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Rural Health Information Hub

Syringe Services Programs

Syringe services programs (SSPs), also referred to as syringe exchange programs (SEPs), are programs that allow people who inject drugs to exchange their used syringes for new, sterile needles, thereby reducing the transmission of infectious diseases like human immunodeficiency virus (HIV) and hepatitis C virus that can be transmitted via needle sharing. For example, in 2015 public health officials reported an outbreak of HIV in rural Indiana that was ultimately linked to injection use of the prescription opioid oxymorphone. Needle and syringe programs can be delivered in several different formats. Some of the main sources include fixed sites, mobile programs, outreach programs, syringe vending machines, and pharmacies.

Syringe services programs have been shown to help prevent the transmission of HIV and viral hepatitis among individuals who inject drugs. The U.S. Department of Health and Human Services (HHS) has issued guidance for use of federal funds in order to implement and expand syringe services programs for individuals who inject drugs. In 2015, the bipartisan budget agreement revised a longstanding ban on syringe services programs.

In 2015, the Centers for Disease Control and Prevention (CDC) reported increased rates of drug injection in suburban and rural areas, particularly related to injection of prescribed opioids and heroin. However, there are substantially fewer harm reduction services available in rural than in urban areas. Prevention programs like SSPs have shown to be effective in reducing transmission rates of diseases such as HIV and hepatitis C.

Examples of Syringe Services Programs

  • The Indiana Syringe Exchange Program was signed into law May 5, 2015, permitting SEPs to be created throughout communities in Indiana. Local health departments, municipalities, or approved nonprofit organizations are allowed to operate a syringe exchange program through this agreement.
  • The Kentucky Harm Reduction and Syringe Exchange Program (HRSEP) was designed in response to an amended law allowing individuals to exchange used hypodermic needles and syringes for clean substitutes. HRSEP provides guidelines to help local health departments initiate HRSEP in their communities.
  • The Winnebago County Drug & Alcohol Coalition, located in Winnebago County, WI, partnered with the AIDS Resource Center of Wisconsin to bring the LifePoint Needle Exchange program to the county. The needle exchange service is located in the county health department. In addition to needle exchange, the program provides information on treatment programs and other services in the county, as well as referrals to treatment.

Considerations for Implementation

Syringe services programs are a controversial topic in some communities. The services may be misconstrued as providing injection drug users with easy access to clean needles thereby enabling their drug use. However, the goal of syringe services programs is to reduce the transmission of blood-borne infections and diseases, such as HIV and hepatitis B and C virus. Collaborations between public health and public safety/law enforcement institutions may improve the acceptability of these types of initiatives in rural communities.

Program Clearinghouse Example

Resources to Learn More

Guide to Developing and Managing Syringe Access Programs
Provides a step-by-step model for designing and managing syringe access programs. Describes planning and design, operational issues, organization issues, external issues, and population-specific considerations.
Author(s): Winkelstein, E.
Organization(s): Harm Reduction Coalition
Date: 2010

North American Syringe Exchange Network
A directory that allows viewers to access state syringe exchange networks. Users can search according to ZIP code or city.

Syringe Services Programs (SSPs): Developing, Implementing, and Monitoring Programs
Provides a list of multiple tools and resources for health departments and other local agencies in creating SSPs.
Organization(s): Centers for Disease Control and Prevention Division of HIV/AIDS Prevention
Date: 2/2016

Tackling the Trifecta: State Approaches to Addressing Co-Occurring Substance Use Disorders, HIV, and Hepatitis C
Highlights the methods used in Louisiana, New York, and West Virginia to prevent the spread of co-occurring HIV and HCV infections and SUD through intravenous drug use. Describes their funding streams, use of data, and community engagement strategies during the development process.
Author(s): Mette, E., Manz, J., & Long, K.
Organization(s): National Academy for State Health Policy
Date: 4/2020