Receptive Syringe Sharing Among Injection Drug Users in Harlem and the Bronx During the New York State Expanded Syringe Access Demonstration Program

Syringe exchange programs (SEP) have been effective in reducing syringe sharing and reuse. To prevent the transmission of blood-borne infections, CDC and other government agencies recommend that injection drug users (IDUs) use a new, sterile syringe for each injection. In order for this recommendation to be implemented fully, drug injectors' access to syringes must be expanded.

On January 1, 2001, the New York state Expanded Syringe Access Demonstration Program (ESAP) took effect. The law allows pharmacies to sell up to 10 syringes at a time without a prescription; it also allows syringe distribution through private doctors, hospitals and clinics to persons age 18 or older; and it permits the possession of those syringes for the purpose of injecting drugs. The law requires that providers register with the New York State Department of Health; it mandates an independent evaluation of the program; and it stipulates that the syringes be accompanied by information on safe use and disposal.

Researchers in the current study sought to assess changes in receptive syringe sharing since the inception of the ESAP. To accomplish this, they combined data on sociodemographic characteristics and syringe use regarding the last injection episode from three ongoing studies in Harlem and the Bronx from January 2001 through June 2003. These data were analyzed as serial cross sections by 10 calendar quarters.

"The ESAP has increased access to sterile syringes for IDUs in New York State," the researchers wrote. Their investigation found that receptive syringe sharing decreased significantly, from 13.4 percent of participants to 3.6 percent in the final quarter. The percentage of IDUs who obtained their most recent injection syringe from an ESAP source (chiefly pharmacies) increased from 7.5 percent in the first quarter to 25 percent in the last quarter. Multiple logistic regression analysis found that variables associated with less receptive sharing were syringe exchange and ESAP syringe source as well as time since ESAP inception. Female gender and white race/ethnicity were significantly associated with more receptive sharing.

"The increase in the use of pharmacies and other ESAP syringe sources in this sample has been accompanied by a decline in receptive sharing," the researchers concluded. "SEPs remained the most frequent syringe source. This highlights the importance of SEP accessibility for IDUs in Harlem and the Bronx. Further research regarding the potential serious barrier that the cost of syringes may represent for many IDUs is suggested. Increasing SEP access and lowering the cost of syringes at pharmacies may lead to greater reductions in unsafe injecting practices, especially for IDUs with low incomes."

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