Training Guide

Guide to Developing and Managing Syringe Access Programs


This manual is designed to outline the process of developing and starting a Syringe Access Program (SAP). It offers practice suggestions and considerations rooted in harm reduction – an approach to drug use that promotes and honors the competence of drug users to protect themselves, their loved ones, and their communities and the belief that drug users have a right to respect, health and life-saving sterile injection equipment.

Throughout this manual, we will refer to programs that provide syringes and needles to injection drug users (IDUs)

whether through a process of exchange, distribution or any other variation – as Syringe Access Programs (SAPs). This term will be used to encompass programs otherwise referred to as needle exchange programs (NEPs), syringe exchange programs (SEPs), needle and syringe programs (NSPs), clean needle programs (CNPs) and/or other commonly used terms. The use of SAP has been deliberately chosen to emphasize the importance of unhindered access to medical equipment that saves lives.

This manual uses as a starting point the evidence that SAPs

  • Reduce the spread of blood-borne infections such as Human Immunodeficiency Virus (HIV) and the hepatitis C virus (HCV).
  •  Support the health and well-being of drug users through linkages to drug treatment, medical care, housing, and other vital social services.
  •  Respect, value and prioritize the human rights and dignity of people who use drugs.
  • Promote a pragmatic public health-driven approach to substance use and addiction.
  • Do NOT encourage, enable, or increase drug use.
  • Do NOT increase crime rates or criminal activity.
  • Do NOT increase needlestick injuries in the community.

These shared understandings have been borne out repeatedly in years of social and scientific research, service provision and above all, from the experience of drug users, their families, and their communities. The history of syringe access in the United States is one of innovation, resourcefulness, activism, compassion, and a commitment to social justice and the human rights of drug users. Following in this tradition, it is critical that any SAP amplify the voices of drug users and prioritize their involvement at every level.

Developing an SAP and doing the daily work required to keep it up-and-running can be challenging – both physically and emotionally. That said, it can also be tremendously rewarding and meaningful. Creativity, humor, flexibility, and the willingness to listen, learn and understand the experiences of those around you will prove to be vital assets.

This manual is simply a guide. It is not meant to be exhaustive, as there are numerous other resources that go into extended detail about many of the topics covered in this manual. We have provided links to these resources whenever possible. Take from this manual the parts that are important and meaningful to you, and leave those pieces that may not apply.