Training Guide

Syringe Access Landscape


Historically, the laws concerning syringe access have fallen in two distinct categories: the arrest, prosecution, and criminalization of those who use, carry, or distribute syringes; and the authorization or “ease” of setting up and running a Syringe Service Program (SSP) in your area. We recognize that some states have engaged in supporting programs with funding services/supplies, we are focusing this report specifically on criminalization and authorization. While information on funding services/supplies is not included in this year’s version of the landscape, we are available to help assess how your state’s elected officials are actively supporting SSPs and to identify ways to encourage legislative changes. To discuss your state’s SSP programs, please contact us HERE.


Most states have a drug paraphernalia law which makes it a crime to possess, distribute, or sell certain materials related to drug use; in many states, syringes are included in their paraphernalia law. That means that unauthorized possession of a syringe can place individuals at risk of arrest, prosecution, and loss of basic human rights. States that support access to syringes have worked with advocates to either strike the word ‘syringe’ out of their paraphernalia laws altogether – meaning that it’s no longer a crime to possess or distribute syringes – or made an exemption to the law for either people who participate in a SSP, or for the actual syringes obtained at an approved SSP.  

Another risk that people who use syringes face from the criminal justice system is that sometimes drug residue on a used syringe can be considered drug possession, drug paraphernalia or in other ways used as evidence of a crime. States that want to support people using SSPs have put in place an explicit protection against drug residue on returned syringes being used for prosecution.

Our state fact sheets address:

  • Whether a state’s drug paraphernalia law includes syringes (in other words, whether possessing a syringe is a crime in that state)
  • Whether the state has an exemption for SSP participants (in other words, even if it is a crime to possess a syringe normally it is not a crime if you get the syringe at an authorized SSP), and 
  • Whether there is a protection against prosecution for drug residue. 

Authorization of Syringe Service Programs
Outside of the criminal legal framework around syringes, some states have specifically authorized SSPs to operate in their state. While clear authorization to operate in a state can in some cases be helpful, in other cases the way these programs have been authorized creates unnecessary barriers in the licensing or running of SSPs. Unnecessary requirements on who needs to approve a program, where programs can be located, or who staffs these locations can make it difficult to get SSPs up and running in the communities they’re needed in. Many times states impose policies that impact how a program runs, which contradict best practices and public health or medical standards, like imposing exchange limitations, or setting requirements for referrals, treatment services, or burdensome data collection (all of which can overburden small programs). 

Our state fact sheets identify three possibilities for authorization: if SSPs are explicitly allowed to operate in the state, if they are actively being prevented from operating based on existing drug paraphernalia or other laws, or if there is nothing preventing an SSP from distributing syringes because a state’s drug paraphernalia law does not criminalize the possession or distribution of syringes. 

We then list out the following areas of requirements that may create a barrier for the licensing or operation of a program. We describe if program authorization is subject to the approval of a state or local government official or body and then whether that approval is subject to any restrictions, such as:

  • Local or law enforcement consultation: meaning that a local agency or law enforcement must be consulted in the approval of an SSP 
  • Location of a program and/or a demonstration of need: meaning programs may only apply if they are located in a specific area, usually one that the CDC or a state or local health department has deemed it a high risk area for drug use
  • Eligible entities: meaning that only specific entities such as a hospital, community health center, or other specified entity is able to apply to be an SSP
  • Staffing: meaning that a program must show that it has a nurse, doctor, or some other specific professional on staff 
  • Renewals: meaning that the approval only lasts for a specific amount of time (usually 1-2 years) and the SSP must then apply for renewal 

We then describe what, if any, policies curtail the operation of SSPs:

  • Exchange limitations: usually a 1-1 requirement or cap per individual transaction meaning that a program may only give participants a syringe in exchange for a returned syringe, going against best practices 
  • Secondary exchange limitations: meaning that a participant may only receive syringes for themselves, and cannot pick up syringes for another person 
  • Registration requirements for participants: meaning that there are steps a person has to go through to register as a participant of an SSP, both placing extra barriers to receiving supplies as well as making this care less confidential
  • Requirements for services, referrals, or supplies offered: meaning that along with syringes an SSP must be able to offer additional services or supplies, or referrals to those services (often drug counseling or treatment), making it more financially or resource heavy to run an SSP
  • Data collection requirements: meaning that an SSP has to collect and report out on certain data, often the number of participants served and/or syringes given out or collected.