Syringe sharing

Will you get more than you bargained for the next time you get a Botox injection? Hepatitis C, perhaps?

When it comes to the loosely regulated Botox industry, patients need to educate themselves about infection control and their rights, warn health advocates.

When it comes to the loosely regulated Botox industry, patients need to educate themselves about infection control and their rights, warn health advocates.

So many things could come to mind when someone is about to stick a needle into your face to purposefully partially paralyze you. Among them, thanks to this year’s Endoscopy Center syringe-sharing fiasco in Las Vegas, should be this: Is this qualified medical professional exercising prudent single-patient-use procedures?

As the needle deactivates your worry lines, remember: If your doctor, nurse, spa aesthetician or Craigslist Botox-party pro is not abiding by rules adopted this summer in reaction to the Endoscopy Center’s hepatitis C outbreak, you could be exposed to similar transference of disease. Trouble is, the regulations apply to ambulatory surgery facilities, not spas and doctor’s offices and living rooms.

Last winter, some 40,000 endoscopy patients were notified that they may have been exposed to hepatitis C or HIV due to the reuse of syringes, and authorities pushed for quick tightening of medical regulations regarding multiple-patient use of vials of medicine. This started instant rumbling in the Botox industry from coast to coast.

Bo knows wrinklesBotox is the brand name for the botulinum toxin, which is used cosmetically to relax frown lines and other wrinkles and reverse visible signs of aging. According to Sherri Aikin, owner, director and nurse practitioner at Illuminations Medical Spa in Southwest Reno, “Botox works by actually affecting the nerve ending of a nerve that attaches to a muscle. There are channels that secrete a neurotransmitter called acetylcholine … and essentially when you inject Botox to a local nerve bundle that you’re blocking, it gums up these channels so that when you attempt to try to make a certain expression, those channels are blocked so that acetylcholine can not penetrate the muscle.”

Here’s the problem: The manufacturer, Allergan, produces Botox in two sizes of vials: 100 units and 50 units. But the only FDA-approved single dose is 20 units. Furthermore, it takes about 38 units for the average patient to have their brows sufficiently unscrewed. So it is common for doctors to use the same vial for multiple patients.

Dr. Julio Garcia of Las Vegas Cosmetic Surgery explains that a large needle is used to draw the Botox from the vial, and then a smaller needle is attached to the syringe to inject the patient. Then, when another patient comes around, and there’s a vial with some Botox left, a fresh needle is used—but not necessarily a fresh syringe. That, says Garcia, allows for the potential contamination of the vial, as syringes may have a small amount of blood in backflow. So why not just insist on a new syringe each time? “It’s just faster not to,” says Garcia.

“The consumer has no way of knowing. It’s terrifying,” he says. “There is a group of physicians that have decided to follow the rules and only sell the whole bottle—single use, single patient, as the label instructs, but which has never been routine. Unfortunately, most are still doing it the old way.”

Sherri Aikin, left, owner of Illuminations Medical Spa in Reno, says, “Needles, first of all, should never be reused on anyone.” Office manager Anica Relaford is also pictured.

Aikin says they use standard diabetic needles at her medical spa. With these needles, the needle and the syringe come packaged together. This ensures that, because the spa has a rigorous single-use policy, neither needles nor syringes are reused.

Bo knows businessBotox is administered by many levels of professionals in a variety of settings. “Anyone who can convince a physician to let them buy it under their license can administer Botox,” says Garcia.

“The underlying issue has been there,” says Garcia. “It’s tragic how it’s been handled by the many involved.”

Most Botox injectors sell by the unit—$8 to $13 per unit. Physicians get the chemical at $280 for a 50-unit vial or $550 for a 100-unit vial, Garcia says. “The profit margin was reasonable if it was multiple patients.” But now that he has gone to selling an entire vial, there is little room for mark-up, as a customer doesn’t need to buy the whole vial and will already have to pay more to cover the cost. Meanwhile, doctors who still use a single vial for multiple users can offer lower prices, which puts doctors who follow the regulations out of business.

“I’ve lost 25 percent of my business because the price goes up for the patient,” says Garcia. “Lucky for me, it wasn’t the core of my business because I am a surgeon. This is just gravy.” But for others, Botox is a staple in their beautification offerings.

“The little spas are closing left and right,” Garcia says. If Allergan made the product in 20-unit vials, the problem could be solved. However, Allergan has little incentive to do that, seeing that it has no competition in this specialty yet.

Sometimes the price varies by the expertise of the injector—you might pay $9 a unit if a nurse practitioner sticks you, or $10 per unit if it’s a nurse, or $12 if it’s a doctor.

“You’re going to keep doing it. I am. I’m used to it,” says a 38-year-old patient who gets injections at her gynecologist’s office and who chose not to disclose her name. “Do I want somebody qualified? Yes. But I’m surprised they [the Board of Health] are saying you should use it single-patient, single-dose because I don’t see anybody using it that way.”

Marla Williams, bureau chief of the Bureau of License and Certification, which governs surgery facilities but not spas or doctors’ offices, says, “Patients should always be concerned about infection control and the rights they have,” but that as of yet, the practice of administering Botox is not regulated.

“Individual clinic settings have never been regulated,” she says. “Regulation comes along based on societal need at any given time. It’s a political decision.”