Improving access to medical care for injection drug users (IDUs) through a pharmacy syringe access program in New York City

Background: The expanded syringe access demonstration program (ESAP), enacted in August 2000 and implemented in January 2001 to reduce infectious disease transmission among injection drug users (IDUs), allows healthcare providers to distribute and pharmacies to sell non-prescription needles/syringes (referred to as “syringes” hereafter) in New York State. Many IDUs lack health insurance and/or fear being mistreated in the healthcare system because of their drug use. ESAP-participating pharmacists may be positioned to provide discrete and confidential health information to syringe customers and help link IDUs with addiction-specialized providers and other medical/social services. Objective: Determine if there is a relationship between frequency of pharmacy syringe purchase visits and access to drug treatment and/or medical care among IDUs in New York City. Methods: Cross-sectional analysis of data collected from participants recruited using street-intercept sampling in 36 socioeconomically disadvantaged, ethnographically-defined neighborhoods in four New York City boroughs was conducted (2005-2007). Interviewer-administered questionnaires collected information on demographics, injection practices, frequency of pharmacy-purchased syringes, access to services, and drug use cessation attempts. Analysis was restricted to self-reported IDUs. Separate logistic regression models predicting frequent pharmacy-use vs. non-pharmacy use and infrequent pharmacy-use vs. non-pharmacy use were created. Results: Of the 218 IDUs enrolled, the median age was 36 (18-58 range), 67% were Hispanic, 18% Black, 72% male, 37% infrequent pharmacy-users and 17% frequent pharmacy-users. After controlling for participation in other syringe access programs, frequent pharmacy-users were significantly more likely to have doctors and share cotton, and less likely to inject frequently, share rinse-water, use shooting galleries, borrow syringes, enter drug treatment or stop injecting, and have heroin dependence than never-pharmacy users. Infrequent pharmacy-users were significantly more likely to share cotton and less likely to inject frequently, lend syringes, enter drug treatment or stop injecting, and have crack or heroin dependence than never-pharmacy users. After adjusting for injection behaviors, infrequent pharmacy-users were older (AOR=3.53), and less likely to stop injecting (AOR=0.36) or enter drug treatment (AOR=0.28). Frequent pharmacy-users were older (AOR=3.95), more likely to have doctors (AOR=3.59), and less likely to enter drug treatment (AOR=0.20). Conclusions: These data suggest that IDUs who use pharmacies frequently tend to have some type of healthcare access. Therefore, an expanded public health role for pharmacies including consultation on medical care, safe injection practices, and drug treatment should be explored. IDUs have the potential to benefit greatly from public health-minded pharmacists and public health efforts to increase pharmacy syringe access should be pursued.