Syringe Services Programs

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Safe syringe disposal unit in a community with a syringe services program
Courtesy of Multnomah County, Oregon

Syringe services programs (SSPs) are community-based prevention programs that can provide a range of services, including access to and disposal of sterile syringes and injection equipment, vaccination, testing, and linkage to infectious disease care and substance use treatment. 

Nearly 30 years of research show comprehensive syringe services programs are safe, effective, and cost-saving.

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  • Nearly 30 years of research show that comprehensive syringe services programs are safe, effective, and cost-saving tools that can prevent HIV and high-risk injection behaviors among people who inject drugs.
  • Syringe services programs protect communities by preventing infectious disease outbreaks and facilitating safe disposal of used syringes. These programs are not associated with increased drug use, crime, or syringe litter in communities.
  • The most effective syringe services programs provide comprehensive services to people who inject drugs, including the distribution of lifesaving medications and referrals to substance use treatment and other health care.

Syringe services programs (SSPs) are community-based prevention programs that can provide a range of services, including access to and disposal of sterile syringes and injection equipment, vaccination, testing, and linkage to infectious disease care and substance use treatment. NIDA, the Centers for Disease Control and Prevention, and others have conducted and supported research on these programs for nearly 30 years. Researchers have found that syringe services programs are safe, effective, and cost-saving tools to prevent HIV and high-risk injection behaviors that can impact the spread of other infectious diseases among people who inject drugs.1-5 These programs may be commonly known as needle exchanges and are considered a type of harm reduction initiative.

Syringe services benefit people who inject drugs and their communities in multiple ways.

Sharing and reusing injection equipment is associated with a high risk of transmission of blood-borne diseases—including life-threatening, HIV, hepatitis B, and HCV—as well as skin and soft tissue infections.6,7 By providing sterile injection equipment, syringe services programs aim to reduce transmission of infectious diseases. Syringe services save lives and can significantly reduce HCV transmission and effectively end HIV outbreaks, especially when combined with medications that treat opioid use disorder.8,9 In the United States, experts point to these services as especially critical for preventing the community spread of HIV and addressing the intertwined public health crises of HIV and opioid use.10

NIDA-funded research has found that syringe services programs do not increase drug use. In fact, program participants in these studies were significantly more likely to enter substance use treatment and reduce or stop drug use.11 Many syringe services programs provide additional  services including the distribution of the overdose-reversing medication , HIV and HCV testing and prevention interventions, vaccination, and referrals for substance use treatment and other health care. These comprehensive approaches result in better substance use outcomes for people who inject drugs and can improve the overall health of communities in which programs operate.12

Syringe services programs have also been found to be an effective and cost-effective strategy for preventing and addressing community outbreaks of HIV and HCV. An outbreak in rural Scott County, Indiana, beginning in 2015 led to more than 200 people being diagnosed with both HIV and HCV. The Indiana State Department of Health credited syringe services programs with halting the increase in transmissions and saving taxpayers an estimated $120 million.13

Most effective programs offer on-demand sterile supplies without restrictions or requirements to return used syringes.14,15 Comprehensive syringe services programs are associated with a decrease in syringe litter in the community,16 in part because they allow people to safely dispose of used syringes. This may in turn decrease the risk of accidental needlestick injuries. In a 2012 NIDA-funded study, researchers found 86% fewer used syringes in parks and sidewalks in a community that had a syringe services program than in a similar community without an equivalent program.17

Studies also show that syringe services programs are not associated with increased crime in communities.18

NIDA is a major funder of research on the safety, efficacy, and utility of syringe services programs and related community-based resources. Current research areas include understanding and overcoming barriers to implementing syringe services programs in diverse settings and communities, as well as leveraging these programs to deliver key services—such as COVID-19 vaccination, pre-exposure prophylaxis (PrEP) for HIV, and psychiatric services—to populations health systems often struggle to reach.

References
  1. Aspinall EJ, Nambiar D, Goldberg DJ, et al. Are needle and syringe programmes associated with a reduction in HIV transmission among people who inject drugs: a systematic review and meta-analysis. International Journal of Epidemiology. 2013;43(1):235-248. doi:10.1093/ije/dyt243
  2. Bernard CL, Owens DK, Goldhaber-Fiebert JD, Brandeau ML. Estimation of the cost-effectiveness of HIV prevention portfolios for people who inject drugs in the United States: A model-based analysis. PLOS Medicine. 2017;14(5). doi:10.1371/journal.pmed.1002312
  3. Neaigus A, Zhao M, Gyarmathy VA, Cisek L, Friedman SR, Baxter RC. Greater drug injecting risk for HIV, HBV, and HCV infection in a city where syringe exchange and pharmacy syringe distribution are illegal. Journal of Urban Health. 2008;85(3):309-322. doi:10.1007/s11524-008-9271-1
  4. Cooper HL, Des Jarlais DC, Ross Z, Tempalski B, Bossak B, Friedman SR. Spatial access to syringe exchange programs and pharmacies selling over-the-counter syringes as predictors of drug injectors’ use of sterile syringes. American Journal of Public Health. 2011;101(6):1118-1125. doi:10.2105/ajph.2009.184580
  5. Marshall BD, Shoveller JA, Wood E, Patterson TL, Kerr T. Difficulty accessing syringes mediates the relationship between methamphetamine use and syringe sharing among young injection drug users. AIDS and Behavior. 2011;15(7):1546-1553. doi:10.1007/s10461-010-9876-8
  6. Centers for Disease Control and Prevention (CDC). Integrated prevention services for HIV infection, viral hepatitis, sexually transmitted diseases, and tuberculosis for persons who use drugs illicitly: summary guidance from CDC and the U.S. Department of Health and Human Services. MMWR Morb Mortal Wkly Rep. 2012; 61(RR05);1-40.
  7. Barocas JA, Eftekhari Yazdi G, Savinkina A, et al. Long-term infective endocarditis mortality associated with injection opioid use in the United States: a modeling study. Clinical Infectious Diseases. 2020. doi:10.1093/cid/ciaa1346
  8. Platt L, Minozzi S, Reed J, et al. Needle syringe programmes and opioid substitution therapy for preventing hepatitis C transmission in people who inject drugs. Cochrane Database of Systematic Reviews. 2017. doi: 10.1002/14651858.cd012021.pub2
  9. Des Jarlais DC, Kerr T, Carrieri P, Feelemyer J, Arasteh K. HIV infection among persons who inject drugs. AIDS. 2016;30(6):815-826. doi:10.1097/qad.0000000000001039
  10. Hodder SL, Feinberg J, Strathdee SA, et al. The opioid crisis and HIV in the USA: deadly synergies. The Lancet. 2021;397(10279):1139-1150. doi:10.1016/s0140-6736(21)00391-3
  11. Surratt HL, Otachi JK, Williams T, Gulley J, Lockard AS, Rains R. Motivation to change and treatment participation among syringe service program utilizers in rural Kentucky. The Journal of Rural Health. 2020;36(2):224-233. doi:10.1111/jrh.12388
  12. Department of Health and Human Services Implementation Guidance to Support Certain Components of Syringe Services Programs, 2016. Department of Health and Human Services. https://www.cdc.gov/hiv/pdf/risk/hhs-ssp-guidance.pdf. Published March 29, 2016. Accessed May 11, 2021.
  13. Sightes E, Ray B, Watson D, Huynh P, Lawrence C. The Implementation of syringe services programs (SSPs) in Indiana: benefits, barriers, and best practices. IUPUI Richard M. Fairbanks School of Public Health. https://fsph.iupui.edu/doc/research-centers/SSP_Report_20180516.pdf. Published May 2018. Accessed May 11, 2021.
  14. Kerr T, Small W, Buchner C, et al. Syringe sharing and HIV incidence among injection drug users and increased access to sterile syringes. American Journal of Public Health. 2010;100(8):1449-1453. doi:10.2105/ajph.2009.178467
  15. Bluthenthal RN, Anderson R, Flynn NM, Kral AH. Higher syringe coverage is associated with lower odds of HIV risk and does not increase unsafe syringe disposal among syringe exchange program clients. Drug and Alcohol Dependence. 2007;89(2-3):214-222. doi:10.1016/j.drugalcdep.2006.12.035
  16. Levine H, Bartholomew TS, Rea-Wilson V, et al. Syringe disposal among people who inject drugs before and after the implementation of a syringe services program. Drug and Alcohol Dependence. 2019;202:13-17. doi:10.1016/j.drugalcdep.2019.04.025
  17. Tookes HE, Kral AH, Wenger LD, et al. A comparison of syringe disposal practices among injection drug users in a city with versus a city without needle and syringe programs. Drug and Alcohol Dependence. 2012;123(1-3):255-259. doi:10.1016/j.drugalcdep.2011.12.001
  18. Trends in crime and the introduction of a needle exchange program. American Journal of Public Health. 2000;90(12):1933-1936. doi:10.2105/ajph.90.12.1933