Strengthening implementation of syringe services programs in Florida: insights from a statewide survey and social...

Syringe services programs (SSPs) are an evidence-based intervention for preventing infectious diseases and reducing the risk of overdose. Florida passed legislation that authorizes the implementation of SSPs (via the Infectious Disease Elimination Act; IDEA) in 2019. However, little is known about how organizational contexts and interorganizational networks shape adoption, implementation, and sustainment of this intervention.

We conducted a cross-sectional, statewide survey of organizations engaged in implementing SSPs and related services between March and May 2025, using a community-based participatory research approach with the Florida Harm Reduction Collective. The survey assessed SSP implementation, barriers and facilitators, implementation climate, organizational sustainability, and interorganizational networks. Data were analyzed using descriptive statistics, t-tests for group comparisons, and social network analysis to examine relational structures and organizational centrality.

A total of 29 organizations representing 18 counties responded to the survey. Eight counties reported operating a sanctioned SSP, while none of the remaining counties had ordinances or champions supporting SSP adoption. Stigma and political resistance, lack of funding, and restrictive laws and policies were cited as major barriers to SSP implementation. There was an overall weak implementation climate for SSPs (mean = 1.4 on a 0-4 scale), though it was significantly stronger in counties with operational SSPs (1.8 vs. 1.1, p = 0.01). Organizations reported relatively strong organizational sustainability (mean = 5.6 on a 1-7 scale), with high ratings for program adaptation and lower scores for funding stability. Social network analysis revealed that the Florida Harm Reduction Collective served as the most central and influential node connecting diverse organizations statewide.

Our findings highlight both structural barriers (e.g., funding, stigma, restrictive policies) and organizational strengths (e.g., adaptability, network connectivity) in Florida's harm reduction landscape. Addressing policy barriers, expanding and stabilizing funding availability, and leveraging statewide networks will be critical for strengthening implementation of SSPs in Florida and expanding equitable access to harm reduction services for people who use drugs.