FY 2016-2017 Uniform Application 

Section III. Behavioral Health Assessment and Plan

Subsection C. Environmental Factors and Plan 

Amendment 

23. Syringe Services Program

The Substance Abuse Prevention and Treatment Block Grant (SABG) restriction1,2 on the use of 

federal funds for programs distributing sterile needles or syringes (referred to as syringe services 

programs (SSP)) was modified by the Consolidated Appropriations Act, 2016 (P.L. 114-113) 

signed by President Obama on December 18, 20153. 

Section 520. Notwithstanding any other provisions 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.

A state experiencing, or at risk for, a significant increase in hepatitis infections or an HIV 

outbreak due to injection drug use, (as determined by CDC), may propose to use SABG to fund 

elements of a SSP other than to purchase sterile needles or syringes. However, directing FY 

2016 SABG funds to SSPs will require a modification of the 2016-2017 SABG Behavioral 

Assessment and Plan (Plan). States interested in directing SABG funds to SSPs must provide the 

information requested below and receive approval on the modification from the State Project 

Officer. Please note that the term used in the SABG statute and regulation, intravenous drug 

user (IVDU) is being replaced for the purposes of this discussion by the term now used by the 

federal government, persons who inject drugs (PWID).

States may consider making SABG funds available to either one or more entities to establish 

elements of a SSP or to establish a relationship with an existing SSP. States should keep in mind 

the related PWID SABG authorizing legislation and implementing regulation requirements when 

modifying the Plan, specifically, requirements to provide outreach to PWID, SUD treatment and 

recovery services for PWID, and to routinely collaborate with other healthcare providers, which 

may include HIV/STD clinics, public health providers, emergency departments, and mental 

health centers4

. SAMHSA funds cannot be supplanted, in other words, used to fund an existing 

SSP so that state or other non-federal funds can then be used for another program.

In the first half of calendar year 2016 the federal government released three guidance documents 

regarding SSPs5: These documents can be found on the Aids.gov website: 

https://www.aids.gov/federal-resources/policies/syringe-services-programs/
1. Department of Health and Human Services Implementation Guidance to Support 

Certain Components of Syringe Services Programs, 2016 from The US Department 

of Health and Human Services, Office of HIV/AIDS and Infectious Disease 

Policyhttps://www.aids.gov/pdf/hhs-ssp-guidance.pdf 

2. Centers for Disease Control and Prevention (CDC )Program Guidance for Implementing

Certain Components of Syringe ServicesPrograms,2016 The Centers for Disease Control 

and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, 

Division of Hepatitis Prevention http://www.cdc.gov/hiv/pdf/risk/cdc-hiv-syringe-exchangeservices.pdf5. 

3. The Substance Abuse and Mental Health Services Administration (SAMHSA)-specific 

Guidance for States Requesting Use of Substance Abuse Prevention and Treatment Block 

Grant Funds to Implement SSPs http://www.samhsa.gov/sites/default/files/grants/sspguidance-state-block-grants.pdf 

Please refer to the guidance documents above when requesting a modification to the state’s 

2016-2017 Behavioral Health Assessment and Plan. 

Please follow the steps listed below to modify the Plan: 

Step 1 •Request a Determination of Need from the CDC

Step 2

•Modify the 2016-2017 Plan to expend FFY 2016 and/or FFY 2017* funds and 

support an existing SSP or establich a new SSP

•Include proposed protocols, timeline for implementation, and overall budget

•Submit planned expenditures and agency information on Table A listed below

Step 3

•Obtain State Project Officer Approval

•Collect all SSP information on Table B listed below to be reported in the FFY 

2019 SABG report due December 1, 2018.

*FFY 2017 and future years subject to authorizing language in appropriation bills.
SSP Program Information 

2016-2017 Behavioral Health Plan Amendment 

TABLE A 

Syringe Services

Program (SSP) Agency Name

Main Address of SSP Dollar amount of 

SABG funds used 

for SSP

SUD 

treatment 

Provider

Y or N

# of locations

(include

any mobile locations)

Narcan Provided

Y or N
SSP Annual Data Collection

TABLE B

Syringe Services Program 

Name

# of unique 

individuals 

served

HIV

Testing

(Please enter total 

number of 

individuals served)

Treatment for 

substance use 

conditions

(Please enter total 

number of individuals 

served)

Treatment for 

physical health

(Please enter total number 

of individuals served)

STD Testing

(Please enter total number 

of individuals served)

Hep C

(Please enter total number 

of individuals served)

ONSITE

testing

REFERRAL 

to testing

ONSITE 

treatment

REFERRAL 

to 

treatment

ONSITE 

treatment

REFERRAL 

to 

treatment

ONSITE 

testing

REFERRAL 

to testing

ONSITE 

testing

REFERRAL 

to testing
End Notes 

1

 Section 1923 (b) of Title XIX, Part B, Subpart II of the PHS Act (42 U.S.C. § 300x-23(b)) and 

45 CFR § 96.126(e) requires entities that receive SABG funds to provide substance use disorder 

(SUD) treatment services to PWID to also conduct outreach activities to encourage such persons 

to undergo SUD treatment. Any state or jurisdiction that plans to re-obligate FY 2016 SABG 

funds previously made available such entities for the purposes of providing substance use 

disorder treatment services to PWID and outreach to such persons may submit an amendment to 

its plan to SAMHSA for the purpose of incorporating elements of a SSP in one or more such 

entities insofar as the plan amendment is applicable to the FY 2016 SABG funds only and is 

consistent with guidance issued by SAMHSA.

2

Section 1931(a(1)(F) of Title XIX, Part B, Subpart II of the Public Health Service (PHS) Act 

(42 U.S.C.§ 300x-31(a)(1)(F)) and 45 CFR § 96.135(a)(6) explicitly prohibits the use of SABG 

funds to provide persons who inject drugs (PWID) with hypodermic needles or syringes so that 

such persons may inject illegal drugs unless the Surgeon General of the United States determines 

that a demonstration needle exchange program would be effective in reducing injection drug use 

and the risk of HIV transmission to others. On February 23, 2011, the Secretary of the U.S. 

Department of Health and Human Services published a notice in the Federal Register (76 FR 

10038) indicating that the Surgeon General of the United States had made a determination that 

syringe services programs, when part of a comprehensive HIV prevention strategy, play a critical 

role in preventing HIV among PWID, facilitate entry into SUD treatment and primary care, and 

do not increase the illicit use of drugs. 

3

 Division H Departments of Labor, Health and Human Services and Education and Related Agencies, 

Title V General Provisions, Section 520 of the Consolidated Appropriations Act, 2016 (P.L. 114-

113) 

4

 Section 1924(a) of Title XIX, Part B, Subpart II of the PHS Act (42 U.S.C. § 300x-24(a)) and 

45 CFR § 96.127 requires entities that receives SABG funds to routinely make available, directly 

or through other public or nonprofit private entities, tuberculosis services as described in section 

1924(b)(2) of the PHS Act to each person receiving SUD treatment and recovery services. 

Section 1924(b) of Title XIX, Part B, Subpart II of the PHS Act (42 U.S.C. § 300x-24(b)) and 45 

CFR 96.128 requires “designated states” as defined in Section 1924(b)(2) of the PHS Act to setaside SABG funds to carry out 1 or more projects to make available early intervention services 

for HIV as defined in section 1924(b)(7)(B) at the sites at which persons are receiving SUD 

treatment and recovery services. 

Section 1928(a) of Title XXI, Part B, Subpart II of the PHS Act (42 U.S.C. 300x-28(c)) and 45 

CFR 96.132(c) requires states to ensure that substance abuse prevention and SUD treatment and 

recovery services providers coordinate such services with the provision of other services 

including, but not limited to, health services. 

 

5 Department of Health and Human Services Implementation Guidance to Support Certain 

Components of Syringe Services Programs, 2016 describes a SSP as a comprehensive 
prevention program for PWID that includes the provision of sterile needles, syringes and other 

drug preparation equipment and disposal services, and some or all of the following services: 

• Comprehensive HIV risk reduction counseling related to sexual and injection and/or 

prescription drug misuse; 

• HIV, viral hepatitis, sexually transmitted diseases (STD), and tuberculosis (TB) 

screening;

• Provision of naloxone (Narcan®) to reverse opiate overdoses; 

• Referral and linkage to HIV, viral hepatitis, STD, and TB prevention care and treatment 

services;

• Referral and linkage to hepatitis A virus and hepatitis B virus vaccinations; and 

• Referral to SUD treatment and recovery services, primary medical care and mental 

health services. 

 

Centers for Disease Control and Prevention (CDC) Program Guidance for Implementing Certain

Components of Syringe Services Programs, 2016 includes a description of the elements of a SSP

that can be supported with federal funds. 

• Personnel (e.g., program staff, as well as staff for planning, monitoring, evaluation, and 

quality assurance); 

• Supplies, exclusive of needles/syringes and devices solely used in the preparation of 

substances for illicit drug injection, e.g., cookers; 

• Testing kits for HCV and HIV; 

• Syringe disposal services (e.g., contract or other arrangement for disposal of biohazardous material);

• Navigation services to ensure linkage to HIV and viral hepatitis prevention, treatment and 

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

prophylaxis, post-exposure prophylaxis, prevention of mother to child transmission and 

partner services; HAV and HBV vaccination, substance use disorder treatment, recovery 

support services and medical and mental health services;

• Provision of naloxone to reverse opioid overdoses 

• Educational materials, including information about safer injection practices, overdose 

prevention and reversing a opioid overdose with naloxone, HIV and viral hepatitis 

prevention, treatment and care services, and mental health and substance use disorder 

treatment including medication-assisted treatment and recovery support services; 

• Condoms to reduce sexual risk of sexual transmission of HIV, viral hepatitis, and other 

STDs;

• Communication and outreach activities; and

• Planning and non-research evaluation activities.