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Department of Health and Human Services 

Implementation Guidance for 

Syringe Services Programs

May 15, 2016 (Revised July 28, 2016)

SAMHSA-specific Guidance for Minority HIV/AIDS Initiative (MAI)

Programs Implementing SSPs 

This guidance was developed in accordance with HHS’s Implementation Guidance for Syringe 

Services Programs (SSPs).

On December 18, 2015, President Barack Obama signed the Consolidated Appropriations Act, 

2016 (Pub. L. 114-113),1 which modifies the restriction on use of federal funds for programs 

distributing sterile needles or syringes (referred to as SSPs, or as syringe exchange programs) for 

HHS programs. The Consolidated Appropriations Act, 2016, Division H states:

SEC. 520. Notwithstanding any other provision of this Act, no funds appropriated in this 

Act shall be used to purchase sterile needles or syringes for the hypodermic injection of 

any illegal drug: Provided, That such limitation does not apply to the use of funds for 

elements of a program other than making such purchases if the relevant State or local 

health department, in consultation with the Centers for Disease Control and Prevention, 

determines that the State or local jurisdiction, as applicable, is experiencing, or is at risk 

for, a significant increase in hepatitis infections or an HIV outbreak due to injection drug 

use, and such program is operating in accordance with State and local law. 

Pertinent language of the Consolidated Appropriations Act of 2016 (the Act) is found here:

http://docs.house.gov/billsthisweek/20151214/CPRT-114-HPRT-RU00-SAHR2029-

AMNT1final.pdf.

While the provision still prohibits the use of federal funds to purchase sterile needles or 

syringes for the purposes of hypodermic injection of any illicit drug, it allows for federal 

funds to be used for other aspects of SSPs based on evidence of a demonstrated need (i.e., 

experiencing, or at risk for, increases in hepatitis infections or an HIV outbreak due to 

injection drug use) by the state or local health department and in consultation with the Centers 

for Disease Control and Prevention (CDC). State and local health departments interested in 

redirecting federal funds to support SSPs should consult with CDC by providing evidence that 

their jurisdiction is (1) experiencing or, (2) at risk for increases in viral hepatitis infections or 

an HIV outbreak due to injection drug use. The scope of the presented evidence should 

address the geographic area that will be served by the SSPs and include county, city and state 

level data, as appropriate.

 1 https://www.congress.gov/114/bills/hr2029/BILLS-114hr2029enr.pdf. Accessed on December 22, 2015.
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Applicable cooperative agreements and grants 

Grants funded under the following six (6) FY 2016 Funding Opportunity Announcements 

(FOAs), the Targeted Capacity Expansion-HIV program FOAs (TI-12-007, TI-13-011, TI-15-

006, TI-15-013, and TI-16-011) and the Minority AIDS Initiative Continuum of Care program 

(TI-14-013) may support SSP services with fiscal year 2016 and 20172 funds, with certain 

approvals, as an optional activity. Requests for funding for SSPs can be considered only if

“...the State or local health department, in consultation with the Centers for Disease Control and 

Prevention, determines that the State or local jurisdiction, as applicable, is experiencing, or is at 

risk for, a significant increase in hepatitis infections or an HIV outbreak due to injection drug 

use”, as stated in the Act. Beginning in FY 2017, newly issued FOAs will include guidance on 

the use of funding to support SSP activities. SAMHSA funds cannot be used to supplant or 

replace state or other non-federal funds currently supporting SSP activities within a state or 

jurisdiction. In other words, SAMHSA funds cannot be used to fund an existing SSP so that 

state or other non-federal funding can be used for other activities or program services.

The grantee, in collaboration with the local public health department, may propose to use their 

SAMHSA funds to implement or support an SSP in accordance with State and local law and the 

following requirements:

1. Provide documentation that the state or local jurisdiction has submitted data and 

supporting documentation to CDC for review and determination of applicability and 

approval for an SSP has been granted.

2. Demonstrate how an SSP fits with the objectives of the FOA and assess the effectiveness 

of SSP activities in referring individuals to substance use disorder prevention and 

treatment, and co-occurring mental health services and in reducing HIV risk behaviors.

3. Receive approval from your Government Project Officer (GPO) and SAMHSA to 

proceed with submission of the request

4. Once approved continue with the reporting requirements specified in your FOA and 

include reporting of the number of participants receiving SSP services, the number and 

types of services directly provided or provided by referrals and the amount of federal 

funds expended on SSP activities.

Allowed use of federal funding to support SSPs

1. Personnel to support SSP implementation and management (e.g., program staff, as well 

as staff for planning, monitoring, evaluation, and quality assurance).

 2 Use of 2017 funds for elements of syringe services programs is subject to an authorized appropriation for the 

fiscal year involved.
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2. Supplies to promote sterile injection and reduce infectious disease transmission 

through injection drug use, exclusive of sterile needles, syringes and other drug

preparation equipment.

3. Testing kits for viral hepatitis (i.e., HBV and HCV) and HIV.

4. Syringe disposal services (e.g. contract or other arrangement for disposal of biohazardous 

material).

5. Navigation services to ensure linkage to: HIV and viral hepatitis prevention, testing, 

treatment and care services, including antiretroviral therapy for HCV and HIV, pre-‐

exposure prophylaxis (PrEP), post‐exposure prophylaxis (PEP), prevention of mother 

to child transmission and partner services; substance use disorder treatment, and 

medical and mental health care.

6. Educational materials, including information about: safer injection practices; 

reversing a drug overdose; HIV and viral hepatitis prevention, testing, treatment and 

care services; and mental health and substance use disorder treatment, including 

medication assisted treatment.

7. Male and female condoms to reduce sexual risk of HIV and other STD infections.

8. Referral to hepatitis A and hepatitis B vaccinations to reduce risk of viral hepatitis 

infection.

9. Communication, including use of social media technologies, and outreach activities 

designed to raise awareness about, and increase utilization, of SSPs.

10. SSP planning and non-research evaluation activities.

SAMHSA funds can only be used to establish new or expand existing SSPs with prior approval 

from the project officer and grants management officer. SSPs are subject to the terms and 

conditions incorporated or referenced in the recipient’s federal funding. SAMHSA funds cannot 

be used to supplant or replace state or other non-federal funds currently supporting SSP activities 

within a jurisdiction. In other words, SAMHSA funds cannot be used to fund an existing SSP so 

that state or other non-federal funding can then be used for another program.

Grantee process for consideration of SSPs 

Approval must be secured from the State Health Department, CDC, and the SAMHSA GPO. 

SAMHSA GPOs may require additional information such as: 

• Description of proposed model(s) and plans, including MOUs with SSP providers who can 

supply needles; 

• Timeline for implementation; 

• Copy of existing SSP protocols or guidelines, if available; 

• Description of current training and technical assistance needs; 

• Location of SSP related activities to be supported with federal funds; and

• Signed statement (i.e., Annual Certification) that the grantee will comply with the language 

in the Consolidated Appropriations Act of 2016.
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Additionally, any changes impacting your current program budget must be submitted to and 

approved by the Division of Grants Management. Budget revisions must include a revised 

budget form SF424a, detailed budget and budget narrative. The budget narrative must include a 

justification for budget changes, including any disposal equipment. The narrative must also 

clearly identify how these costs are related to activities in the budget.

Awardees implementing new or expanding existing SSPs will need to collect basic SSP metrics 

information (e.g., number of syringes distributed, estimated number of syringes returned for safe 

disposal, number of persons tested for HIV or viral hepatitis, referrals to HIV, viral hepatitis and 

substance use disorder treatment) and amount of federal funds used for this program.

If you have any questions, contact your SAMHSA Project Officer.