Research Opportunities

Project NEXUS is a survey of people who use drugs at 6 syringe services programs across the U.S. The aim of this survey is to learn more about the health, substance use behaviors, HIV/HCV prevalence, and access to and use of prevention services among people who use drugs – especially in non-urban areas of the country that are not typically included in large surveys. SSPs will be randomly selected and invited to participate. Project sites will enroll up to 300 participants in a 30-minute survey with HIV and HCV testing. SSPs will be financially supported to implement the survey, and all participants will receive an incentive for completing the survey and HIV/HCV testing.

Organized syringe service in the US began when Dave Purchase set a TV dinner table on a street in Tacoma, WA in 1988. The number of programs grew rapidly over the next several years and NASEN was founded in 1992.  NASEN began holding an annual conference for information exchange and mutual support by programs.  The plenary talk at these initial conferences was entitled “syringe exchange in the known universe,” and provided information on SEP activities in the US and both national and international research on SEPs.

            With the continuing growth of SEPs in the US, it became clear that a formal mechanism for collecting information about SEPs in the country was needed to inform the SEP community, public health departments, and the US government.  In 1994, NASEN and the Chemical Dependency research unit of Beth Israel Medical Center in New York City initiated the first annual National Syringe Exchange Survey with funding from amFAR.

            The survey has provided information on the numbers of syringe service programs, their organizational characteristics, the numbers of syringes distributed and other services provided by the programs.  The information has been used to inform the public and public officials of the critical importance of the programs, and to obtain funding for the programs.  One important function of the annual surveys has been to document the evolution of the programs into multi-service organizations that address the many health and social service needs of people who use drugs in the US.

            The National Syringe Exchange Survey was renamed as the Dave Purchase Memorial Survey after Dave’s passing.

            The opioid epidemic, the overdose epidemic, COVID-19 pandemic, and increasing federal support for drug user health have created new challenges and opportunities for SSPs in the US.  The Dave Purchase Memorial Survey will continue to collect, analyze and provide information to the SSP community and to public health officials during these interesting times.  

Don Des Jarlais

• Adaptation of U.S. Syringe Service Programs in Response to the COVID-19 Pandemic (PTX)
• Dave Purchase 2014 Data Summary (PTX)
• Dave Purchase 2015 Data Summary  

• A comparison of syringe disposal practices among injection drug users
  The United States (U.S.) approved use of federal funds for needle and syringe programs (NSPs) in December 2009. This study compares syringe disposal practices in a U.S. city with NSPs to a U.S. city without NSPs by examining the prevalence of improperly discarded syringes in public places and the self-reported syringe disposal practices of injection drug users (IDUs) in the two cities.
• Differences between men and women who inject drugs
  People who inject drugs (PWID) in rural areas of the United States have had limited access to syringe service programs (SSP). Rural SSP have recently surged, but accompanying research is lacking about PWID utilization, barriers, and preferences for SSP design and how those preferences vary by gender.
• Expansion of Syringe Service Programs in the United States, 2015–2018
  There have been substantial increases in the number of SSP programs established and the number of syringes distributed in response to the opioid epidemic. Ensuring high-quality services in these new programs will be critical to successfully addressing the current epidemic.
• Harm reduction in the United States
  The history of harm reduction in the USA has led to the development of some of the most important methods for treating persons for drug use disorders, such as methadone and buprenorphine for opiate use disorder.
• HIV incidence among injecting drug users in New York City
  There have been no studies showing that participation in programmes which provide legal access to drug-injection equipment leads to individual-level protection against incident HIV infection. We have compared HIV incidence among injecting drug users participating in syringe-exchange programmes in New York City with that among non-participants.
• Ingenuity and Resiliency of Syringe Service Programs
  As COVID-19 accelerated throughout 2020, syringe service programs (SSPs) faced challenges necessitating programmatic adaptations to prevent overdose deaths while simultaneously keeping workers and participants safe from COVID-19.
• NEP attendance and health care utilization promote entry into detoxification
  This study was undertaken to identify factors associated with entry into detoxification among injection drug users (IDUs), and to assess the role of needle-exchange programs (NEPs) as a bridge to treatment. IDUs undergoing semiannual human immunodeficiency virus (HIV) tests and interviews were studied prospectively between 1994 and 1998, during which time an NEP was introduced in Baltimore.
• Reduced risk of hepatitis B and hepatitis C among injection drug users
  Reduced risk of hepatitis B and hepatitis C among injection drug users in the Tacoma syringe exchange program. This case-control study examined the association between syringe exchange use and hepatitis B and C in injection drug users.
• The Impact of COVID-19 on Syringe Services Programs in the United States
  We conducted a rapid mixed methods assessment of SSP response to the COVID-19 pandemic in the United States (U.S.) to quantify and characterize changes in services provided by SSPs and the potential impact on PWID. Quantitative data were collected by the North American Syringe Exchange Network (NASEN), which maintains a directory of SSPs in the U.S. On March 31, 2020, NASEN emailed a short electronic survey to SSPs in the directory that asked a question about changes in SSP operations. Survey completion was voluntary and not incentivized. We analyzed data collected through April 16, 2020.
• Understanding the public health consequences of suspending a rural SSP
  We conducted semi-structured interviews with 27 PWID (59.3% male, 88.9% White) to explore access to sterile injection equipment and overdose prevention resources, high-risk injection practices, and HIV risk perceptions following the KCHD SSP suspension. Participants were recruited from street locations frequented by PWID. Interviews were audio-recorded and transcribed verbatim. We employed an iterative, modified constant comparison approach to systematically code and synthesize textual interview data.