Comparing harm reduction and overdose response services between community-based and public health department syringe service programmes using a national cross-sectional survey

Bradley R Ray; Jamie L Humphrey; Sheila V Patel; Christopher F Akiba; Ricky N Bluthenthal; Hansel Tookes; Paul A LaKosky; Lynn D Wenger; Alex H Kral; Barrot H Lambdin

doi:10.1016/j.lana.2024.100757

Comparing harm reduction and overdose response services between community-based and public health department syringe service programmes using a national cross-sectional survey

Lancet Reg Health Am. 2024 May 6:34:100757. doi: 10.1016/j.lana.2024.100757. eCollection 2024 Jun.

Affiliations

¹ RTI International, Research Triangle Park, NC, United States.
² University of Southern California, Los Angeles, CA, United States.
³ University of Miami Miller School of Medicine, Miami, FL, United States.
⁴ North American Syringe Exchange Network, Tacoma, WA, United States.

Abstract

Background: Syringe services programmes (SSPs) are an evidence-based strategy to reduce infectious diseases and deliver overdose prevention interventions for people who use drugs. They face regulatory, administrative, and funding barriers that limit their implementation in the US, though the federal government recently began providing funding to support these efforts. In this study we aim to understand whether the organisational characteristics of SSPs are associated with the provision of syringe and other overdose response strategies.

Methods: We examine four outcomes using the National Survey of Syringe Services Programs (NSSSP) (N = 472): syringe distribution, naloxone distribution, fentanyl test strip (FTS) availability, and buprenorphine implementation. These outcomes are assessed across three organizational categories of SSPs-those operated by public health departments (DPH), community-based organizations (CBOs) with government funding, and CBOs without government funding-while adjusting for community-level confounders.

Findings: The proportion of SSPs by organizational category was 36% DPH, 42% CBOs with government funding, and 22% CBOs without government funding. Adjusting for community-level differences, we found that CBO SSPs with government funding had significantly higher provision of all four syringe and overdose response services as compared to DPH SSPs and across three of the four services as compared to CBO SSPs without government funding. CBO SSPs without government funding still had significantly higher provision of three of the four services as compared to programmes maintained by the DPH.

Interpretation: CBO SSPs have strong potential to expand overdose response services nationally, particularly if provided with sustained and adequate funding. Communities should aim to provide funding that does not hinder SSP innovation so they can remain flexible in responding to local needs.

Funding: This study was supported by Arnold Ventures (20-05172).

Keywords: Community-based organization; Harm reduction; Public health; Syringe service program.