Syringe Services Programs

Syringe Services Programs (SSPs) are a community-based HIV prevention strategy for persons who inject drugs (PWID). SSPs aim to reduce PWID’s risk of getting and transmitting HIV, viral hepatitis, and other blood-borne infections by using sterile injection equipment for each injection.

photo of a person in scrubs holding the hand of a patient

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 and medication-assisted treatment for opioid use disorder.

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

SSPs prevent overdose deaths by teaching PWID how to prevent overdose and how to recognize, respond to, and reverse a drug overdose by providing training on how to use naloxone, a medication used to reverse overdose. Many SSPs provide “overdose prevention kits” containing naloxone to PWID.

SSPs have partnered with law enforcement, providing naloxone to local police departments to help them respond and prevent death when someone has overdosed. 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.
  • Stop substance abuse.
  • Prevent overdose deaths.
  • Support public safety.

Strategy Essential Elements

  • Provide vaccination, testing, linkage to infectious disease care and substance use treatment.
  • Provide access to and disposal of syringes and injection equipment.
  • Offer referrals to medicated-assisted treatment.
  • Protect first responders and the public by providing safe needle disposal and reducing the presence of discarded needles in the community.

SSP Training

There is no CDC-supported training currently available for SSP.  Technical assistance for SSP implementation 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. Surveillance for Viral Hepatitis — United States, 2016pdf icon.
  • CDC. Estimated HIV incidence and prevalence in the United States, 2010–2015. HIV Surveillance Supplemental Report. 2018;23(No. 1)pdf icon. Published March 2018.
  • 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 Statespdf iconexternal icon. 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 editionpdf icon. 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.