The Debate about Needle Reuse

Although syringe makers and medical professionals alike caution against needle re-use, the practice is widespread, judging from the response to an informal survey we conducted for this article. Forty-three out of the 57 readers we surveyed re-use their needles, from two to as many as 150 times.

From our small and unscientific sample, it seems that our readers change their pen needles more frequently. Re-use of pen needles range from two days to one week.

Only 14 out of the 57 surveyed said they do not re-use syringes, but most from this group did not give a reason. The needle re-users, on the other hand, were more voluble in their reasons, as the chart below illustrates:

The reader who said he uses his syringes up to 150 times said he knows it is time to change his syringe when “my girlfriend can hear the skin break from the other side of the dinner table.” He also said the finer needles produce “too little trauma to promote quick healing.” He prefers duller needles because “there’s less pain and better healing associated with each shot.”

Another respondent wrote that he re-uses “needles until they are so dull I have to hammer them into my hide. ” He also added nonchalantly, “Never had a problem.”

What accounts for the fact that some people can re-use their needles many times and others cannot? Differences in pain thresholds, and in thicknesses of skin? Machismo?

Reactions to Becton Dickinson Ad

Considering the high rates of needle re-use among our readers, perhaps it was not surprising that a recent Becton Dickinson ad urging syringe users to use their syringes only once prompted some reactions:

  • “The ‘They can be used only once’ blurb by an unknown manufacturer of needles is the lousiest, dirtiest bit of commercialism I have yet seen in any diabetes publication. As any of us who are on a budget know, we use a needle as long as it will go in comfortably. This used to be six or seven times, but just recently I notice that four uses is about maximum. My conclusion is that the manufacturer is no longer coating the needle with silicone or is doing something to force us to use it only once.”
  • “The pictures of the highly magnified needle point are ridiculous-stainless steel does not look that way after sticking it into soft flesh, and if it does I would like to know the brand so I can buy some other. We diabetics (at least after living 38 years with diabetes as I have) are not stupid and I am fed up with the barrage of ads for every high-profit item ever created for a diabetic.”
  • “Yes, I re-use my “disposable” syringes, up to 100 times [and] I’ve never had a problem of any kind. I consider the recent spate of advertising by B-D to be a gross distortion, designed only to promote more sales.”
  • “If B-D is so concerned about our welfare and comfort, why don’t they produce a more durable, long-lasting syringe or pen needle. Of course, the reason is quite simple; they’re in the business of making money.”
  • “I can safely get 5-10 uses out of one needle saving insurance companies and Medicare a lot of money (and us too ultimately). B-D’s position is that they shouldn’t be used more than once bcause they sell more needles that way. They’ve got a captive market. Or maybe they can devise some way for us to have thicker skin?”

Not All Negative Press

Since Becton Dickinson has most of the US market share in syringes, most of the readers who responded to our survey also use B-D syringes, and many of them had good things to say about B-D products. (see main article).

Becton Dickinson Responds

We asked Barry Ginsberg, MD, Medical Director at Becton Dickinson, to respond to the concerns of the critical letter-writers. “We have seen virtually no negative reaction to the B-D ad,” says a surprised Ginsberg.

Under the Law…

“These needles are not designed for re-use” explains Ginsberg. “They’ve never been tested for re-use. If we make such a claim to the FDA, we have to prove to them that it’s safe for re-use but no one has ever been able to prove that it’s safe to re-use syringes.”

Ginsberg says that the law requires Becton Dickinson to let consumers know that B-D needles are approved for single use only. “So anyone who recommends using it more than once may be legally liable because they’d be recommending off-label use for a device,” says Ginsberg. He says all other needle manufacturers are required by law to say the same thing.

The Reasons for Single Use

Using needles only once will minimize the risk of the needle breaking off in the body, prevent lipodystrophy, and reduce pain.

Prevent lipodystrophy. Frequent injections with a dull needle at the same site can cause the subcutaneous fat in that body area to turn into scar tissue or to become lumpy. Using a fresh needle each time supposedly cuts down on such formations. Ginsberg says that several European studies have shown that as many as 25_35% of their self-injecting patients have lipodystrophy.

Minimize breakage. Ginsberg speculates that 1 in 1 million needles break off. There is no exact figure since not all breakages are reported to Becton Dickinson. “People who don’t re-use their needles won’t experience needle breakage,” claims Ginsberg.

So what should you do if a needle breaks off and remains in your body? “We don’t recommend that you go after them surgically because you won’t find it,” advises Ginsberg. “You’d have to make a 1-inch incision to get it out. B-D needles are the thinnest in the world. The needle won’t travel a lot, it’ll just move in the area every time you move. Eventually it will be worn off by the body reaction around it.” Since the needles are surgical stainless steel, it won’t cause an infection in the body if left alone. If you leave it in, some scar tissue may eventually form around it.

Ginsberg recounts a story of a woman whose surgeon tried to find the needle that had broken off inside her. The attempt left her with a wound infection, and then the wound had to be treated. She had to be hospitalized for 100 days and ended up with a $100,000 hospital bill.

Minimize pain. “Pain increases by 15% with every re-use,” claims Ginsberg. So why do many of our polled readers claimed to experience little or no pain when injecting with a used needle? “If it hurts only by 15%, you really won’t notice it,” says Ginsberg. “When we took patients who re-use syringes all the time and gave them fresh syringes each time, they’d come in and tell us that these syringes hurt less than the others.” Ginsberg says he cannot understand why patients who buy thinner needles to make injections less painful in the first place would re-use the needles since a duller needle is more painful.

A Veteran RN’s Opinion

Jane J. Seley, RN, MPH, MSN, GNP, CDE, with the Beth Israel Medical Center in New York, also opposes needle re-use. “Using a needle twice is the maximum,” she says. In line with American Diabetes Association (ADA) guidelines, Seley recommends keeping needles capped and refrigerated after each use.

Seley says she had seen B-D’s magnified pictures of re-used needles, and they helped to convince her of the dangers of needle re-use. “Needles are coated with a lubricant (silicone) which becomes reduced with each use,” she says. Seley says patients should spend more time trying to get insurance companies to lower their prices for syringes and other diabetic supplies.

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