Syringe services programs (SSPs) are evidence-based public health initiatives that can reduce risk behaviors associated with injection drug use by providing access to sterile syringes, ultimately reducing disease transmission of HIV and hepatitis C and preventing outbreaks. SSPs also typically provide services such as naloxone distribution, testing for blood-borne infections, referrals to counseling and/or drug abuse treatment, and syringe disposal, which can further mitigate harm from injection drug use. Decades of research and experience suggest SSPs are safe, efficacious, and cost-effective, boost substance use treatment initiation, and do not contribute to an increase in drug use or criminal activity.  

Since the earliest SSPs, state drug paraphernalia laws have created an uncertain and complex legal environment for SSPs in the US because these laws generally prohibit the distribution, possession, or both, of any item that one knows (or should know) will be used with illicit drugs, or that is designed or intended to be used with illicit drugs.   

This article, published in the Journal of Law, Medicine, and Ethics by researchers at the Center for Public Health Law Research at Temple University Beasley School of Law, and epidemiologists at Drexel University’s Dornsife School of Public Health, analyzes scientific legal mapping that provides a thorough account of the key elements of state laws controlling SSPs and syringe possession and distribution from January 1, 2010, through June 1, 2024, in all 50 US states and the District of Columbia.