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Appalachia has seen a large increase in hepatitis C infections tied to injection drug use. Syringe services programs (SSPs) that give enough access to sterile injection equipment can cut hepatitis C transmission by 56%, and combined with medication-assisted treatment, by 74%. Yet access to SSPs has been limited in the United States, especially in rural areas and in southern and midwestern states. This report tracks how SSPs expanded in three states from 2013 to August 1, 2017.
Key findings
- In 2013, one SSP operated, in a free clinic in West Virginia; SSPs were illegal in Kentucky and North Carolina.
- By August 2017, both states had legalized them, and 53 SSPs operated across the three states.
- Many offer integrated services addressing hepatitis, HIV, overdose, addiction, unintended pregnancy and neonatal abstinence syndrome.
How each state got there
| State | Legal path | By August 2017 |
|---|---|---|
| Kentucky | A March 2015 law let health departments run SSPs once approved by county boards of health, county fiscal courts and city councils. Winning approval took extensive education, town hall meetings and data to dispel myths — such as the idea that SSPs enable drug use — and counties that did this reported more support from police, courts and community leaders | 24 SSPs |
| North Carolina | A 2013 Good Samaritan/Naloxone Access Law, plus protection from paraphernalia charges for people who warn an officer about needles before a search. A July 11, 2016, law let any group that promotes proven ways to reduce drug-use risks start an SSP after notifying the state's Safer Syringe Initiative | 20 SSPs serving about 3,983 clients in 52 of 100 counties |
| West Virginia | SSPs are neither banned nor expressly allowed. The first ran in a free clinic; the state funded a 2015 pilot at the Cabell-Huntington Health Department, and the West Virginia Harm Reduction Coalition formed in February 2017 | 9 SSPs serving about 4,376 clients |
- North Carolina's SSPs were run by 10 harm reduction coalitions, three churches or church partners, two AIDS service organizations, two local health departments, two substance use treatment centers and a drug users' union. None of the state's five counties rated vulnerable to HIV and hepatitis C outbreaks had an SSP in the program's first year, though some of their residents used existing SSPs.
- In West Virginia, health departments ran seven SSPs and free clinics two; four were in 3 of 28 vulnerable counties. All had fixed sites, five also offered mobile services, five used peer delivery and six had peer counselors.
Number of syringe services programs and client visits in the three states, 2013–2017. From CDC's MMWR.
What the programs offer
| Service | Kentucky (24) | North Carolina (20) | West Virginia (9) |
|---|---|---|---|
| Needle and syringe exchange | 100% | 100% | 100% |
| Naloxone education | 71% | 100% | 89% |
| Hepatitis C screening | 83% | 40% | 78% |
| Linkage to hepatitis C treatment | 100% | 100% | 100% |
| HIV screening | 83% | 55% | 100% |
| Linkage to behavioral treatment | 100% | 85% | 67% |
| Pregnancy testing | 63% | — | 100% |
| Mobile services | 8% | 65% | 56% |
| Median hours open per week | 3 | 8 | 4 |
— = not reported.
What comprehensive SSPs should include
Beyond sterile needles, syringes and other equipment, comprehensive programs should improve access to medication-assisted treatment, counseling and social support; naloxone and training to prevent fatal overdose; the full range of contraception, including long-acting reversible methods; prenatal care; vaccination; and screening and treatment for hepatitis B and C and HIV. The authors suggest health departments evaluate SSPs by clients served, syringes given out and returned, hours open, testing, services and referrals, and by health outcomes such as hepatitis, HIV, overdose and treatment rates.
Limits: data were self-reported and client counts estimated; North Carolina was in its first year; underground programs weren't counted; growth was rapid, so current data should come from state or local agencies; and the data can't show whether services were good enough.
With community support and laws that don't prohibit them, SSPs can be run in many ways by many kinds of organizations, including in rural areas.
Sources
Based on Bixler D, Corby-Lee G, Proescholdbell S, et al., "Access to Syringe Services Programs — Kentucky, North Carolina, and West Virginia, 2013–2017," Morbidity and Mortality Weekly Report 67(18), CDC, as corrected; a work of the United States government in the public domain.
Лицензия: CC0 1.0 (общественное достояние) · По материалам www.cdc.gov
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