More NYC Pharmacies are Selling Syringes Without a Prescription to Injection Drug Users in Effort to Curtail Spread of Disease

NEW YORK CITY, Nov. 26 ??? Pharmacists are growing more comfortable with New York???s nearly two-year-old law that permits syringe sales to injection drug users without a prescription in order to help reduce disease transmission, according to three new studies by researchers at The New York Academy of Medicine. Drug-users are increasingly taking advantage of the program in many, though not all, parts of the city.

The studies appear in a 117-page supplement to the current Journal of the American Pharmaceutical Association. They document the successes and lingering challenges of New York???s ???Expanded Syringe Access Demonstration Program??? (ESAP), which allows anyone 18 and older to purchase up to 10 sterile syringes at once without a prescription at specially registered pharmacies. An estimated 200,000 injection drug users (IDUs) reside in the city and are at high risk for acquiring HIV, hepatitis B and C viruses and other bloodborne diseases. Findings of the Academy-authored studies in the supplement, entitled ???Preventing Blood-Borne Infections through Pharmacy Syringe Sales and Safe Community Needle Disposal,??? are as follows:

-More pharmacists in high-risk New York City neighborhoods threw their support behind ESAP after the program was implemented, according to research by Phillip Coffin, MIA, project director in the Academy???s Center for Urban Epidemiologic Studies (CUES). Coffin and colleagues found that the proportion of pharmacists in high-risk neighborhoods who ???personally supported??? syringe sales increased from 36% in August 2000 (before non-prescription sales were legal) to 63% in January 2001 (when ESAP took effect). In ???Pharmacist Attitudes About Selling Syringes to IDUs,??? Coffin and colleagues surveyed 130 pharmacists before, and 231 pharmacists after, the law???s adoption. Interestingly, some of the pharmacists who registered for the program said they opposed selling syringes to IDUs, while some supporters had not yet registered. Pharmacists who opposed syringe sales to drug users cited concerns about customers??? appearance and fears that more syringes would be discarded around the neighborhood.

-Pharmacists in New York City are apparently not discriminating by race, age or gender against purchasers of syringes, according to a study led by Ruth Finkelstein, ScD, Director of the Academy???s Office of Special Populations. She called the finding ???encouraging.??? Less encouraging is that more than half of the city???s pharmacies (51%) had not registered with ESAP as of March 2002, and even some pharmacies that are registered were not making syringes available as of March. For the study, ???Evaluating Pharmacy Syringe Sales Without Prescriptions,??? Academy testers visited 89 randomly selected, ESAP-registered pharmacies in 14 New York City neighborhoods. Testers were able to buy syringes at 61 stores, and success or failure at purchase was unrelated to age, gender, and race/ethnicity. The Bronx was the worst-performing borough, with two-thirds of its pharmacies failing to sell syringes despite having registered to do so. Those findings were brought to the immediate attention of the state Health Department, which took action to reach out to Bronx pharmacists. ???Given that 40% of New York City???s opioid-related hospital discharges take place in the Bronx, the lack of pharmacy access in this high-need borough demands attention,??? Finkelstein said in her report. Performance was better in the other boroughs: 89% of visits to Staten Island pharmacies resulted in purchases, 83% in Manhattan, 71% in Brooklyn and 67% in Queens.

Some pharmacists need further education about the syringe sales program, the study revealed. In the 28 pharmacies that would not sell syringes, the most common explanation given was that sales are illegal without a prescription. The study also found that it is extremely difficult to buy a single syringe in participating pharmacies. Testers were required to buy a 10-pack in 62% of pharmacies visited, and drug-users might not have the money to purchase a 10-pack. Syringe cost varied widely, from $.30 to $2.00 for a single syringe and from $2 to $8 for a 10-pack.

-The number of Harlem pharmacies participating in ESAP grew from 49% to 79% in the program???s first year, according to a study led by Crystal Fuller, PhD, an epidemiologist in CUES and a faculty member at Columbia University???s Mailman School of Public Health. Despite this considerable increase between March 2001 and March 2002, far fewer IDUs in Harlem are buying their needles at pharmacies than in other boroughs, the study found. Surveys of more than 600 Harlem drug users revealed that 12.5% had purchased a syringe from a pharmacy after the program began, compared to 4.9% before it began. In Brooklyn and Queens, more than 50% of drug users have purchased syringes from pharmacies since ESAP began, published reports show. Several possible explanations exist, according to the study, ???Impact of Increased Syringe Access: Preliminary Findings on Injection Drug User Syringe Source, Disposal and Pharmacy Sales in Harlem, N.Y.??? Drug users can get clean needles free of charge in Harlem, home to the state???s largest concentration of ???Syringe Exchange Programs.??? Black and Latino drug users (who dominate Harlem???s IDU community) have been more reluctant than whites to buy needles at pharmacies. Finally, some drug users may not realize that they can buy syringes at pharmacies, because the law legalizing the practice also prohibited advertising it. In another finding, Fuller???s study revealed that no harmful effects -- such as more discarded needles on Harlem streets, or altercations inside pharmacies -- have occurred as of June 2002 since ESAP began. That news will be useful for the state as it evaluates whether to continue allowing non-prescription sales at registered pharmacies when the program???s trial-period ends in 2004. Sale of syringes to persons who inject drugs remains illegal in 11 states, the District of Columbia, and the U.S. Virgin Islands.

The New York Academy of Medicine is a non-profit institution founded in 1847 that is dedicated to enhancing the health of the public through research, education and advocacy, with a particular focus on urban populations, especially the disadvantaged.

Posted on November 26, 2002

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Andrew J. Martin
Director of Communications
The New York Academy of Medicine
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amartin@nyam.org

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