Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Ave NW, Washington, D.C., 20052, United States.
Int J Drug Policy. 2019 Aug;70:22-32. doi: 10.1016/j.drugpo.2019.04.006. Epub 2019 May 3.
Syringe Services Programs (SSPs) have been proposed as a key intervention to address increasing rates of opioid injection, overdose, and infectious disease transmission in the U.S. In recent years, multiple states and jurisdictions have enacted laws and policies to enable implementation of SSPs. These statutory and regulatory changes have resulted in the expansion of SSPs in a short period of time under a patchwork of different regulations and policies. Understanding how SSPs are responding to this evolving policy environment in the midst of a worsening opioid crisis can inform the development of strategies to maximize the role SSPs play in the response to the opioid crisis.
In-depth, semi-structured and audio-recorded interviews were conducted with 25 individuals running 23 SSPs in the U.S. A thematic content analysis was employed to identify and group themes across the domains of interest based on inductive and deductive coding of verbatim interview transcripts.
Despite progress in expanding the number of SSPs in recent years, programs described encountering legal, policy, funding, and community barriers that are limiting the scope, scale, and reach of SSPs. To address these barriers, programs are employing multiple strategies to educate about and advocate for SSPs, engage policymakers and communities, combat pervasive stigma, strengthen funding, and reach at-risk populations.
This qualitative study of a geographically diverse sample of SSPs provides key insights into the legal and policy barriers, funding challenges, and contextual factors impacting SSPs and the strategies programs are pursuing to counter these barriers. Coupling these strategies with policy changes that address the underlying legal and financial barriers and advancing efforts to combat stigma around drug use and addiction stand to substantially expand the role of SSPs as part of the public health response to the opioid crisis in the U.S.
注射器服务项目（SSP）被提议作为解决美国阿片类药物注射、过量用药和传染病传播率上升的关键干预措施。近年来，多个州和司法管辖区颁布了法律和政策，以实现 SSP 的实施。这些法规和政策的变化导致 SSP 在不同法规和政策的拼凑下在短时间内得到扩展。了解 SSP 如何在阿片类药物危机恶化的情况下应对这一不断变化的政策环境，可以为制定战略提供信息，以最大限度地发挥 SSP 在应对阿片类药物危机中的作用。
对美国 23 个 SSP 的 25 名管理人员进行了深入、半结构化和录音访谈。采用主题内容分析，根据对逐字采访记录的归纳和演绎编码，在感兴趣的领域内识别和分组主题。
尽管近年来 SSP 的数量有所增加，但项目描述遇到了法律、政策、资金和社区障碍，这些障碍限制了 SSP 的范围、规模和覆盖面。为了解决这些障碍，项目采用了多种策略来宣传和倡导 SSP，与政策制定者和社区合作，打击普遍存在的污名化，加强资金支持，并接触高危人群。
本研究对 SSP 的地理多样化样本进行了定性研究，提供了关键的法律和政策障碍、资金挑战以及影响 SSP 的背景因素的见解，以及项目正在采取的应对这些障碍的策略。将这些策略与解决潜在法律和财务障碍的政策变化以及推进打击吸毒和成瘾污名化的努力相结合，有望大大扩大 SSP 在应对美国阿片类药物危机的公共卫生应对中的作用。
