General Update on the Expanded Syringe Access Program (ESAP)
In 2000, the New York State Legislature changed the Public Health Law to authorize a demonstration program to expand access to sterile hypodermic needles and syringes among injection drug users. It also serves the needs of persons with diabetes and others who self-administer medications. This is a public health measure to prevent the spread of blood borne diseases, most notably HIV, hepatitis B, and hepatitis C.
The Expanded Syringe Access Program (ESAP) became effective on January 1, 2001. Since then, ESAP-registered pharmacies may sell or furnish hypodermic needles and syringes, in quantities of ten or less, to persons 18 years of age or older without a medical prescription. Participation is entirely voluntary. The law also allows furnishing of syringes by health care practitioners, hospitals, and clinics that are registered in ESAP. Initial evaluations of the program found it to be effective in increasing access to sterile syringes for intravenous drug users in New York State and reducing syringe sharing significantly.
Another important component of ESAP is the promotion of safe sharps disposal. All 930 hospitals and nursing homes in New York State are required by law to accept household sharps, but not all are convenient to customers. Pharmacies, clinics, and health care practitioners that wish to accept household sharps for safe disposal must separately register for this program component. Today, there are 91 facilities hosting kiosks or wall mounted units in 20 counties and the setting type has broadened. However, with the current 8 mobile van programs, the number of sites increase to over to over 120. 81 (88 %) of these sites are open to the public while 10 (12) are for their clients only. The program continues to grow. It is estimated that more than 23,612 pounds of syringes have been collected through this program.
Other goals of ESAP are to provide persons who are self-injectors with information on the dangers of injection drug use, how to access drug treatment, how to prevent the spread of HIV and blood-borne diseases and how to safely dispose of used hypodermic needles and syringes.
Other goals of ESAP are to provide persons who are self-injectors with information on the dangers of injection drug use, how to access drug treatment, how to prevent the spread of HIV and blood-borne diseases and how to safely dispose of used hypodermic needles and syringes.
As of January 2008, 3186 providers had been registered in ESAP. Of these, 3,088 (96.9) of them are pharmacies, 54 (1.7%) are health care facilities and the other 44 (1.4%) are health care practitioners. In reality, there are only 30 practitioners but some of them have registered several times because they work in multiple sites. Health care ESAP-registered facilities include hospitals, nursing homes, diagnostic and testing centers, private practitioners, and pharmacies within hospitals. The outreach to non-ESAP pharmacies continues.
The AIDS Institute provides funding and/or supplies to agencies to implement demonstration projects that promote access to sterile needles and syringes and improve the safety of disposing used sharps. Not all demonstration projects are the same. Some projects involve coalitions that support safe syringe disposal. Others involve community-based organizations (CBOs) partnering with pharmacies to provide them with education on ESAP and safe disposal. Other CBOs promote safe disposal, while others may use ESAP-registered health care providers to furnish syringes in a storefront, mobile van, or on the street. Currently, there are over 30 ESAP demonstration projects throughout the sate. In 2006, through the demonstrated projects, an estimated 133,500 syringes were furnished and 20,200 "fitpacks" were given out to clients for proper disposal of syringes.
A study conducted in 2006 by the National Development and Research Institute, Beth Israel Medical Center and the New York Academy of Medicine, strongly suggested that implementation of ESAP did not increase heroin use, drug injection, or criminal activity.
For additional updates on ESAP and to learn more about the ESAP Demonstration Projects contact: Dr. Wesley E. Badillo, ESAP Coordinator, at web03@health.state.ny.us or call (212) 417 4746.