Syringe Service Programs (SSP) Improve Health Outcomes for People Who Use Drugs (PWUD)

Background: Syringe Service Programs (SSP) are social service programs designed to promote public health by providing support to people who use drug (PWUD), access to sterile syringes and Naloxone (Narcan), which reverses opioid overdoses, and safer use techniques. The efficacy of SSP’s is well-documented however stigma and apathy towards those who use drugs limit communities from implementing SSP services for fear of “enabling or promoting substance use”. This study examines associations of various program components in a SSP in a major Midwest city with health outcomes of participants.

Methods: We used data derived from treatment administrative information of a SSP, merged with state medical examiner data. There were 1,400 participants enrolled in the SSP during a three-month period in 2018, and only 570 are verified with the records of Missouri Department of Mental Health and included in final analyses. Our outcome of interest is whether the participant was still living after three-year post-enrollment (Yes/No), as verified with the Missouri Department of Health and Senior Services death records. Our focal independent variables are three intervention components of SSP, including safer use supplies (Yes/No), substance use treatment referral (Yes/No), and harm reduction education (Yes/No). SSP participants could receive any of these three treatment components. We apply hierarchical logistic regression to examine the relationships of each of these treatment components with health outcomes of participants (Model 1-3), and then include all three treatment components in one model (Model 4). All analyses control for demographics and HIV status (positive, negative, unknown).

Results: Among 570 participants, 53 were not alive after three years post-program enrollment. Analysis demonstrated nonsignificant associations of examined health outcomes with access to safer-use supplies and receiving a referral for treatment (Models 1 and 2), when other intervention components are not included. However, there is a statistically significant relationship between harm reduction education and a positive health outcome (Model 3, OR=2.49, SE=.99, p<.05). When all three intervention components are included in Model 4, both receiving harm reduction education (OR=3.70, SE=1.67 p<.05) and safer use supplies (OR=3.92, SE=1.99 p<.05) are statistically and positively associated with the dependent variable. A full inclusion of three components strengthens the association between harm reduction education and the outcome, and also makes the association with safer-use supplies significant.

Conclusions and Implications: The harm reduction education component consisted of safer use education, overdose reversal education, and other life-preserving messaging. When considering individually, harm reduction education has a stronger relationship to positive health outcomes than safer use supplies alone; however, both services significantly improve the odds of improved outcomes when provided together. They may be a human connection that many PWUD lack. When participants only picked up the supplies, that may suggest a contemplative stage of change. Practically, our findings demonstrate the importance of increased touchpoints for those people who use drugs (PWUD). It is important to move beyond ideological barriers which limit adoption of SSPs while also expanding access to treatment and recovery support services.