ArticleHarm reduction journal2023
How do contextual factors influence naloxone distribution from syringe service programs in the USA: a cross-sectional study.
Article in Harm reduction journal, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers.
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Who cites it
16 citing papers in PubMed, 22 citations in OpenAlex.
- Organize and mobilize for implementation effectiveness to improve overdose education and naloxone distribution from syringe services programs: a randomized controlled trial.Implementation science : IS · 2024Trial
- Projected Outcomes of Reducing Federal Funding for Syringe Service Programs via Executive Order.JAMA network open · 2026Article
- "With a little help from my friends" - collaborating with community experts to improve sampling and obtain a high response rate for a statewide naloxone availability survey.BMC public health · 2026Article
- Reciprocal influences between overdose experiences and naloxone access among people who use drugs utilizing a syringe services program: a cross-lagged panel model.Harm reduction journal · 2026Article
- Driving Time, Distance, and Cost to Access Syringe Services Programs in the US.JAMA network open · 2026Article
- "No judgment, no preaching": approaches to harm reduction service provision for people who use drugs in North Carolina.Harm reduction journal · 2026Article
- Drug checking services: barriers and facilitators to implementation by U.S. syringe services programs.Harm reduction journal · 2026Article
- Sociodemographic, behavioral, and geospatial factors associated with syringe services program use in San Francisco, California.Drug and alcohol dependence · 2026Article
- Implementation determinants of safer smoking supplies in U.S. syringe services programs.Implementation science communications · 2025Article
- Association of safer smoking supply distribution with participant encounters and naloxone distribution from syringe services programs: Findings from the National Survey of Syringe Services Programs in the United States.Drug and alcohol dependence reports · 2025Article
- Article
- Racialized environments and syringe services program implementation: County-level factors.Drug and alcohol dependence · 2024Article
- Community-led approaches to making naloxone available in public settings: Implementation experiences in the HEALing communities study.The International journal on drug policy · 2024Article
- Safety strategies and harm reduction for methamphetamine users in the era of fentanyl contamination: A qualitative analysis.The International journal on drug policy · 2024Article
- Substance use patterns, sociodemographics, and health profiles of harm reduction service recipients in Burlington, Vermont.Harm reduction journal · 2024Article
- Updates on syringe coverage and service uptake among needle and syringe programs in the United States, 2019-2020.The International journal on drug policy · 2024Article
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Authors and funding
8 authors at 5 institutions in 1 country.
Funding
Abstract
backgroundNaloxone is a medication that can quickly reverse an opioid overdose. Syringe service programs (SSPs) are community-based prevention programs that provide a range of evidence-based interventions in the USA, including naloxone distribution. Attributes of SSPs make them ideal settings for naloxone distribution-they have staff and delivery models that are designed to reach people who use drugs where they are. We assessed which outer and inner setting factors of SSPs were associated with naloxone distribution in the USA.
methodsWe surveyed SSPs in the USA known to the North American Syringe Exchange Network in 2019. Using the exploration, preparation, implementation and maintenance framework, we assessed inner and outer contextual factors associated with naloxone distribution among SSPs (n = 263 or 77% of SSPs). We utilized negative binomial regression to assess which factors were associated with the number of naloxone doses distributed and people receiving naloxone.
resultsSSPs reported distributing 710,232 naloxone doses to 230,506 people in the prior year. Regarding outer setting, SSPs located in areas with high levels of community support had a higher level of naloxone distribution (aIRR = 3.07; 95% confidence interval (CI): 2.09-4.51; p < 0.001) and 110% (p = 0.022) higher rate of people receiving naloxone (aIRR = 2.10; 95% CI 1.46-3.02; p < 0.001) in the past 12 months. The legal status of SSPs and the level of need was not significantly associated with naloxone distribution. Regarding inner setting, SSPs with proactive refill systems (aIRR = 2.08; 95% CI 1.27-3.41; p = 0.004), greater number of distribution days (aIRR = 1.09 per day; 95% CI 1.06-1.11; p < 0.001) and older programs (aIRR = 1.06 per year; 95% CI 1.02-1.11; p = 0.004) were associated with higher levels of naloxone distribution. Also, SSPs with proactive refill systems (aIRR = 2.23; 95% CI 1.38-3.58; p = 0.001); greater number of distribution days (aIRR = 1.04; 95% CI 1.02-1.07; p < 0.001) and older programs (aIRR = 1.11; 95% CI 1.05-1.17; p < 0.001) were associated with a higher number of people receiving naloxone.
conclusionWe identified outer and inner setting factors of SSPs that were associated with greater naloxone distribution. It is critical to ensure SSPs are adequately resourced to build community support for services and develop service delivery models that maximize naloxone distribution to address the nation's opioid overdose crisis.
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