Syringe Services Programs

Content From: HIV.gov•5 min read

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Summary

Unsafe injection practices, like sharing injection drug equipment, puts people who inject drugs at risk of overdose and of getting and transmitting certain infectious diseases.
Syringe services programs (SSPs) are a key part of preventing the spread of infectious disease through injection drug use.
SSPs can help reduce the spread of blood-borne diseases and connect people to other health services, like HIV diagnosis and treatment and medication-assisted treatment for opioid use disorder.

Opioid Epidemic Increases Risks for HIV and Other Infectious Diseases

The nation is experiencing a public health crisis involving the misuse of prescription opioid pain medications as well as use of heroin and fentanyl. This has led to an increase in unsafe injection practices that put people who inject drugs (PWID) at risk of overdose and of getting and transmitting blood-borne infectious diseases.

HIV, viral hepatitis, and other blood-borne pathogens can spread through injection drug use if people use needles, syringes, or other injection equipment that was previously used by someone who had one of these infections. Injecting drugs can also lead to other serious health problems, such as skin infections, abscesses, and endocarditis.

Until recently, CDC had observed a steady decline since the mid-1990s in HIV diagnoses attributable to injection drug use. However, recent data show progress has stalled. Over 2,500 new HIV infections occur each year among PWID.

The best way to reduce the risk of getting and transmitting disease through injection drug use is to stop injecting drugs. For people who do not stop injecting drugs, using sterile injection equipment for each injection can reduce the risk of infection and prevent outbreaks.

Syringe Services Programs Reduce the Transmission of Infectious Disease and Save Lives

SSPs are a safe, effective, and cost-saving way to prevent the spread of HIV and HCV through injection drug use.

Syringe services programs, often called SSPs, are a key component of a comprehensive strategy to combat the nation’s opioid crisis and prevent the spread of infectious disease through injection drug use. SSPs are associated with an approximately 50% reduction in HIV and hepatitis C virus (HCV) incidence and serve as a bridge to other health services, including HIV and HCV diagnosis and treatment and medication-assisted treatment (MAT) for opioid use disorder. That’s why SSPs are a key strategy of the Ending the HIV Epidemic initiative, the nation’s plan to end the HIV epidemic in the United States.

What Are SSPs?

SSPs are community-based prevention programs that can provide a range of services, including

Access to and disposal of sterile syringes and injection equipment.
Linkage to substance use disorder treatment.
Distribution of naloxone, a medication that reverses overdoses.
Vaccination, testing, and linkage to treatment for infectious diseases, including HIV and hepatitis B and C.
Education about overdose prevention and safer injection practices.
Abscess and wound care.
Referral to social, mental health, and other medical services.

SSPs protect the public and first responders by facilitating the safe disposal of used needles and syringes. Providing testing, counseling, and sterile injection supplies also helps prevent outbreaks of other diseases.

Nearly 30 years of research shows that comprehensive SSPs are safe, effective, and cost saving; do not increase illegal drug use or crime; and play an important role in reducing the transmission of viral hepatitis, HIV, and other infections. They also play an important role in improving the health of PWID; people who use SSPs are five times more likely to enter drug treatment and three times more likely to stop injecting drugs than people who don’t use SSPs.

HHS Funds Can Support Certain Components of SSPs

Appropriations language from Congress in recent fiscal years has permitted use of funds from HHS, under certain circumstances, to support SSPs with the exception that funds may not be used to purchase needles or syringes.

State, local, tribal, or territorial health departments must first consult with the Centers for Disease Control and Prevention (CDC) and provide evidence that their jurisdiction is experiencing or at risk for significant increases in hepatitis infections or an HIV outbreak due to injection drug use.

CDC has developed guidance and consults with state, local, or tribal and territorial health departments to determine if they have adequately demonstrated need according to federal law. Decisions about use of SSPs to prevent disease transmission and support the health and engagement of PWID are made at the state and local level.

After receiving a request for determination of need, CDC has 30 business days to notify the requestor whether the evidence is sufficient to demonstrate a need for SSPs. When CDC finds there is sufficient evidence, state, local, tribal, and territorial health departments and other eligible HHS grant recipients may then apply to their respective federal agencies to direct funds to support approved SSP activities. Each federal agency (e.g., CDC, HRSA, SAMHSA) developed its own guidance for its funding recipients regarding which specific programs may apply and its application process:

CDC maintains a list of jurisdictions that have consulted with CDC and have been determined to have adequately demonstrated need according to federal law. These jurisdictions are currently experiencing or are at risk of significant increases in viral hepatitis infection or an HIV outbreak due to injection drug use.

Take a Closer Look

CDC has released the SSP Technical Package, a suite of materials for use by health departments; national, state, and community partners; and decision-makers that review the safety and effectiveness of SSPs. Materials highlight use of SSPs in combatting the opioid epidemic, including:

Evidence of the effectiveness of strategies and approaches for supporting successful planning, design, implementation, and sustainability of SSPs.
Recommendations for a best practice for SSPs to reduce new HIV and viral hepatitis infections.
Evidence of the effectiveness of SSPs in reducing HIV and viral hepatitis.

Other materials include: