In 1988, Dave Purchase, began distributing syringes in his hometown of Tacoma, Washington, paving the way for the first legally operating SSP in the United States. Today, Dave Purchase Project (named for its founder) continues to operate the Tacoma Needle Exchange as well as the North American Syringe Exchange Network (NASEN), a program that supports operational SSPs through loan assistance, fiscal sponsorship, program start-up kits, and lower-cost harm reduction supplies through the NASEN Buyers Club. NASEN also maintains an online directory of syringe services programs (SSPs) in the United States, U.S. Virgin Islands, and Puerto Rico. The NASEN Directory, started in 1992, is the oldest and most comprehensive list of SEPs in the United States.

Recently, more public attention has been given to the NASEN Directory. In response to the many inquiries we have received about the directory—and the many misconceptions of what the directory represents that have fueled those inquiries—Dave Purchase Project would like to clarify the procedures through which the directory has been generated and maintained, as well as changes to those procedures over time. In particular, it is crucial for those who may seek to analyze directory information to understand what the NASEN Directory represents, and what it does not. In that way, we can see what sorts of inferences can and, importantly, cannot be made using data derived from this source.

The NASEN Directory is not, nor has it ever claimed to be, a comprehensive listing of all SSPs operating in the United States. The organizations listed in the NASEN Directory represent a highly selected subset of SSPs operating in the North America. Specifically, SSPs may only be listed in the directory if that SSP has been in touch with NASEN (often, though not exclusively) because they are a member of the NASEN Buyers Club) and has expressly provided consent to have their information listed in the directory. Thus, the only conclusion that can be inferred by the appearance of an SSP in the NASEN Directory is that they are likely (though not necessarily) members of the NASEN buyer’s club and have authorized NASEN to list them in the Directory.

It cannot be concluded from the NASEN Directory that there are no syringe exchange activities occurring in the areas where no SSPs are listed. An SSP may be operating but have had no prior contact with NASEN. An SSP may be a member of the NASEN Buyers Club but have declined to have their information included in the Directory. Indeed, the decision by an SSP to be included in the NASEN Directory is a calculated one that signals SSP operators’ level of comfort in the legal environment in which they operate and readiness to have their exchange activities publicly declared, and likely scrutinized by local authorities.

Importantly, the NASEN Directory not only represents a limited sample of operating SSPs, it represents a highly selected sample. SSPs that enjoy reliable funding from state and local sources may have no need to join the NASEN Buyers Club or be in contact with NASEN at all. Further, many Buyers Club members have declined to be listed in the NASEN directly, usually as a direct consequence of the policy environment in which they operate. Despite overwhelming evidence in support of this public health intervention, 18 states had still not explicitly legalized SSPs as recently as 2019. Still more are facing aggressive opposition from local leaders who are motivated by ideological bias to hinder the operation of these evidence-based programs.

Consequently, it cannot be assumed that the group of SSPs listed in the NASEN Directory and those SSPs “missing” from the directory are comparable.

The NASEN Directory came into existence when the Harm Reduction movement in the United States was largely comprised of individuals, mutual aid collectives, ad-hoc associations, and volunteer organizations that were engaged in the practice, then mostly unsanctioned or illegal, of providing new, sterile, drug injection equipment to people who inject drugs. A major goal was to slow and stop the transmission of Human Immunodeficiency Virus (HIV), the virus that causes AIDS, via the practice of sharing or reusing injection equipment.

The NASEN Directory began as a collection of information shared among SSPs and early harm reduction practitioners to enable communication among syringe exchange proponents, so that they could share information, experiences, frustrations, strategies, and victories within the nascent syringe exchange community in the United States.

Early iterations of the NASEN Directory were colloquially referred to as the “NASEN Phone Book.” That Phone Book, quite literally, a phone book: a printed, stapled, alphabetized list of SSPs by state, which was distributed to participants of North American Syringe Exchange Conferences (NASEC). As remains the case today, the early versions included only SSPs that had granted NASEN authorization to include them in the directory. In the mid-1990s, the NASEN Directory was made publicly available, via the NASEN website, to a larger audience. However, this resource remained relatively unknown and rarely accessed by persons outside of harm reduction circles until relatively recently.

The current iteration of the online NASEN Directory that appears on the NASEN website (i.e., “the map”) is very different from the pre-2018 iterations (i.e., the “phone book”). Prior to 2018, the NASEN Directory retained much of its earlier, static, “phone book” formatting. Website visitors would be presented with an alphabetical listing of states and territories. Clicking on the name of a state or territory would download a document containing alphabetical listing of the SSPs operating in that state. Post 2018, the online NASEN Directory was overhauled. In addition to providing a more user-friendly interface, NASEN’s modifications reflected the fact that consumers of SSP services had increasingly started to access the Directory in their search for services. Thus, NASEN created a map of SEPs that is searchable by state, services offered, ZIP code, etc.

Prior to 2018, the information listed in the NASEN Directory was not systematically updated. When SSP closures or other significant changes in operations were confirmed, NASEN would update the directory. However, no systematic attempt was made to ensure that NASEN Directory data reflected up-to-date information. SSPs closed, relocated, merged, split, changed names, and underwent numerous other operational changes that were not necessarily reflected in the Directory. Since 2018, SSPs listed in the Directory are required to confirm their information as well as their consent to be listed in the Directory on an annual basis.

The inclusion of an SSP in any iteration of the NASEN directory does not necessarily coincide with their inception as an SSP, though it may have coincided with their “official” existence. Many SSPs began operating well before they became “official” SSPs. These efforts consisted (and still consist in parts of the United States today) as underground networks of people who use drugs and harm reduction allies who engage in unsanctioned syringe exchange--distributing harm reduction supplies as an act of civil disobedience and avoiding detection by local authorities. Thus, the date of an SSP’s inclusion in the NASEN directory most often coincides with the decision by the operators of the SSP to publicly acknowledge their harm reduction activities and deal with any potential consequences.

Most SSPs begin as ad-hoc groups of committed volunteers responding on a public-health emergency in their communities. To assume no syringe exchange or distribution of sterile injection equipment occurred in any specific location before an “official” SSP appeared (i.e., was included in the NASEN directory) is to fundamentally misunderstand the genesis and history of the founding of most SSPs in the United States.

Source: https://lawatlas.org/datasets/syringe-services-programs-laws