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.

Background: In response to the recent and growing shift from injecting heroin to smoking fentanyl, an increasing number of syringe services programs (SSPs) in the United States are distributing safer smoking supplies. There is a lack of research on whether safer smoking supply distribution is associated with increased SSP engagement and naloxone distribution from SSPs. Therefore, we aimed to assess predictors of safer smoking supply distribution by SSPs and estimate associations between safer smoking supply distribution and scale of harm reduction services. Methods: We used cross-sectional data from the National Survey of Syringe Services Programs, which surveyed SSPs from March and August 2023 about services delivered in 2022. We examined factors associated with safer smoking supply distribution and estimated associations between smoking supply distribution and the number of participant encounters and naloxone doses distributed. Results: Of the 429 SSPs included, 187 (44.1 %) distributed safer smoking supplies to participants. SSP organizational type, service delivery method, urbanicity, and regional Census divisions were associated with safer smoking supply distribution. Compared to SSPs that did not distribute safer smoking supplies, those that did reported more participant encounters (aRR=1.62, 95 % CI: 1.19-2.20) and naloxone doses distributed (aRR=1.26, 95 % CI: 0.91-1.74). Conclusions: SSPs distributing safer smoking supplies had greater participant engagement and naloxone distribution. To maximize their full individual and population-level health benefits, SSPs should be supported technically, legally, and financially to implement safer smoking supply distribution for their participants.