"Despite the proven and potential benefits, SSPs remain somewhat controversial in the United States owing to the 'war on drugs' ideology and the misconception that substance use disorders (SUD) represent a moral failing, as well as the fear that SSPs might lead to drug use initiation.10,24 At the time of inaugural SSP development in the 1980s, one notable barrier was the 1988 ban on the use of federal funding for SSP programs until they could be proven safe and effective.10,24

"As evidence on the benefits of SSPs mounted, over the decades there were several attempts to lift the funding ban.24 After the HIV outbreak in Scott County, Indiana, brought national attention to the event and SSPs were included in the public health response, the federal ban was removed again in 2015 to allow for the use of federal funds to support SSP operations in areas or jurisdictions deemed at risk for outbreaks, excepting the actual purchase of needles and syringes.10 This change has facilitated SSP expansion.25 However, SSPs have been slow to spread to vulnerable areas, reflecting continuing stigma as well as hurdles posed by state and local drug paraphernalia laws.26 By 2015, many states had updated policies to allow for licensed SSPs, but today there are still several states that prohibit them.11 Other regulations also affect the number of syringes that can be distributed or exchanged, for example, requiring a used syringe to be collected for each clean syringe dispensed (ie, 1-for-1 syringe exchange).27 Overall, in the United States there continues to be a complicated regulatory landscape that hinders adequate access to sterile injection supplies.

"In contrast, other countries including Canada, Australia, and many European Union nations are permissive and supportive of SSPs, with costs shared by national and local governments and even international organizations.4,28"


Thakarar, K., Nenninger, K., & Agmas, W. (2020). Harm Reduction Services to Prevent and Treat Infectious Diseases in People Who Use Drugs. Infectious disease clinics of North America, 34(3), 605–620. doi.org/10.1016/j.idc.2020.06.013