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Syringe Services Programs

Sometimes called "needle exchange" or "syringe exchange," syringe programs provide access to clean sterile equipment used for the preparation and consumption of drugs as well as tools for the prevention and reversal of opioid overdose, such as naloxone training and distribution, fentanyl testing strips, and more. Comprehensive syringe services programs also provide additional social and medical services such as: safe disposal of syringes and needles; testing for HIV and hepatitis C infection and linkage to treatment; education about overdose and safer injection practices; referral and access to drug treatment programs, including MAT; tools to prevent HIV and other infectious disease, such as condoms, counseling, or vaccinations; and linkage to medical, mental health, and social services.

Why this strategy works

Syringe services programs are a key component of overdose prevention strategies, because they can facilitate access to and uptake of services and interventions for reducing overdose, enhancing health and wellbeing, and improving public health and safety.

First, some, but not all, people who use drugs experience homelessness, poverty, and other social or financial insecurities that make acquiring clean injection equipment challenging, even in locations where syringes can be purchased without a prescription. The free distribution of clean injection equipment lowers the frequency of syringe sharing and re-use, with major protective impacts on the rates of infectious diseases like HIV and hepatitis C as well as other injection-related infections or soft tissue injury. Individuals who participate in syringe services programs are also more likely to seek treatment for a substance use disorder.

Second, syringe services programs provide people who use a non-judgmental environment in which they are able to build supportive and trusting relationships, talk freely about their needs and concerns, and re-enforce feelings of self-worth, empowerment, and control. Relief from the shame and judgment carried by the stigma associated with drug use gives people the freedom to think objectively about the risks their drug use may pose to themselves and others and to strategize steps they can take to mitigate those risks. For people who are socially marginalized and have internalized stigma about their drug use, these services can substantially benefit their safety and chances of survival.

Third, if and when someone who uses drugs chooses to seek medical care, naloxone access, or substance abuse treatment, syringe services programs and their staff are able to help their participants connect with and navigate these services, making syringe services programs a key component of overdose prevention efforts on all fronts.

Syringe Services programs works best when:

  • They provide an adequate supply of sterile syringes. Limiting the number of syringes an individual may receive reduces the effectiveness of the intervention. Programs with one-for-one exchange policies, for example, allow participants as many syringes as the number of used syringes they return, thus undercutting the program's own effectiveness. When no limits are set on the number of syringes distributed, participants are more likely to have clean syringes on hand when they need them, and they can provide syringes to many more people that can't attend the program themselves, thus multiplying the program's effectiveness. This also increases participants' incentive to visit the program and interact with staff and counselors. 
  • These needs and concerns specific to the local drug using community are addressed and accommodated by the program.
  • Program participants who are seeking treatment for opioid use disorder or for other physical or mental health concerns are offered assistance in accessing appropriate care.

Syringe service programs-What the research says

  • Syringe services program participants are five times more likely to enter drug treatment and 3.5 times more likely to cease injecting compared to those who don't utilize these programs.
  • Syringe services programs are more effective at preventing disease and maximizing service coverage when distribution rules are less restrictive, such as when the program is distribution-based, not exchanged-based, and when distribution limits are high.
  • A key element to success of syringe service programs in reducing disease and overdose and in reducing disease and overdose and in connecting with more participants with care is the refocusing of public responses to drug use away from criminal justice approaches, which discourage safer drug use behaviors and requests for help, to public health approaches focused on the underlying drivers of these risks. Law enforcement officials can play an important role as partners in this shift by directing people found using illicit drugs to treatment programs rather than arresting and detaining them.
  • A recent study found that individuals who use drugs who were recently incarcerated are at significantly higher risk of overdose and are more willing than their non-incarcerated peers to receive training for and administer naloxone when this is offered by a syringe services program, making syringe service programs a particularly important intervention for assisting these high-risk individuals.
  • Some regions have begun implementing syringe access and disposal services at pharmacies and have achieved success in decreasing syringe sharing and reuse. However, a study in San Francisco found that more than 65% of interviewees who used drugs regularly disposed of syringes at syringe service programs, and almost none disposed of syringes at pharmacies, indicating that pharmacies alone cannot fill the role played by these programs with respect syringe disposal.

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