The Nonimpact of the Expanded Syringe Access Program upon Heroin Use, Injection Behaviours, and Crime Indicators in New York City and State

• Author: Andrew Golub,Bruce D. Johnson,David Vlahov,Don C. Des Jarlais,Sherry Deren,Crystal Fuller
• Published date: 01 June 2006
• DOI: 10.3818/JRP.8.1.2006.27
• Date: 01 June 2006
• Subject Matter: Article

EXPANDED SYRINGE ACCESS PROGRAM • 27

* The Nonimpact of the Expanded Syringe

 Access Program Upon Heroin Use, Injection

 behaviours, and Crime Indicators in New

 York City and State

Bruce D. Johnson, Andrew Golub, Sherry Deren

National Development and Research Institutes, Inc.

Don C. Des Jarlais

Beth Israel Medical Center

Crystal Fuller, David Vlahov

New York Academy of Medicine

* Abstract

The Expanded Syringe Access Program (ESAP) in New York State (NYS) made syringes

available to injection drug users without prescriptions through pharmacies and health

care providers on January 1, 2001. This program was intended to provide illicit drug

users with clean syringes so as to reduce transmission of blood-borne diseases, including

HIV and Hepatitis C. The legislation that established ESAP mandated evaluation of the

new policy’s impact on trends in drug treatment and crime using existing indicators.

This study, part of a larger evaluation, examined ESAP’s impact on criminal activity

and substance abuse. Findings strongly suggest that implementation of ESAP did not

increase heroin use, drug injection, or criminal activity. Policy implications are discussed

and recommendations for increasing syringe access are made.

This study was primarily supported by National Institute on Drug Abuse (NIDA) grant R01DA

14219-04 to evaluate the Expanded Syringe Access Demonstration Program. Additional support

was provided by NIDA grants P30DA11040, R01DA09056, R01DA13690, R01DA09339, T32

DA07233, and by the Centers for Disease Control (U48/CCU209663). Funding from the

National Institute of Justice (94-IJ-CX-A013, OJP-2001-C003) supported the collection and

analysis of arrestee data. Special thanks is extended to the New York State Ofce of Substance

Abuse Services for providing data documenting trends in drug treatment admission and to the

New York State Division of Criminal Justice Services for providing the microdata on arrests

in New York State. Additional support was provided by National Development and Research

Institutes and the New York Academy of Medicine.

The authors thank Tracy Durrah, Tom Miller, Doris Randolph, and Ronald Walker for managing

the ADAM data collection process in New York. Points of view and opinions expressed do not

necessarily reect the positions of the New York State Department of Criminal Justice Services or

the Ofce of Alcohol and Substance Abuse Services, the National Institute of Justice, NIDA, the

New York Academy of Medicine, or the National Development and Research Institutes.

JUSTICE RESEARCH AND POLICY, Vol. 8, No. 1, 2006

© 2006 Justice Research and Statistics Association

28 • JUSTICE RESEARCH AND POLICY

EXPANDED SYRINGE ACCESS PROGRAM • 29

* Introduction

The Expanded Syringe Access Program (E SAP), rst implemented in New York

City (NYC) and New York State (NYS) in January 20 01, made needles and

syringes legally available to injec tion drug users (I DUs) without a prescription.

The program was not wit hout controversy, however, as some thought that this

new policy, mandated by new public health legislation, would substantially

increase crime a nd substance abuse.

This st udy is part of a larger effort to evaluate the impact of ESAP on drug

use and crime. The analysis is focu sed upon trends in arrests and treatment

indicators in New York City and New York State before and after January

2001, when implementation of ESAP began a nd public health regulations were

changed to permit pu rchase of syringes w ithout a prescription. B efore discuss -

ing these t rends in det ail, however, we rs t provide an overview of the histor y

of syringe policies, heroin abuse , injection practice s, and HIV/A IDS policies in

New York State as background to this analysis.

Heroin In jection, H IV, and Syringe Polic y Before ESA P

Historic ally New York City has been the center of America’s heroin culture

since soon af ter 1900 (Cou rtwrig ht, 2002; Musto, 2002); it continues to have

the largest number of heroin users in America and possibly the world. During

the 1964 –1974 period, large numbers of baby boomers (esp ecially t hose born

between 1945 and 1954) in New York’s inner-c ity neighborhoods bega n using

heroin, and many became addicted and came to inject heroin multiple t imes

per day ( Johnson et al., 1985; Johnson, T homas, & Golub, 1998; Johnson &

Golub, 2002). This cohort of heroin injectors (in their 50s in the 2000s) contin-

ues to have among the highest rates of heroin use and injection among arrestees

(Golub & Johnson, 2005).

In respon se to a dramatic ex pansion in heroin us e and addiction, t he NYS

legislature p assed several laws in t he 1960s t hat were intended to “get tough”

on addicts and dealers. It m ade the posse ssion of hypoderm ic syringes and

needles a criminal offense; crimin ally possessing a hypodermic instrument

(PL220.45) has been and remains a class A misdemeanor under NYS law (NYS

Penal L aw 20 05). C onviction can result in a sente nce of up to one year in a

county jail. Imposing controls on syr inges was considered a relatively m inor,

political aspect of the legislation to cont rol heroin add iction in the 1960 s.

However, needle control policies became a major ash point between America n

criminal jus tice and public health con stituencies in t he 1980 and 1990s, as t he

HIV/A IDS epidemic spread, esp ecially among I DUs.

Prior to 2001, NYS public health re gulations required th at pharmacies sell

syringes /needles only to someone h aving a prescription from a med ical doctor.

Thus, diabetic patients (or those with other medical conditions) could easily

obtain and  ll a presc ription for syri nges at the pha rmacy reta il price. But the