A public health approach to overdose prevention relies on multiple evidence-based strategies that work together to prevent overdose and drug-related health harms. Medications for opioid use disorder reduce use and significantly lower overdose risk. At the same time, harm reduction measures such as naloxone distribution and drug checking directly prevent fatalities, reduce infectious disease transmission, and create low-barrier entry points that connect people to treatment.

One critical entry point to reach people who use drugs with these services is Public Health – Seattle & King County’s syringe service program (often known as the needle exchange.) Every two years, we conduct a survey of syringe service program clients as part of a statewide survey in partnership with University of Washington’s Addictions, Drug & Alcohol Institute (ADAI). The aim is to understand the needs of our clients and provide data to inform effective services to improve the health of people who use drugs. Read more about findings from the statewide survey here.

We sat down with Sara Glick, PhD, Epidemiologist for Public Health – Seattle & King County, Associate Professor at the University of Washington, and the lead researcher and author of the local report, to learn about the report findings.

To start, can you tell us about the services provided at the syringe services program?

The Public Health – Seattle & King County (PHSKC) syringe services program (SSP) was established more than 35 years ago at the height of the HIV/AIDS epidemic. 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

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 drug use. For example, one-third of respondents used the program for the first time within the past year. It is clear that the SSP sites reach people in our community who are in need of supportive services — about 70% 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?

In our last survey in 2023, we saw a substantial increase in fentanyl use and decrease in heroin use. In the 2025 survey, we saw mostly the same patterns as 2023. Methamphetamine, crack/cocaine, and fentanyl use continue to be the most common drugs used among people getting services at the SSP. We did see some decrease in fentanyl use since 2023. This is the same period of time when we saw a decrease in fatal overdoses.

We also continue to see 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 suggests a lower risk of HIV and hepatitis C. However, the risk of overdose remains very high due the use of fentanyl. 

What did we learn about treatment access and interest?

The majority of people were interested in reducing or stopping their opioid and/or stimulant use.

In 2025, 45% of all participants accessed any type of treatment in the past year. Among people who use opioids, one-third had accessed methadone and 13% had used buprenorphine. We also found that 29% of participants reported unsuccessfully being able to access substance use treatment in the past year.

The good news is that we have some new forms of medication to treat opioid use, including long-acting injectable buprenorphine, and 21% of participants were interested in that. Our low-barrier clinic at the Downtown Public Health Center offers both oral and long-acting injectable buprenorphine. There is a lot of work going on in the community to reduce the barriers to these newer treatments, including mobile access and field-based services.

What do the findings tell you about opportunities to prevent overdoses in King County?

The majority of survey participants reported carrying naloxone, a medication that can be used to reverse an opioid overdose. In 2025, 79% of survey participants had naloxone with them at some point in the past three months. That’s a little bit lower than what we saw in 2023, which tells us that we need to continue to distribute more naloxone.

What did the survey show about the most pressing needs for individuals?

For the first time, we included questions about food insecurity in our survey. We found that most participants (69%) reported that they either sometimes or often run out of food. We also ask people what services they receive at the SSP, and three of the top five services are food/drinks, hygiene supplies, and clothing like socks. These findings show that many of our participants are not able to meet their basic needs. It can be challenging for people to engage in other services like treatment when they are struggling just to find food to eat.

Anything else you’d like to share?

SSPs are unique and important public health programs. They 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 16, 2026