Syringe Expanded Access and Disposal

State: NY Type: Model Practice Year: 2004

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The Erie County Department of Health’s (ECDOH) Syringe Expanded Access and Disposal project (SEAD) is an educational/action program which targets residents of the eight counties that comprise Western New York who use syringes. Information from a variety of sources indicated that these community members had limited knowledge of legal access to new, clean syringes without a prescription and appropriate avenues of disposal of used syringes, needles and lancets. The program creates awareness of the Expanded Syringe Access and Disposal Program (ESAP) instituted into law by the New York State legislature on January 1, 2001. The regulations amended Part 80 of Title 10 (Health) NYCRR, pursuant to Section 3381 of the Public Health Law. A new section of Part 80, Section 80.137 established ESAP, which allowed the selling/furnishing and possession of ten (10) clean, unused syringes without a prescription from registered pharmacies.

A complement to the former portion of the law implemented loose mandates on avenues of disposal. Because the law prohibited pharmacies from advertising the program, public awareness and usage were low.The ECDOH with funding provided by the New York State Department of Health (NYSDOH) initiated a countywide demonstration project to promote awareness of the new law. By facilitating partnerships with local agencies, businesses, and concerned community members a coordinated approach to safe disposal of used syringes, lancets, and needles was developed and implemented along with an outreach plan to educate county residents about legal access to syringes and safe disposal of medical waste. ECDOH's outreach plan placed a special focus on diabetics, as documentation revealed a 2:1 rate of needle usage when compared to all other syringe using populations combined. Due to the success of the program in Erie County, expansion to all eight counties of Western New York soon began. The effectiveness of the program is consistently evaluated and effectiveness is determined through key informant interviews, surveillance, syringe disbursement and documented waste removal.

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Erie County Department of Health
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Syringe Expanded Access and Disposal
The Erie County Department of Health’s (ECDOH) Syringe Expanded Access and Disposal project (SEAD) is an educational/action program which targets residents of the eight counties that comprise Western New York who use syringes. Information from a variety of sources indicated that these community members had limited knowledge of legal access to new, clean syringes without a prescription and appropriate avenues of disposal of used syringes, needles and lancets. The program creates awareness of the Expanded Syringe Access and Disposal Program (ESAP) instituted into law by the New York State legislature on January 1, 2001. The regulations amended Part 80 of Title 10 (Health) NYCRR, pursuant to Section 3381 of the Public Health Law. A new section of Part 80, Section 80.137 established ESAP, which allowed the selling/furnishing and possession of ten (10) clean, unused syringes without a prescription from registered pharmacies. A complement to the former portion of the law implemented loose mandates on avenues of disposal. Because the law prohibited pharmacies from advertising the program, public awareness and usage were low.The ECDOH with funding provided by the New York State Department of Health (NYSDOH) initiated a countywide demonstration project to promote awareness of the new law. By facilitating partnerships with local agencies, businesses, and concerned community members a coordinated approach to safe disposal of used syringes, lancets, and needles was developed and implemented along with an outreach plan to educate county residents about legal access to syringes and safe disposal of medical waste. ECDOH's outreach plan placed a special focus on diabetics, as documentation revealed a 2:1 rate of needle usage when compared to all other syringe using populations combined. Due to the success of the program in Erie County, expansion to all eight counties of Western New York soon began. The effectiveness of the program is consistently evaluated and effectiveness is determined through key informant interviews, surveillance, syringe disbursement and documented waste removal.
The antecedent to the SEAD program was developed in response to the community’s limited access to and knowledge of appropriate safe disposal. While ESAP had been established for some time the community remained largely uninformed as local newspapers continued to report large volumes of used syringes being found in houses where elderly had once lived, sanitation workers being stuck by loose syringes mixed in with recyclables, beaches littered with syringes that had washed ashore, and Municipal Housing Authority officials complaining that staff had been injured cleaning up loose syringes around housing complexes. Others simply allowed these materials to pile up in their homes lacking information about safe disposal procedures and unaware of any convenient location for disposal. According to the ESAP law, all Article 28 facilities (hospitals, nursing homes) have to accept used medical waste that is appropriately packaged for disposal. Unfortunately, there are no regulations compelling them to make it easily accessible to the public. The agency partnered with the Kmart Pharmacies in Western New York to have freestanding needle disposal units. These units, called kiosks, are supplied by the state health department (NYSDOH). ECDOH has placed them in ten (10) Kmarts and located them near the pharmacy area. A press conference was held on July 10, 2002 to kick off the program, billboard advertisement was used to create awareness, and outreach by peer educators in the community was initiated. Any persons purchasing medications that are injectable and/or syringes are educated on proper needle disposal by the pharmacy staff. Sharps containers are provided free of charge in small portable sizes that hold 10 – 15 used syringes (Fit Packs) and larger quart size containers. Return of used sharps in either one of the supplied containers or a safe alternative to the kiosks is encouraged. Seven additional kiosks are located in the Western New York area at other sites including the Erie County Health Department, the Diabetes Endocrinology Center of WNY, a private pharmacy, a faith based organization, and at several Municipal Housing Authority apartment complexes. At these sites sharps containers and educational literature related to safe injection practices and alternative disposal practices is also available. Staff at all the sites have been trained to promote the project. Three new community based sites are scheduled for activation within the next three months. These sites are located at agencies that service the Hispanic and Native American populations in the city of Buffalo.There have been approximately 30,000 Fit Packs and 2,000 quart size sharps containers distributed and 3,845 pounds of medical waste have been collected by a regulated medical waste hauler to date.
Agency Community Roles:ECDOH, in collaboration with the NYSDOH, Stericycle, Kaleida Health’s Project Reach (our regions syringe exchange program), Western New York Coalition for Diabetes Prevention, and WNY HIV/AIDS Public Health Coalition initially proposed to expand syringe access and disposal by utilizing clinics and community sites for syringe exchange and disposal. New partners have been brought on after the initial planning meetings identified gaps in representation including representatives of the sanitation department, police, pharmacies, and public housing. ECDOH is the lead agency on the project and provides direction, coordination and fiscal management of the project. NYSDOH provides funding and technical assistance, Stericycle provides in-kind medical waste disposal services, Project Reach promotes the program through outreach workers in the community and the WNY HIV/AIDS and Diabetes Coalitions provide a strong network of providers, educators and consumers to promote this initiative. Other partners including the Erie County Medical Center Clinical Education Initiative have implemented a community awareness campaign including a dinner lecture series geared towards Physicians, Pharmacists and Certified Diabetes Educators. Ongoing presentations are made by ECDOH staff upon request to community based organizations, health and human services agencies, and community members. The HIV Peer Outreach program routinely include information about the program in the materials they distribute targeting areas of high risk for drug use and HIV infection. Costs and Expenditures:The ECDOH with funding provided by the New York State Department of Health (NYSDOH) initiated a countywide demonstration project to promote awareness of the new law. By facilitating partnerships with local agencies, businesses, and concerned community members a coordinated approach to safe disposal of used syringes, lancets, and needles was developed and implemented along with an outreach plan to educate county residents about legal access to syringes and safe disposal of medical waste.  The outreach plan placed a special focus on diabetics, as documentation revealed a 2:1 rate of needle usage when compared to all other syringe using populations combined. Due to the success of the program in Erie County, expansion to all eight counties of Western New York soon began. The effectiveness of the program is consistently evaluated and effectiveness is determined through key informant interviews, surveillance, syringe disbursement and documented waste removal. The program is currently supported by small amounts of funding and larger in-kind contributions by participating partners.   Implementation:The ECDOH, with funding provided by the New York State Department of Health (NYSDOH), initiated a countywide demonstration project to promote awareness of the new law. By facilitating partnerships with local agencies, businesses, and concerned community members a coordinated approach to safe disposal of used syringes, lancets, and needles was developed and implemented along with an outreach plan to educate county residents about legal access to syringes and safe disposal of medical waste. The outreach plan placed a special focus on diabetics, as documentation revealed a 2:1 rate of needle usage when compared to all other syringe using populations combined. Due to the success of the program in Erie County, expansion to all eight counties of Western New York soon began. The effectiveness of the program is consistently evaluated and effectiveness is determined through key informant interviews, surveillance, syringe disbursement and documented waste removal.  
There have been approximately 30,000 Fit Packs and 2,000 quart size sharps containers distributed and 3,845 pounds of medical waste have been collected by a regulated medical waste hauler to date. As this is a new and unique program to the region, ECDOH has mostly qualitative information (newspaper reports, etc.) as baseline data.
Ongoing sustainability is dependent on small streams of money for the purchase of supplies such as sharps containers and transfer of “ownership” of the kiosk sites to the organizations where they are located. Continued in–kind donations of supplies and services such as kiosks, fit packs and medical waste pick up provide components of sustainability. Recognition of the merits of the program and buy in by agencies such as the Buffalo Municipal Housing Authority insurers who also insure over 500 Municipal Housing Authorities across the country create opportunities for long-term growth and sustainability.
 
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