Association between a citywide ban on syringe distribution and provision of harm reduction services

Syringe services programs (SSPs) decrease HIV and overdose incidence among people who use drugs (PWUD). In May 2024, Pueblo, Colorado, banned syringe distribution, citing public complaints about syringe litter. The ban was overturned in June 2024. The two SSPs in Pueblo halted syringe distribution during the three-week ban but continued other services. The effect of short-term syringe bans on harm reduction services is unknown.

We analyzed program data from one SSP in Pueblo, Colorado, and syringe litter pickup data from the Pueblo Department of Parks and Recreation from January to September 2024. We used Interrupted Time Series analysis to evaluate the association between the syringe distribution ban and four weekly outcomes: SSP visits, naloxone kits distributed, syringes distributed, and syringe litter collected.

The ban was associated, on average, with 31 fewer visits (95% CI: -48, -15), 23 fewer naloxone kits distributed (95% CI: -34, -12), and 2406 fewer syringes distributed (95% CI: -3308, -1504) every week. There was an immediate decrease of 120 syringe litter units collected (95% CI: -285, 46) weekly. After the ban was overturned, there was an immediate increase and increasing trend in visits, naloxone kits, and syringes distributed, and no changes in syringe litter. Naloxone distribution did not return to expected levels in the 16 weeks following the ban being overturned.

Banning syringe distribution in Pueblo, Colorado was associated with sustained decreases in SSP usage and naloxone distribution. Eliminating funding for certain SSP activities could inadvertently decrease access to naloxone.