Expanding access to sterile syringes through pharmacies: Assessment of New York's Expanded Syringe Access Program

Objectives: To investigate the evolution of pharmacist practices, attitudes, and experiences with the Expanded Syringe Access Program (ESAP), which permits over-the-counter sale of syringes by registered pharmacies in New York State. Design: Longitudinal study. Setting: New York State in 2002 and 2006. Participants: 506 (2002) and 682 (2006) managing pharmacists (response rates similar to 70%) at ESAP-registered pharmacies (n = 346 in both years). Intervention: Mailed surveys (2002 and 2006). Main outcome measures: Pharmacist practices, attitudes, and experiences with ESAP over time. Results: Approximately 75% of pharmacists reported that ESAP had facilitated timely/emergency access to syringes, and more than 90% in each year reported no problems or very few problems administering ESAP. The practice of placing additional requirements on the sale of syringes decreased from 2002 (51.4%) to 2006 (45.1%), while a 55% increase in syringe sales was reported between 2002 (43.3/month) and 2006 (67.1/month). The sale of sharps containers also increased between 2002 (85.2%) and 2006 (92.8%). Community independent pharmacies and those located outside New York City generally expressed more favorable attitudes and experiences with ESAP, although these differences decreased over time. Conclusion: Pharmacy-based syringe access is a viable harm-reduction alternative in the fight against blood-borne diseases, with ESAP now equaling the number of syringes being distributed by syringe exchange programs in New York State. Continued education/training is necessary to increase participation in ESAP and to further reduce barriers to ESAP use.