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Syringe Access Programs

January 31, 2022
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WRITTEN BY Dr. Joshua Mueller and Dr. Ramon Martinez III

From 2001 to 2015, the number of opioid-related hospitalizations and emergency room visits in Missouri more than doubled, indicating that the use of injection drugs such as heroin and fentanyl has risen drastically. This development has put individuals who use injection drugs at increased risk of contracting blood borne infections, such as HIV or hepatitis C, through the use of contaminated syringes. While surveillance of injection drug-related infectious diseases is difficult, the Centers for Disease Control and Prevention has designated Missouri as a state with significant risk of outbreaks of hepatitis C or HIV due to injection drug use. As such, they have issued a determination of need for syringe access programs in the state. SB 690 and HB 1844, filed in 2022, would allow syringe access programs to operate in Missouri. These programs must register with the Department of Health and Senior Services in order to avoid violating laws prohibiting the manufacture, distribution, delivery, or sale of drug paraphernalia. New exchanges would be prohibited from operating within 500 feet of a school building.


  • Syringe access programs (SAPs) provide sterile syringes to people who use injection drugs.
  • These programs have been shown to decrease the spread of blood borne infections, such as HIV and hepatitis C, and reduce unsafe disposal of contaminated syringes.
  • Because syringe access programs may remove barriers to using injection drugs, the programs are more effective at reducing morbidity and mortality when implemented in conjunction with other interventions, such as providing counseling and redirection to treatment programs.
  • Access to SAPs may increase entry into drug cessation programs, which have been shown to increase the likelihood of ending drug use. 


  • There are relatively few studies of SAPs in nonurban areas, so the impacts of these programs may vary by location.
  • To date, studies on SAPs rely on relatively small sample populations, so more research is needed to understand their comprehensive effects.
  • Many studies rely on self-report or tests of non-representative populations (for example, arrestees) to establish the effects of SAPs, so the results of implementing these programs are often difficult to determine.


This Note has been updated. You can access the previous version (published December 2020) here.

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