2011 National Survey of Syringe Exchange Programs: Summary of Results

Don C. Des Jarlais, Vivian Guardino, Ann Nugent, Kamyar Arasteh,

David PurchaseThis work was funded by amfAR, The Foundation for AIDS Research with support from the Elton John AIDS Foundation (EJAF) and the

Irene Diamond Foundation.

Characteristics of SEPs Participating in BIMC/NASEN SurveysUnited States, 1996-2011

Numbers of 1996 1997 1998 2000 2002 2004 2005 2006 2007 2008 2009 2010 2011

SEPs known to NASEN 101 113 131 154 148 174 166 188 186 184 201 194 197

SEPs Participating in survey (%) 87

(86%)100

(88%)110

(84%)127

(82%)126

(85%)109

(63%)118

(71%)150

(80%)131

(70%)123

(67%)149

(74%)149

(77%)144

(73%)

Cities with SEPs participating 69 78 77 98 97 88 90 113 100 98 115 119 117

States with SEPs participating * 29 33 33 36 32 32 29 32 31 30 33 33 32

Syringes exchanged (millions) 13.9 17.5 19.4 22.6 24.9 24.0 22.5 27.6 29.5 29.1 33.1 35.5 36.9

Total of SEP budgets ($, millions) 7.3 8.4 8.6 12.0 13.0 11.6 14.5 17.4 19.6 21.3 21.6 21.7 19.3

Total of SEP budgets in 2011-adjusted $ (millions) (adjusted using a constant 3% annual inflation rate)

10.6 11.9 12.0 16.0 16.5 14.0 17.1 20.0 22.0 23.2 22.9 22.4 19.3

Public funding as % of total SEP budgets 62% 67% 69% 74% 67% 76% 74% 79% 73% 79% 80% 82% 84%

* This category includes the District of Columbia and/or Puerto Rico.

Number of syringes exchanged and Total SEP budgets 1996-2011

1996 1997 1998 2000 2002 2004 2005 2006 2007 2008 2009 2010 20110

5

10

15

20

25

30

35

40

Syringes exchanged (millions) Total of SEP budgets in 2010-adjusted $ (millions)*

*adjusted using a constant 3% annual inflation rate

1996 1997 1998 2000 2002 2004 2005 2006 2007 2008 2009 2010 20110

50

100

150

200

SEPs known to NASEN and cities with SEPs participat-ing

SEPs Known to NASEN Cities with SEPs participating

National Survey of Syringe Exchange Programs Methodology

2010 Survey• 194 SEPs contacted in first quarter 2010• 149 SEPs (77%) submitted completed

surveys by early summer.2011 Survey

• 197 SEPs contacted in second quarter 2011• 144 SEPs (73%) submitted completed

surveys by late summer.

SEP Budget Dollars2010 2011

Total $$$ $21,674,495 $19,345,206 City Gov $ $6,021,484 $5,157,416

County Gov $ $2,328,563 $1,683,229

State Gov $ $9,336,118 $8,793,482

Federal Gov $ ------------ $637,518

Foundation $ $2,127,053 $2,081,362

Individual Donations $833,686 $584,780

Out-of-pocket $ $29,830 $28,145

NASEN $ $67,116 $36,750

CBO Donation $ $27,410 $53,944

Corporate Donation $ $57,350 $82,464

Other $ $563,906 $202,841

Budget Status 2010 vs. 2011

Increased Budget

Decreased Budget

Same Budget Did Not Answer0

10

20

30

40

50

60

70

40

5447

8

38 37

60

9

2010

2011

Num

ber

of S

EPs

SEPs That Participated in 2010 & 2011 Surveys

Total Budget $$

2010 $17,451,562 (as reported by 110 SEPs)

2011 $17,866,457 (as reported by 110 SEPs)

Steroids

Cocaine mixed w/other drug NOT heroin

Other amphetamine (uppers/Dexedrine)

HIV medications and/or insulin

Other

Heroin mixed w/other drug (not cocaine)

Downers (benzodiazepines, tranquilizers)

Other opiates (OxyContin, Percodan, etc)

Methamphetamine (crystal meth/ice/crank)

Heroin and cocaine

Cocaine by itself

Heroin by itself

0 10 20 30 40 50 60 70 80

1

2

2

2

3

6

7

16

17

18

18

68

Percent of NSEP Participants Injecting the following Drugs in 2011*

Percent of SEP Participants*Weighted by number of syringes distributed

Type of Exchange Conducted by SEPs in 2011Variation No. (%)

Allowed receipt of more syringes than brought in 123 (85%)

Used A Distribution Model 84 (58%)

Used Start-up Packs 81 (56 %)

Used A Minimum 48 (33%)

Had a Limit on Syringes Exchanged 44 (31%)

Number of Syringes Distributed by Syringe Exchange Programs (SEPs), by Program Size:

2010 & 2011SEP Size(Syringes

Distributed)

No. of

SEPs2010

Total syringes exchanged

2010

No. of

SEPs2011

Total syringes exchanged

2011

Small(< 10,000) 22

92,316(0.3%) 19

54,709(0.1%)

Medium(10,000-55,000) 25

714,320(2.0%) 33

965,472(2.6%)

Large(55,001-499,999) 75

12,576,461(35.4%) 72

13,472,727(36.5%)

Very Large(500,000) 18

22,127,202(62.3%) 18

22,383,837(60.7%)

Total 140 35,510,299 142 36,876,745

* In 2010, nine programs responding to the survey did not track the number of syringes exchanged, in 2011 two programs did not indicate the number of syringes they distributed.

Returned/Collected Syringes in 2010 and 2011

2010 2011

29,549,25830,837,933

Syringes Exchanged By Programs ThatParticipated in Both 2010 & 2011 Surveys

2010 (n=110*)• 32,947,282

syringes distributed

• 27,204,851 syringes collected

2011 (n=110*)• 34,447,074

syringes distributed

• 28,983,403 syringes collected

*Only programs which reported the number of syringes distributed in both 2010 and 2011 are included in the calculations above . In 2010, seven programs in this group did not report the number of syringes they collected , the number was eight in 2011.

Secondary Exchange & Methods of Encouragement Used by SEPs in 2011

Secondary Exchange No. (%) SEPs allowing secondary exchange 130 ( 90%) SEPs encouraging secondary exchange 116 (81%)Methods of Encouragement Talked about it 109 (76%) Gave extra supplies 103 (72%) Provided sharps containers 96 (67%) Had no limit on syringes exchanged 83 (58%) Peer education 61 (42%) Enrolled people receiving syringes from secondary exchange

23 (16%)

Gift certificates/Other incentives 14 ( 10%)

SEPs Providing On-Site Medical Services

•2010Number of SEPs=65

•2011Number of SEPs=75

Overdose Rescue & Drug Treatment Medications Provided by SEPs in 2010 & 2011

Buprenorphine

Suboxone

Naloxone

0% 10% 20% 30% 40% 50%

5%

9%

44%

8%

10%

47%

20112010

Percent of SEPs

Additional Program Characteristics in 2010 & 2011

2010 No. (%)

2011 No. (%)

Did not operate for two months or more 6 (4%) 8 (6%)

Any full-time (paid) staff 95 (64%) 83 (58%)

Operated by city, county or state health department

35 (23%) 34 (24%)

501-C3 Status 116 (78%) 100 (69%)

Additional Program Characteristics in 2010 & 2011

2010 No. %)

2011 No. (%)

Operated a Delivery Service 69 (46%) 77 (53%)

Was involved in formal external evaluation

23 (15%) 20 (14%)

Problems SEPs Encountered in 2010 & 2011

Police harassment of staff / program

Other

Any type of problem due to gentrification?

Retaining participants

Operations disrupted by government or law enforcement

Legal status

Police harassment of participants (at/near site)

Lack of community support

Reaching or recruiting participants

Lack of outreach

Staff burnout

Lack of political support

Staff shortage

Lack of resources/Lack of funding

0% 10% 20% 30% 40% 50% 60% 70% 80%

5%

6%

9%

11%

9%

8%

14%

15%

24%

20%

24%

21%

44%

69%

6%

6%

9%

13%

13%

15%

19%

22%

22%

24%

28%

30%

56%

75%

2011 2010

Percentage of SEPs

Quality of Relationship Between SEPs and Police as Reported by SEPs in 2010 & 2011

Quality of Relationship

2010No. (%)

2011No. (%)

Very Good 35 (23%) 29 (20%)Somewhat good 55 (37%) 42 (29%)Neutral 44 (30%) 50 (35%)Somewhat poor 6 (4%) 5 (3%)Very poor 1 (1%) 1 (1%)Non-existent 8 (5%) 17 (12%)

Strategies SEPs Used in 2011 to Gain Law Enforcement Support

Strategy # of SEP’s %

Meetings 69 48%Trainings 38 26%

Officer Liaisons 38 26%Coalition work w/other public health activists 35 24%

None 32 22%Invitation to exchange 26 18%Didn’t have capacity/resources for strategy 20 14%Other 16 11%Street demonstrations 4 3%

Federal Funding in 2010 and 2011SEPs … 2010 2011

Applied for federal funding

20(13%)

19(13%)

Received federal funding20

(13%)14

(10%)

Programs Used Federal Funding in 2010 and 2011 to

2010 2011Maintain Present Services Only 9 (45%) 7 (50%)

Expand Present Services 7 (35%) 1 (7%)Add New Services 2 (10%) 2 (14%)Maintain/Expand Present Services

1 (5%) 2 (14%)

Didn’t Answer 1 (5%) 2 (14%)

Naloxone Services and Fundingat SEPs in 2011

# of SEP’s

%

Program distributes Naloxone 68 47%Funding source for programs providing Naloxone

Regular budget item 35 51%Special funding 33 49%

Type of Naloxone Provided by SEPs in 2011

11.8%

67.6%

20.6%

Intranasal NaloxoneInjectable NaloxoneBoth

Very Special Thanks to:

• Alisa Solberg

• Jill Westermark

• Kay Borba

for their generous help contacting SEPs and encouraging survey submissions.