Explaining the relationship between race/ethnicity and pharmacy purchased syringes among injection drug users in New York City

Objective: Pharmacy syringe sales without a prescription became legal in New York State on January 1, 2001 through the Expanded Syringe Access Demonstration Program (ESAP). At the same time, Pharmacy use among Black and Hispanic injection drug users was found to be significantly lower when compared to Whites. The purpose of this study was to assess the factors that could explain the relationship between race/ethnicity and pharmacy use. Design: Data were combined from 2 on-going injection drug user (IDU) studies in 2 New York City neighborhoods. Social and behavioral factors independently associated with ever purchasing a nonprescription syringe in the past 6 months and examined using cross-sectional logistic regression. Results: Of 337 IDUs, the majority were male (79%). Hispanic (73%) and had a mean age of 35 years. In bivariate analysis, IDUs who reported pharmacy use were less likely to be Black or Hispanic, older, and to have reported recent syringe exchange program (SEP) attendance compared to non-pharmacy users. Additionally, pharmacy users were more likely to have knowledge of ESAP, and report discrimination by police in the past year compared to non-users. After adjustment for recent SEP attendance (adjusted odds ratio [AOR]=0.27; 95% confidence interval [CI]=0.14-0.55), ESAP knowledge (AOR= 13.11; 95% CI=6.54-26.31), discrimination by police (AOR=3.56; 95% CI=1.73-7.35), and discrimination due to race (AOR=0.25, 95% CI=0.11-0.58), race/ethnicity was not a significant predictor of pharmacy use. Conclusions: Race/ethnicity may not be an important determinant of ESAP when more salient social circumstances, such as past discrimination, are considered. Educational efforts should be enhanced to reach those who continue to perceive barriers to ESAP.