Funding for Syringe Services Programs

Funding overview

The Consolidated Appropriations Act of 2018 permits use of funds from the Department of Health and Human Services (HHS), under certain circumstances, to support syringe services programs (SSPs), with the exception that funds may not be used to purchase needles or syringes.

HHS released guidance for state, local, tribal, and territorial health departments that will allow them to request permission to use federal funds to support SSPs. The guidance states that eligible state, local, tribal, and territorial health departments must consult with CDC and provide evidence that their jurisdiction is (1) experiencing, or (2) at risk for significant increases in hepatitis infections or an HIV outbreak due to injection drug use.

Each federal agency (e.g., CDC, HRSA, SAMHSA) developed its own guidance for its funding recipients regarding which specific programs may apply and its application process.

The CDC Program Guidance for Implementing Certain Components of Syringe Services Programs, 2016 provides specific procedures for CDC-funded grantees. The CDC guidance details which SSP activities can be supported with CDC funds, which relevant CDC cooperative agreements can be used to support SSPs, and the process by which CDC-funded programs may request to direct resources to implement new or expand existing SSPs for PWID. More information about federal funding for syringe services programs is available below.

Recipients

FAQs about funding for SSPs

Can federal resources be used to support the implementation of SSPs?

The Consolidated Appropriations Act of 2018 permits use of funds from the Department of Health and Human Services (HHS), under certain circumstances, to support SSPs, with the exception that funds may not be used to purchase needles or syringes.

What parts of SSPs can federal funding support?

The federal law requires that the health departments where grantees interested in using federal funds for SSPs are located must first consult CDC to determine if there is a need for SSPs. Only after demonstrating the need for SSPs in consultation with CDC may federal funds be used to support various components of SSPs including, but not necessarily limited to, the following:

• Personnel
• Testing kits for viral hepatitis (HBV and HCV) and HIV
• Syringe disposal services
• Navigation services to ensure linkage to HIV and viral hepatitis prevention, treatment and care services including antiretroviral therapy for HCV and HIV; HIV pre- and post-exposure prophylaxis (PrEP and PEP), prevention of mother-to-child transmission of HIV and viral hepatitis; hepatitis A and hepatitis B vaccination; substance use disorder treatment, and recovery support services; and medical and mental health services
• Provision of naloxone to reverse opioid overdoses
• Educational materials, including information about safer injection practices, overdose prevention and reversing opioid overdose with naloxone, HIV and viral hepatitis prevention, treatment and care services, and mental health and substance use disorder treatment including medication-assisted treatment and recovery support services
• Condoms to reduce risk of sexual transmission of HIV, viral hepatitis, and other sexually transmitted diseases (STDs)
• Communication activities
• Planning non-research evaluation activities

Not all of the components listed above will be supported by all participating HHS agencies (i.e., CDC , Health Resource and Services Administration, Substance Abuse and Mental Health Services Administration). Use of funding will depend on each HHS agency's authorities, policies and procedures, as well as state and local laws and regulations.

Are there restrictions on what federal funds can support when setting up or expanding an SSP?

Current federal law prohibits the use of federal funds to purchase sterile needles or syringes for the purposes of illegal use of drugs by injection. The Department of Health and Human Services Implementation Guidance to Support Certain Components of Syringe Services Programs, 2016 also specifies that federal funding may not be used for the procurement of other equipment whose only purpose is to prepare drugs for illegal drug injection (e.g., cookers). Programs that use federal funding for SSPs must adhere to federal, state, and local laws, regulations, and other requirements related to such programs or services. SSPs are also subject to the terms and conditions incorporated or referenced in the recipient's funding agreement.

What is the process for getting approval to use Federal funding to support SSPs?

Federal grantees must follow a two-step process for obtaining approval to use federal funds to start new or expand existing SSPs.

• Step 1: State, local, territorial, and tribal health departments must submit a determination of need (DON) request to CDC with data documenting that the jurisdiction is either (1) experiencing or (2) at risk for but not yet experiencing, increases in viral hepatitis infections or an HIV outbreak due to injection drug use. An affirmative determination of need by CDC can then be used to justify the use of federal funds from CDC, HRSA and SAMHSA. On March 31, HHS released the Implementation Guidance to Support Certain Components of Syringe Services Programs, 2016 [PDF – 1.4 MB, 22 pages], which outlines what SSP activities can now be supported and how state, local, territorial, and tribal communities should consult with CDC to demonstrate their need for these programs.
• Step 2: Health departments and other grantees must follow agency-specific guidance, and work with their project officers to request funds to support SSPs.

CDC's Program Guidance for Implementing Certain Components of Syringe Services Programs, 2016 provides specific procedures for CDC-funded grantees.

Other HHS guidance:

• Health Resources and Services Administration (HRSA)-Specific Implementation Guidance to Support Certain Components of Syringe Services Programs, 2016
• Substance Abuse and Mental Health Services Administration (SAMHSA)

Funding data

FAQ about CDC Program Guidance for Implementing SSPs

What is the purpose of the CDC Program Guidance for Implementing SSPs?

The purpose of CDC's Program Guidance for Implementing Certain Components of Syringe Services Programs, 2016 is to provide specific procedures for CDC-funded grantees. The CDC guidance details which SSP activities can be supported with CDC funds, which relevant CDC cooperative agreements can be used to support SSPs, and the process by which CDC-funded programs may request to direct resources to implement new or expand existing SSPs for PWID.

What is the process for requesting use of CDC funds for SSPs?

After obtaining CDC notification that the jurisdiction has sufficiently demonstrated need to use federal funding for SSP activities, CDC directly-funded state and/or local health departments, or other eligible entities, should discuss plans to direct funds to SSP activities with their CDC project officer. Local health departments, who are not directly funded by CDC, must work with CDC directly-funded state and/or local health departments to request program funding to support SSPs.

In accordance with CDC Office of Grant Services (OGS) guidelines, jurisdictions must then prepare a proposal that identifies the SSP activities that will be supported by CDC funds. The proposal should include: 1) a proposed program plan and 2) a revised budget. For all grantees, the proposal, including the proposed program plan and revised budget, must be submitted to OGS with a courtesy copy to the CDC project officer. Once approved by both the OGS Grants Management Specialist and the CDC Project Officer, the requestor will receive a revised Notice of Award signed by the OGS Grants Management Officer. Grantees must obtain this approval before using their awarded funding to implement any SSP activities.

CDC will then approve or disapprove requests to direct funding to support SSPs activities within 30 business days upon receipt of all requested information. After request approval, CDC will work in partnership with grantees to determine the appropriate process measures to capture for SSPs.

What needs to be included in requests to use CDC funds to support SSPs?

CDC grantees cannot request that funds be directed to support SSP activities unless the jurisdictional health department has first demonstrated the need for SSPs, in consultation with CDC, and received a notice of approval from the CDC SSP Review Panel. During the processes of requesting either: 1) determination of need or 2) directing CDC funds to support SSPs, grantees should contact their project officers to discuss specific capacity building and technical assistance needs and, if needed, submit a request(s) for additional technical assistance or training. All proposals to request the use of CDC funds to support SSPs should include the following elements, unless otherwise noted:

• CDC's notice of approval that the jurisdiction has sufficiently demonstrated need to use federal funding for SSP activities
• Description of proposed new or expanded SSP-related activities
• Timeline for implementation
• Impact on current activities funded under the respective funding opportunity announcement (FOA)
• Copy of existing protocols and guidelines for SSP-related activities, if available
• Budget and budget justification, proposed activities and measures
• Description of current training and technical assistance needs related to planning, implementing, and evaluating SSPs, as appropriate
• Location of SSP-related activities to be supported with federal funds

If a jurisdiction (county, city, state, etc.) wants to discuss the potential need for and benefits of SSPs, who is the primary point of contact in the state’s department of health?

Entities seeking information about the potential needs for and benefits of SSPs in their jurisdiction should contact their state HIV and viral hepatitis coordinator(s). For jurisdictions where CDC has been consulted and concurred that need exists, the point of contacts can be found at Syringe Service Program.

How do we know if injection drug use (IDU) is on the rise and that the risk of hepatitis B, hepatitis C, or HIV infection among persons who inject drugs (PWID) is increasing in our state or municipality?

To best assess if unsafe injection drug use is occurring in your jurisdiction, examine all national and local data sources available to you that are either known or may reasonably be associated with unsafe (non-sterile) illegal injection of drugs. Such data sources include, but are not limited to, the following:

• Drug overdose deaths (especially opioid-related)
• Access to care related to illegal injection of drugs (e.g., data on the use of care and treatment services for drug overdose or intoxication related to injectable drugs)
• Demand for medication-assisted therapy (e.g., data on the use of care and treatment services for drug overdose or intoxication related to injectable drugs)
• Demand for medication-assisted therapy (e.g., methadone, buprenorphine, naltrexone)
• The six variables used in CDC's national analysis (Percent White, Non-Hispanic Population; Drug Overdose Deaths per 100K Persons; Per Capita Income; Percent Unemployed Population;Prescription Opioid Sales per 10K; Buprenorphine Prescribing Potential by Waiver per 10K Persons)
• EMS calls for drug overdose
• Arrests for drug possession or sales
• Arrests for possession of needles, syringes, or other drug paraphernalia
• Population surveys assessing prevalence of IDU
• State prescription drug monitoring plan data to identify for hot spots of prescribed opioids
• Rates of endocarditis or skin and soft tissue infections
• Medical examiner and toxicology records