Reductions in syringe service program funding could increase overdose deaths

A new study published today in JAMA Network Open projects that reductions in federal funding for syringe service programs (SSPs) could lead to substantial increases in mortality among people who inject drugs in the United States.

Researchers from the University of Colorado Anschutz examined the potential long-term effects of federal funding cuts to SSPs using a microsimulation model representing people who inject drugs nationwide in a variety of funding reduction scenarios over a five-year period. SSPs provide evidence-based harm reduction services, including sterile syringe access, naloxone distribution and wound care as well as provide access to medications for opioid use disorder and connections to health and social services.

Our findings suggest that disruptions to SSP funding like the ones currently proposed are likely to have serious and measurable consequences for public health. Even relatively modest reductions in services will be associated with increased mortality, while sustained, large-scale funding losses could be catastrophic."

Kirk Fetters, MD, infectious disease clinical fellow at CU Anschutz and study co-first author

Researchers modeled scenarios in which total SSP funding was cut by 11% and 80%, lower and upper estimates of how much funding comes to SSPs from federal sources across the US. Across all scenarios, all-cause mortality increased 0.1-5%, and overdose mortality increased 0.2-6.9% over five years. In the worst-case scenario, at 80% sustained reduction in federal funding, the model projected 39,600 additional deaths overall among people who inject drugs nationwide, 15,600 of which would be due to overdose.

"These estimates underscore the critical role that SSPs play in preventing overdose deaths and supporting the health of vulnerable populations," says Josh Barocas, MD, associate professor at CU Anschutz and study senior author. "Policies that reduce access to these services will have far-reaching consequences that extend well beyond the immediate funding cuts themselves and impede our ability to end the overdose crisis. This is a time we should be doubling down on evidence-based strategies to curtail overdoses, not cutting funding."

The researchers used data from the Centers for Disease Control and Prevention's National HIV Behavioral Surveillance system and other published sources to create a representative cohort of people who inject drugs across the United States. The study found that increased mortality was observed across most analyses, reinforcing the conclusions that cuts to or restrictions on SSP funding will worsen health outcomes.

"SSPs are a cornerstone of evidence-based harm reduction," says Pranav Padmanabhan, MPH, epidemiology PhD student at CU Anschutz and study co-first author. "This study provides important data for policymakers evaluating the public health implications of funding decisions affecting overdose prevention and related services."