What Are Needle Exchange Programs?

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Community-based needle exchange programs (NEPs) provide clean needles or syringes to people who inject drugs (PWID). They are also called syringe service programs or syringe exchange programs. Collection of used syringes and other harm reduction services to address social, medical, and mental health needs are also provided.

Read on for more information on needle exchange programs, how to access them, and where to find support for substance abuse.

Sterile injection drug use items including a syringe, cooker, and alcohol swab

ezza 116 / Getty Images

How Do Needle Exchange Programs Work?

People in need of needle exchange can go to an NEP location and pick up sterile syringes. Locations may be physical storefronts, but others are mobile, such as distributing from a van or the supply bag of NEP outreach workers.

Many programs allow you to take as many supplies as you need, without restrictions or requirements, after returning used syringes.

Safer use supplies, information, and services may also be available to reduce disease risk and harm related to injecting drugs. Program staff or caseworkers may be able to talk you through what is available and make referrals for care.

Safety and Effectiveness of NEPs

Key research findings and takeaways about NEPs include:

  • People new to injecting drugs utilizing a NEP were five times more likely to enter a substance abuse program and three times more likely to stop using drugs than those who didn't access a NEP.
  • The use of the programs' services was associated with a 50% reduction in HIV and hepatitis C infections.
  • In a study comparing a city with NEPs vs. a city without, the risk of people disposing of used needles improperly was eight times higher in the city without NEPs.
  • NEPs do not increase drug use or crime.

What Is the Purpose of Needle Exchange Programs?

Reducing disease risk is a primary aim of needle exchange programs.

Sharing used needles that may be contaminated with infected blood can contribute to the transmission of infections from one person to another, including HIV and hepatitis. In fact, 1 in 10 people who inject drugs is diagnosed with HIV.

Safe use supplies (including sterile cookers and tourniquets), safer sex materials (such as condoms), and first aid items for wound care are typically made available to further reduce disease risk.

NEPs also provide links to substance use treatment for people who want to quit.


NEPs may provide a range of services and resources based on community needs, such as:

  • Provide clean syringes and sterile supplies for injection drug use
  • Collect used syringes
  • Screening for infections, such as sexually transmitted infections (STIs), HIV, and viral hepatitis
  • Safer sex information and supplies
  • Vaccinations
  • Wound care
  • Naloxone and training on how to use it to prevent overdose death
  • Referrals to substance abuse programs and other mental or medical health resources


There are a number of benefits of NEP services, including:

  • Reduction in HIV and hepatitis infections among PWID
  • Cost-effective way to prevent and address HIV outbreaks
  • Increased likelihood of PWID to reduce, stop, or seek treatment for substance abuse
  • Reduction of syringe litter in communities

Addressing Misconceptions About NEPs

In 30 years of research on NEPs, findings have not found that NEPs increased:

  • Drug use
  • Violence
  • Syringe waste

Who Has Access to Needle Exchange Programs?

People who inject drugs reap the most benefit from accessing NEPs. However, NEPs are not legal in all states. As of this writing, 39 states allow or locally permit NEPs.

Harm reduction strategies are rooted in supporting anyone who may need them. Others may seek out services at NEPs, such as people who:

  • Use any type of syringe for prescribed or non-prescription medicine
  • Want to learn about and access naloxone
  • Are family and friends of those who inject drugs
  • Engage in high-risk behaviors, such as sex workers
  • Want safer sex information, supplies, or STI testing

Locating Needle Exchange Programs

There are over 400 NEPs in the United States. To access one near you, some resources include:

How to Find Substance Abuse Treatment Near You

A number of resources can help you find local treatment, including:


Needle exchange programs reduce the risk of disease associated with injection drug use and link people with substance abuse treatment. Services include providing sterile syringes, collecting used syringes, and referrals to treatment. NEPs are legal in many states, but not all.

The programs are safe and effective at reducing rates of HIV and hepatitis among PWID, reducing syringe waste, and increasing the likelihood that participants reduce or quit using or seek out treatment for substance abuse. People seeking supplies and information about overdose prevention and safer sex may also use the programs.

A Word From Verywell

Because there is stigma around substance use and laws governing NEPs, it can be hard to navigate available services. These programs provide harm reduction services without judgment to address the needs of people who inject drugs. They aim to meet people where they are to reduce the risk associated with injection drug use and support if and when a person who uses is ready to make a change. Whether you use injectable drugs or are supporting a loved one who does, these programs can provide safe and effective resources.

Frequently Asked Questions

  • What are the negative effects of needle exchange programs?

    Of the potential concerns around needle exchange programs, research has found no association with an increase in crime or drug use. Research has demonstrated a reduction—not an increase—in syringe litter in cities with an NEP.

  • Where are needle exchange programs legal in the U.S.?

    Needle exchange programs are legal or allowed in 39 states. However, states vary regarding whether syringes are included in drug paraphernalia laws, whether the programs are expressly prohibited, and whether participants are protected from prosecution due to returning needles with drug residue.

  • Are needle exchange programs effective?

    Researchers have found that needle exchange programs are safe and effective. Among people who inject drugs (PWID), they are associated with a reduction in syringe litter and HIV and hepatitis infections, as well as reducing or stopping use, and/or seeking treatment.

12 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Vearrier L. The value of harm reduction for injection drug use: a clinical and public health ethics analysisDisease-a-Month. 2019;65(5):119-141. doi:10.1016/j.disamonth.2018.12.002

  2. Centers for Disease Control and Prevention. Syringe services program technical package.

  3. Centers for Disease Control and Prevention. Summary of information on the safety and effectiveness of syringe services programs (ssps).

  4. Tookes HE, Kral AH, Wenger LD, et al. A comparison of syringe disposal practices among injection drug users in a city with versus a city without needle and syringe programsDrug Alcohol Depend. 2012;123(1-3):255-259. doi:10.1016/j.drugalcdep.2011.12.001

  5. Centers for Disease Control and Prevention. Syringe service programs (ssp) factsheet.

  6. Centers for Disease Control and Prevention. HIV and injection drug use.

  7. Centers for Disease Control and Prevention. Syringe services program (ssp) faqs.

  8. National Institutes on Drug Abuse. Syringe services program.

  9. amfAR Opioid & Health Indicators Database. Syringe exchange program legality.

  10. North Carolina Department of Health and Human Services. Syringe programs faqs.

  11. Fernández-Viña MH, Prood NE, Herpolsheimer A, Waimberg J, Burris S. State laws governing syringe services programs and participant syringe possession, 2014-2019Public Health Rep. 2020;135(1_suppl):128S-137S. doi:10.1177/0033354920921817

  12. National Harm Reduction Coalition. Syringe access in your state.

By Katie Wilkinson, MPH, MCHES
Katie Wilkinson is a public health professional with more than 10 years of experience supporting the health and well-being of people in the university setting. Her health literacy efforts have spanned many mediums in her professional career: from brochures and handouts to blogs, social media, and web content.