Strengthening Syringe Services Programs (SSPs) through Direct Program Funding

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NASTAD and project partners, VOCAL-NY and University of Washington (UW), selected grant recipients for the CDC-supported funding opportunity: Strengthening Syringe Services Programs (SSPs) through Direct Program Funding. Overall, 65 programs across 31 jurisdictions were awarded a total of $6 million dollars for the first year of the initial two-year funding cycle. This five-year grant initiative intends to support organizations around the country with the funding and resources to strengthen the capacity of SSPs.

This project aims to strengthen the capacity of SSPs through direct program funding to continue serving as critically essential access points for core syringe and safer drug use supplies, overdose prevention information and materials, and a range of services for people who use drugs (PWUDs), such as adult vaccination services, HIV and viral hepatitis testing and linkage to care services, and referral and navigation efforts.

The Strengthening SSPs grant initiative goals are to: 

  • Provide low-threshold, direct funding to SSPs through a transparent process that prioritizes programs operating within communities experiencing significant health disparities, have limited access to resources for PWUDs, and represent a diversity of program size, scale, and geographic location and participant diversity. 

  • Offer enhanced capacity building assistance on organizational and fiscal development, particularly for a diverse range of programs that represent, and work within, disproportionately affected communities.  

View the map below to view the recipients of the grant.



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Cochise Harm Reduction (CHR)

Cochise Harm Reduction (CHR) works to improve the lives of people who use drugs in Cochise County, AZ though direct services, advocacy, and education.

CHR delivers harm reduction services to people who use drugs (PWUD) in Cochise County (CC). It consists of two programs: Street Outreach Team (SOT) Program and Peer Distribution Program (PDP) and operate a hotline to manage delivery requests for services and supplies. The SOT operates primarily through “fixed delivery routes”: a unique combination of fixed site and mobile delivery service. The PDP offers part-time employment opportunities as peer distributors in their rural communities.


Crossroads Recovery Center

Crossroads Recovery Center’s mission is to help ensure native people have access to harm reduction services through an Indigenous model of care that is not only culturally appropriate, but also encourages connectivity to traditional practices and Nuumuu language. Crossroads Recovery Center provides meaningful linkage to other services such as spiritual advisors, cultural activities, addiction treatment, housing and healthcare, along with other social services as needed.

The current SSP operation is located on the Bishop Paiute Tribal Reservation in Inyo County. The organization is authorized to serve Inyo and Mono County. Combined, both counties have seven different tribal communities that are unique and have limited access to resources. The organization’s greatest success is to have the cultural capital and trust to go into any of the tribal areas to provide services. Another recent accomplishment has been receiving state authorization for both counties. The program itself has been built by Natives Who Use Drugs (NWUD) and those with other lived experience. Another major accomplishment was the development of Skoden in response to high overdose rates and the need for culturally grounded interventions through applied harm reduction principles.

Gender Health Center (GHC)

Gender Health Center (GHC) is a grassroots, non-profit organization located in Sacramento, CA. Its mission is to provide education, advocacy, harm reduction, mental health, and other health services to underserved/marginalized populations, with a specialization in gender and sexual identities, and a focus on social justice. GHC’s vision recognizes that the provision of gender affirming services in a safe and supportive environment results in improved quality of life for transgender people.

GHC’s Syringe Exchange Program is located in Sacramento, CA - with its area of service extending to all of Sacramento County and neighboring counties through the mail delivery program and secondary outreach. It offers safe syringe distribution and disposal, overdose prevention and education resources and materials, referrals to Medication Assisted Treatment Programs (MAT) for Substance Use Disorder, and provide linkage to other essential resources such as mental health care, wound care and treatment, and HIV/HCV/STI testing.

Humboldt Area Center for Harm Reduction (HACHR)

The Humboldt Area Center for Harm Reduction (HACHR) is committed to building stronger, healthier communities by co-creating spaces that foster dignity, equity, and choice.

HACHR’s peer-run program serves as a vital touchpoint providing low-barrier access to sterile injection equipment, safer smoking supplies, overdose prevention, sex work supplies, linkages to Medication Assisted Treatment (MAT), HIV and hepatitis C testing, as well as, connections to the life-saving care needed by many of the participants.

Punks with Lunch, a project of HEPPAC (PWL)

Punks with Lunch (PWL) aims to empower, engage and enhance the health and well-being of individuals who use drugs and are experiencing street homelessness in Oakland, CA. Founded in 2015, PWL has provides low barrier, lifesaving and harm reducing services to marginalized and disenfranchised communities. The organization seeks to amplify voices, improve engagement and linkages to allied health and social services, and advocate for the health and dignity of those they serve.

PWL provides safer drug use and overdose prevention supplies and education, food, PPE, hygiene and linkages to medical and social services systems including MOUD. It utilizes evidence-based public health practices including a needs-based distribution model for syringes and safer smoking supplies. PWL partners with social service, health, and mutual aid organizations that offer services including: MOUD, HIV/HCV testing, wound care, housing linkages, benefits assistance and legal support.


San Juan Basin Public Health

San Juan Basin Public Health's (SJBPH) mission is to protect human and enviormental health and inspire well-being in our community.

SJBPH has been building a comprehensive SSP since July 2021. The SJBPH clinic sees any patient who needs services for STI testing and treatment, HIV testing, and PrEP. The focus on PrEP services has been instrumental in bringing greater access to patients. The clinic also provides access to and linkage with other healthcare in the area, including behavior health and treatment for HIV and HCV. The clinic provides naloxone and fentanyl test strips to PWID and PWUD clients who may have come in for other services. The clinic offers naloxone/fentanyl test strip events in the SJBPH lobby, and provides these important tools during outreach events, focusing on PWUD. Many local providers refer patients to SJBPH for their expertise in sexual health services and accessibility. The clinic is a trusted healthcare source for the LGBTQ+ and Spanish-speaking populations through providing comprehensive, quality care while addressing conditions that may lead to health disparities.


Connecticut Harm Reduction Alliance (CTHRA)

 The Connecticut Harm Reduction Alliance (CTHRA) is dedicated to promoting the dignity and wellbeing of individuals and communities impacted by drug use. Through advocacy, training, and services, CTHRA aims to ensure the availability, adequacy, accessibility, and acceptability of services and resources that remediate the adverse consequences of drug use.

 CTHRA has been providing SSP services since 2014. CTHRA’s medical services, including wound care and vaccinations, are provided at its drop-in center, on its RV, and during evening outreach. CTHRA also runs sex workers’ outreach groups in its New Haven drop-in center. CTHRA built a vaccine program to provide COVID-19, Mpox, and influenza vaccinations, and are working towards being able to offer additional vaccines. CTHRA operates a low-barrier, harm reduction emergency winter shelter program for individuals with significant medical needs or whose substance use puts them at risk of discharge from other shelters.

District of Columbia



Florida Harm Reduction Collective, Inc. (FLHRC)

 FLHRC’s mission is to redefine public health by meeting Floridians who use drugs where they are at through syringe access, overdose prevention, and all other healthcare needs in between. Its vision is a state free of HIV, hepatitis C, drug overdoses, and soft tissue infections; a state where drug use, education, prevention, and treatment organizations work together to develop programs that further healthier decision making for people who use drugs (PWUDs), their families, and communities.

 FLHRC has worked to establish and strengthen harm reduction advocacy by bringing together stakeholders such as SSPs, groups looking to operate an SSP, Recovery Community Organizations, Health Departments, behavioral health, OD prevention programs, and sex worker rights groups. FLHRC has helped organizations exploring the steps to opening an SSP by hosting community and individual webinars.

Rebel Recovery

 Rebel Recovery Florida is a low barrier recovery community organization that provides recovery support services, education, and advocacy to those impacted by drug use and those living with or at risk of HIV/AIDS.

Rebel Recovery operates FLASH, a peer-operated mobile 1-to-1 syringe exchange. Wound care is facilitated biweekly at 2 sites by medical school doctors to reduce ED visits. Testing service now includes HIV self-tests, PrEP screening, and peer education through partnerships with the Health Council of Southeast Florida and PBC Department of Health. FLASH encounters adults with justice system history and those in need of aftercare services following hospital-based stabilization. Many of these individuals end up unsheltered or unstably housed and fall out of care. They successfully re-engage in supportive services, initiate medication-assisted recovery, link to clinical health providers, and access infectious disease testing/treatment/PrEP through coordination with Rebel Recovery’s programs and community providers.

 Underground Recovery Jax (URJ)

Underground Recovery Jax (URJ) promotes better health outcomes for individuals affected by the harms associated with substance use, blood-borne infections, and overdose through providing direct peer support, outreach, and education. URJ envisions a community where services and support to reduce the harms associated with high-risk behaviors will be regularly available, non-exploitative, and non-criminalized.

URJ is a mobile SSP that began in 2020. Volunteers meet participants in the community and provide services and supplies as requested. URJ utilizes a hub and spoke model to reach more people via secondary distribution. Hub participants are trained, collect data, and provide feedback to direct the program.


Access Point of Georgia, Inc.

 Access Point of Georgia supports the health of drug users through outreach efforts, advocacy, and education for people who use drugs (PWUDs) to use the safest options available for themselves and the community. The organization supports all pathways to recovery by providing harm reduction services and recovery resources to active PWUDs, regardless of a desire for abstinence.

Access Point of Georgia provides syringe distribution and disposal, safer injection kits, smoking and snorting equipment, naloxone kits, safer sex supplies, medical room for HIV/HCV testing, warm hand-off referrals, peer support groups, overdose prevention events, and more.



Iowa Harm Reduction Coalition (IHRC)

Iowa Harm Reduction Coalition (IHRC) works to create health equity for people who use drugs (PWUDs) and do sex work in Iowa communities through advocacy, education, and direct health services. IHRC is committed to building power among people impacted by the war on drugs, including PWUDs and communities of color; committed to acceptance of stigmatized and marginalized peoples and PWUDs; and committed to dismantling systems of race, class, and gender-based privilege.

IHRC provides harm reduction services to Polk, Linn, Johnson, and surrounding counties utilizing direct outreach, fixed site availability in Polk County, and mail-based services statewide. In addition, IHRC contributes supplies and information to a lockbox program in Linn County, which includes Cedar Rapids. IHRC services include safer drug use education, sterile supply distribution and safe disposal, on-site screening for infectious diseases with referral to treatment based on confirmatory testing, referral to local providers of medications for opioid use disorder (MOUD) or other treatment services, housing referrals and winter supplies, and overdose education with free naloxone distribution and fentanyl test strips.


Idaho Harm Reduction Project (IHRP)

IHRP promotes health and safety for all Idahoans impacted by drug use through advocacy, harm reduction, and evidence-based programming.

IHRP offers harm reduction services, HIV and hepatitis C testing, community naloxone distribution, and capacity-building and technical assistance. IHRP was recently awarded funding to implement wound care services, STI testing and treatment, and low-barrier buprenorphine beginning in early 2023.


Joshua Olt's Lets Talk Foundation (JOLT)

JOLT Harm Reduction provides harm reduction services and programs that address the negative health and social consequences of high-risk behaviors and social injustices that impact individuals engaged in those high risk behaviors. JOLT focuses on work with people who use drugs (PWUDs), people engaged in sex work, and people who are living unsheltered with special attention paid to Black, Indigenous, and other people of color (BIPOC) and people who identify as LGBTQIA+.

JOLT has two locations: a primary fixed site and a satellite site in a neighboring rural county. JOLT offers mobile outreach as well. Peoria outreach works with people who are unstably housed or who are unsheltered. In Tazewell County, outreach provides more mobile delivery services due to it largely being a rural area.

The Puerto Rico Project

The Puerto Rico Project is a Latine led street outreach harm reduction organization dedicated to meeting individuals' basic needs by restoring dignity and improving the quality of life for those affected by stigma and harm. The project’s goal is to reduce the number of fatal overdoses by expanding access to Narcan, harm reduction supplies, and basic needs. The project attains this by implementing resources for people impacted by social inequalities led with compassion, acceptance, and love for those the organization serves.

The Puerto Rico Project’s SSP distributes syringes, safer smoking kits, and other harm reduction supplies. Additionally, the Puerto Rico Project uses a food pantry, which was kickstarted by founder its Melissa Hernandez, as a stable location for a syringe access program and wound care.


Indiana Recovery Alliance (IRA)

The Indiana Recovery Alliance operates under the philosophy of harm reduction to educate the community and to promote the health and dignity of the individuals and communities impacted by drug use. The organization collaborates with people to assist in any positive change, as a person defines it for themselves, beginning where the person is at, with no biases or condemnations. The Indiana Recovery Alliance also address the effects of drug use including overdose, HIV, hepatitis C, chaotic substance use and incarceration.

The IRA is the only drug-user-led and staffed SSP in Indiana. It serves participants from south-central Indiana. The IRA has an office, and a mobile van used to visit two locations, three times a week. The IRA brings resources and services directly to the most vulnerable people. It provides street outreach at encampments/non-traditional living spaces three days per week and distribute safer-use supplies, clothing, weather protection gear, wound care kits, naloxone, safer sex supplies, and naloxone.




Capitol Area Reentry Program, Inc. (CARP)

 The Capitol Area Reentry Program, Inc. (CARP) goal is to redefine reentry in Baton Rouge through a holistic approach to routine screening, compassionate engagement, and harm-reductive services aimed to reduce health disparities among people who use drugs (PWUD) and LGBTQ+ individuals.

CARP provides harm reduction and prevention to PWUD through the Be Safe Syringe Service Program. The Be Safe Program offers clients (guests) five different-sized syringes, a supply kit that includes a tie, cooker, cotton pellets, naloxone/Narcan (their choice of nasal or intermuscular), sharp containers/disposal, wound, and hygiene care kits, HIV/AIDS, hepatitis C, and Syphilis screening and linkage to care.

Central Louisiana AIDS Support Services, Inc. (CLASS)

The mission of Central Louisiana AIDS Support Services (CLASS) is healthy living for all humans. While CLASS remains committed to its original mission of serving people living with HIV/AIDS and preventing the transmission of the virus, it is also leading efforts focused on ending epidemics, fighting stigma, and promoting health for all, especially among our most marginalized and impoverished community members.

CLASS offers the only free syringe services program known as Fresh Works in Alexandria, LA. Persons in the region can access the Fresh Works Program that includes offering free sterile syringes and related drug injection supplies, overdose prevention supplies, syringe disposal, counseling, and referral services.


Trystereo is an all-volunteer harm reduction collective based in New Orleans, Louisiana. It was founded in 2011 to affirm the dignity of people who use drugs (PWUD) and to address limited resources in the community. The organization operates on the principles of harm reduction to offer material, educational, and advocacy support to PWUD and their communities in southeastern Louisiana.

Trystereo is an all-volunteer collective, the second-largest SSP in Louisiana, and the only SSP that mails supplies throughout the state. Trystereo operates two weekly drop-ins in New Orleans and operates a text hotline and mobile delivery service. Trystereo distributes syringes, safer injection kits, intramuscular naloxone kits, and fentanyl test strips. The organizations partners with NEXT Distro to ship supplies across the state to people without access to harm reduction programs.



 HRH413 is dedicated to strengthening drug using communities by full inclusion of people who use drugs (PWUD)/trade sex through all levels of all service provision. HRH413 believes to sit at the drug user table and respects PWUD/trade sex and the participants are the experts in their communities. The organization’s mission is to nurture and strengthen this expertise into highly effective mutual aid, outreach and advocacy.

HRH413 has only employed people who identify as active drug users/sex workers from the communities it serves. The organization focuses on underserved communities who can't or won't access traditional fixed SSP sites in the area. HRH413 also operates an overdose response team/protocol. 


SPARC Women's Center

The SPARC Center opened in November 2017 with the mission of providing low barrier, no-cost harm reduction services to at-risk women and non-men who use drugs and who sell sex. Located in Southwest Baltimore, SPARC is comprised of a comprehensive outreach program, drop-in center, and clinical space. SPARC’s harm reduction-based service provision is a low barrier, non-judgmental, non-coercive, and non-punitive.

SPARC provides low barrier, no-cost harm reduction services to non-men who use drugs and/or sell sex. SPARC offers SSP services through its drop-in Center and mobile services, including traditional outreach, mobile medical services, and supply delivery. SPARC’s SSP is unique in that it is offered in tandem with a host of other mobile medical and social services, increasing the likelihood that participants will receive care or be linked quickly and warmly.


Amistad Syringe Service Program & Harm Reduction Center

 Amistad exists to help improve the quality, health and safety of the lives of the community members who have been disproportionality impacted by systemic injustice and oppression, the continued negative impact of the War on Drugs, and stigma relating to substance use, homelessness, complex trauma, HIV/HCV status, and poverty.

India Street Harm Reduction Center & SSP is a drop-in/street outreach health program for people who use drugs (PWUD). It offers ODP community naloxone distribution and street outreach. Recently, the organization restructured the programming through creating focus groups with PWUD, which have resulted in culture shifting and the crafting of a drop-in space within a clearer harm reduction lens. The organization has initiated robust distribution and drug user health education, along with hiring practices aimed at a fully PWUD-led staff.

Maine Access Points (MAP)

Maine Access Points goal is to recognize the resiliency of people who use drugs (PWUD) and to work in collaboration to create access points for overdose prevention and harm reduction services in Maine.

MAP offers mobile and home-delivery services in York, Washington, and Oxford counties, a brick-and-mortar in Washington county, as well as a state-wide mail program. Supplies available include safer use kits, wound care kits, safer sex kits, and PPE and testing.


Harm Reduction Michigan (HRMI)

Harm Reduction Michigan’s (HRMI) mission is to decrease substance use-related harms in Michigan, in a respectful manner in collaboration with people who use drugs and alcohol. They are dedicated to improving the community’s health and well-being by supporting people in abstinence, moderation, and safer use.

Marquette County Health Department

The health department’s mission is to enrich lives in their community by preventing disease, promoting healthy lifestyles, and protecting the environment.

Marquette County Health Department launched New Points in September of 2018 and has grown to provide safer use supplies and education for a variety of drug consumption methods, including intravenous injection, nasal insufflation, inhalation, rectal administration, and oral ingestion. Overdose prevention education and naloxone nasal spray distribution is also available for program participants and community groups. Additionally, the program provides sharps containers and collection of full containers to encourage responsible sharps disposal in the community. New Points provides fentanyl test strips, various hygiene products, medication lock boxes, and COVID-19 rapid test kits. Referrals and navigation to pertinent medical and social services are provided based on eligibility and accessibility of local resources.

Punks with Lunch Lansing (PWLL)

Punks with Lunch Lansing (PWLL)’s mission to inspire, motivate, and grow community involvement in supporting the most vulnerable neighbors through the distribution of harm reduction supplies, clothing, food, and other essentials. The organization fulfills its mission by providing free food, hygiene items, harm reduction supplies, clothing, and camping gear to members of the Lansing community.

PWLL currently operates a "Harm Reduction Hub" \ and holds bi-weekly distribution events where the organization provides basic needs supplies, as well as, harm reduction supplies. The supplies that are distributed include first aid, sterile water, syringes, smoking kits, snorting kits, fentanyl testing strips, Narcan, and more.

 Wellness Services Inc.

Wellness Services, Inc.’s mission is to employ a harm reduction model to its everyday practices and believe in advocating for marginalized populations across a myriad of social justice issues.

Wellness Services, Inc.’s SSP program (STEP) has been in operation since 2010 and is 1 of the 4 legacy sites in Michigan. It offers distributes safer smoke, snort, and injection kits, fentanyl test strips, wound care kits, condoms, and naloxone. The program hosts a wound care clinic and offers HIV/HCV/STI testing and linkages to community resources.


Harm Reduction Sisters (HRS)

Harm Reduction Sisters’ (HRS) mission is to provide a feminist response, utilizing innovative harm reduction principles and practices to address the existing gaps for people who use drugs (PWUD) and experience trauma.

HRS is a syringe service program based in Duluth, MN, providing mobile, peer-distribution, and mail-delivery harm reduction services to 12 counties in NE MN, as well as, across the border in Superior, WI. HRS distributes syringes, Fentanyl strips, wound care kits, and Naloxone. In July 2021, HRS began providing mobile, low-barrier, rapid HIV testing to communities in the Duluth area. The HIV Tester also serves as a Peer Navigator, providing harm reduction education and linking people with reactive tests to immediate telehealth care, labs, and local clinics. HRS began offering Non-Medical HIV Case Management in Duluth and surrounding communities in October 2021, open to anyone who is living with HIV and is interested in a harm reduction-informed and outreach-based case management program. The Outreach Case Manager meets clients in comfortable environments to collaboratively develop an individualized care experience providing HIV prevention programs for individuals at high risk for HIV.

Rural AIDS Action Network (RAAN)

Rural AIDS Action Network (RAAN) envisions rural communities where persons living with or affected by HIV/AIDS live dignified lives and receive appropriate and compassionate medical care, and where communities understand the realities of transmission and prevention. RAAN leads rural Minnesota in prevention through a broad array of client services, risk reduction, advocacy, and awareness. RAAN provides culturally competent, inclusive, person-centered, and trauma informed programs and services.

RAAN has been an established organization for over 25 years. The Duluth SSP has been in operation since 2014. RAAN provides culturally competent, trauma-informed services and are a trusted partner throughout the communities. RAAN utilize social media (Facebook), community events, conferences, and community engagement activities to recruit people who use drugs (PWUD) for its services. The harm reduction programs includes outreach, education, HIV (rapid and confirmatory) and HCV testing, condom distribution, syringe services, and naloxone training and distribution.

Southside Harm Reduction Services (SHRS)

Southside Harm Reduction Services (SHRS) has a mission to promote the human rights to health, safety, and autonomy of people who use drugs (PWUD).

SHRS is a grassroots, comprehensive harm reduction program primarily serving the unsheltered, Indigenous community in South Minneapolis. For the past several years, SHRS has been the largest SSP in the state by volume, despite being only 5 years old. SHRS provides uniquely low-threshold services that are accessible to people who are often unable to access more medicalized, location-based SSPs, HIV testing and preventive care. When founded, SHRS met a hugely unmet need– Hennepin County declared an HIV outbreak in this community in 2020– by bringing SSP services into the streets, where people are at.


Confluence HRKC

Confluence HRKC is a Kansas City-based SSP that provides safe injection supplies, wound care kits, naloxone, and fentanyl test strips to Missourians who use drugs. Confluence HRKC uses mobile delivery, street-based outreach, and mail order models to distribute supplies. Confluence HRKC is committed to providing judgment-free, reliable, and compassionate services to participants while working towards just, equitable, and transformative drug policy in the state of Missouri.

Confluence HRKC is a mobile SSP that delivers syringes, naloxone and wound care supplies across the Kansas City, MO metropolitan area. In February 2023, the organization will partner with NEXT Distro to provide mail-based delivery across the state. The organization also operates a text hotline and quite literally meets people "where they are" to distribute syringes.

Kansas City CARE Clinic dba KC CARE Health Center (KC CARE Health Center)

Kansas City CARE Clinic dba KC CARE Health Center (KC CARE Health Center)’s goal is to promote health and wellness by providing quality care, access, research, and education to the underserved and all people in the community. Its vision is to create solutions for a healthy community.

Founded in 1993, Xchange was the only SSP in the region for decades. Xchange’s greatest recent accomplishment was completing its first large-scale survey of 268 clients, including HIV status and involvement in sex work, which will inform client-directed quality improvement.


MoNetwork's mission is to fight for real change and equity with and for individuals with substance use disorder, their loved ones, and people who use drugs (PWUD). The organization accomplishes this by using evidence-based practices, fighting for progressive policy change, and addressing the social justice inequities in the system.

The organization runs an SSP, which includes individuals who provide the following services: hepatitis C and HIV testing; wound care; address housing needs; and mental health services. The organization also provides street outreach and visits areas most impacted by overdose. It also provides Naloxyboxy which is the organization’s outside box that contains naloxone. The organization allows people to pick up the box outside of its business hours.

Power4STL (The T)

The T promotes holistic healing from trauma related to bullet injuries and overdose in St. Louis. The T transforms healthcare delivery through education and anti-racist, relationship-based care. The T works to create a community of health where people have the tools and care they need to heal from TRAUMA - right here, right now.

The T began its syringe exchange program as an extension of its COVID-19 pandemic focused outreach to those with housing insecurity in 2020. It collaborated with a grassroots community-based organization in North St. Louis city where a small syringe outreach program had already began. This collaboration grew to seven locations with a focus on the health and wellbeing of people who use drugs (PWUD). In 2021, a robust walk-in component was added to the outreach to allow for access to more, including showers, hot food, clothing, and space for rest, in additional to safer use support. In 2022, an additional component of clinical care for soft tissue infection and wound treatment was added with several health professionals added to the staff. Throughout the past year, The T has also added greater capacity to its navigation support, providing transportation, funding, and support to access treatment for a small but impactful cohort of participants.



Butte-silver Bow Health Department

The mission of the Butte-Silver Bow Health Department is to protect and improve the health of Butte-Silver Bow residents. Its vision is for Butte-Silver Bow to be Montana’s healthiest county.

The health department’s SSP is housed in its Title X clinic at the county health department. It offers SSP services and distributes safe injection kits, syringes, and Narcan kits. It disposes of used syringes and have performs HIV, hepatitis C, and syphilis rapid antibody tests. The health department also provides linkage to its onsite vaccination program, onsite reproductive health provider, and visiting service providers during SSP hours. It also makes referrals to treatment, medical, housing, and other related services. Butte-Silver Bow Health Department has previously offered mobile services in the community to be more accessible to participants, especially during the height of COVID-19 restrictions.

Open Aid Alliance (OAA)

Open Aid Alliance (OAA) works with the unique potential of each individual to overcome stigma as they seek greater health. For 34 years, OAA has been working with people affected by HIV, HCV, and drug use.

OAA operates two fixed site SSPs and a statewide mail order program. The fixed sites are in Missoula and Polson, MT. Missoula is an urban center and Polson is located on the traditional lands of the Salish and Kootenai tribes and the current Flathead Indian Reservation. Some of the services OAA provides are hepatitis C and HIV testing and wound care.

North Carolina

Center for Prevention Services (CPS)

Center for Prevention Services (CPS) is a non-profit organization with a mission to promote health and resilience through progressive approaches that integrate evidence-based prevention, harm reduction, and multifaceted systems of care.

CPS operates QCHR which includes a fixed drop-in center, pop-up sites, and mobile delivery where program members can access free Naloxone, HIV/HCV testing, linkage to treatment, safer consumption supplies, drug-checking, safer sex supplies, wound care, and referrals. QCHR has a peer-distribution program that delivers supplies to justice-involved people, people experiencing homelessness, sex workers, rural communities, and BIPOC communities. QCHR offers training in overdose prevention, overamping, harm reduction, and drug user cultural-competency to community partners. QCHR recently launched a Housing 1st pilot program tailored for PWUD and collaborates with research teams to identify HIV and HCV treatment and prevention barriers experienced by PWUD in Black communities.

Holler Harm Reduction

Holler Harm Reduction works with folks who use drugs and the people who care about them to ensure safe use and reduce negative aspects of substance use while enhancing community, advocacy and health in real time. Holler Harm Reduction supports drug users and believe in their autonomy. The organization aims to serve the community and the individual.

Holler Harm Reduction offers mobile distribution of harm reduction supplies. It operates a drop-in space where participants get supplies, talk through witnessed overdoses/reversals, and learn evidence-based practices. The organization is also a participating site for a statewide drug-checking program.

NC Survivors Union (NCSU)

NC Survivors Union aims to improve the lives of people who have been targeted by the war on drugs by:1) organizing, growing, and strengthening community-led grassroots groups, 2) educating, mobilizing, and advocating for policies and programs grounded in harm reduction, healing, and disability justice, and 3) providing direct services in areas where high-risk communities are denied even the most basic services.

NCSU provides a fixed-site SSP, mobile efforts, and secondary distribution. NCSU offers safer injection and consumption supplies and drug user health information. The organization also conducts HIV and HCV testing; on-site drug testing; and offers linkages to care, such as COVID-19 vaccination. NCSU is people who use drug (PWUD)-led and hires outreach workers from its participant population. The organization engages with many community-focused research projects. NCSU facilitates community education through weekly harm reduction support groups and multiple educational trainings.

Western North Carolina AIDS Project (WNCAP)

WNCAP’s mission is to provide equitable access to care and reduce harm from HIV, hepatitis C, and drug use.

WNCAP’s peer-led SSP has two fixed-sites and a mobile unit to distribute safer drug use supplies, overdose prevention education/materials, HIV/HCV testing, referrals, linkage to care, and navigation services. Recent expansions include Naloxone distribution, COVID-19 rapid-test distribution, and on-site vaccinations for COVID-19, Influenza, Hep A/B, and Mpox.

North Dakota


New Hampshire

New Jersey

New Mexico


New York

Bronx Móvil c/o National Harm Reduction Coalition

Bronx Móvil is a cooperative harm reduction organization that is mobile, street-based, and completely bilingual (Spanish/English). It is co-led and focused on people who use drugs (PWUD), inject drugs, and who are unhoused, and/or experiencing housing insecurity and homelessness. The organization’s aim is a healthier Bronx, an empowered community, and to meet the immediate needs of participants. Bronx Móvil believes that harm reduction must be 24/7 and culturally and linguistically centered.

Bronx Móvil's outreach bags include nutritional support, harm reduction supplies (including PPE), and street survival supplies (clothes, sleeping bags, backpacks). Bronx Móvil’s peer delivered syringe exchange and empowerment model allows for community leaders to engage in services in their networks at all hours. Bronx Móvil operates Narcanazo, which includes training of participants; engaging within injection networks; addressing emerging diseases, such as Mpox, COVID-19, etc.; and distributing safer use supplies, syringes, naloxone, etc.

Next Harm Reduction (NEXT)

NEXT Harm Reduction (aka NEXT Distro or “NEXT”) is an online and mail-based harm reduction program. NEXT provides mail-based support to people who use drugs (PWUD) that cannot access harm reduction services in-person due to their lack of proximity to a pre-existing SSP. NEXT also supports other harm reduction organizations begin or scale their mail-based work.


Hancock Public Health

Hancock Public Health’s goal is to improve ourselves and communities; promote public health and the prevention of disease; and protect people and the environment.

Hancock Public Health’s current SSP started in July 2020 with a goal to address the rise of new hepatitis C virus infections and drug overdose in its area. The SSP provides supplies and harm reduction services, including peer recovery supporters, to its key populations.

River Valley Organizing

River Valley Organizing is an organization committed to restorative and transformative solutions for public health and justice that defy the isolation of incarceration, the impacts of radicalized drug policies, the desolation of environmental degradation, and violent policing; empowering and strengthening health and morale for all. The organization is creating a multi-racial, multicultural working-class organization that radically builds community outside of existing institutions and to build community power.

The organization’s harm reduction campaign, UnHarming Ohio, provides services, such as exchanging syringes, distributing Narcan, and more. The organization also works to decrease police interactions within the community.


Oklahoma Harm Reduction Alliance (OKHRA)

The Oklahoma Harm Reduction Alliance (OKHRA) is a grassroots organization with a mission to meet Oklahomans who use drugs where they are through evidence-based education, advocacy, policy reform, and low barrier health services.

OKHRA is a grassroots organization providing SSP services through its direct street outreach, mail-based outreach, bar outreach, policy/advocacy, and a syringe take-back program. OKHRA distributes doses of naloxone, Fentanyl test strips, syringes; and collects syringe waste.

Stop Harm on Tulsa Streets, Inc. (SHOTS)

Stop Harm on Tulsa Streets (SHOTS)’s mission is to make it as easy as possible for people who use drugs (PWUD) to access harm reduction services so they may live their lives in health, dignity, and autonomy.

SHOTS is a drug-user led, mobile-based SSP based in Tulsa, Oklahoma. SHOTS has provided Tulsa and surrounding areas with low-barrier access to new syringes, injection alternatives, naloxone, syringe disposal, and other harm reduction services since 2018.


Stabbin’ Wagon

The Stabbin’ Wagon’s mission is aimed at reducing harmful outcomes associated with substance use, meeting folks where they are without judgment or coercion. The Stabbin’ Wagon is community-based and led by folks with lived experience. The organization’s values reflect access, inclusion, self-determination, autonomy and equity. The Stabbin’ Wagon provides ultra-low barrier services that encourage people to use substances more safely and consider alternatives. The organization is committed to fighting stigma and ending the racist & classist War on Drugs.

Stabbin’ Wagon uses a holistic, evidence-based approach to delivering harm reduction services that address recreational and chaotic substance use and overdoses. The organization currently provides safe injection supplies, injection alternatives, Naloxone/Narcan, Fentanyl test strips, safer sex supplies and HIV/hepatitis C rapid tests, referrals/support to detox/treatment including medical assisted therapy (MAT).


Rhode Island

Project Weber/RENEW

Project Weber/RENEW provides peer-led harm reduction and recovery support services, builds relationships with the people that it serves, and fights for systemic change. The organization empowers people who engage in drug use and/or sex work to make healthier and safer choices in their own lives.

Project Weber/RENEW operates two drop-in centers; provide four hours of daily stationary outreach services in downtown Providence; and conduct daily, peer-led street outreach in substance use hotspots. We hold support groups and operate a dedicated drop-in space for men engaged in sex work.

South Carolina

Fyrebird Recovery

Fyrebird Recovery’s mission is to become a community resource through harm reduction for individuals and communities affected by substance use and mental health through the organization’s harm reduction model. The organization utilizes street outreach, community engagement, and advocacy to promote and improve community for PWUD and/or affected by mental health.

The organization’s SSP is based on a street outreach model in which it provides outreach events with full services and delivery options throughout the county. From the start of the program in May 2022, it has expanded and begun providing full range harm reduction supplies, both nasal and intramuscular naloxone, food, hygiene products, and referrals.

South Dakota


Meharry Medical College

Meharry Medical College is a global academic health sciences center advancing health equity through innovative research, transformative education, exceptional and compassionate health services, and policy-influencing thought leadership. True to its legacy, Meharry empowers diverse populations to improve the well-being of humankind.

Meharry Addiction Clinic (MAC) is part of Meharry Medical College (MMC), the second oldest HBCU medical school in the U.S. Its services include a low barrier MOUD clinic, a drug user health outreach program and SSP, and partnerships with the college’s infectious disease, family medicine, and substance use disorder (SUD) treatment clinics. MAC purchased a mobile SSP that will serve Davidson County starting February 2023. MAC also hired an SSP director who co-founded the first SSP in Tennessee.

Partnership to End AIDS Status, Inc. (PEAS)

The Partnership to End AIDS Status, Inc. (PEAS)’s mission is to deliver services and comprehensive HIV/HCV testing and education to the most highly affected communities during vulnerable hours and in non-traditional settings.

PEAS is a Memphis-based SSP. PEAS provides HIV/HCV testing, linkage to PrEP and HIV/HCV care, and naloxone access. PEAS is a Black-owned and operated business targeting services to underserved, Black, and LGBTQ+ populations.

Positively Living and Choice Health Network (PL/CHN)

Positively Living & Choice Health Network (PLCHN)’s mission is to empower, promote, and inspire wellness. PL/CHN's vision is one of health, equity, and hope. Beyond providing HIV support services for nearly 30 years, PL/CHN has a medical clinic providing HIV and HCV treatment, HIV prevention services, and a SSP to promote community health for Knoxvillians and folks in the surrounding 15 rural counties.

PL/CHN began in 1996 as an HIV service organization providing case management to those living with HIV/AIDS in Appalachia. In 2018, PL/CHN added a medical clinic to provide HIV treatment and prevention care, as well as, an outreach SSP. The organization’s harm reduction program provides wraparound care in 2 rural and 1 urban site, syringe access, naloxone distribution, wound care, vein finding, HIV/HCV rapid and confirmatory testing, and linkage to HIV/HCV treatment.

Tennessee Recovery Alliance (TRA)

Tennessee Recovery Alliance (TRA) is a community-based organization whose mission is to educate and provide tools for safer drug use to homeless individuals, people who use drugs (PWUD), sex workers, and any individual in need. TRA plans to expand services and volume in 2023 to make lifesaving supplies (syringes, naloxone, safer sex & safer drug use supplies) more accessible for East Tennessee in a nonjudgmental environment that offers dignity and values lived experience.

TRA is a SSP that provides direct services and addresses unmet community needs, including those specific to LGBTQ+ and BIPOC communities. TRA has provided lifesaving supplies underground for the last three years including syringes, injection supplies, fentanyl test strips, linkages to care, and naloxone kits.


WeCareTN supports trans women of color through education and empowerment with the goal that they have the same equity and quality of life as envisioned.

WeCareTN is currently operating a state-level SSP. Being an organization founded and led by a native Memphian and Black trans woman, WeCareTN is uniquely positioned to apply a highly successful wraparound approach to culturally-enriched, transformative justice, and healing approach through its syringe exchange program, broadening and expanding its reach and fulfilling its mission.




Virginia Harm Reduction Coalition (VHRC)

Virginia Harm Reduction Coalition's (VHRC) mission is to improve the health of the drug-using community it serves by advocating for, developing, and implementing evidence-based solutions to address the adverse effects of drug use. VHRC addresses health inequities faced by people who use drugs (PWUD) by providing them with safer-use supplies and social services, advocating for health policies that address their specific needs, and collaborating with other agencies to deliver public health services.

VHRC serves the cities of Roanoke and Martinsville and the counties of Henry, Franklin, and Patrick, with the latter four localities constituting the West Piedmont area of rural Appalachian Virginia. VHRC provides 1) safer-use education; 2) sterile syringes; 3) condoms; 4) intramuscular and nasal naloxone; 5) HCV/HIV testing, treatment referrals, and care navigation; 6) connection to medical, mental health, and substance use disorder (SUD) treatment services; and 7) case management services.


Vermont CARES

Vermont CARES provides life-saving harm reduction services, education and resources to Vermonters affected by HIV, hepatitis C, and substance use by increasing access to care, reducing social stigmas, and building relationships. Vermont CARES’ philosophy is: Celebrate every small change. Accept people where they are at. Respect individual choice and welcome diversity. Envision compassionate communities. Stand up for the rights of those we serve.

Vermont CARES operates in 11 of the 14 counties in the state and consists of three brick & mortar locations for SSP services in geographically diverse areas of the state; a fully equipped HIV testing van; and a seven-passenger van used for mobile delivery services and transportation needs when available. Vermont CARES provides a variety of harm reduction supplies and services.


Blue Mountain Heart to Heart

Blue Mountain Heart to Heart’s goal is to improve the health and quality of life for its clients through the use of evidence-based, high quality, client-centered harm reduction and case management approaches for stigmatized patient populations, including people living with HIV/AIDS and substance use disorder.

The organization’s SSP opened in 1998, when it was largely oriented toward HIV prevention. In the 25 years since, this program has evolved to include three fixed sites and provides various services, such as syringe exchange, safer smoking kits, naloxone kits, and more.

The People’s Harm Reduction Alliance (PHRA)

The People’s Harm Reduction Alliance (PHRA) is a community-based peer-run non-profit that has provided harm reduction and other health services to people who use drugs (PWUD) since 2007. PHRA is passionate about supporting drug users to live their own best possible lives – however they envision and define that. PHRA believes that no one knows what drug users need more than drug users. PHRA serves its community by distributing vital harm-reduction supplies within a respectful, non-judgmental context.

PHRA operates two physical Seattle locations, multiple outreach van routes, and a statewide Naloxone mail-order program. PHRA distributes syringes, doses of Naloxone, and fentanyl test strips. PHRA provides a variety of other supplies to help drug users lead safer and healthier lives, such as: smoking kits, snorting kits, and boofing kits. PHRA additionally offers a variety of healthcare services: wound care, HCV testing and treatment, HIV testing, low-barrier suboxone treatment for those who want to change their relationship with opioids, reproductive health supplies and harm reduction doula services, and outdoor survival supplies.

United Territories of Pacific Islanders Alliance – Washington (UTOPIA)

United Territories Of Pacific Islanders Alliance – Washington (UTOPIA)’s mission is to provide sacred spaces to strengthen the minds and bodies of QTPIs – Queer and Trans Pacific Islanders – through community organizing, community care, civic engagement and cultural stewardship. The organization’s vision is creating a world of cultural wealth, dignity, healing, and liberation for QTPIs that honors ancestors and supports future generations and themselves.

UTOPIA’s Mapu Maia Clinic serves as a trusted, culturally aligned, free health care resource for community. The Mapu Maia Clinic provides resources for substance use and mental health services, including prevention, harm reduction, treatment, and recovery support services. The Mapu Maia Clinic has served the community since the outbreak of the pandemic and has provided health care needs and services to community members through trusted partnerships/volunteer efforts of health care providers and organizations.?UTOPIA and the Mapu Maia Clinic focuses on the unique needs of the queer, trans, gender variant Pacific Islander community members.


West Virginia

Milan Puskar Health Right (MPHR)

MPHR is a primary care clinic providing free health care to un/underinsured low-income residents. MPHR promotes health through direct service, education, & advocacy. MPHR believes in the dignity and worth of all people. Basic non-judgmental health care is a right, not a privilege. MPHR provides compassionate care that starts with the expressed needs of the patient. MPHR advocates for patients individually and collectively at the local, state, and national level to ensure the best possible outcomes.

MPHR’s operates the LIGHT Project, as well as, other community engagement opportunities that educate priority populations about COVID-19, influenza, and HIV and hepatitis prevention, treatment, and services. The organization provides individuals with referrals to off-site testing/vaccinations.



Northern Mariana Islands

American Samoa

Puerto Rico

Corporación El Punto en la Montaña (EPM)

Firmly standing by the belief that all human beings bear the right to health, EPM emerges as a riposte to the current public health crisis on its island, and mostly amongst those living in rural municipalities, areas bound to oblivion. Based on the harm reduction model, a non-judgmental approach to human behavior, EPM’s mission is to reduce the health-wise harm associated with active drug injection in rural Puerto Rico.

As part of EPM’s SSP, the organization included the services of a nurse for ulcers and abscess cleaning, piloted a case managing project currently incorporated into its regular operation, and developed memorandums of understanding with organizations that provide additional services to participants. This has increased the quality of the direct services the organization provides as a harm reduction organization, and at the same time improves the health of participants that only receive services from EPM. All these activities take place in a mobile unit, a 2014 Ford Transit.

Iniciativa Comunitaria de Investigacion (ICI)

Iniciativa Comunitaria de Investigacion (ICI) is a vanguard organization that works in solidarity with the community in its development and transformation. ICI advocates for the recognition and respect of the fundamental rights of the community and its individuals. ICI proposes and promotes an inclusive public policy that is sensitive and committed to achieving quality of life, healthy and harmonious coexistence, especially in human beings who suffer social exclusion.

ICI operates Punto Fijo, which was the first SSP in Puerto Rico. ICI believes that harm reduction interventions for people who use drugs (PWUD) should be accessible. This is the main goal of the implementation of Punto Fijo Harm Reduction Center (PFHRC). The PFHRC offers its services to people over the age of 18 who use drugs in the metropolitan area of San Juan and surrounding towns. ICI created an overdose prevention project in response to the opioid epidemic where the participant takes the lead role as the first responder in an overdose case. ICI also provides COVID-19 vaccines to PWUD.

Marshall Islands


Federated States of Micronesia

Virgin Islands

This project is supported by the Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $ 6,954,478 with 100 percent funded by CDC/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by CDC/HHS, or the U.S. Government.