes online, few people take advantage of this opportunity.
Benefits of syringe access
Expanding syringe access offers numerous public health benefits:
- SSPs reduce the transmission of HIV, HCV, and other blood-borne diseases. High SSP coverage — “high coverage” means SSPs give participants at least enough syringes to use a clean needle every time they inject — is associated with a 50% reduction in HCV acquisition risk.
- SSPs in Tennessee provide referral to addiction treatment services, including MAT. When high SSP coverage is combined with opioid replacement therapy (medication-assisted treatment), HCV acquisition risk drops by 80%.
- SSP participants are more likely to stop using drugs and seek treatment. We think it’s okay to use drugs, for the record, but new SSP enrollees are 5x more likely to enroll in addiction treatment and 3x more likely to stop using drugs altogether. 🤷🏼♂️
- SSPs promote safe syringe disposal. One 2012 federally-funded study compared the prevalence of syringe litter in two similar communities — one without an SSP, one with an SSP. Researchers found 86% fewer used syringes on sidewalks and in parks in the community with an SSP.
- SSPs can improve the overall health of their communities. Here in Tennessee, SSPs are required to provide referrals to mental health, addiction treatment, and HIV/HCV testing providers. Combined with the distribution of naloxone, a medication that reverses opioid overdose, and referrals to other health care service providers, SSPs can improve communities’ overall health.
Myths about syringe access
- Syringe access enables or increases drug use. Injection drug use is an unavoidable reality in every community across the country — if not the world. No evidence exists to support the erroneous assertion that syringe exchanges increase drug use.
- SSPs promote crime. Peer-reviewed, federally-funded studies have found that syringe exchange programs are not associated with increases in crime rates.
Basics of Tennessee’s Syringe Services Programs
In response to the opioid syndemic, the State of Tennessee began recognizing Syringe Services Programs (SSPs) as legitimate programs in late 2017 with the Safe Syringe Act (T.C.A. § 68-1-136).†
Syringe exchanges need TDoH approval to operate legally. Organizations or health departments can apply to run a Syringe Services Program by filling out a free SSP application online. Surprisingly, the application is not unnecessarily heavy or cumbersome — it has about 20 fields in total, including several long-answer questions and a handful of questions requiring document uploads.
Applicants must identify at least one location to operate from. Property ownership isn’t required; rather, SSPs usually partner with local stakeholders that are willing to lend their locations to organizations running SSPs. Locations must be at least 2,000 feet away from the nearest park and school; in Memphis and Nashville, this requirement drops to 1,000 feet.
TDoH classifies SSPs as fixed or mobile.
- Fixed. SSP never moves from this location.
- Typically has longer operating hours, more days of operation than their mobile counterparts.
- May not be conveniently located near areas with high demand for syringe access.
- Far fewer fixed SSPs in Tennessee than mobile SSPs.
- Usually indoor.
- Example: PEAS, Inc. of Memphis.
- Mobile. “Mobile” is a bit of a misnomer. “Mobile” syringe exchange implies a service delivery model in which organizations make multiple stops at various locations with high demand for syringe services or even deliver to participants. Here in Tennessee, “mobile” just refers to SSPs that set up and break down their equipment before and after each scheduled operating date.
- Typically has shorter operating hours, fewer days of operation.
- By nature, more conveniently located near areas with high demand for syringe services.
- Many more mobile SSPs in Tennessee than fixed SSP sites.
- Usually outdoor.
- Example: A Betor Way of Memphis.
The State of Syringe Services Programs in Tennessee — East, Middle, and West
Growth has been slow, with just seven organizations running 15 active SSP locations across the Volunteer State: six in West Tennessee, two in Middle Tennessee, and seven in East Tennessee. West Tennessee is also home to an unofficial SSP. Learn more about Tennessee’s syringe exchanges by visiting our complete, up-to-date directory of SSPs in Tennessee.
East Tennessee, by far, has proven more welcoming to harm reduction efforts than Middle or West Tennessee. We believe this is true for three reasons:
- East Tennessee being disproportionately affected by the opioid-HIV/HCV syndemic. While certainly unfortunate, the syndemic’s disproportionate effects on East Tennessee created a climate in which local stakeholders were — and still are — more willing to adopt forward-thinking changes.
- More funding opportunities being extended to Appalachian communities.
- The region having more urban areas than Middle or West Tennessee. The Knoxville, Chattanooga, and Tri-Cities metropolitan areas are each home to more than 300,000 residents. Not only are densely populated cities typically more open to adopting harm reduction efforts, they host more businesses, organizations, and individuals, thus increasing the likelihood one (or more) of them engages in harm reduction.
† Some sources, including the “SSP FAQs” on the State of Tennessee’s website, claim that SSPs were made legal in 2018. This is false. We know this is false because the Safe Syringe Act (T.C.A. § 68-1-136) is included in the 2017 edition of Tennessee Code Annotated.
Expanding syringe access in Tennessee
We propose several ways to expand syringe access in Tennessee:
- Rolling back requirements for Syringe Services Programs
- Adding a syringe exchange component to community health departments
- Encouraging pharmacies and pharmacists to sell syringes without prescriptions
- Educating law enforcement and people who use drugs about existing syringe possession laws
- Legalizing or, if not, decriminalizing syringe possession
1. Modifying requirements for SSPs
Since 2017, the Tennessee Department of Health has allowed community organizations and health departments to apply for official status as Syringe Services Programs. Here in Tennessee, SSP status comes with several benefits, including:
- In-kind contributions. such as HIV/HCV self-testing kits, condoms, and naloxone
- Legal immunity. Staff, volunteers, and participants receive legal immunity from criminal charges, specifically Possession of Drug Paraphernalia.
- Stronger grant applications. Thanks to being co-opted by TDoH, organizations that hold official SSP status may have stronger grant applications than harm reduction programs without SSP status.
Although the state’s SSP application requirements aren’t too overbearing, the following SSP-related changes could expand syringe access in Tennessee:
- Allowing truly mobile SSPs
- Reducing the 2,000-foot zoning requirement
- Repealing the strict “one-for-one” exchange standard
- Extending Safe Syringe Act participant immunity
Allowing truly mobile SSPs
Here in the Volunteer State, all SSP locations are fixed in nature. Although the state categorizes SSPs into two categories — mobile and fixed — “mobile” simply means programs don’t have permanent locations, with staff members setting up and breaking down their equipment (e.g., chairs, tables, tents) before and after each session. Both must report their planned locations — as well as what times and days they’ll be there — to TDoH when applying.
Typically conducted by foot, bike, or vehicle, “mobile” syringe access programs are just that — mobile. They generally follow fixed routes, making stops at designated locations at specified times. Allowing SSPs to operate in this manner, including letting them deliver supplies directly to participants, could improve syringe access.
Reducing the 2,000-foot zoning requirement
Per T.C.A. § 68-1-136(g)(1), part of the Safe Syringe Act, SSPs must not conduct operations within 2,000 feet of the nearest park or school (see picture).
SSPs must operate at state-approved physical locations. Fortunately, TDoH is quite lenient about location selection, with the 2,000-foot requirement being the only restriction.
Organizations interested in creating SSPs frequently don’t have enough funding — if any funding, at all — to rent or buy permanent locations. As such, they often rely on partnerships with local stakeholders (e.g., individuals, businesses, organizations, municipalities) that either own property or have access to property suitable for hosting SSP operations.
This 2,000-foot SSP location requirement limits the number of potential locations organizations can use to host their syringe exchanges.
Here’s a real-world example of how this requirement limits SSP growth in Tennessee: In April 2022, we — Tennessee Harm Reduction, a Jackson-based 501(c)(3) nonprofit organization — began seeking out property owners in West Tennessee to host our syringe exchange.
Two months later, in June, a local resident and business owner offered to let us use her small business’s location as an SSP site. The area is home to a substantial homeless population, thus making it a great location for an SSP. Sadly, it was within 1,700 feet of a local park. The local park, Unity Park, is a memorial to half-dozen lives lost in the 1999 tornadoes that struck Jackson and Madison County.
It seems the 2,000-foot requirement is meant to keep SSPs out of sight of children. What’s the point in avoiding a park — a park with no playground or equipment — that very, very few people visit?
This is just one example of how the 2,000-foot mandate is preventing state-approved SSPs from operating.
In certain municipalities, this 2,000-feet requirement is reduced to 1,000 feet: The county must have a “metropolitan form of government” and 500,000 residents, and the municipality (the city or town hosting the SSP) must have 165,000 residents.
Although four cities (Nashville, Memphis, Knoxville, Chattanooga) have at least 165,000 residents according to the 2010 Census, only two counties (Davidson, Shelby) have 500,000 residents — thus, this reduced 1,000-foot requirement only applies to SSPs in Nashville or Memphis.
Reducing the 2,000-foot threshold to 1,000 feet for all cities and counties, not just the largest ones, would make the application process easier, thus potentially leading to more SSP locations, in turn increasing syringe access.
Repealing the strict one-for-one exchange standard
Per T.C.A. § 68-1-136(b)(2), a statute within the Safe Syringe Act, the State of Tennessee requires SSPs strive to maintain one-to-one syringe exchange, meaning SSPs give participants the same number of syringes they return (see picture). Although no penalties exist for SSPs that deviate from this recommended practice, this clause inherently restricts syringe access, thereby encouraging syringe reuse and sharing, in turn increasing HIV/HCV transmission risks.
Extending Safe Syringe Act participant immunity
As discussed in Section 1, “Are syringes legal in Tennessee?”, the Safe Syringe Act gives SSP participants immunity from Possession of Drug Paraphernalia charges while “engaged in the exchange or in transit to or from the exchange” (see picture).
Notice this offers no protection to participants when they’re not visiting an SSP. For context, on average, our participants visit us every 5 to 60+ days. Why just protect participants for a couple hours, at most, and not at all times?
Extending the Safe Syringe Act’s participant immunity clause to include all-around protection would make participants feel more comfortable about collecting used syringes, thereby increasing the number of used syringes they return to SSPs and reducing the likelihood of improper syringe disposal. It may also make participants more willing to visit SSPs, in turn improving participant retention.
2. Adding syringe exchange to the many functions of health departments
Health departments are invaluable assets to communities across the state. All 95 counties in Tennessee have one. Local health departments provide free healthcare services to Tennesseans, including highly valuable services to people who inject drugs, such as HIV and viral hepatitis testing, STD control, and hepatitis A and B vaccinations.
Adding syringe distribution and collection services would hardly increase health departments’ expenses. And although we want every county to have a Syringe Services Program, which provide comprehensive, wraparound harm reduction services, adding syringe exchange as a function of health departments would sufficiently expand syringe access in the meantime until statewide SSP access is a reality.
3. Encouraging pharmacies to sell syringes through workplace education campaigns and professional education
The State of Tennessee could push pharmacies towards providing syringe access by offering civil immunity from lawsuits related to dispensing syringes to non-prescription customers. Tennessee could achieve expanded syringe access by implementing a program similar to the New York State Department of Health’s Expanded Syringe Access Program, which allows registered pharmacies to sell up to 10 syringes at a time to adults without prescriptions. Health care facilities and providers, including doctors and other medical practitioners, can also furnish syringes under ESAP.
Even if pharmacies in Tennessee began selling syringes to PWID, they would not become known by drug-using communities as safe sources of syringes overnight. The damage has been done — pharmacists’ consistent refusal to sell syringes to people without prescriptions has led most PWID to view pharmacies as discriminatory and unyielding.
Of course, PWID-oriented education about syringe access at pharmacies could help pharmacies become known as syringe access points. SSPs could inform participants about pharmacies’ newfound willingness to sell syringes without prescriptions — or, more specifically, not discriminate against people thought to inject drugs — through educational materials. In addition to legislative changes to the Safe Syringe Act that require SSPs, and potentially addiction services providers, health departments, and pharmacies, to offer such education to participants, TDoH could also create a PWID-directed public awareness campaign for added community awareness.
4. Educating law enforcement about existing syringe possession laws
Tennessee’s Drug Paraphernalia Immunity Law — T.C.A. § 40-7-124
Even though the Drug Paraphernalia Immunity Law has been around for seven years, many — if not most — LEO in Tennessee aren’t aware of the Drug Paraphernalia Immunity Law. Most PWID aren’t aware of it either. Professional education targeted at law enforcement, including public education targeted at PWID, could reduce occupational needlestick injuries and improve drug users’ trust in law enforcement — and improve syringe access altogether.
In our opinion, the most effective PWID-focused public education campaign would require SSPs to educate participants about Tennessee’s Drug Paraphernalia Immunity Law (T.C.A. § 40-7-124). The state — per T.C.A. § 68-1-136(b)(4), a section of the state law that codifies Syringe Services Program requirements (T.C.A. § 68-1-136) — already requires SSPs to offer educational materials on five subjects (see picture).
Getting SSPs to educate participants about our Drug Paraphernalia Immunity Law by adding it as a sixth type of required educational material would be an effective, affordable avenue for raising awareness of this law among PWID.
Another effective solution might involve legally requiring police to inform people of this law immediately after asking to search someone’s vehicle. This would quickly boost awareness of the Drug Paraphernalia Immunity Law, all while helping law enforcement officers incur fewer needlestick injuries.
Note: Of the two SSPs I’ve been to, none provide all of these forms of education. One had information available about (#4.) HIV/AIDS/viral hepatitis prevention, and the other offered a single brochure that covered (#4.) HIV/AIDS/viral hepatitis prevention and (#5.) overdose prevention. So, the state would need to enhance its supervision of SSPs and enforcement of this requirement to have optimal impact.
5. Legalizing or decriminalizing syringe possession
T.C.A. § 39-17-402(12) is a statute that defines drug paraphernalia (see picture). Although it doesn’t explicitly mention syringes, syringes are considered drug paraphernalia if their owner intends on using them to inject drugs.
As mentioned in Section 1, “Are syringes legal in Tennessee?”, the legality of syringe possession isn’t black and white. It depends on myriad factors, some of which are out of PWID’s hands.
Most PWID in Tennessee are unfamiliar with syringe legality, instead assuming syringes are outright illegal. This leads to several unideal behaviors, including syringe reuse and sharing, hiding syringes during LE contact — in turn increasing LEO’s risk of occupational needlestick injury — and improper disposal of syringes (i.e., syringe litter). Anti-syringe laws also perpetuate the intense distrust most PWID feel towards LE.
Legalizing syringe possession, even if people intend on using them to inject drugs, would improve syringe access, as well as reduce syringe reuse and sharing, the incidence of occupational needlestick injury among LEO, and many other unwanted side effects that stem from a lack of syringe access. Although not as ideal as legalization, decriminalizing syringe possession would offer much of the same benefits.