Syringe services programs

There is strong evidence that syringe services programs (SSPs) reduce HIV infection² and injection risk behavior such as needle or syringe re-use, borrowing, sharing, renting, and lending among people who inject drugs (PWID)^{2, 3}.

SSPs reduce the risk of HIV transmission among PWID that use the services⁴. Studies report mixed effects of SSPs alone on hepatitis C virus (HCV) infection, with no effects or an increased risk of HCV infection in PWID^{5, 6}. SSPs combined with opioid substitution therapy or implemented with supportive syringe policies and laws can reduce HCV infection among PWID in some cases^{6, 7}. Pharmacy-based SSPs can reduce syringe sharing behavior among PWID, though additional research is needed to confirm effects of pharmacy-based SSPs on HIV and HCV infection and safe syringe disposal³. SSPs are more beneficial when implemented in multi-component harm reduction interventions and include 100% coverage (i.e., all injections are done with a new clean needle or syringe), and when the policy and legal environment promotes access to and use of SSPs among PWID^{2, 7}. SSPs reduce injection risk behavior in hospital, pharmacy, community, and mobile settings; effects of SSPs on syringe re-use may vary depending on syringe dispensing policies⁸.

SSPs may increase use of drug treatment and health services and reduce drug injection among PWID⁹. Such interventions also appear to increase public safety, protect first responders, and reduce opioid overdose deaths⁹.

Available evidence suggests that fear of law enforcement encounters and arrest is a common barrier to using SSPs among PWID^{10, 11}. Program location and transportation difficulties also appear to be barriers to regular attendance of SSPs among PWID in rural areas¹². Gaining statewide support, buy-in from law enforcement and communities, and building strong partnerships with local communities are recommended strategies to successful SSP expansion and implementation¹³.

Expanding SSPs appears to be cost-effective in preventing HIV among PWID¹⁴. The cost to establish and operate a comprehensive SSP varies by number of clients served and geographic location; cost estimates range from $0.4 million for a rural SSP (serving 250 clients per year) to $1.9 million for an urban SSP (serving 2,500 clients per year)¹⁵. Expanding SSPs in rural areas is recommended to meet the needs of PWID living in those areas^{16, 17}.

As of August 2019, 31 states and Washington, D.C. have laws explicitly authorizing syringe services programs (SSPs) in locations throughout the state; disposal services and drug abuse treatment are required to be provided at SSPs in 13 states and 6 states, respectively¹⁸. Washington State, for example, has about 30 SSPs operated through local health departments, community organizations, and tribal entities¹⁹. California provides a wide range of services in more than 50 syringe exchange programs statewide²⁰. New Mexico provides SSPs and a variety of health and social services through community organizations and federally qualified health centers (FQHCs); New Mexico’s harm reduction efforts are intended to reach vulnerable populations and reduce stigma and obstacles to care and treatment²¹.

The Consolidated Appropriations Act of 2018 permits the use of federal funds from the Department of Health and Human Services (DHHS) to support SSPs. State, local, tribal, and territorial governments that intend to implement new SSPs or expand existing programs can request permission to use federal funds to support certain components of SSPs (e.g., syringe disposal services, screening and treatment for HIV and HCV, and referrals to substance abuse prevention and treatment services), with the exception of purchasing sterile needles or syringes. DHHS and the Centers for Disease Control and Prevention provide guidance for funding and program implementation²².