SSP

What is a Syringe Service Program (SSP)?

Syringe Service Programs (SSPs) provide sterile syringes and collet used syringes in order to reduce transmission of HIV, viral hepatitis, and other bloodborne infections assosicated with resuse of contaminated injection equipment by drug users.  Project ACT’s SSP is part of a comprehensive health strategy that includes HIV and HCV counseling and testing, education on reducing sexual and drug use-related health risks.  Additionally the SSP will provide linkage to drug treatment and referral to other medical and social services.

For more information regarding our Syringe Service Program, please contact our SSP coordinator, Sara Alese @ 865.525.1540 ext. 205

FAQ’s

What is Project ACT?

Project ACT began in 2014 as the Prevention Program of Positively Living, a local Community Based Organization.  Positively Living serves vulnerable groups struggling to survive the challenges created by HIV/AIDS, homelessness, mental illness, addiction, and disabilities. Our mission is to improve the lives of the people we serve through advocacy, counseling, socialization, housing, case management and support.  In 2014 Project ACT began offering free HIV and Hepatitis C (HCV) testing to the community.  After Tennessee legalized Syringe Service Programs (SSP), Project ACT saw the need in the community and developed a SSP.

What is a Syringe Service Program (SSP)?

Syringe service programs (SSPs) provide sterile syringes and collect used syringes to reduce transmission of HIV, viral hepatitis, and other bloodborne infections associated with reuse of contaminated injection equipment by drug users. Project ACT’s SSP is part of a comprehensive health strategy that includes HIV and HCV counseling and testing, education on reducing sexual and drug use-related health risks. Additionally the SSP will provide linkage to drug treatment and referral to other medical and social services.

Will an SSP increase the number of syringes in the community?

No. Numerous studies show that SSPs actually decrease the number of used syringes in the community by providing safe disposal of syringes. Project ACT’s SSP will be collecting and disposing of used syringes.

Will an SSP increase crime rates?

Research shows that SSPs benefit the health and safety of a community. Most SSPs offer comprehensive social services including mental health treatment, case management, group counseling, food programs, and referrals to medical and addiction treatment.2 Positively Living will be offering these wraparound services to participants of our syringe service program here in Knoxville, TN.

Why does the community need an SSP?

Knox and the surrounding counties are at an elevated risk of HIV and HCV infection for People Who Inject Drugs (PWID).  PWID’s account for 27.7% of new cases of HIV in east Tennessee region and HCV cases have been rising rapidly, paralleling the rise in opioid addiction, including heroin use. The CDC has identified 41 counties in the state of Tennessee that are at risk for an HIV outbreak similar to the one in Indiana. Indiana spent $16 million to stop the outbreak just in Scott County. If a similar outbreak were to occur in all 10 of east Tennessee’s vulnerable counties state expenditures could reach $160 million.

Is having an SSP cost effective for the community?

SSP’s save money in a number of different ways. The cost of operating an SSP in the community will be much lower than the cost to provide medical care to those who become infected with HIV and HCV through IDU.

How can Project ACT’s SSP help the community’s problem with drugs, overdose and Hepatitis C?

Decades of research show that SSP’s are effective at lowering rates of HIV and HCV. Positively Living will be offering supportive services and referrals including: mental health referrals, preventing overdose deaths with naloxone, and connecting participants to recovery programs.  Other wrap around services will include educational materials on family planning, condoms, Pre Exposure Prophylaxis (PrEP Navagation).

Will an SSP encourage drug use in the community?

No, decades of evidence conclude that SSPs DO NOT increase drug use and are actually shown to reduce drug use as these programs connect people who inject drugs to treatment.

How do SSP’s connect people to drug treatment?

Project ACT’s SSP will act as a gateway to treatment by utilizing existing social networks to help link participants to recovery programs and navigate application processes. Research indicates that syringe service program participants are 5 times more likely to enter drug treatment than non-participants (Hagan et al, 2000).

How do SSP’s decrease HIV, Hepatitis C and Hepatitis B among injection drug users?

SSP’s decrease the transmission of bloodborne disease by decreasing the likelihood that people who inject drugs will share syringes. Project ACT’s SSP will also collect used syringes from the community, removing them from use and disposing of them by regulated medical waste standards. SSP’s have been known to decrease HCV transmission by up to 50% (Turner et al, 2011). HIV infection rates have decreased as much as 80% among people who inject drugs in areas where SSPs are located (Des Jarlais et al, 2011).

How many states have SSPs?

Twenty states explicitly authorize SSP’s, including Kentucky and North Carolina. Georgia and West Virginia have SSP’s in some major cities.

How will the SSP benefit law enforcement?

Project ACT’s SSP will benefit law enforcement and other first responders by reducing the number of needlestick injuries. SSP’s decrease the amount of discarded syringes by accepting used injection equipment from program participants. Studies have shown up to 66% decrease in needlestick injuries.

FACT SHEET

There is no evidence to show that SSPs encourage drug use or cause an IDU to increase their drug use.

In general, IDUs are not likely to travel long distances to a SSP. A New York City study found that IDUs were much more likely to use an exchange if they lived within walking distance and could easily access services.3 Most syringe service participants already live in the neighborhood.

Studies in Baltimore have shown that a relatively small percentage of SSP users (approximately 8%) form new social contacts through participating in a SSP.4

In comparing crime rates of areas close to SSPs and areas further away from SSPs, the research demonstrates that there are no significant differences in arrest rates over time between both areas.5 In Baltimore, break-ins and burglaries (economically-motivated crimes often related to drug use) actually fell by 11% in areas with SSPs, but increased by 8% in non-SSP exchange areas.6

Syringe service Programs: reducing the risks of needlestick injuries

One commonly voiced community concern with regard to a syringe service program (SSP) is the fear of a “needlestick injury” resulting from improperly discarded syringes in parks, gutters, or garbage bags. SSPs provide sterile syringes to reduce the spread of HIV, hepatitis and other blood borne illnesses and link injection drug users (IDUs) to health promotion services such as medical and mental health treatment. SSPs actively encourage and educate clients about safe disposal in order to lessen the number of improperly discarded syringes. In addition, SSPs supply puncture-proof ‘sharps’ containers and information on safe disposal discard used syringes to every client who utilizes the program.

Risk of Infection

The risk of becoming infected with a blood borne virus through a needlestick is extremely low. A recent review analyzing studies of HIV transmission risk through needlestick injuries among health care workers estimated the risk of infection to be less than 1 in 400 (0.23%)7. In the majority of studies reviewed, no cases of transmission were documented following needlestick injuries. Risk of infection from needlesticks in community settings (outside health care facilities) appears to be negligible. Studies of community needlestick injuries (primarily among children) in England8, Ireland9, Spain10, Italy11, Australia12, and South Africa13 found no cases resulting in infection.

The reasons for a relatively low risk of infection include: 

Not all used needles carry a virus.

While HIV and other blood borne diseases can survive outside the body in a used needle, these viruses are very fragile, and will often die if subject to external environmental conditions, such as air or water.

Most needlestick injuries are superficial and carry far less risk of virus transmission than intravenous drug use, where needles directly enter veins.

Syringe service programs: improving the safety of their community

There is a particular need for safe disposal methods for IDUs, who might be apprehensive to carry syringes (especially used ones) because of their fear of law enforcement.14 Paraphernalia laws discourage IDUs from carrying or properly disposing of syringes.15 Yet, research demonstrates that the presence of a SSP results in fewer used syringes improperly discarded.16

SSPs provide a safe and accessible method for IDUs and others to dispose of used syringes. Similar to hospitals and other healthcare settings, used syringes are collected in special puncture-proof “sharps” containers. These containers are picked up and safely disposed of according to special procedures designated for hazardous waste.

The vast majority of syringes distributed by SSPs are returned. In many states, including New York, syringe service policies actively encourage participants to return as many used syringes as possible.17

In New York State, all syringe service staff receive training by the State Health

Department that outlines precautions to avoid a needle stick injury, appropriate safe disposal methods, and procedures to clean an accidental blood spill. Most SSPs offer safe disposal as a community resource and are called upon to retrieve used syringes in public spaces.

Research collected from states across the nation shows that the presence of a syringe service program does not result in an increase in discarded syringes in public.

In Baltimore, after an SSP was implemented, the number of inappropriately discarded syringes decreased by almost 50%.18

In Portland, the number of discarded syringes decreased by almost two-thirds after the NEP opened.19

In 1992, Connecticut repealed a law forbidding the sale of syringes without a prescription. As a result, reports show a reduction in needle sharing by 50 percent and a decrease in HIV infections by over 30 percent. In addition, law enforcement officials experienced two-thirds fewer needle stick injuries.20

In San Francisco, approximately 3.5 million syringes were recovered and safely disposed of in 2000. These included approximately 2 million syringes recovered at SSPs.21

Syringe service Programs and Hepatitis C 

The hepatitis C virus (HCV) is the most common chronic blood-borne infection in the U.S. Infection with HCV can lead to severe liver disease, potentially resulting in cirrhosis, liver cancer, and end-stage liver disease. HCV is the leading cause of liver transplants in the U.S and a leading cause of mortality among people living with HIV. Approximately 8,000 to 10,000 people die each year in the U.S. due to liver disease caused by hepatitis C, and hepatitis C-related liver disease is now a leading cause of mortality in people with HIV.

Transmission

The great majority of HCV infections are found among people with a history of drug injection, including people who have been incarcerated.22 HCV is easily transmitted among drug injectors by sharing syringes or other injection paraphernalia (such as cookers, filters)23. Hepatitis C is easier to transmit through shared injection equipment than HIV, and HCV is usually the first blood borne virus IDUs acquire.24 As a result, as many as 50-90% of IDUs have been infected with HCV.25 Unlike some other forms of viral hepatitis, there is no vaccine to prevent HCV.

According to global estimates from the World Health Organization, approximately 170 million people live with hepatitis C.26 In the Unites States, roughly 4 million people have been infected with hepatitis C.27

Syringe service programs and hepatitis C prevention

SSPs provide drug injectors with sterile syringes and other equipment (“cookers”, filters, sterile water, alcohol swabs) to reduce the risks of sharing injection equipment. A large body of research demonstrates that SSP participants are less likely to engage in high-risk injection behavior that can transmit HIV.28 These changes in behavior can also reduce the risk of HCV transmission among IDUs who use SSPs.29 SSPs also educate IDUs about HCV risks and prevention and link drug injectors to HCV screening, diagnosis and treatment, including vaccination for other forms of hepatitis. Research on the effectiveness of SSPs in reducing hepatitis C transmission among drug injectors has produced mixed results. However, surveys across several countries indicate that areas with greater syringe access through SSPs have lower rates of hepatitis C among IDUs. A long-range study of drug injectors in New York City found a significant decline in HCV rates from 1990 to 2001, corresponding to a dramatic expansion in syringes

distributed by SSPs during this period.30

Hepatitis C in the U.S.: high prevalence populations

Current/former IDUs: 50-90%

Injection drug use is the most common route of transmission accounting for 60% of all new infections. HCV infection rates in IDUs range from 50% to 90%.31

HIV+ people: 25-30%

Approximately one third of all HIV-infected people in the US are co-infected with HCV.32 Since HIV and HCV share similar transmission routes, co-infection is common particularly among injection drug users.

Centers for Disease Control and Prevention Recommendations

CDC’s National Hepatitis C Prevention Strategy recognizes that HCV is both a preventable and a treatable disease. CDC recommendations for IDUs include education, testing and medical referral for treatment, vaccination for hepatitis A and hepatitis B, using sterile syringes only once, and referral to syringe service and other harm reduction programs.

References

  1. Centers for Disease Control and Prevention. 2005. Syringe service Programs (December 2005). Retrieved from http://www.cdc. gov/idu/facts/aed_idu_syr.pdf, on 2/11/06; Centers for Disease Control and Prevention. 2005. Access to Sterile Syringes (December 2005). Retrieved from http://www.cdc.gov/idu/facts/aed_idu_acc.pdf, on 2/11/06
  2. Heimer R, Khoshnood K, Bigg D, Guydish J, Junge B. 1998. Syringe use and reuse: Effects of syringe service programs in four cities. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology 18 (Supplement 1): S37-S44; Hagan H, McGough JP, Thiede H, Hopkins S, Duchin J, Alexander ER. 2000. Reduced injection frequency and increased entry and retention in drug treatment associated with needle-exchange participation in Seattle drug injectors. Journal of Substance Abuse Treatment 19(3): 247-252.
  3. Rockwell R, Des Jarlais DC, Friedman SR, Perlis TE, Paone D. 1999. Geographic proximity, policy, and utilization of syringe service programs. AIDS Care 11(4): 437- 442.
  4. Junge B, Valente T, Latkin C, Riley E, Vlahov D. 2000. Syringe service not associated with social network formation: Results from Baltimore. AIDS 14(4): 423-426.
  5. Marx MA, Crape B, Brookmeyer RS, Junge B, Latkin C, Vlahov D, Strathdee SA. 2000. Trends in crime and the introduction of a needle exchange program. American Journal of Public Health 90(12): 1933-1936.
  6. Center of Innovative Public Policies, Inc. April 2001. “Needle Exchange Programs: Is Baltimore a Bust?”
  7. http://www.safeneedledisposal.org accessed 3/18/06
  8. Baggaley RF, Boily MC, White RG, Alary M. (2006). Risk of HIV-1 transmis- sion for parental exposure and blood transfusion: a systematic review and meta-analysis. AIDS 20(6): 805-12.
  9. Makwana N, Riordan FA. (2005). Prospective study of community needlestick injuries. Arch Dis Child. 90(5):523-4.
  10. Nourse CB, Charles CA, McKay M, Keenan P, Butler KM. (1997). Childhood needlestick injuries in the Dublin metropolitan area. International Journal of Medicine 90(2): 66-9.
  11. Aragon Pena, A.J., Arrazola Martinez, M.P., Garcia de Codes, A., Davila Alvarez, F.M. and de Juanes Pardo, J.R. (1996). Hep- atitis B prevention and risk of HIV infection in children injured by discarded needles and/or syringes. Atencion Primaria, 17: 138-140.
  12. Montella, F., DiSora, F. and Recchia, O. (1992). Can HIV-1 infection be transmitted by a discarded syringe? Journal of Acquired Immune Deficiency Syndromes, 5: 1274-1275.
  13. Russell FM, Nash MC. (2002). A prospective study of children with community-ac- quired needlestick injuries in Melbourne. Journal of Pediatric Child Health. 38(3): 322-3.
  14. de Waal N, Rabie H, Bester R, Cotton MF. (2006). Mass needle stick injury in children from the Western cape. Journal of Pediatric Medicine. 52(3):192-6.
  15. Centers for Disease Control and Prevention. (2005). State and Local Policies Regarding IDUs’ Access to Sterile Syringes (December 2005). http://www. cdc.gov/idu/facts.
  16. Burris S, Blankenship KM, Donoghoe M, Sherman S, Vernick JS, Case P, Lazzarini Z, Koester S. (2004). Address- ing the “risk environment” for injection drug users: The mysterious case of the missing cop. Milbank Quarterly 82(1): 125-56. Beletsky L, Macalino GE, Burris S. (2005). Attitudes of police officers towards syringe access, occupational needle-sticks, and drug use: A qualitative study of one city police department in the United States. International Journal of Drug Policy 16: 267-274.
  17. Doherty MC, Junge B, Rathouz P, Garfein RS, Riley E, Vlahov D. (2000). The effect of a needle exchange program on numbers of discarded needles: A 2-year follow-up. American Journal of Public Health 90(6): 936-939.
  18. Paone D, Des Jarlais DC, Caloir S, Clark J, Jose B. (1995). Operational issues in syringe services: the New York City tagging alternative study. Journal of Community Health 20(2): 111-123.
  19. Doherty MC, Junge B, Rathouz P, Garfein RS, Riley E, Vlahov D. 2000. The effect of a needle exchange program on numbers of discarded needles: A 2-year follow-up. American Journal of Public Health 90(6): 936-939.
  20. Oliver KJ,Friedman SR, Maynard H, Magnuson L, Des Jarlais DC. 1992. Impact of a needle exchange program on potentially infectious syringes in public places. Journal of Acquired Immune Deficiency Syndromes 5: 534-535.
  21. Groseclose SL, Weinstein B, Jones TS, Valleroy LA, Fehrs LJ, Kassler WJ. 1995. Impact of increased legal access to needles and syringes on practices of injecting-drug users and police officers – Connecticut, 1992-1993. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology 10(1): 71-72.
  22. Update: Syringe service Programs – United States, 2002 (Editorial Note). MMWR Weekly, July 15, 2005. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5427a1.htm,
  23. Centers for Disease Control (2001) National Hepatitis C Prevention Strategy: A Comprehensive Strategy for the Prevention and Control of Hepatitis C Virus Infection and Its Consequences. Division of Viral Hepatitis, National Center for Infectious Diseases, Summer 2001.
  24. Hagan H, Thiede H, Weiss NS, Hopkins SG, Duchin JS, Alexander AR. (2001). Sharing of drug preparation equipment as a risk factor for hepatitis C. American Journal of Public Health 91: 42-46.
  25. Hagan H, Thiede H, Des Jarlais DC. (2004) Hepatitis C virus infection among injection drug users: Survival analysis of time to seroconversion. Epidemiology. 15(5):543-549.
  26. Hagan H, Des Jarlais DC. (2000). HIV and HCV infection among injecting drug users. The Mount Sinai Journal of Medicine 67(5-6): 423-428.
  27. World Health Organization. (2000). Hepatitis C prevalence fact sheet. Retrieved from: http://www.who.int/mediacentre/factsheets/fs164/ en/
  28. Centers for Disease Control (2001) National Hepatitis C Prevention Strategy: A Comprehensive Strategy for the Prevention and Control of Hepatitis C Virus Infection and Its Consequences. Division of Viral Hepatitis, National Center for Infectious Diseases, Summer 2001.
  29. Gibson DR, Flynn NM, Perales D. (2001). Effectiveness of syringe service programs in reducing HIV risk behavior and HIV seroconversion among injecting drug users. AIDS 15: 1329-1341.
  30. Hagan H, Des Jarlais DC, Friedman SR, Purchase D, Alter MJ. (1995). Reduced risk of hepatitis B and hepatitis C among injection drug users in the Tacoma syringe service program. American Journal of Public Health 85(11): 531-537.
  31. Des Jarlais DC, Perlis T, Arasteh K, Torian LV, Hagan H, et al. (2005). Reductions in hepatitis C virus and HIV infections among injecting drug users in New York City, 1990-2001. AIDS 19 Suppl 3:S20-5.
  1. Alter MJ, Moyer LM. (1998). The importance of preventing hepatitis C virus infection among injection drug users in the United States. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology 18(S1):S6-S10.
  2. Sulkowski MS, Mast EE, Seeff LB, Thomas DL., (2000). Hepatitis C Virus infection as an opportunistic disease in person infected with human immunodeficiency virus. Clinical Infectious Diseases Apr:30 Suppl 1:s77-84.

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