Tribally-affiliated syringe services programs in the United States: a brief report

Few studies have examined the implementation of syringe services programs (SSPs) that serve Indigenous people who inject drugs in the United States (US). There are 574 Federally-recognized tribes in the US, each characterized by unique traditions, values, and customs. Given the diversity of tribes, better understanding SSP implementation in Native contexts first requires examining the degree to which tribes in the US implemented these programs.

This research describes the number of SSPs that are affiliated with Federally-recognized tribes in the US.

From July to September 2022, we conducted an online search of all 574 Federally-recognized tribes to determine how many had affiliated SSPs. We downloaded a list of Federally-recognized tribes from the Bureau of Indian Affairs (BIA) and conducted Boolean searches on Google for the name of each tribe and SSPs. Our searches included several synonyms for SSPs, including "needle exchange," "syringe exchange," and "harm reduction." In instances where "harm reduction programs" were identified, we reviewed website contents to determine if the program was inclusive of a SSP. We considered SSPs to be affiliated with Federally-recognized tribe(s) if they were housed in a tribal health clinic or tribal organization, or via an explicit partnership with a Federally-recognized tribe.

We identified 21 SSPs that were affiliated with Federally-recognized tribes. The majority (85.7%) of SSPs were affiliated with a single tribe. Eight of the SSPs also offered medications for opioid use disorder (MOUD) on-site (e.g., the SSPs operated out of health clinics that offered MOUD).

The results of this study demonstrate that there are at least 21 SSPs that are affiliated with Federally-recognized tribes in the US, with some serving multiple tribes. This research makes a noteworthy contribution to the public health literature given that no systematic exploration of the number of SSPs affiliated with tribes has been conducted. The scale of substance use inequities among Indigenous people underscores the critical importance of communities implementing and managing their own comprehensive harm reduction programs.