This article reports new legal data on state syringe services program (SSP) and drug paraphernalia laws in the United States. Scientific legal mapping methods were used to develop a longitudinal legal dataset capturing state-level SSP and drug paraphernalia laws in effect from January 1, 2010, through June 1, 2024. During that period, the number of states with a legal mechanism allowing for syringe distribution from SSPs nearly doubled. However, legal barriers to SSP operations remain in many states.

Drug overdose and drug-related harm are major sources of preventable injury and death in the United States. The criminalization and stigmatization of people who use drugs continues to inform law and policy that is ineffective at preventing this harm. While harm reduction interventions such as syringe services programs (SSP) have been widely adopted, the laws that govern these programs often impose restrictions that make SSP operation more difficult and less effective. For example, 23 state permit SSPs to operate only if they receive authorization from state or local government officials, and 5 states continue to adhere to some version of a “one for one” exchange model. This article presents data on these and other state laws that impede the work of SSPs. It also highlights ways the experience and expertise of people who use drugs can be integrated into the creation and implementation of SSP operational models. Removing barriers to these life-saving programs is critical to decreasing drug-related harm.