Implementing Syringe Services Programs in Michigan

February 28, 2023

Throughout the world, syringe services programs have delivered significant public health benefits. Syringe services programs afford people who inject drugs with access to sterile injection equipment, referrals to substance use disorder treatment, overdose prevention resources, and other health and social services. Despite their public health value, syringe services program implementation can be challenging for a variety of reasons including policy impediments and the stigma associated with substance use.

Prior to 2017, there were only four syringe services programs legally operating across 22 sites in Michigan. However, the number of syringe services programs in the state rapidly grew as a response to the addiction and overdose crisis. As of 2022, 35 syringe services programs operated across 86 sites across Michigan. The rapidity with which syringe services programs were scaled up across Michigan is a noteworthy public health achievement and may inform how these programs grow in other states.

In collaboration with the Michigan Department of Health and Human Services and Vital Strategies, researchers from the Bloomberg School of Public Health’s Bloomberg Overdose Prevention Initiative team recently interviewed syringe services program operators across Michigan (n=19) to document the contributing factors to the rapid increase in service availability. See the full report here.

Participants explained that syringe services program implementation launched after the Michigan Department of Health and Human Services engaged members of the public health and healthcare workforce in discussions about strategies for meeting the public health needs of people who use drugs. For most participants, funding from the Michigan Department of Health and Human Services to support syringe services program implementation was an essential first step.

“…the majority of [syringe services programs] have been started because the state provided funding and wanted to see a program locally, so they approached the [local] health department, offered this funding, and then the health department started a program.”

Many participants reported that they initially had limited knowledge of how to operate a syringe services program prior to launching their programs. Participants described a “learning curve” in tailoring program operations to fit the local contexts.

“[Syringe services program implementation] was very much a learning curve, and it still is because the policies are always changing, the laws are always changing, the community is always changing… you’ll never be bored running the syringe service program.”

Many participants reported that syringe services program staff members had personal connections (e.g., knew someone with a substance use disorder) or lived experiences related to substance use.

“I definitely stay here for the harm reduction program… seeing how my son has struggled, and how he has been treated by people, and a lot of health professionals as well, I just want people who need help to know there are people who can help you in a compassionate, nonjudgmental way.”

The importance of community engagement was a common thread linking syringe services program operators in Michigan. Participants held a shared view that community engagement was critical for successful implementation and subsequent operations.

“So it really was about a good year and a half of just planning and meeting before we were actually able to operate.”

Participants reported that syringe services programs and recovery support services were not well-connected. This disconnect was partially attributed to the recovery community being reluctant to support syringe services programs due to stigma and concerns that the provision of sterile injection equipment would enable or otherwise encourage substance use.

“…their substance abuse counselors weren’t in favor of our program, didn’t necessarily like it in their building…”

Many syringe service program operators described scenarios in which they reached out to law enforcement before implementation to provide information about program operations, attempt to resolve any concerns, and answer questions.

“We also approached law enforcement before we actually started the [syringe services program]. …and said, ‘We’re going to be doing this, just so you’re aware of this,’ to get some feedback from them… And so, they’re not out there arresting people.”

In some instances, participants described scenarios in which law enforcement engaged in policing practices that adversely affected syringe services program clients.

“…[participants] had situations with law enforcement where they said they’d taken all of their supplies, like unopened boxes of syringes that they’ve pretty much just picked up from us, and they confiscate all of that…”

Participants emphasized that additional funding to support syringe services program expansion was essential for meeting the public health needs of people who inject drugs.

“Money is what we need to thrive. To hire more staff and a recovery coach…You know, it would be awesome if we had a nurse and recovery coach on our mobile unit going out to different spots.”

The inability to use state monies to purchase sterile injection equipment was frequently described as a major challenge.

“the one thing that I need to run this program is the one thing that I can’t buy with the money that I get. It really makes no sense.”

Looking ahead to spending opioid litigation funds, states and local governments should consider the implications of these findings as they work to scale up access to syringe services programs. Based on the evaluation on Michigan’s SSP expansion, states should:

1. Ensure funding continuity for existing syringe services programs and create funding opportunities to support additional programs.
2. Support linkages between established syringe services programs and nascent programs as doing so may facilitate implementation and enhance sustainability.
3. Launch community-level interventions to correct misunderstandings about syringe services programs and eliminate stigmatization of substance use.
4. Better integrate harm reduction and substance use disorder treatment services to afford people who inject drugs with enhanced access to the health and human services needed to improve public health.
5. Amend state laws to explicitly authorize syringe services program operations.
6. Increase funding for syringe services programs and allow programs to purchase sterile injection equipment with state dollars is necessary to support program operations.

This post was co-authored by:

• Sean T. Allen, DrPH, MPH; Suzanne M. Grieb, PhD, MSPH; Samantha J. Harris, PhD, MPA; Catherine Tomko, PhD; and Fernanda Alonso, PhD, LL.M. at the Johns Hopkins Bloomberg School of Public Health.
• Julie Rwan, MPH; Esther Mae Rosner, LMSW; and Eric G. Hulsey, DrPH, MA at Vital Strategies.
• Mary Miller, MSN, RN; Zekiye Lukco, MTS; and Brandon Hool, MPH at the Michigan Department of Health & Human Services.