Implementation and maintenance of the Expanded Syringe Access Program (ESAP) in New York City (NYC) Pharmacies

Carolyn Hernandez1, Rachel J. Stern1, Natalie D. Crawford, MPH1, 2, Katherine Standish1, Crystal Fuller, PhD1, 2

Center for Urban Epidemiologic Studies, New York Academy of Medicine1, Department of Epidemiology, Columbia University2

Background: The Expanded Syringe Access Program (ESAP) was established in New York in 2001 to reduce infectious disease transmission among injection drug users (IDUs) by legalizing non-prescription syringe sales in pharmacies. ESAP has been widely adopted (58.6% of NYC pharmacies registered within the first year of ESAP's implementation). The purpose of this analysis is to determine if pharmacies in four NYC boroughs 1) continue to be registered with ESAP, 2) provide the mandated safety pamphlet, and 3) opt to post a decal in their window to indicate their participation in ESAP.

Methods: We visited all ESAP-registered chain and independent pharmacies located in ethnographically-mapped neighborhoods of high drug use activity in Upper Manhattan, Bronx, Brooklyn and Queens that were included on a state-maintained list as well as additional pharmacies identified through street outreach not included in this list.

Results: Of 195 pharmacies visited, 13 closed, 6 were inside clinics, and 176 were open pharmacies. Of these, 77% remained registered and willing to sell syringes, 18% were not registered, and 5% were registered but ceased selling syringes because they did not want IDUs in pharmacies. Most pharmacies lacked Spanish or English safety inserts, which convey health information, are required with each syringe sale, and serve as proof that syringes were purchased legally. Of those with safety inserts, 6% had English inserts and 21% had Spanish and English inserts. In two boroughs, 15% had ESAP decals posted. After offering decals to those without them, this proportion increased to 24% (p-value=0.81).

Conclusions: Most ESAP-registered pharmacists maintain registration and sell syringes indicating continued support for ESAP among NYC pharmacists. Public health efforts are necessary to help ensure that law-required safety pamphlets are being provided to syringe customers.