Origin of Syringe Services Programs
Syringe services programs began in Europe in the 1980s as part of an effort to reduce rates of blood borne diseases such as Hepatitis B virus (HBV) infection, HIV and HCV among people who inject drugs. Urban areas in the United States followed suit and initiated such programs. Boston, Massachusetts and Tacoma, Washington were the locations of some of the earliest syringes services programs in the United States. Amsterdam had early success in decreasing the rate of HIV infection among people who inject drugs by instituting syringe services programs. Syringe services programs have been controversial since their inception because of their association with intravenous drug use and disenfranchised populations. The US government instituted a ban on federal funds to be used for syringe exchange programs in 1988. This ban was lifted briefly in 2009 and reinstated in 2011. However, in 2016, language was included in the federal appropriations bill that allows federal funding for syringe exchange programs, with the exception of paying for syringes. The costs associated with a syringe services program vary but the cost of the syringe itself is minor, estimated by the CDC in 2005 to be less than $1.00. Guidance has been issued by the Centers for Disease Control and Prevention that details how to request federal funding. When applying for federal funding, information must be provided that establishes a compelling need for a syringe services program. However, complying with the determination of need requirements is not overly complicated and the request should be made early when planning to establish a syringe services program.
Syringe services programs vary from mobile units to fixed sites or sites with both a mobile presence and a fixed site, and by the types of services provided
Types of Syringe Services Programs
Syringe services programs vary from mobile to fixed sites, the number of syringes that can be provided, and the types of services offered. At programs requiring a “one for one” exchange of syringes, an individual can only receive a needle if s/he turns one in. In others, individuals can receive as many syringes as s/he thinks are needed between visits to the program. A 2001 California study of syringe services programs found that clients were less likely to reuse syringes at programs where they were provided syringes on an as-needed basis, rather than one-for-one. Limiting the availability of syringes has been shown to be a risk factor for sharing needles. The Joint United Nations Programme on HIV/Acquired Immunodeficiency Syndrome (AIDS) (UNAIDS) recommends providing 200 sterile syringes per person who injects drugs every year for a high level of coverage.
Syringe service programs can be fixed sites, or can combine a fixed site with a mobile unit or other outreach. Other programs are co-located in community clinics that provide or refer people to various health services, such as substance use disorder treatment, HIV and HCV treatment or other health care for the consequences of injection drug use.
It is well-established that syringe services programs are effective at decreasing blood borne diseases. However, since they began in the 1980s, they have been the source of controversy and some contend, wrongly, that they perpetuate a permissive attitude toward drug use. There is no evidence to support the contention that syringe services programs increase drug use, crime, or the presence of discarded syringes.
Unfortunately, the call to establish syringe services programs usually is preceded by a crisis in a community – increasing rates of opioid misuse, whether prescription drug or heroin, along with a lack of access to treatment, may presage an increase in HIV and HCV. The crisis exists and then the community must respond to the crisis.
The purpose of this guide is to provide information about the important role syringe services programs can play in the opioid epidemic. It can also be used for community members seeking to establish syringe service programs, ideally before an outbreak of HIV, HCV, or overdose deaths. This is not a technical guide to developing syringe services programs. Other guides exist to aid those who wish to develop these programs. However, this guidebook provides more recent data considering today’s opioid epidemic and is intended to introduce community members to the basics of syringe services programs, identify the need for them in certain at-risk communities, and provide guidance on what to should consider when establishing these programs.
The term "syringe services program" is used throughout this guide although other terms are used for such programs, including needle exchange programs, syringe access programs, and other terms. The term syringe services program is used because it more accurately reflects that such programs provide an array of services, including the distribution of sterile syringes.