How Harm Reduction Prevents Syringe Litter
Authors
Key Points
Media Contact
For general and media inquiries and to book our experts, please contact: pr@rstreet.org
Introduction
The United States may finally be turning the tide on the overdose crisis, with drug-related fatalities falling nearly 24 percent from 2023 to 2024. But some communities are grappling with another drug-use-related challenge that endangers this progress by driving backlash against harm reduction: needle waste.
Residents of communities from Portland, Oregon, to New York City have expressed concerns about used syringes discarded in their public spaces. While these fears are understandable—after all, we all want our communities and loved ones to be safe—they have led some lawmakers to blame harm reduction and introduce restrictions on the very programs that have helped reduce overdose deaths. Harm reduction is actually one of the most useful tools available to communities looking to ensure the proper disposal of needles and injection equipment.
Harm Reduction Does Not Increase Syringe Litter
To identify solutions to needle waste in a community, it is first important to identify the problem. Is syringe litter actually on the rise? And, if so, what is causing it?
It can be difficult to parse whether the number of improperly discarded syringes is actually increasing within a given community or if there is just more focus on the issue. For example, both record levels of homelessness and increased public drug use have drawn more attention to the issue of syringe litter and may even exacerbate it. Because improperly discarded needle waste is rarely counted systematically, distinguishing between objective and perceived increases is a challenge.
However, in the instances where an increase in syringe litter can be confirmed, the reasons behind it are typically multifaceted. One issue may be fentanyl’s short duration of effect, which leads people to inject far more frequently than people using heroin—thereby using and discarding more needles. Consequently, even if a majority of people properly dispose of most of their syringes, more may end up in public spaces simply because people are using more needles. Another challenge is that unhoused individuals who lack a means to store their used injection equipment or transport it to dedicated disposal sites may be more likely to discard it improperly. In addition, laws criminalizing paraphernalia possession encourage people to discard their needles as quickly as possible to avoid arrest, even if that is in a public place.
Fortunately, a variety of interventions can help facilitate safe syringe disposal.
Syringe Services Programs (SSPs)
Although real and perceived increases in syringe litter have brought SSPs under fire, research repeatedly shows that the programs reduce needle waste. This is in large part because they provide participants with varied means of safe disposal, including collecting used syringes on-site, providing take-home sharps containers, and engaging in regular cleanups.
The approach works. A Los Angeles study found that people who received sterile syringes from an SSP were significantly less likely to dispose of their equipment improperly compared to those who accessed syringes through other sources. And research shows that the presence of an SSP in a neighborhood is associated with reductions in syringe litter in the surrounding area. Furthermore, providing as many syringes as an individual participant requests—known as need-based distribution—does not increase needle waste in the community.
Community Sharps Containers
Another way to help reduce syringe litter is to strategically place one-way receptacles—akin to the sharps containers sometimes seen in public bathrooms for disposing of insulin-injection needles—in neighborhoods that see high levels of public drug use and improper disposal. These community drop boxes have the distinct benefit of being anonymous, low profile, available 24 hours a day, and widely accepted by communities once in place. In a Baltimore study, for example, nearly 3,000 used syringes were discarded into just three repurposed mailboxes over the pilot period of 10 months. Not only did people who use drugs use the boxes, but law enforcement used them as well. In addition, follow-up focus groups found that fears that the boxes would encourage loitering and social disorder did not come to fruition. Similarly, recent research from Philadelphia’s Kensington neighborhood showed that individuals—especially those who were unstably housed—used the boxes once they were aware of them.
Syringe Buyback Programs
A promising strategy that some cities have begun testing in recent years is syringe buyback. As the name suggests, these programs purchase used needles and syringes from individuals who collect them from public spaces like parks or sidewalks. Funding comes from a variety of sources depending on the community, from existing city cleanup budgets to opioid settlement funds. The approach operates similarly to bottle-return programs and has had positive results.
For example, Portland, Maine, launched its syringe buyback program in January 2025 and saw a 76 percent decrease in improperly discarded syringes in the first six weeks of operation. A similar program in Boston, started in 2021, resulted in 50 percent fewer complaints about syringe litter. Unfortunately, since the latter program’s closure due to funding shortfalls, complaints have skyrocketed again. Importantly, in addition to reducing syringe litter, these types of programs can serve as an added point of connection to link unstably housed individuals to social services and people struggling with a substance use disorder to treatment.
The Role of Policy
Local innovation and tailoring is at the heart of effective efforts to reduce syringe litter in our communities. But these interventions cannot be implemented without the right policies in place. To ensure that communities are able to optimally address needle waste, states should:
- Authorize SSPs to distribute sterile injecting equipment and collect and dispose of used syringes.
- Allow SSPs and other community-based organizations to distribute take-home sharps containers.
- Enact needlestick prevention laws to protect individuals transporting used syringes for safe disposal from paraphernalia criminalization.
- Include locally relevant syringe-disposal efforts among prioritized spending of opioid settlement funds.