State Laws

While syringe services programs have existed in the United States since the 1980s, several states did not have laws in place until recently that allowed for the establishment of syringe services programs. In addition, states that did allow them, such as Maryland and Massachusetts, limited the number of syringe programs or limited the location of the programs. Below is an overview of a few states with new laws allowing for these programs. The impetus behind the new laws in these states has been the opioid overdose epidemic, as well as increasing rates of injection drug use and HCV and HIV in areas that previously had low prevalence of both injection drug use and HCV and HIV.


Kentucky Harm Reduction Coalition maintains a list of syringe services programs located in Kentucky. They are located within county health departments and provide screening for infectious disease, the opioid overdose antidote naloxone, and other services for people who inject drugs. As the map below shows, of the 220 counties identified by CDC to be at-risk for increased HIV rates, 54 are in Kentucky. The Commonwealth has moved quickly to make certain that syringe services programs programs are available in many of the at-risk counties, with more planned.

54 Kentucky counties with increased vulnerability to rapid HIV outbreak among people who inject drugs, and preventive syringe exchange programs

In 2015, the Kentucky legislature passed a comprehensive law addressing burgeoning rates of heroin use and overdose death. This legislation allowed county health departments to establish Harm Reduction and Syringe Exchange Programs. The legislation took effect under an emergency provision in May 2015 and requires local approval under a three-step process for an exchange program to be operated. There must first be a local needs assessment, then community collaboration and lastly a determination of how best to reach individuals in need of the program. Other states should consider the severity of their situation and whether requiring such a process will prevent the swift establishment of syringe services programs in their community. The Kentucky Public Health Department guidelines also list other issues to consider such as how the syringes will be delivered and what outcome measures will be gathered. Kentucky code is here.

North Carolina

Syringe service programs became legal in 2016 with the signing of HB972. Passage of the bill allows governments and non-governmental entities to establish syringe services programs. It also allows for limited immunity to those using or working in the programs. The Act states that the purpose of such programs is to “Reduce the spread of HIV, AIDS, viral hepatitis, and other bloodborne diseases in this State. (2) Reduce needle stick injuries to law enforcement officers and other emergency personnel. (3) Encourage individuals who inject drugs to enroll in evidence-based treatment.” It also allows for limited immunity for possession or a needle or residual controlled substance in the needle or other device if the individual has documentation that the needle was provided to the individual from an exchange program developed pursuant to the law. The North Carolina Harm Reduction Coalition has an overview of the law and how it is applied in North Carolina. The National Harm Reduction Coalition lists syringe exchange programs in North Carolina on its site. Syringe exchange programs in North Carolina vary from fixed sites to mobile. Link to the North Carolina General Assembly website is here.

West Virginia

The first syringe services program in West Virginia was in Morgantown, West Virginia in 2015. Since then, others have been established, including locations in Huntington and Charleston WV. The West Virginia Department of Health and Human Resources partnered with the city of Huntington and the Cabell Huntington Health Department to initiate their syringe services program. The Huntington and Charleston syringe services programs both partner with a local recovery center to provide peer support to clients. Read more about Huntington’s strategic plan to address the opioid crisis here. Find West Virginia’s code here.

The first syringe services program in West Virginia was in a free clinic in Morgantown WV in 2015. Others have since been established then and are affiliated with county health clinics. The syringe services programs are usually limited to half a day one day a week at the community health clinics. Screening for infectious disease and referrals to treatment are provided at all the clinics. The Kanawha County Clinic partners with local recovery organizations to answer questions and provide treatment referrals and support for individuals coming to the syringe services program. More on the Kanawha County program is here.

Additional State Laws

In 2017, Tennessee passed and the Governor signed legislation revising current law on syringe services programs. Find a link to the Tennessee state legislative code here.

In 2017, Virginia also passed legislation allowing syringe services programs. The law allows Virginia’s Commissioner of Health to establish and operate harm reduction programs that include sterile syringe distribution, during a public health emergency.

For a state by state look at laws relating to syringe access, LawAtlas updated as of May 2016.