"Some of the most adverse health consequences of drug use are experienced by PWID. A global review of services aimed at reducing adverse health consequences among PWID has suggested that only 79 countries have implemented both needle and syringe programmes and opioid substitution therapy. Only four countries were classified as having high levels of coverage of both of those types of interventions.

"The basic service offered by SSPs [Syringe Services Programs] allows PWID [People Who Inject Drugs] to exchange used needles and syringes for new, sterile needles and syringes. Providing sterile needles and syringes and establishing appropriate disposal procedures substantially reduces the chances that PWID will share injection equipment and removes potentially HIV- and HCV-contaminated syringes from the community. Many SSPs have become multiservice organizations, providing various health and social services to their participants (8).

Return on Investment for Needle and Syringe Programs: "Investment in NSPs (2000-2009) has resulted in:
"• An estimated 32,050 HIV infections and 96,667 HCV infections averted;
"• Substantial healthcare cost savings to government related to HCV and HIV;
"• Substantial gains in Disability Adjusted Life years.

Cost Effectiveness of Needle and Syringe Programs: "It was estimated that:
"• For every one dollar invested in NSPs, more than four dollars were returned (additional to the investment) in healthcare cost-savings in the short-term (ten years) if only direct costs are included; greater returns are expected over longer time horizons.
"• NSPs were found to be cost-saving over 2000-2009 in seven of eight jurisdictions and cost-effective in the other jurisdiction. Over the longer term, NSPs are highly cost saving in all jurisdictions.

Political Support for Needle and Syringe Programs (NSPs) in Australia: "Australia’s first NSP was trialled in New South Wales in 1986 with the provision of NSP services becoming New South Wales Government policy in early 1987 and the remaining states and territories implementing NSPs soon after via primary, secondary and pharmacy outlets (Dolan et al., 2005). This occurred following the discovery of HIV and the potential threat that this virus posed to the Australian community.

Cost Savings from Syringe Exchange in Australia:"In Australia the [Needle and Syringe] Program is the single most important and cost-effective strategy in reducing drug-related harms among IDUs. Australian Governments invested $130 million in NSPs between 1991 and 2000 resulting in the prevention of an estimated 25,000 HIV infections and 21,000 HCV infections, with savings from avoided treatment costs of up to $7.8 billion (Health Outcomes International et al., 2002). In the decade 2000-2009, the gross funding for NSPs was $243 million.

"We found that a large proportion of SEP [syringe exchange program] participants in NYC do not obtain adequate numbers of syringes from the SEPs to meet their monthly injecting needs. In addition, characteristics of social marginalization and vulnerability – homelessness and public injecting – were associated with inadequate syringe acquisition.

Syringe Exchange Activity in Australia: The number of needles and syringes distributed in Australia increased during the past decade (from ~27 million to ~31 million). Expenditure on NSPs increased by 36% (adjusted for inflation) over this time period, mostly associated with personnel and not principally for equipment (Table a); a significant portion of the increased investment has been the Illicit Diversion Supporting Measures for NSPs to increase referrals to drug treatment and other services.

"As of March 2014, 204 SSPs were known to be operating in the United States in 2013."