What is an SSP?

Syringe services programs (SSPs) are also referred to as syringe 

exchange programs (SEPs) and needle exchange programs 

(NEPs). Although the services they provide may vary, SSPs 

are community-based programs that provide access to sterile 

needles and syringes, facilitate safe disposal of used syringes, 

and provide and link to other important services and programs 

such as

• Referral to substance use disorder treatment programs.

• Screening, care, and treatment for viral hepatitis and HIV.

• Education about overdose prevention and safer injection 

practices.

• Vaccinations, including those for hepatitis A and hepatitis B.

• Screening for sexually transmitted diseases. 

• Abscess and wound care.

• Naloxone distribution and education.

• Referral to social, mental health, and other medical services.

CS 300156-H March 29, 2019

Syringe Services 

Programs (SSPs) FAQs

Are SSPs legal?

Some states have passed laws specifically 

legalizing SSPs because of their life-saving 

potential. SSPs may also be legal in states where 

possession and distribution of syringes without a 

prescription are legal.

Decisions about use of SSPs as part of prevention 

programs are made at the state and local levels. 

The Federal Consolidated Appropriations Act of 

2016 includes language that gives states and 

local communities meeting certain criteria the 

opportunity to use federal funds provided through 

the Department of Health and Human Services 

to support certain components of SSPs, with the 

exception of provision of needles, syringes, or 

other equipment used solely for the purposes of 

illicit drug use.
Do SSPs help people to stop

using drugs?

Yes. When people who inject drugs use an SSP, they 

are more likely to enter treatment for substance use 

disorder and stop injecting than those who don’t use 

an SSP.1,2,3,4 New users of SSPs are five times as likely 

to enter drug treatment as those who don’t use the 

programs. People who inject drugs and who have 

used an SSP regularly are nearly three times as likely 

to report a reduction in injection frequency as those 

who have never used an SSP.2

Do SSPs reduce infections?

Yes. Nonsterile injections can lead to transmission 

of HIV, viral hepatitis, bacterial, and fungal infections 

and other complications. By providing access to 

sterile syringes and other injection equipment, SSPs 

help people prevent transmitting bloodborne and 

other infections when they inject drugs. In addition to 

being at risk for HIV, viral hepatitis, and other bloodborne and sexually transmitted diseases, people who 

inject drugs can get other serious, life-threatening, 

and costly health problems, such as infections of the 

heart valves (endocarditis), serious skin infections, 

and deep tissue abscesses. Access to sterile injection 

equipment can help prevent these infections, and 

health care provided at SSPs can catch these 

problems early and provide easy-to-access treatment 

to a population that may be reluctant to go to a 

hospital or seek other medical care.5,6,7

Do SSPs cause more needles in 

public places?

No. Studies show that SSPs protect the public and 

first responders by providing safe needle disposal 

and reducing the presence of needles in the 

community.8,9,10,11,12,13

Do SSPs lead to more crime

and/or drug use?

No. SSPs do not cause or increase illegal drug use. 

They do not cause or increase crime.14,15

Are SSPs cost effective? 

Yes. SSPs reduce health care costs by preventing HIV, viral 

hepatitis, and other infections, including endocarditis, a lifethreatening heart valve infection. The estimated lifetime cost 

of treating one person living with HIV is more than $450,000.16

Hospitalizations in the U.S. for substance-use-related 

infections cost over $700 million each year.17 SSPs reduce 

these costs and help link people to treatment to stop using 

drugs.

Do SSPs reduce drug use and

drug overdoses? 

SSPs help people overcome substance use disorders. If 

people who inject drugs use an SSP, they are more likely to 

enter treatment for substance use disorder and reduce or stop 

injecting.1,2,3,4 A Seattle study found that new users of SSPs 

were five times as likely to enter drug treatment as those who 

didn’t use the programs.2 People who inject drugs and who 

have used an SSP regularly are nearly three times as likely to 

report reducing or stopping illicit drug injection as those who 

have never used an SSP.2 SSPs play a key role in preventing 

overdose deaths by training people who inject drugs how 

to prevent, rapidly recognize, and reverse opioid overdoses. 

Specifically, many SSPs give clients and community members 

“overdose rescue kits” and teach them how to identify an 

overdose, give rescue breathing, and administer naloxone, a 

medication used to reverse overdose.18,19,20,21,22,23
1. Wodak A, Cooney A. Do needle syringe programs reduce HIV 

infection among injecting drug users: a comprehensive review of the 

international evidence. Subst Use Misuse. 2006;41(6-7):777–813.

2. Hagan H, McGough JP, Thiede H, Hopkins S, Duchin J, Alexander ER. 

Reduced injection frequency and increased entry and retention in 

drug treatment associated with needle-exchange participation in 

Seattle drug injectors. J Subst Abuse Treat. 2000;19(3):247–252.

3. Strathdee SA, Celentano DD, Shah N, et al. Needle-exchange 

attendance and health care utilization promote entry into 

detoxification. J Urban Health. 1999;76(4):448-460.

4. Bluthenthal RN, Gogineni A, Longshore D, Stein M. (2001). Factors 

associated with readiness to change drug use among needleexchange users. Drug Alcohol Depend. 2001;62(3):225-230.

5. Robinowitz N, Smith ME, Serio-Chapman C, Chaulk P, Johnson KE. 

Wounds on wheels: implementing a specialized wound clinic within 

an established syringe exchange program in Baltimore, Maryland. 

Am J Public Health. 2014;104(11):2057-2059. doi:10.2105/

AJPH.2014.302111.

6. Grau LE, Arevalo S, Catchpool C, Heimer R. Expanding harm 

reduction services through a wound and abscess clinic. Am J Public 

Health. 2002;92(12):1915-1917. 

7. Pollack HA, Khoshnood K, Blankenship KM, Altice FL. The impact of 

needle exchange-based health services on emergency department 

use. J Gen Intern Med. 2002;17(5):341-348.

8. Tookes HE, Kral AH, Wenger LD, et al. A comparison of syringe 

disposal practices among injection drug users in a city with versus 

a city without needle and syringe programs. Drug Alcohol Depend. 2012;123(1-3):255-259. doi:10.1016/j.drugalcdep.2011.12.001.

9. Riley ED, Kral AH, Stopka TJ, Garfein RS, Reuckhaus P, Bluthenthal 

RN. Access to sterile syringes through San Francisco pharmacies and 

the association with HIV risk behavior among injection drug users. J 

Urban Health. 2010;87(4):534-542. doi:10.1007/s11524-010-9468-y.

10. Klein SJ, Candelas AR, Cooper JG, et al. Increasing safe 

syringe collection sites in New York State. Public Health Rep. 2008;123(4):433-440. doi:10.1177/003335490812300404.

11. de Montigny L, Vernez Moudon A, Leigh B, Kim SY. Assessing a drop 

box programme: a spatial analysis of discarded needles. Int J Drug 

Policy. 2010; 21(3):208-214. doi:10.1016/j.drugpo.2009.07.003.

12. Doherty MC, Junge B, Rathouz P, Garfein RS, Riley E, Vlahov D. The 

effect of a needle exchange program on numbers of discarded 

needles: a 2-year follow-up. Am J Public Health. 2000;90(6):936-939.

13. Bluthenthal RN, Anderson R, Flynn NM, Kral AH. Higher syringe 

coverage is associated with lower odds of HIV risk and does not 

increase unsafe syringe disposal among syringe exchange program 

clients. Drug Alcohol Depend. 2007;89(2-3):214-222.

14. Marx MA, Crape B, Brookmeyer RS, et al. Trends in crime and the 

introduction of a needle exchange program. Am J Public Health. 2000;90(12),1933–1936.

15. Galea S, Ahern J, Fuller C, Freudenberg N, Vlahov D. Needle exchange 

programs and experience of violence in an inner city neighborhood. J 

Acquir Immune Defic Syndr. 2001;28(3),282-288.

16. Farnham PG, Gopalappa C, Sansom SL, et al. Updates of lifetime 

costs of care and quality of life estimates for HIV-infected persons 

in the United States: Late versus early diagnosis and entry into 

care. J Acquir Immune Defic Syndr. 2013;64(2):183-189. doi:10.1097/

QAI.0b013e3182973966.

17. Ronan, M., & Herzig, S. (2016). Hospitalizations related to opioid 

abuse/dependence and associated serious infections increased 

sharply, 2002-12. Health Affairs (Millwood). 2016;35(5):832-837. doi: 

10.1377/hlthaff.2015.1424. 

18. Seal KH, Thawley R, Gee L. Naloxone distribution and 

cardiopulmonary resuscitation training for injection drug users to 

prevent heroin overdose death: A pilot intervention study. J Urban 

Health. 2005;82(2):303–311. doi:10.1093/jurban/jti053.

19. Galea S, Worthington N, Piper TM, Nandi VV, Curtis M, Rosenthal 

DM. Provision of naloxone to injection drug users as an overdose 

prevention strategy: Early evidence from a pilot study in New 

York City. Addict Behav. 2006;31(5):907-912. doi:10.1016/j.

addbeh.2005.07.020.

20. Tobin KE, Sherman SG, Beilenson P, Welsh C, Latkin CA. Evaluation 

of the Staying Alive programme: Training injection drug users to 

properly administer naloxone and save lives. Int J Drug Policy. 2009;20(2):131-136. doi:10.1016/j.drugpo.2008.03.002. 

21. Doe-Simkins M, Walley AY, Epstein A, Moyer P. Saved by the nose: 

Bystander-administered intranasal naloxone hydrochloride for opioid 

overdose. Am J Public Health. 2009;99(5):788-791. doi:10.2105/

ajph.2008.146647.

22. Bennett AS, Bell A, Tomedi L, Hulsey EG, Kral AH. Characteristics of an 

overdose prevention, response, and naloxone distribution program 

in Pittsburgh and Allegheny County, Pennsylvania. J Urban Health. 2011;88(6):1020-1030. doi:10.1007/s11524-011-9600-7.

23. Leece PN, Hopkins S, Marshall C, Orkin A, Gassanov MA, Shahin RM. 

Development and implementation of an opioid overdose prevention 

and response program in Toronto, Ontario. Can J Public Health. 2013;104(3):e200-204.

Endnotes