Opioid Crisis Is Raising Risks of HIV & Other Infectious Diseases
The nation is experiencing a public health crisis involving the misuse of prescription opioid pain relievers as well as heroin and fentanyl. This misuse has led to an increase in unsafe injection practices that put people who inject drugs (PWID) at risk of overdose deaths and 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 materials that were 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. Notably, new HIV infections among people who inject drugs, the group most affected by the expanding opioid epidemic, increased from 2014 to 2015.
The best way to reduce the risk of acquiring 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.
SSPs Reduce the Transmission of Infectious Disease and Save Lives
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. They 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 10-year plan to reduce new HIV infections in the United States by 75 percent in five years and by 90 percent by 2030.
What Are Syringe Services Programs (SSPs)?
Syringe service programs (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 people who inject drugs—people who use syringe services programs are five times more likely to enter drug treatment and three times more likely to stop injecting drugs.
HHS Funds Can Support for Certain Components of SSPs
Appropriations language from Congress in fiscal years 2016-2018 permits 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 people who inject drugs 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 Program Guidance for Implementing Certain Components of Syringe Services Programs, 2016
- HRSA Program Guidance for Implementing Certain Components of Syringe Services Programs
- SAMHSA Program Guidance for Implementing Certain Components of Syringe Services Programs
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.
Key Resources About Using Federal Funds to Support SSPs
- View CDC’s April 2016 webinar, Obtaining Approval for Use of Federal Funds for SSPs. In this webinar CDC walked participants through the process of requesting a determination of need for SSPs in consultation with CDC. Participants received practical information and tips for preparing these requests as well as responses to their questions:
- Read CDC’s Syringe Services Programs: Developing, Implementing, and Monitoring Programs, a compendium of tools and resources to assist health departments and local partners in planning, designing, or implementing SSPs in their jurisdictions.
- View HRSA’s TargetHIV webinar, Ryan White HIV/AIDS Program (RWHAP) Part B Coverage of Treatment & Services In Syringe Services Programs (SSPs). In this webinar, trainers from NASTAD reviewed strategies to support RWHAP core medical and support service access/delivery within and/or in combination with local SSPs, specifically for RWHAP Part B Programs and AIDS Drug Assistance Programs (ADAPs).
Take a Closer Look
CDC has released 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, and highlights their use in combatting the opioid crisis. These materials are available online at https://www.cdc.gov/ssp/ and include:
- A summary outlining the evidence of SSP effectiveness on reducing HIV and viral hepatitis
- A fact sheet outlining the ways SSPs can prevent transmission of blood-borne infections, help stop substance use, and support public safety
- A fact sheet for health departments and community partners to share, that describes what SSPs are and what they do
- Frequently asked questions and answers about SSPs
Other materials include:
- CDC – Vital Signs: HIV and Infectious Drug Use
- HHS – Five-Point Strategy to Combat the Opioid Crisis
- HHS – Transcending the Epidemic - A Presentation by ADM Brett P. Giroir, Assistant Secretary for Health and Senior Advisor for Opioid Policy (March 19, 2019)
- HIV.gov Blog – Infectious Disease Consequences of the Opioid Crisis Explored at 3rd Plenary Session at CDC’s National HIV Prevention Conference featuring Assistant Secretary for Health (March 22, 2019)
- HIV.gov Blog – Syringe Service Programs Are Safe, Effective, and Cost-Saving – By Jonathan Mermin, M.D., M.P.H., RADM and Assistant Surgeon General, USPHS, Director, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention (June 26, 2019)