Drug User Health

Harm Reduction Initiative

Early in the HIV/AIDS Epidemic, injection drug use was one of the major risk factors for new AIDS cases in New York State.  The AIDS Institute recognizes that harm reduction strategies are needed to prevent the transmission of HIV, hepatitis B and C and other blood-borne diseases in substance users, their sexual partners, and children.

Recent research and evaluation of SEPs and the Expanded Syringe Access Program in New York State show that HIV seroprevalence in PWID decreased from 52% in 1990 to 20% in 2000, declined further to an estimated 8-10% in 2009, and declined to less than 3% in 2015.  There has also been an associated reduction in the transmission of Hepatitis C (HCV), another desirable outcome of increased syringe access in NYS. 

In May 1992, the New York State Department of Health filed emergency regulations for authorization to conduct hypodermic syringe and needle exchange programs. Section 80.135 of Title 10 of the State of New York Official Codes, Rules and Regulations provides the regulatory authority by which community-based, not-for-profit organizations, and government entities may be granted a waiver to obtain, possess, and furnish hypodermic syringes and needles without a prescription in programs designed to reduce the transmission of HIV.  The target population is PWID who are not ready, willing, or able to abstain from drug use or enter substance use treatment programs.  The regulations require that syringe exchange services be provided within a comprehensive harm reduction model, where clients can learn methods for risk reduction for themselves and their partners.  Programs must elicit community support in order to receive approval of their waiver applications.

The Harm Reduction Initiative supports comprehensive and complementary services with funds from the New York State Department of Health (NYSDOH). Harm Reduction Initiative contractors receive funding to provide an array of services to substance users, their families, and communities. Funds provide harm reduction/recovery readiness/relapse prevention services to substance users which includes intakes and assessment, individual and group counseling and education, support groups, acupuncture, mental health services, behavioral interventions, referrals and linkage and navigation to health care, supportive services, and substance use treatment.

In addition to the provision of sterile injection equipment and supplies, harm reduction services may include:

  • Case finding and education on risk reduction practices related to sexual and drug-using behaviors with an emphasis on opioid overdose prevention and safety planning;
  • Distribution and demonstration of male and female condoms, dental dams, and opioid overdose kits containing naloxone;
  • Distribution and demonstration of bleach kits and safer injection techniques;
  • Distribution of other harm reduction supplies and literature;
  • Behavioral interventions delivered to individuals and groups;
  • Community level interventions to neighborhoods, law enforcement and substance users to promote and provide opioid overdose prevention training and anti-stigma campaigns regarding drug users;
  • HIV/STD/HCV education, counseling and testing and linkage to treatment and care; and
  • Provision of supportive services, partner notification assistance, PrEP and PEP promotion, care management, health care services, legal assistance, and housing services.
  • Drug User Health Hub services, including opioid overdose aftercare to individuals who have experienced an overdose and/or their significant others; buprenorphine prescribing, induction and maintenance; and activities to reduce barriers to access to care and other services. Programs must provide referrals for these services if they are unable to provide them directly. (Please see the About the AIDS Institute description of Drug User Health Hubs for more information on these sites.)

There are currently 23 approved harm reduction/syringe exchange programs in New York State: 14 in New York City, and one each in Buffalo/Jamestown/Niagara Falls/Lockport, Rochester, Ithaca/Binghamton/Norwich, Mount Vernon, Albany/Schenectady/Troy/Catskill/Hudson, Syracuse/Utica/Watertown, Plattsburgh/Ticonderoga, Poughkeepsie/Newburgh/Kingston/Monticello and Nassau/Suffolk Counties on Long Island.

Program models include street-side services, mobile vans, storefront centers, walking teams, special arrangements, emergency exchange, visits to single room occupancy hotels, and the Peer Delivered Syringe Exchange (PDSE) model.

The significant reduction in HIV transmission among PWID is attributed to the improvement in syringe access in NYS, with the implementation and growth of SEPs since 1992. Approximately seven million syringes are exchanged annually through these programs. SEPs also accept household-generated sharps from non-SEP participants and conduct community sweeps to remove syringes that are not properly disposed of.  The number of referrals provided by SEPs continues to increase and include referrals to detoxification and substance use treatment programs, health care services, HIV counseling and testing, and social services.

Contact:

Maxine Phillips
Director, Harm Reduction Unit
Division of HIV/STD/HCV Prevention Services
(212) 417-4661
maxine.phillips@health.ny.gov

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Expanded Syringe Access Program (ESAP)

In May 2000, the New York State Legislature enacted Chapter 56 of the Laws of 2000 creating the Expanded Syringe Access Program (ESAP). The purpose of this program is to reduce the transmission of blood-borne diseases, including HIV and hepatitis, by enhancing access to clean, sterile syringes. Under this program, up to ten syringes may be sold or furnished to a person 18 years of age or older without a prescription by pharmacists, health care facilities, and health care practitioners who have registered with the New York State Department of Health.

As of April 2016, there are 3,110 registered ESAP providers. Of these registered providers, about 45% are located in the five boroughs of New York City. The remaining ESAP providers are located throughout the rest of the state. There are ESAP-registered providers in every New York State county with the exception of Hamilton.

Of the registered providers, 3,037 (97.7%) are pharmacies. The other providers include hospitals, nursing homes, clinics and private practitioners. About 4 million syringes are sold without a prescription annually in New York State.

To become an ESAP provider, an application must be submitted to the Bureau of Narcotics Enforcement. Please see the following link for the application:

To find ESAP-registered pharmacies, medical providers or Article 28 facilities where syringes can be obtained without a prescription, call 1-800-541-AIDS (1-800-541-2437) or visit the NYS Department of Health website at:

To find locations statewide where hypodermic needles and syringes can be obtained without a prescription, as well as locations where syringes and drugs can be disposed of safely in secure and anonymous drop boxes (kiosks), please visit the Point at:

The Point is a New York State-specific, mobile friendly locater tool for harm reduction material and services (e.g., sterile syringes, disposal sites for used syringes and drugs, naloxone, and free HCV testing). The site offers a search function to help find locations near addresses of interest (e.g., home or work) as well as a map to navigate to these locations.

Contact:

Wesley E. Badillo, MD, MPH
Coordinator/Expanded Syringe Access Program
Office of Drug User Health
(212) 417-4746
wesley.badillo@health.ny.gov

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Opioid Overdose Prevention Program

Opioid overdose is a significant and growing problem throughout all regions of New York State.  In 2014, there were 1,273 overdose deaths statewide in which either heroin or opioid analgesics were involved.  In 2015, there were 1,503 opioid overdose deaths in the regions of New York State outside of New York City.   In 2014, there were 4,384 outpatient emergency room (ER) visits statewide for opioid overdoses, up from 3,583 the prior year.  In 2015, there were 4,478 opioid overdose outpatient ER visits in regions of New York State outside of New York City.

Fatal overdoses are preventable, especially if bystanders are trained to respond in a safe and effective manner. Most overdoses are not instantaneous, and bystanders are frequently present. Prevention measures include understanding specific risk factors (such as polydrug use and recent abstinence), recognizing the signs of an overdose, and responding appropriately. Responses include contacting emergency medical services by calling 911 and administering naloxone, an FDA-approved drug which reverses opioid overdoses.

Since April 2006, it has been legal in New York State for trained non-medical persons to administer naloxone to individuals experiencing an opioid overdose.  The AIDS Institute registers eligible programs to do the training and provides naloxone.  Eligible programs include hospitals; diagnostic and treatment centers; health care practitioners; drug treatment programs; not-for-profit community-based organizations; state and local government agencies such as health departments and school districts; public safety agencies; colleges, universities and trade schools; and pharmacies.  The responders include individuals who are themselves at risk for an overdose; their families and friends; individuals working for agencies serving persons at risk for an overdose; and others in the community who may be positioned to intervene.  There are over 400 approved opioid overdose prevention programs in NYS.  These programs have trained over 160,000 individuals, almost 70,000 of whom were trained in 2016 alone.  Nearly 3,000 naloxone administrations have been documented for community (non-public safety) responders, with more than 1,000 in 2016 alone. These figures represent only those administrations reported and are, therefore, believed to substantially underrepresent the actual number of naloxone administrations. 

Through a collaboration that has included the AIDS Institute, the Division of Criminal Justice Services, the Harm Reduction Coalition, the Office of Alcoholism and Substance Abuse Services and Albany Medical College, more than 10,000 law enforcement personnel have become trained overdose responders. Of these, 2,500 are also qualified as instructors and can train their colleagues.  The public safety overdose responders are documented as having administered naloxone more than 2,600 times between June 2014 and December 2016.

The AIDS Institute, in collaboration with the Department of Corrections and Community Supervision and the Harm Reduction Coalition, trains individuals incarcerated in the State’s prisons prior to their release.  As of March 2017, this program is in 10 correctional facilities, with expansion to other facilities under way.  More than 5,200 incarcerated individuals have been trained through December 2016, with 2,500 receiving naloxone upon release. 

Through a collaboration that has included the AIDS Institute, the State Education Department, the Office of Alcoholism and Substance Abuse Services, the Harm Reduction Coalition and the New York Statewide School Health Services Center, school nurses and other school personnel are trained in opioid overdose response and provided with naloxone.  In some cases, local school districts are becoming registered opioid overdose programs. In other cases, they are working with other registered overdose programs, such as local health departments.  Sixty-four school districts have registered as of March 15, 2017.  These registrations include 248 distinct schools.

Due to a law change in 2014, pharmacies can dispense naloxone through both patient-specific prescriptions and non-patient specific prescriptions (standing orders). In pharmacies with standing orders, people do not need to bring in a prescription in order to obtain naloxone. There are currently over 2,000 pharmacies throughout the state with naloxone standing orders in place.  A directory of these pharmacies may be found at

For information about training and programs, please call the New York State Department of Health, AIDS Institute, at 1-212-417-4770 or visit the website at:  www.health.ny.gov/overdose.

Contact:

Mark R. Hammer
Office of Drug User Health
(212) 417-4669
Mark.Hammer@health.ny.gov

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Safe Sharps Collection Program

Safe disposal is critically important for the health and safety of New Yorkers and the environment. In addition to the hospitals and nursing homes in New York State that are mandated by law to accept used sharps as a free community service, the Expanded Syringe Access Program (ESAP) implemented the NYS Safe Sharps Collection Program.

Through the New York State Safe Sharps Collection Program, pharmacies, health clinics, community-based organizations, public transportation facilities, housing projects, county landfills, waste transfer stations, police stations, bus depots, airports, community colleges, town halls, shelters, parks and other venues have become settings for safe sharps collection.

The NYS Department of Health provides sharps collection kiosks and/or wall mounted units to sites. It also makes available small personal sharps containers, known as Fitpacks.

The sharps collection sites can be found in 33 of the 62 counties in NYS. Over 230 entities have registered as safe sharps collection sites.

To view the collection sites directory, as well as the hospital and nursing homes sharps directories, visit

To find locations statewide where hypodermic needles and syringes can be obtained without a prescription, as well as locations where syringes and drugs can be disposed of safely in secure and anonymous drop boxes (kiosks), please visit the Point at

The Point is a New York State-specific, mobile friendly locater tool for harm reduction material and services (e.g., sterile syringes, disposal sites for used syringes and drugs, naloxone, and free HCV testing). The site offers a search function to help find locations near addresses of interest (e.g., home or work) as well as a map to navigate to these locations.

There is an application process to become a safe sharps collection site.  Participating organizations are required to comply with state and local hazardous waste regulations. To obtain the application, visit

Contact:

Wesley E. Badillo, MD, MPH
Coordinator/Expanded Syringe Access Program
Office of Drug User Health
(212) 417-4746
wesley.badillo@health.ny.gov

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Drug User Health Hubs

The AIDS Institute’s Office of Drug User Health has enhanced its Harm Reduction/Syringe Exchange Programs (SEPs) to become comprehensive Drug User Health Hubs. The array of services offered via the hubs are varied and are determined and defined by the needs of the participants who are served by the agency. Categories of services may include buprenorphine; opioid overdose prevention; supportive services and counselling for individuals who have experienced an overdose; referrals from law enforcement, emergency departments (EDs), families and emergency services; and anti-stigma activities related to drug use and people who use drugs (PWUD). The services are delineated as follows:

Medical

  • Accessible buprenorphine – This service includes an eligibility assessment for buprenorphine, medical intake and assessment, buprenorphine prescribing and induction, dosage determination and maintenance. Buprenorphine may also be used as a tool for crisis intervention in instances when illicit substances that are available are too potent and likely to cause an opioid overdose. Prescribing includes follow-up sessions with staff to promote treatment adherence.
  • Wound Care – This service includes medical care for abscesses resulting from injection drug use.
  • HCV testing, diagnosis and treatment in an environment that is supportive of the individual drug user’s well-being.
  • Triage/Presenting Issue – This service is a rapid assessment of a client’s presenting problem and appropriate treatment, referral, or linkage and navigation to a collaborating provider. Testing and counseling for HIV/HCV/STD and hepatitis A and B vaccinations may be included in these encounters.

Opioid Overdose Prevention or Aftercare for an Overdose

  • Opioid Overdose Prevention (OOP) – This includes OOP training and provision of a naloxone overdose reversal kit.
  • Safer Injection Practices -  This includes safety planning education related to high-potency substances like fentanyl and strategies for reducing harm while using drugs. This includes the provision of syringes.
  • Aftercare for an Opioid Overdose – This may be a referral from an ED, Emergency Medical Technician or other first responder for an individual who has experienced an overdose or for family members or significant others of victims of overdose. Hub staff or peers may be stationed in an ED to facilitate referrals for aftercare.

Law Enforcement Assisted Diversion (LEAD)

  • Law Enforcement Assisted Diversion – This service allows PWUD who are stopped by law enforcement for low level infractions to be diverted to the drug user health hub instead of being arrested and incarcerated. LEAD clients can access needed services from the hub and can avoid involvement in the criminal justice system.
  • Law Enforcement Referrals – Hubs are also able to accept referrals of PWUD who require assistance but are not involved in the criminal justice system.

Anti-Stigma Activities

  • Cultural Competency for Provision of Services for People Who Use Drugs – Hub staff work with other providers to help them embrace a harm reduction philosophy in their practices and provision of services for PWUD.
  • Cultural Competency for Communities – Hub staff work with communities to destigmatize PWUD and foster dignity and respect for all community members.

Contact:

Allan Clear, Director
Office of Drug User Health
90 Church Street
New York, New York 10007
212-417-4770
Allan.Clear@health.ny.gov

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Buprenorphine Access Initiative

The goals of the Buprenorphine Access Initiative are to:

  • Increase the number of certified health care practitioners who prescribe buprenorphine.
  • Develop a current directory of physicians who prescribe buprenorphine.
  • Increase the number of patients who are prescribed buprenorphine.
  • Incorporate buprenorphine prescribing more broadly, so that individuals have access to buprenorphine at a range of settings including primary care clinics, harm reduction programs, federally qualified health centers, emergency departments (EDs), OB/GYN settings, housing services, and other community-based organizations.
  • Incorporate buprenorphine prescribing more broadly so specific populations, including younger opioid users and women of child-bearing age, have access to buprenorphine.

Expanding access of buprenorphine is a priority. The benefits of buprenorphine include:

  • Protecting people from experiencing an opioid overdose. If individuals continue to use additional opioids while on buprenorphine, buprenorphine provides a protective factor from a lethal overdose.
  • Improving adherence to other medications/therapies (HIV, HCV, Diabetes, and Hypertension).
  • Providing stability to meet responsibilities (work, child care, maintain housing, legal, etc.)
  • Reducing HIV and hepatitis transmission for those that are injecting opioids.
  • Increasing access points for meaningful engagement with supportive and health care services.

Additional activities include:

Targeted/Ongoing Provider Education and Support

  • Support for new and existing buprenorphine prescribers by hosting buprenorphine waiver trainings around the state.
  • Follow-up with those who have taken the course to answer outstanding questions and offer mentoring services to new prescribers.
  • Targeted provider education activities, including buprenorphine academic detailing to create provider and consumer materials as part of the Buprenorphine Provider Toolkit, provider academic detailing activities, and buprenorphine webinars.
  • Creating guidelines for client-centered buprenorphine service delivery with best practices to provide meaningful, non-punitive supportive services for individuals accessing buprenorphine.

Buprenorphine Working Group

The AIDS Institute convened the first statewide Buprenorphine Working Group, comprised of 35 buprenorphine providers and subject matter experts from around the state. The purpose of this working group is to:

  • Serve as a leading body of providers who offer guidance and recommendations related to the expansion and implementation of buprenorphine efforts statewide.
  • Assist in the development of Provide educational kits to distribute to providers, to include appropriate resources and materials for both providers and patients.
  • Supporting the Office of Drug User Health’s efforts to increase buprenorphine prescribing among providers through ongoing waiver trainings throughout NYS.

Local Health Department (LHD) Initiatives

Contracts are in place with three LHDs in high-burden areas of the state -- Onondaga, Erie and Sullivan -- to develop local strategies to address the opioid epidemic, including expanding access to buprenorphine.

Contact

Narelle Ellendon, RN
Opioid Program Manager
Office of Drug User Health
90 Church Street, 13th Floor
New York, NY 10007
212-417-4668
narelle.ellendon@health.ny.gov
buprenorphine@health.ny.gov

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