Syringe access programs reduce risk of infectious disease and overdose, improve access to healthcare and treatment, and do not increase drug use overall.

Syringe Access Programs (SAPs), also called Needle Syringe Programs (NSPs) or Needle/Syringe Exchange Programs (NEPs and SEPs) give those who inject drugs the opportunity to get hypodermic needles or syringes at little to no cost and without a prescription. SAPs are recommended for inclusion in harm reduction programs by many organizations—including the World Health Organization1, the White House,2 and the American Medical Association3—due to their proven effectiveness in reducing the transmission of diseases like HIV and Hepatitis C.4

Why are these programs important?

Research has shown that syringe access programs are important on two levels: Firstly, they reduce the transmission of blood-borne diseases like HIV and Hepatitis C.5 Secondly, they increase the ability of medical professionals to tend to the overall health and well-being of drug users to whom they may not otherwise have access.6

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Sharing drug injection equipment like needles and syringes is a direct route for transmitting HIV and other diseases.7 For intravenous drug users who cannot or will not seek treatment, access to sterile needles and syringes reduces the transmission of bacterial infections,8 making SAPs an important element of harm reduction.9 

According to a study released by the World Health Organization, there’s compelling evidence that SAPs are a cost-effective means of reducing HIV transmissions—without increasing existing drug use.10 These findings were also supported by Former U.S. Surgeon General Dr. David Satcher.11 

Some cost-effectiveness analyses have estimated that syringe access programs can save up to $3,000 per client,12 and if the U.S. invested an additional $10 million to syringe access, it would prevent 194 HIV infections per year and save lifetime treatment costs of $75.8 million.13 

Syringe access programs also provide information on the proper disposal of needles and syringes, reducing the chances that people who inject drugs will share those items and removing contaminated syringes from the community.14

Additionally, syringe access programs are able to provide other health and social services to drug users who come seeking clean injection tools.15 Drug users who use needles are considered high-risk not only for HIV and hepatitis, but also for sexually transmitted diseases, skin infections related to injection, bacterial infections, unplanned pregnancy, and other health issues. Many syringe access programs incorporate education, disease prevention, HIV testing and hepatitis screening, and other health services.16 Nurses and other medical professionals can offer these services when a client comes in for clean needles or syringes, allowing them to reach and treat drug users that otherwise might not seek medical help.17

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How do they work?

Syringe access programs are usually community-based programs that may be funded by charitable organizations, local health departments, private donors, or even pharmaceutical companies.18 A person who injects drugs can come to a designated location to get free or low-cost needles and syringes, and to safely dispose of previously used injection tools.

Many syringe access programs also provide additional health services to drug users who come for clean needles and syringes. Those services may include:19

  • HIV testing
  • Hepatitis screening
  • Testing for sexually transmitted diseases
  • Wound treatment
  • Safe injection tools like sterile water or alcohol swabs
  • Overdose prevention information
  • Prophylactics
  • Referral to substance use disorder treatment programs
  • Information about medication-assisted treatments
  • Educational materials about safe sex, disease prevention, and safe injection practices
  • Counseling
  • Referral to HIV/hepatitis treatment resources
  • Referral to other mental health and social services

Risk reduction: Hepatitis C

According to the Mayo Clinic, Hepatitis C is a viral infection that affects the liver and may result in liver damage – or even liver failure. Symptoms can include anything from fatigue and weight loss to easy bleeding and bruising, jaundice, nausea, and muscle aches. The condition can be treated, and new medications have been shown to clear the virus in some patients.20

In the U.S., injecting drugs is the most common means of transmitting Hepatitis C.21 The CDC estimates 33% of people ages 18 to 30 who inject drugs have Hepatitis C.22 For older users or former users, that number skyrockets to 70 to 90%, because sharing needles was much more common before the risks of disease transmission became clear.23

Research has shown that HCV, the Hepatitis C virus, can survive in a contaminated syringe for up to 63 days,24 so the use of clean needles for every drug injection is crucial for the prevention of HCV transmission.25 While studies have shown varying results in the reduction of HCV using syringe access programs alone,26 research has proven that combining syringe access programs with other services like counseling or substance use disorder treatment increases the effectiveness.27

Risk reduction: HIV

HIV is the virus that causes Acquired Immunodeficiency Syndrome (AIDS), an infection that damages the immune system. It’s predominantly transmitted through sexual contact or through contact with infected blood. Symptoms vary based on the phase of the infection, and while HIV and AIDS can be treated, there is currently no cure.28

According to the CDC, 6% of new HIV cases and 10% of new AIDS cases in the United States in 2015 were attributed to intravenous drug use.29 Also released in 2015, the CDC’s most recent National HIV Behavioral Surveillance (NHBS) system behavioral study conducted amongst those who inject drugs. The study included the following findings:30

  • 30% of those interviewed shared syringes that were used by others
  • 39% had received treatment for a substance use disorder in the previous 12 months
  • Younger users of injected drugs were more likely to have shared injection equipment

Syringe access programs have been proven to reduce the rates of HIV transmission, with one finding a 5.8% decrease in HIV prevalence.31 If the U.S. invested an additional $10 million to syringe access, it would prevent 194 HIV infections per year,32 with an estimated saving of $3,32433 to $7,000 per case of HIV prevented.34

In the National HIV/AIDS Strategy for the U.S., the White House recommends access to sterile needles and syringes as one of the most effective, evidence-based approaches to preventing HIV infection:

Among injection drug users, sharing needles and other drug paraphernalia increases the risk of HIV infection. Several studies have found that providing sterilized equipment to injection drug users substantially reduces risk of HIV infection, increases the probability that they will initiate drug treatment, and does not increase drug use.35

The World Health Organization agrees. In a research review, the WHO found that syringe access programs “substantially and cost-effectively reduce the spread of HIV” among drug users.36 As in the case of reducing rates of Hepatitis C, reductions in the transmission of HIV are most effective when syringe access programs are combined with other harm reduction measures like counseling and treatment.37

1. World Health Organization “Effectiveness of sterile needle and syringe programming in reducing HIV/AIDS among injecting drug users” 2004. Available at: http://www.who.int/hiv/pub/prev_care/effectivenesssterileneedle.pdf
2. National HIV/AIDS Strategy for the United States, 2010. Available at: https://www.whitehouse.gov/sites/default/files/uploads/NHAS.pdf
3. National Research Council (US) and Institute of Medicine (US) Panel on Needle Exchange and Bleach Distribution Programs; Normand J, Vlahov D, Moses LE, editors. Washington (DC): National Academies Press (US); 1995. Available at: https://www.ncbi.nlm.nih.gov/books/NBK232356/
4. World Health Organization “Effectiveness of sterile needle and syringe programming in reducing HIV/AIDS among injecting drug users” 2004. Available at: http://www.who.int/hiv/pub/prev_care/effectivenesssterileneedle.pdf
5. World Health Organization “Effectiveness of sterile needle and syringe programming in reducing HIV/AIDS among injecting drug users” 2004. Available at: http://www.who.int/hiv/pub/prev_care/effectivenesssterileneedle.pdf
6. Carolyn K. Burr , EdD, RN, corresponding author a Deborah S. Storm , MSN, PhD,a Mary Jo Hoyt , MSN,a Loretta Dutton , MPA,b Linda Berezny , RN, BA,b Virginia Allread , MPH,a and Sindy Paul, MD, MPHb Integrating Health and Prevention Services in Syringe Access Programs: A Strategy to Address Unmet Needs in a High-Risk Population Public Health Rep . 2014 Jan-Feb; 129(Suppl 1): 26–32.
7. The Centers for Disease Control and Prevention “HIV and Injection Drug Use” Available at: https://www.cdc.gov/hiv/risk/idu.html
8. World Health Organization “Effectiveness of sterile needle and syringe programming in reducing HIV/AIDS among injecting drug users” 2004. Available at: http://www.who.int/hiv/pub/prev_care/effectivenesssterileneedle.pdf
9. Academy for Educational Development, New Attitudes and Strategies: A Comprehensive Approach to Preventing Blood-Borne Infections among IDUs. 2000, at http://www.cdc.gov/HIV/projects/IDU-ta/brochure.htm.
10. Wodak, A.; Cooney, A. (2004). "Effectiveness of Sterile Needle and Syringe Programming in Reducing HIV/AIDS Among Injecting Drug Users" (PDF). World Health Organization. Retrieved 18 July 2013.
11. US Surgeon General Dr. David Satcher, Department of Health and Human Services, "Evidence-Based Findings on the Efficacy of Syringe Exchange Programs: An Analysis from the Assistant Secretary for Health and Surgeon General of the Scientific Research Completed Since April 1998," (Washington, DC: Dept. of Health and Human Services, 2000), p. 11. http://home.mchsi.com/~apclc/8fedstudies2.pdf
12. Centers for Disease Control and Prevention “Access to clean syringes” https://www.cdc.gov/policy/hst/hi5/cleansyringes/index.html
13. Centers for Disease Control and Prevention “Access to clean syringes” https://www.cdc.gov/policy/hst/hi5/cleansyringes/index.html
14. Don C. Des Jarlais PhD, Ann Nugent, Alisa Solberg MPA, Jonathan Feelemyer MS, Jonathan Mermin MD, and Deborah Holtzman PhD. "Syringe Service Programs for Persons Who Inject Drugs in Urban, Suburban, and Rural Areas - United States, 2013," Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report (MMWR) 2015;64:1337-1341. http://www.cdc.gov/mmwr/pdf/wk/mm6448.pdf
15. Don C. Des Jarlais PhD, Ann Nugent, Alisa Solberg MPA, Jonathan Feelemyer MS, Jonathan Mermin MD, and Deborah Holtzman PhD. "Syringe Service Programs for Persons Who Inject Drugs in Urban, Suburban, and Rural Areas - United States, 2013," Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report (MMWR) 2015;64:1337-1341. http://www.cdc.gov/mmwr/pdf/wk/mm6448.pdf
16. Syringe exchange programs --- United States, 2008. Centers for Disease Control and Prevention (CDC). MMWR Morb Mortal Wkly Rep. 2010 Nov 19; 59(45):1488-91.
17. Carolyn K. Burr , EdD, RN, Deborah S. Storm , MSN, PhD,a Mary Jo Hoyt , MSN,a Loretta Dutton , MPA,b Linda Berezny , RN, BA,b Virginia Allread , MPH,a and Sindy Paul , MD, MPHb Integrating Health and Prevention Services in Syringe Access Programs: A Strategy to Address Unmet Needs in a High-Risk Population Public Health Rep . 2014 Jan-Feb; 129(Suppl 1): 26–32.
18. Harm Reduction Coalition: http://harmreduction.org/issues/syringe-access/tools-best-practices/funding-syringe-access/
19. Centers for Disease Control and Prevention “Syringe Services Programs” https://www.cdc.gov/hiv/risk/ssps.html
20. The Mayo Clinic: Hepatitis C: http://www.mayoclinic.org/diseases-conditions/hepatitis-c/home/ovc-20207365
21. Centers for Disease Control and Prevention “Access to clean syringes” https://www.cdc.gov/policy/hst/hi5/cleansyringes/index.html
22. Centers for Disease Control and Prevention “Access to clean syringes” https://www.cdc.gov/policy/hst/hi5/cleansyringes/index.html
23. Centers for Disease Control and Prevention “Access to clean syringes” https://www.cdc.gov/policy/hst/hi5/cleansyringes/index.html
24. Paintsil, Elijah Et al “Survival of Hepatitis C Virus in Syringes: Implication for Transmission among Injection Drug Users” J Infect Dis. (2010) 202 (7): 984-990.doi: 10.1086/656212
25. Centers for Disease Control and Prevention “Access to clean syringes” https://www.cdc.gov/policy/hst/hi5/cleansyringes/index.html
26. Hagan, Holy, Pouget, Enrique, Des Jarlais, Don. A Systematic Review and Meta-Analysis of Interventions to Prevent Hepatitis C Virus Infection in People Who Inject Drugs J Infect Dis . 2011 Jul 1; 204(1): 74–83. doi: 10.1093/infdis/jir196
27. Centers for Disease Control and Prevention “Access to clean syringes” https://www.cdc.gov/policy/hst/hi5/cleansyringes/index.html
28. The Mayo Clinic: HIV/AIDS: http://www.mayoclinic.org/diseases-conditions/hiv-aids/basics/symptoms/con-20013732
29. The Centers for Disease Control and Prevention “HIV and Injection Drug Use” Available at: https://www.cdc.gov/hiv/risk/idu.html
30. Michael W. Spiller, PhD1, Dita Broz, PhD1, Cyprian Wejnert, PhD1, Lina Nerlander, BMBCh1 , Gabriela Paz-Bailey, MD, PhD1, for the National HIV Behavioral Surveillance System Study Group HIV Infection and HIV-Associated Behaviors Among Persons Who Inject Drugs — 20 Cities, United States, 2012 Morbidity and Mortality Weekly Report (MMWR) March 20, 2015 / 64(10);270-275
31. Hurley et al., 1997 Hurley, S.F., Jolley, D.J., and Kaldor, J.M. Effectiveness of needle-exchange programmes for prevention of HIV infection. Lancet . 1997; 349: 1797–1800
32. Centers for Disease Control and Prevention “Access to clean syringes” https://www.cdc.gov/policy/hst/hi5/cleansyringes/index.html
33. Tran, B.X. et al. The cost-effectiveness and budget impact of Vietnam's methadone maintenance treatment programme in HIV prevention and treatment among injection drug users. Global Public Health . 2012; 7: 1080–1094
34. Wammes et al., 2012 Wammes, J.J. et al. Cost-effectiveness of methadone maintenance therapy as HIV prevention in an Indonesian high-prevalence setting: A mathematical modeling study. International Journal of Drug Policy . 2012; 23: 358–364
35. National HIV/AIDS Strategy for the United States, 2010. Available at: https://www.whitehouse.gov/sites/default/files/uploads/NHAS.pdf
36. World Health Organization “Effectiveness of sterile needle and syringe programming in reducing HIV/AIDS among injecting drug users” 2004. Available at: http://www.who.int/hiv/pub/prev_care/effectivenesssterileneedle.pdf
37. World Health Organization “Effectiveness of sterile needle and syringe programming in reducing HIV/AIDS among injecting drug users” 2004. Available at: http://www.who.int/hiv/pub/prev_care/effectivenesssterileneedle.pdf