Across King County and Washington state, syringe service programs (SSPs) or needle exchanges provide a critical access point for programs and services for people who use drugs.
SSPs provide sterile syringes and other harm reduction supplies, including naloxone, as well as safe disposal of used syringes. SSPs also connect people with drug treatment, case management, and health care. Other services include testing for HIV, hepatitis, TB, and other infections, wound care, and limited primary care. Individuals receive education about harms associated with drug use and how to minimize them.
Every two years, University of Washington’s Addictions, Drug & Alcohol Institute (ADAI), in partnership with Public Health – Seattle & King County, conducts a statewide survey of people who utilize SSPs. You can view information from ADAI about the recent statewide survey here.
This year, the team at Public Health – Seattle & King County took a deep-dive into the findings from about 500 participants at Public Health’s SSP sites. The findings provide important information for continuing to adapt and respond effectively to the needs of our community.
We sat down with Sara Glick, PhD, Epidemiologist for Public Health – Seattle & King County, Associate Professor at University of Washington, and the lead researcher and author of the local report, to learn about the report findings.
First off, can you tell us a little bit about the survey and why it’s important?
The goal of the survey is to provide our SSP and other local stakeholders with information that can be used to improve the health and lives of people who use drugs. By talking directly with people who use our services, we can learn first-hand how best to tailor services to meet emerging needs of our communities. We aim to collect, analyze, and share the data fairly quickly to help provide a current look at the issues and challenges people are facing.
From the survey, who are these programs reaching?
These programs see a mix of people who have used SSPs for many years as well as people newer to substantial drug use. For example, over a quarter of respondents used the program for the first time within the past two years. It is clear that the SSP sites reach people in our community who are in need of supportive services — about three quarters of respondents reported they are currently unhoused or are living in temporary or unstable living situations.
What are the biggest changes you’ve seen since the last survey? What do you attribute those to?
Compared to our 2021 survey, we’ve seen a steep increase in fentanyl use, continued high levels of methamphetamine use, and a decrease in heroin use. This mirrors what we see in our local data on fatal overdoses.
The survey also asked participants to select a single “main” drug. The most common response was fentanyl (42%), followed by methamphetamine (22%). This is a significant change in the main drug used since 2021 when 4% of participants reported fentanyl and 43% reported heroin.
We’ve also seen a decline in injection drug use locally. This is coupled with a decline in syringe sharing among people who inject drugs who get services at the SSP, which suggest a lower risk of HIV and hepatitis C. However, the risk of overdose remains very high due the high prevalence of fentanyl use.
What did we learn about treatment access?
The majority of people (70%) were interested in reducing or stopping both their opioid and stimulant use.
In 2023, 45% of all participants accessed any type of treatment in the past year, while one-third of participants reported unsuccessfully being able to access substance use treatment in the past year. We still need to work across our community to increase access to effective and low-barrier substance use treatment.
What do the findings tell you about opportunities to prevent overdoses in King County?
The majority of survey participants reported both carrying and using naloxone, a medication that can be used to reverse an opioid overdose. In 2023, 85% of survey participants had naloxone with them at some point in the past three months which is higher than any previous year. The majority of participants (70%) also reported using naloxone on another person in the past three months. Local efforts can continue to expand naloxone access and training so that everyone who uses drugs, their families and friends, and our community knows to use this life-saving medication.
What did the survey show about the most pressing needs for individuals?
Participants were asked about their single most important need. The most common response, overwhelmingly, was “housing.” We also asked participants directly how their drug use would change if they had stable housing. The majority said they would quit or use less. These findings support the importance and profound need for affordable and supportive housing.
Anything else you’d like to share?
SSPs are unique and important public health programs. They are able to provide flexible, compassionate, and life-saving services to people who use drugs, who often refrain from seeking more traditional health care services. This is due to stigma experienced in health care settings, the need for appointments, the long wait times for many walk-in sources of care (e.g., emergency departments), and cost. The success of this survey highlights the trust that people who use drugs have with SSP services and their willingness to share information to benefit the program and their community.
Originally published April 25, 2024.