Syringe Services Programs

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 infective endocarditis, 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

Many syringe services programs provide additional services including the distribution of the overdose-reversing medication naloxone, 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.¹¹

Image

NIDA | Source: CDC, NHLBI

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.¹² 

Many syringe services programs provide additional services, including the distribution of the overdose-reversing medication naloxone, 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.¹¹

Syringe services programs have 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

Image

Courtesy of Multnomah County, Oregon

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

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.