title: Impact of increased syringe access: preliminary findings on injection drug user syringe source, disposal, and pharmacy sales in Harlem, New York.
abstract: OBJECTIVE
  To evaluate the New York State Expanded Syringe Access Demonstration Program (ESAP) through injection drug user (IDU) surveys, discarded needles and syringes studies, and pharmacy sales and experiences surveys.
  
  
  METHODS
  Pre-post comparison.
  
  
  METHODS
  In Harlem, New York City, risk surveys among street-recruited IDUs, needle/syringe street counts on 27 systematically sampled city blocks, and Harlem pharmacist reports of sales and experiences.
  
  
  METHODS
  Number and types of IDU syringe sources, block mean counts of discarded needles and syringes, level of pharmacy nonprescription syringe sales (NPSS), and pharmacists' experiences.
  
  
  RESULTS
  Comparing 209 pre-ESAP with 396 post-ESAP IDUs, pharmacies as a primary syringe source increased: 3.4% to 5.3% (P < .001, and ever pharmacy use increased: 4.9% to 12.5% (P < .001), respectively. Compared with pre-ESAP IDUs, post-ESAP IDUs tended to be younger and more often black. Harlem pharmacy participation in ESAP increased considerably from March 1, 2001, to March 1, 2002, 49% to 79%, respectively. Among three Harlem pharmacies, there was a modest increase in NPSS; pharmacists reported no problems, and no discarded needles and syringes were observed in pharmacy areas. In the three pharmacies, the proportion of syringe sales that were NPSS was 46% (110 to 240 NPSS/month), 3% (25 to 90 NPSS/month), and 0%. The mean ratios of needles/syringes to background trash have not increased in Harlem since ESAP began.
  
  
  CONCLUSIONS
  To date, no evidence of harmful effects discarded needles/syringes, pharmacy altercations) resulting from ESAP were observed. While NPSS have increased in Harlem, pharmacy use among IDUs remains low. In Harlem, efforts are underway to increase ESAP awareness and reduce socioenvironmental barriers to ESAP.
authors.affiliation: Center for Urban Epidemiologic Studies, New York Academy of Medicine, NY, USA. cf317@columbia.edu
authors.forename: Crystal M
authors.initials: CM
authors.lastname: Fuller
authors.forename: Jennifer
authors.initials: J
authors.lastname: Ahern
authors.forename: Liza
authors.initials: L
authors.lastname: Vadnai
authors.forename: Phillip O
authors.initials: PO
authors.lastname: Coffin
authors.forename: Sandro
authors.initials: S
authors.lastname: Galea
authors.forename: Stephanie H
authors.initials: SH
authors.lastname: Factor
authors.forename: David
authors.initials: D
authors.lastname: Vlahov
mesh_terms: D006801:Humans; D017744:Medical Waste Disposal; D009519:New York City; D015819:Substance Abuse, Intravenous; D013594:Syringes / Q000706:statistics & numerical data / Q000600:supply & distribution*
chemical_list: D017744:Medical Waste Disposal