Harm reduction is a set of practical, public health strategies designed to reduce potential harms associated with drug use and promote healthy lifestyles and communities. There is no universal definition for harm reduction, but the idea is to ensure there is no judgement about a person’s drug use and sexual activity, meet people where they are in terms of ability and willingness to modify behaviors, and elicit positive change based on client centered goals, needs, circumstances, and readiness to change.
What are syringe services programs (SSPs)?
SSPs are programs that provide comprehensive harm reduction services. This can include, but is not limited, to sterile needle and injection drug equipment distribution; safe disposal for used needles/syringes; HIV/hepatitis C virus (HCV) testing and linkage to care; overdose prevention education and naloxone distribution; referrals to substance use disorder treatment, medical care, mental health providers, and social services; and other tools to prevent acquisition of bloodborne pathogens and sexually transmitted infections (STIs).
Are SSPs legal in Tennessee?
Yes, SSPs are legal in Tennessee. SSPs were signed into Tennessee law on May 17, 2018, allowing non-governmental organizations or local health departments to operate a syringe services program after approval by the Tennessee Department of Health (TDH). Click here to view §T.C.A Title 68, Chapter 1.
Does the law include zoning requirements in the legislation for SSP locations?
Yes, the law requires SSPs to be located 2,000 feet from any school or park (1,000 feet from any school or park for Shelby, Davidson, Knox, and Hamilton Counties).
What services are Tennessee SSPs required to provide?
By law, SSPs are required to provide the following services:
· Distribution of unused needles/syringes and injection drug equipment
· Collection and safe disposal of used needles/syringes and injection drug equipment
· Education on prevention of: overdoses, bloodborne pathogens, and drug abuse as well as treatment for mental illness and substance use disorder
· Referral to mental health and substance use disorder treatment to individuals who request it
· Referral to or direct provision of naloxone
· Referral to or direct provision of HIV and hepatitis C testing
What are the benefits of SSPs?
People who use drugs (PWUD) and people who inject drugs (PWID) are often marginalized and often lack access to the traditional health care and social services system due to stigma against drug use, cost, and fear of legal consequences. Aside from providing participants with sterile syringes and collecting used ones, SSPs provide HIV and hepatitis C testing and refer participants to the medical care and social services based on client-centered goals.
Additionally, SSPs reduce needle stick injuries among first responders by collecting used syringes and educating participants to inform law enforcement when syringes are in their possession. SSPs also reduce fatal overdoses by distributing naloxone, the opioid overdose reversal medication, and educating participants how to prevent and respond to an overdose.
Lastly, SSPs save healthcare dollars by reducing HIV and hepatitis C infections and preventing bacterial infections such as skin abscesses and heart valve infections or endocarditis.
Why does Tennessee need SSPs?
HIV, hepatitis C and drug overdose deaths are intertwined crises in the central Appalachian states due to the opioid epidemic. Tennessee is home to one of the highest opioid prescribing rates in the United States, and drug overdose rates have risen drastically since 2013. In Tennessee, declines in HIV among PWID stalled, and chronic hepatitis C infections continue to rise 20,000 each year since 2016. Coupled with high rates of poverty and unemployment, changing trends in opioid use, and challenges with access to health care, many of Tennessee’s counties are highly vulnerable to the rapid dissemination of HIV and hepatitis C among PWID. By providing sterile syringes to clients, the chance of transmitting HIV or hepatitis C to another person through injection drug use is reduced. In addition, by providing syringe services, naloxone, and referrals to substance use disorder treatment, SSPs reduce accidental overdoses due to opioids and other controlled substances.
Who can visit an SSP?
Anyone can visit an SSP. SSPs are built on the harm reduction model, which offers support and resources to those who may need them. The following people might visit an SSP:
· PWUD, including PWID
· People who are on opioid pain management treatment and would like naloxone
· People who engage in commercial sex work
· People requesting safer sex supplies and HIV and hepatitis C testing
· People who use syringes to administer prescribed medications (i.e. insulin) or non-prescribed medications (i.e. hormones and/or steroids)
· Family and friends of someone who injects drugs and would benefit from naloxone
· Persons seeking naloxone or overdose prevention education
· Persons seeking information on prevention of bloodborne pathogens and/or sexually transmitted infections
What does “limited immunity” mean?
The law protects SSP staff, volunteers, and enrolled participants from being charged with possession of syringes or other injection supplies, including those with residual amounts of controlled substances in them. Tennessee’s limited immunity law only protects those who are in transit to or from a TDH-approved SSP and are able to present an SSP participant card to law enforcement. Limited immunity does not protect those in possession of illegal drugs or paraphernalia not obtained by an SSP.
Who can start an SSP in Tennessee?
In Tennessee, any non-governmental organization or local health department can start an SSP, after approval by TDH.
What are the requirements for starting an SSP?
Interested agencies or organizations should complete and submit a TDH SSP application. The application can be found here . Along with the application, additional requirements can be found here . For questions about or assistance with the application, email SSP.Health@tn.gov.
What are the requirements for an SSP after the program has been approved by TDH?
TDH approved SSPs are required to report annually. The annual reporting form can be found here . SSPs report on the following metrics:
· Number of needles/syringes dispensed by the program
· Number of needles/syringes collected by the program
· Number of total participant visits
· Number of naloxone kits distributed
· Number of referrals given to substance use disorder and mental health treatment
· Number of HIV and hepatitis C tests performed by the program
· Participant demographic information (e.g., race/ethnicity, age range, current gender identity, health insurance status)
This information is used to help TDH expand programs across the state to areas of greatest need.
Additionally, all TDH approved SSPs are required to participate in a site visit 30 days after SSP operations begin as well as an annual site visit, which are both conducted by the Tennessee SSP liaison.
Who should we submit the application and/or annual reports to at TDH?
How are SSPs funded?
SSPs are funded through various mechanisms. TDH allocates limited funding from the Centers for Disease Control and Prevention (CDC) to support SSPs across Tennessee. Federal dollars are used to support program infrastructure such as staff, supplies (e.g., alcohol pads, sterile water, cotton), syringe disposal services, HIV and hepatitis C testing, and educational materials. Organizations can secure SSP funding for syringes and injection supplies through private grants, donations, and fundraising (please refer to the resources tab for additional funding information).
What are the restrictions on using public funds for syringes and injection supplies?
By law, federal and state dollars cannot be used for the purchase of needles, syringes, and cookers. The following can be supported using public funds:
· Supplies (e.g., alcohol pads, sterile water, cotton)
· HIV and hepatitis C test kits
· Syringe disposal services
· Referral to medical care and social services
· Communication, outreach, and educational materials
What SSP models are allowed in Tennessee?
In Tennessee, SSPs are allowed to operate as a fixed site and/or a mobile site. A fixed site is an SSP is located in a building or specific location, such as a storefront, office, or other space with street-level access. A mobile site is an SSP operated from a van, bus, or other mobile unit to deliver services. However, if operating as a mobile site, the SSP is required to have a consistent location when delivering services due to zoning requirements.