FAQ on Syringe Exchange Programs


What are Syringe Exchange Programs (SEPs)?

SEPs collect used and potentially contaminated syringes from people who inject drugs and exchange them for sterile syringes in order to prevent HIV, hepatitis C, and needle-stick injury. Most SEPs also offer a variety of social services, including access to housing progams, career services and addiction treatment.


Why does North Carolina need SEPs?

North Carolina is experiencing a rapid rise in injection drug use, leading to increases in hepatitis C infections. Over the past four years acute hepatitis C cases have more than doubled[1], and the cost of treating North Carolina Medicaid patients with chronic hepatitis C rose from around 8 million dollars in 2013 to over 50 million in 2014[2]. These costs will continue to rise, creating an additional burden on NC taxpayers unless we act now. Also, heroin death rates have tripled over the past four years[3] and programs are needed to help people who struggle with addiction to seek treatment.


Do SEPs encourage drug use?

NO. Decades of scientific evidence have concluded that SEPs DO NOT cause any increase in drug use[4]. In fact, many studies have demonstrated that SEPs decrease drug use by effectively connecting people who use drugs to treatment.


Do people who use drugs actually return syringes to SEPs?

YES. Research indicates that over 90% of syringes distributed by SEPs are returned[5].


How do SEPs connect people to drug treatment?

People who use drugs are often marginalized and encounter numerous barriers when seeking drug treatment. SEPs act as a gateway to treatment by helping SEP clients connect to resources and navigate the complex application process. In fact, research indicates that SEP participants are five times more likely to enter drug treatment than non-participants[6].


How do SEPs benefit law enforcement?

It is also estimated that one in three officers will be stuck by a syringe during their career and 28% will suffer more than one needle-stick injury[7]. SEPs are proven to lower needle-stick injury to law enforcement by 66%[8].


How do SEPs decrease HIV, hepatitis C and hepatitis B among injection drug users?

SEPs decrease the transmission of bloodborne disease by decreasing the likelihood that people who inject drugs will share syringes and by collecting used syringes from the community and properly disposing of them. Studies show that SEPs decrease hepatitis C transmission among people who inject drugs by as much as 50%[9]. HIV infection rates have decreased by as much as 80% in areas with SEPs[10].


How do SEPs save taxpayer money?

The lifetime cost of treating an HIV-positive person is estimated to be between $385,200 and $618,900[11], while hepatitis C costs $100,000-$500,000 to treat[12]. Since most people who inject drugs are uninsured or reliant on programs such as Medicaid, taxpayers bear most of this cost. With individual needles and syringes costing less than 50 cents, it is far cheaper to prevent a new case of HIV than to assume many years of treatment costs. According to a recent analysis, every dollar spent on SEPs would save at least an estimated three dollars in treatment costs averted[13].


How do SEPs decrease crime?

SEPs decrease crime by connecting participants to drug treatment, housing, food pantries and other social services. In one study, Baltimore neighborhoods with syringe exchange programs experienced an 11% decrease in crime compared to those without syringe exchange, which saw an 8% increase in criminal activity[14].


How many states have SEPs?

Twenty states in the U.S. explicitly authorize SEPs, including Kentucky, Indiana and Nebraska. Georgia and West Virginia also have SEPs in some major cities.

[1] NC Department of Health and Human Services surveillance data

[2] NC Department of Health and Human Services surveillance data

[3] NC Injury Prevention Branch.

[4] Institute of Medicine. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries. An Assessment of the Evidence. Washington, D.C.: National Academies Press; 2006.

[5] Ksobiech, K, 2004, Harm Reduction Journal. Return Rates for Needle Exchange Programs: A common criticism answered. http://www.harmreductionjournal.com/content/1/1/2

[6] Hagan H, McGough JP, Thiede H, Hopkins S, Duchin J, Alexander ER., “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, vol. 19, 2000, p. 247–252.

[7] Lorenz, J., Hill,. J & Samini, B. (2000). Occupational Needle-stick Injury in a Metropolitan Police Force. American Journal of Preventative Medicine, 18, 146-150.


[8] Groseclose, S.L. et al., “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 & Human Retrovirology, vol. 10. no. 1, 1995, p. 82–89.

[9] Turner, K. et al. “The impact of needle and syringe provision and opiate substitution therapy on the incidence of hepatitis C virus in injecting drug users: pooling of UK evidence,” Addiction, E-publication ahead of print, 2011.

[10] Des Jarlais, D.C., Arasteh, K., & Friedman, S. R. (2011). HIV among drug users at Beth Israel Medical Center, New York City, the first 25 years. Substance Use & Misuse, 46(2-3), 131-139.

[11] Schackman, B.R., Gebo, K.A., & Walensky, R.P. et al. (November 2006). The lifetime cost of current Human Immunodeficiency Virus care in the United States. Medical Care, 44(11), 990-997.

[12] Mizuno, Y. et al. (2006). Correlates of health care utilization among HIV-seropositive injection drug users. AIDS Care,18(5):417-25.

[13] Nguyen, T.Q., Weir, B.W., Pinkerton, S.D., Des Jarlais, D.C., & Holtgrave, D. (July 23, 2012). Increasing investment in syringe exchange is cost-saving HIV prevention: modeling hypothetical syringe coverage levels in the United States (MOAE0204). Presented at the XIX International AIDS Conference, Washington D.C. Session available online at http://pag.aids2012.org/session.aspx?s=198. (date last accessed: December 11, 2012)

[14] Center for Innovative Public Policies. Needle Exchange Programs: Is Baltimore a Bust? Tamarac, Fl.: CIPP; April 2001.