Needle exchange programs (NEP) assist with the safe disposal of syringes and provide referrals to treatment. NEPs can provide sterile needles and syringes on-site or connect you to other programs in your community that do.1,2
What Are Needle Exchange Programs?
Needle exchange programs follow a harm reduction model. This means they aim to decrease harm related to drug misuse, allowing you to use drugs more safely. The goal is to minimize judgment around your use of illicit substances and to focus on positive changes you may make toward recovery and/or your life circumstances.1,2
Sometimes NEPs are also referred to as Syringe Services Programs (SSP) or Syringe Exchange Programs (SEP).
The following are the primary focuses of NEPs:1
- Facilitate disposal of used syringes in a safe manner
- You can bring used or “dirty” syringes and injection equipment to the facilities, and they will properly dispose of them for you.
- Assist with access to sterile needles and syringes
- Some NEPs will provide you with clean, sterile injection supplies and syringes, and others may need to refer you to where you can get them. It depends on how the facility is set up. Either way, they will facilitate getting you sterile supplies.
- The turning in of used syringes and injection equipment and receiving new, sterile equipment and syringes are sometimes referred to as “needle exchange.”
- Provide referrals to treatment for recovery from substance misuse and overuse
- If you express interest in moving to an abstinence-based model of treatment and want to completely discontinue using, NEPs can help you find a program.
Some needle exchange programs may provide additional services, such as:1
- Testing for diseases and medical treatment
- NEPs sometimes have the staff and funding to be able to test for diseases such as hepatitis and HIV. Although they usually cannot treat such serious conditions, they can provide you with details about who can.
- Basic health services
- If the NEP you go to has medical staff, they can do physicals and provide vaccines. This would not replace having a primary care physician, but it is a valuable service provided by certain NEPs.
- Education about overdose awareness
- NEPs sometimes partner with community education providers and offer education on the signs and symptoms of overdose. This way, you will know when to take appropriate action if you or a loved one are experiencing these symptoms.
- Safer injection practices
- Learning safer injection practices can be tantamount to your overall health and recovery because it can prevent injection-related complications (skin conditions). Also, it will teach you the importance of sterile practices (for example, staying away from sharing needles) and the proper way to store used needles for when you come back to the NEP for them to properly dispose of them for you.
- Counseling and therapeutic services
- Some NEPs have properly credentialed clinical staff available to you. If this is the case, you would be able to schedule an appointment or get treatments such as cognitive-behavioral therapy and behavioral modification. Other modalities may also be offered, depending on the NEP you go to. If this is not an option, the staff at the NEP could refer you to services.
Are Needle Exchange Programs Effective?
Research shows that if you use a needle exchange program, your chances of entering treatment and discontinuing needle use are greater than if you do not use one.1
Newer members of NEPs are five times as likely to enter treatment than non-members. Also, utilizing NEPs regularly reduces the routine use of needles three times.1
These statistics have been attributed to the fact that NEPs reduce stigma, provide you with accountability (to drop off used syringes and injection equipment), and provide a safe place for you to go to.1
Do NEPs Reduce Infections?
Nonsterile injections can lead to the transmission of viral hepatitis, HIV, sexually transmitted diseases (STDs), bacterial and fungal infections, and other complications. By providing access to sterile injection equipment and syringes, NEPs help prevent transmitting bloodborne and other infections from occurring because of using non-sterile equipment and needles.1
If you inject illicit substances, you are at risk of getting other life-threatening, serious illnesses such as:1
- Serious skin infections
- Deep tissue abscesses
- Endocarditis (infections of the heart valves)
Although access to sterile injection equipment and needles can increase your prevention rates for these conditions, many NEPs provide referrals for treatment. Utilizing NEPs can help you catch such conditions early on, thereby increasing your recovery rates from them.1
Are NEPs Cost-Effective?
NEPs reduce health care costs since they prevent transmission of serious illness and infections related to needle use of nonsterile injection equipment and syringes. For example, the estimated cost of treating HIV is greater than $450,000 for each case. Hospitalizations in the United States for infections related to illicit substance use cost over $700 mill annually. NEPs substantially reduce these costs.1
Studies show that NEPs protect the public and first responders as well. Officers run the risk of being stuck by a used needle during their careers. If they are not disposed of properly, the public can be exposed to used needles in community areas such as public parks, city squares, and downtown areas. NEPs provide safe needle disposal, which reduces the presence of needles in the community.1
Do NEPs Reduce Drug Use and Drug Overdoses?
NEPs play an integral role in preventing overdose from injecting illicit substances. They will train you to:1,3
- Recognize signs of opioid overdose quickly
- Prevent opioid overdose
- Reverse opioid overdose if it does occur by administering naloxone
- Give rescue breathing
Some NEPs will provide you with an “overdose rescue kit.” These kits will include naloxone, a drug that helps to reverse an overdose. The kits can also include a rescue breathing shield and other first-aid materials.1,3
Needle Exchange: Who Needs It?
Although many NEPs use a needs-based approach, if you utilize syringes and injection equipment to use illicit substances like opioids, you could benefit from using NEPs.2
Needle exchange programs will do a 1:1 syringe exchange with you or accept as many needles as you bring in and provide you with the amount that you need between visits. If you think you would benefit from this, you will need NEPs.1
At a governmental level, jurisdictions that are determined to be experiencing significant increases in hepatitis infection or HIV outbreak due to injection drug use following Center for Disease Control and Prevention (CDC) consultation would benefit from NEPs. In other words, if you live in an area that is considered high risk for hepatitis infection or HIV outbreak, you could benefit from using NEPs.4
The CDC created a guidance document to assist state and local health departments in managing HIV and Hepatitis C outbreaks because of injecting drugs. These guidelines provide best practices to establish NEPs in such areas.4
Where Are Needle Exchange Programs Offered?
Not all NEPs are alike. Programs can differ in size and delivery venue.
Some NEPs operate out of mobile units. Other NEPs operate at fixed sites that can be found in community clinics. Sometimes, you will find a NEP mobile unit outside of a fixed site for ease of access. All NEPs are free of charge to you.1,3
If you are enrolled in a treatment program such as Intensive Outpatient Programs (IOP), NEP can be a modality offered by the center. In this case, you would establish a fee schedule for the treatment program, and the NEP component would be at no cost to you. The NEP may be in a specific part of the treatment center building, or they may opt for a mobile unit outside of the building. They will notify you of its specific location. 1,3
Are NEPs Legal?
Many states have passed laws legalizing NEPs due to their successful track record. States where the possession and distribution of syringes without prescription are legal tend to have NEPs.5
Researchers published an article that stated 39 states (including the District of Columbia) had laws effective August 1, 2019, that removed legal impediments to, explicitly authorized, and/or regulated NEPs.5
Thirty-three states had one or more laws that were consistent with legal possession of syringes if you were using NEPs.5
Although some states still have legal barriers up, preventing the operation of NEPs, this number continues to decline.
How to Find Needle Exchange Programs
If you are residing in a state where there are NEPs, you can use the search words, “Find a needle exchange program near me” or SSP or SEP.6
The North American Syringe Exchange Network (NASEN) provides a directory of needle exchange programs where you can enter a zip code, city, or state to find their nearest site.6
You can also go to a treatment center or community center where a professional or educated and credentialed peer support specialist could provide a referral.
If you or a loved one feels you could benefit from using a needle exchange program, or you’re unsure of where to start, contact a treatment specialist at 800-662-4357.
- Centers for Disease Control and Prevention. (2019, May 23). Syringe Services Programs (SSPs) FAQs.
- Centers for Disease Control and Prevention. (2020, December). Needs-Based Distribution at Syringe Services Programs.
- Centers for Disease Control and Prevention. (2016). Program Guidance for Implementing Certain Components of Syringe Services Programs.
- Centers for Disease Control and Prevention. (2018). Syringe Services Programs: Determination of Need for Syringe Services Programs.
- Fernandez-Vina, M. H., Prood, N. E., & Herpolsheimer, A. (2020). State Laws Governing Syringe Services Programs and Participant Syringe Possession, 2014-2019. Sage Journals, Public Health Reports, 135(1), suppl, 2020.
- The North American Syringe Exchange Network (NASEN). (2022). SSP Locations.