Syringe Services Programs

Syringe Services Programs (SSPs) are a public health strategy for persons who inject drugs (PWID). SSPs aim to reduce HIV infection, viral hepatitis, and other blood-borne infections, such as endocarditis, by promoting the use of new or sterile injection equipment for each injection. Syringe distribution and disposal options are core SSP services, expanded services complement core services and improve PWID health and well-being; while SSPs provide core services, ideally and when possible, expanded services can also be provided.

About Syringe Services Programs

Syringe Services Programs (SSPs) are associated with an estimated 50% reduction in HIV and hepatitis C virus (HCV) incidence. When combined with medications that treat opioid dependence (also known as medication-assisted treatment), HIV and HCV transmission is reduced by over two-thirds, according to research.

SSPs serve as a bridge to other health services, including HIV and HCV testing and treatment, HIV pre-exposure prophylaxis (PrEP), and medication-assisted treatment.

In some jurisdictions, PWID can access sterile needles and syringes and other injection paraphernalia through SSPs and through pharmacies without a prescription.

SSPs can also prevent overdose by teaching people how to recognize, respond to, and reverse a drug overdose (e.g., naloxone). Many SSPs distribute and train clients to administer naloxone along with other harm reduction measures, such as safer injection practices.

SSPs have partnered with law enforcement and other first responders, such as EMT workers and fire fighters, to provide lifesaving naloxone if someone is experiencing overdose. SSPs also protect first responders and the public by providing safe needle disposal and reducing the presence of discarded needles in the community.

Strategy Goals

  • Prevent transmission of blood-borne infections
  • Reduce or stop substance use
  • Prevent overdose deaths
  • Reduce publicly discarded needles
  • Increase HIV/STD treatment initiation and retention

Strategy Essential Elements

  • Provide onsite access to and disposal of syringes and injection equipment
  • Provide onsite vaccination and testing services
  • Offer referrals to medicated-assisted treatment, medical and psychosocial care, food, housing, and other services
  • Provide onsite wound care, safer injection instruction, and training on administering the overdose prevention medication, i.e., naloxone
  • Provide onsite sexual HIV/STD prevention (e.g., condoms, lubricant, PrEP)

SSP Training

There is no CDC-supported training currently available for SSP. Technical assistance for the implementation of SSPs, including jurisdictional SSP institutes, is available.

To request technical assistance:

  1. CDC’s directly funded health department and CBO partners may request technical assistance by submitting a request in the CBA Tracking System.
  2. Organizations not directly funded by CDC may contact their local health department for assistance in submitting a request.

If you have questions or need additional assistance, please contact DHAPCBB@cdc.gov.

SSP Resources

The Centers for Disease Control and Prevention (CDC) has information and program guidance on SSPs.

  • CDC, Satcher Health Leadership Institutes, NASTAD. Syringe Service Programs: A Technical Package of Effective Strategies and Approaches for Planning, Design, and Implementation; 2020.
  • CDC. Summary of Information on The Safety and Effectiveness of Syringe Services Programs (SSPs).
  • CDC. Syringe Services Programs (SSPs) Fact Sheet.
  • CDC. Interim Guidance for Syringe Services Programs.
  • CDC. Viral Hepatitis Surveillance Report, United States, 2019.
  • CDC. Estimated HIV incidence and prevalence in the United States, 2010–2015. HIV Surveillance Supplemental Report. 2018;23(No. 1). Published March 2018.
  • Broz D, Carnes N, Chapin-Bardales J, Des Jarlais DC, Handanagic S, Jones CM, Paul McClung RP, Asher AK. Syringe services programs’ role in ending the HIV epidemic in the U.S: Why we cannot do it without them. Am J Prevent Med 2021 Nov;61(5 Suppl 1):S118-S129.
  • Chahal HS, Marseille EA, Tice JA, Pearson SD, Ollendorf DA, Fox RK, Kahn JG. Cost-effectiveness of early treatment of hepatitis C virus genotype 1 by stage of liver fibrosis in a US treatment-naive population. JAMA Intern Med 2016 Jan;176(1):65-73.
  • Aspinall EJ, Nambiar D, Goldberg DJ, Hickman M, Weir A, Van Velzen E, Palmateer N, Doyle JS, Hellard ME, Hutchinson SJ. Are needle and syringe programmes associated with a reduction in HIV transmission among people who inject drugs: A systematic review and meta-analysis. Int J Epidemiol Feb 2014;43(1):235-48. doi: 10.1093/ije/dyt243. Epub 2013 Dec 27. PMID: 24374889.
  • Platt L, Minozzi S, Reed J, Vickerman P, Hagan H, French C, Jordan A, Degenhardt L, Hope V, Hutchinson S, Maher L, Palmateer N, Taylor A, Bruneau J, Hickman M. Needle syringe programmes and opioid substitution therapy for preventing hepatitis C transmission in people who inject drugs. Cochrane Database Syst Rev 2017;9:CD012021. doi:10.1002/14651858.CD012021.pub2.
  • Fernandes RM, Cary M, Duarte G, Jesus G, Alarcão J, Torre C, Costa S, Costa J, Carneiro AV. Effectiveness of needle and syringe programmes in people who inject drugs – An overview of systematic reviews. BMC Public Health 2017;17(1):309. doi:10.1186/s12889-017-4210-2.
  • HIV and Injection Drug Use – Vital Signs – CDC. Centers for Disease Control and Prevention. Published December 2016.
  • Des Jarlais DC, Nugent A, Solberg A, Feelemyer J, Mermin J, Holtzman D. Syringe service programs for persons who inject drugs in urban, suburban, and rural areas — United States, 2013. MMWR Morb Mortal Wkly Rep 2015;64(48):1337-1341. doi:10.15585/ mmwr.mm6448a3.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • Childs R. Law enforcement and naloxone utilization in the United States. North Carolina Harm Reduction Coalition; 2016.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • HIV Infection, Risk, Prevention, and Testing Behaviors among Persons Who Inject Drugs—National HIV Behavioral Surveillance: Injection Drug Use, 20 U.S. Cities, 2015. HIV Surveillance Special Report 18. Revised edition. Published May 2018. Accessed July 30, 2018.
  • 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.
  • 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.