Syringe Service Programs

"Syringe service programs (SSPs), which at minimum provide access to and disposal of sterile syringes and injection equipment for people who use drugs (PWUD), were initiated in Australia, Europe, and the United States in response to the hepatitis B and HIV epidemics of the 1980s.^1,2 Over the past 4 decades, SSPs have responded creatively and effectively to these ongoing epidemics^3,4 and to the emergence of new health crises that have faced PWUD, such as hepatitis C virus (HCV), unsafe drug supply, opioid overdose, endocarditis, and skin and soft tissue infections.^5-10 As the novel coronavirus 2019 (COVID-19) pandemic wreaks havoc around the world, SSPs have been forced to pivot and reimagine service delivery to protect the lives of their program participants, volunteers, and staff.

"SSPs have historically been grassroots and community-led responses, designed, implemented, and staffed by current and former PWUD, HIV and social justice activists, and people who deeply care for those who are marginalized and stigmatized by their drug use.^11-15 There is a strong evidence base for the effectiveness of SSPs in reducing injection risk behaviors and infectious disease transmission among program participants.^16,17 SSPs in the United States have developed into multiservice organizations in many cases, providing testing and linkage to care for people with HIV and HCV as well as linkage to substance use treatment.¹⁶

"SSPs receive funding from a variety of sources including city, county, state health departments; private foundations; corporate donations; other community-based organizations; and local fundraising efforts. Services are provided through drop-in centers, mobile service sites, fixed outdoor sites (pop-up tables, mobile vans, etc.), outreach, and delivery, and are often staffed by volunteers as well as paid staff. SSPs are designed to be welcoming and non-stigmatizing and are often the only source of health care with which PWUD engage.^18-20 Thus, SSPs fill a unique role in promoting health and well-being in the lives of PWUD, and engagement with SSPs has consistently been associated with lower risk behaviors and better health outcomes among participants.^21-23 Furthermore, SSPs have integrated overdose education and naloxone distribution (OEND) into service provision and have pioneered opioid-related overdose prevention efforts since the late 1990s.^24-26 As of 2019, 94% of SSPs in the United States were also offering OEND programs,⁹ which prepare laypersons—PWUD, family members, peers—as prospective responders in overdose events by providing training in rescue breathing, access to naloxone, and directions for naloxone administration."