Syringe services programs, often called SSPs, are community-based prevention programs that can provide a range of services. SSPs are a harm reduction intervention that have been in existence since the late 1980s and have been scientifically proven to reduce transmission of human immunodeficiency virus (HIV), hepatitis B and C and other bloodborne pathogens in person who inject drugs (PWID). SSPs provide a safe space to those struggling with substance use disorder. Services available at SSPs can include linkage to substance use disorder treatment; access to and disposal of sterile syringes and injection equipment; and vaccination, testing and linkage to care and treatment for infectious diseases. SSPs protect the public and first responders by facilitating the safe disposal of used needles and syringes. Providing testing, counseling, and sterile injection supplies also reduces the transmission of and prevents outbreaks of viral hepatitis, HIV and other infections. Nearly thirty years of research shows that comprehensive SSPs are safe, effective, and cost-saving, do not increase illegal drug use or crime.
North Dakota Century Code 23-01-44 requires Syringe Service Programs authorized by NDDoH to report on the status of programs biannually. Information reported includes basic demographics of participants and service utilization information. Below are the available reports by reporting period.
2017 Legislative Session
Syringe service programs became legal in the state of North Dakota for communities who are deemed at risk for increase of HIV and viral hepatitis with the passage of Senate Bill (SB) 2320 during the 2017 Legislative Session. SB 2320 created and enacted two additions to the North Dakota Century Code (NDCC). The first addition to the NDCC adds a new subsection to section 19-03.4-02. This new subsection created and enacted an addition that provides clarification to the court and law enforcement about determining whether an object is drug paraphernalia. The subsection adds “whether the object is a needle or syringe collected during the operation of a needle exchange program under chapter 23–01-44 to aid in the prevention of bloodborne diseases” to the list of considerations. This addition grants the consideration to law enforcement on whether to subject needles collected under an exchange as drug paraphernalia. By working with local law enforcement, SSPs can legally collect injection equipment without the risk of penalty for possession of drug paraphernalia.
The second addition to the NDCC adds a new section to chapter 23-01-44 that authorizes or legitimizes SSPs in North Dakota given appropriate authorization as a qualified entity. The addition also clarifies that the North Dakota Department of Health (NDDoH) will be the final authorizing agency to request or deny a local entity or organization the authority to operate an SSP and will perform ongoing assessment of the programs for adherence to requirements of the statue. This document will serve as guidance to entities for the required components of an SSP program that must be considered for NDDoH to authorize the program. One provision to the law is that no state general funds are to be used to purchase injecting equipment, which includes needles, syringes and other equipment for the process of injecting. However, if available, state general funds can support the development, implementation, and/or evaluation of SSP.
2019 Legislative Session
SB 2198 in the 2019 Legislative session further amended section 19-03.1-23 to protect persons who are in possession of appropriately collected syringes and needles from penalties related to the possession of a controlled substance.
2021 Legislative Session
The HHS Public Health Division in collaboration with the Behavioral Health Division developed the guidance and requirements for syringe service programs in North Dakota. The below guidance is for qualified entities that are establishing a SSP. Entities shall comply with this guidance to become an authorized syringe service program in North Dakota.
The HHS Public Health Division has developed the below forms with the assistance of current authorized SSPs. The participant enrollment form template and participant log template can be used by SSP to collect data and provide a guide for participant visits. These two forms can be modified by SSP to ensure that they meet their needs. The SSP biannual report form is required to be submitted to the NDDoH twice per year. The biannual report for the reporting period of January 1 - June 30 is due on July 15 of that same calendar year and for the reporting period July 1 - December 31, the biannual report form is due January 15 of the following calendar year.
Implementing & Operating a SSP
The HHS Public Health Division along with partner organizations including NASTAD, AIDS United and the Harm Reduction Coalition provided trainings on SSPs and how to work with persons who inject drugs. Below are recordings of the topics covered during this training. The trainings were held in September 2018 and April 2023.
September 2018 Training
- Final Training Slides
- Recordings of Sessions
April 2023 Training
ND Vulnerability Index
A 2014-2015 outbreak of HIV infection among a rural network of persons who inject drugs (PWID) underscored the intersection of the expanding crises of opioid misuse, injection drug use, and associated increases in bloodborne infectious diseases. The North Dakota Department of Health identified counties potentially vulnerable to rapid spread of HIV, if introduced, and new or continuing high rates of hepatitis C virus infections among PWID. The North Dakota County Vulnerability Index Report identifies which counties are most at-risk for potential HIV or hepatitis C outbreaks among PWID.