Addictions, Drug & Alcohol Institute

Surveys and Interviews with People Who Use Drugs

The team at ADAI’s Center for Community-Engaged Drug Education, Epidemiology, and Research (CEDEER) regularly collects community-level data directly from people who use drugs to learn more about their needs to help shape relevant and impactful services and policies. The WA State Syringe Service Program Health Survey is conducted every two years, followed by qualitative interviews on opposite years with people who use drugs.

Washington State Syringe Service Program Health Surveys

This survey is conducted in partnership with Public Health-Seattle & King County, WA State Department of Health, and syringe service programs (SSPs) across the state. The goal of the survey is to profile health behaviors and health care needs and preferences of SSP participants in WA State.

SSP staff and volunteers administer the voluntary, anonymous, face-to-face questionnaire to participants who come in for SSP services. Each survey includes standard questions on:

  • Participant demographics
  • Substance use patterns and behaviors
  • Opioid and stimulant overdose
  • Health care concerns and needs
  • Use of drug treatment and health care services

In addition to standard questions, each survey also includes novel questions to explore emerging or “hot-topic” issues.  

NOTE: As data are cross-sectional (a snapshot) they are best interpreted as describing the situation at the time of the survey. Individuals surveyed are not linked over time, so the data cannot be interpreted as changes in individuals over time. Also, because a sampling frame is not utilized, population level trends over time cannot be formally compared and the data cannot be said to be representative of all people who use SSP’s, or inject drugs, in WA State. Despite these limitations, a large number of people are surveyed across the entire state and the findings consistently align well with impressions from diverse people across the state.

2021 WA State Syringe Service Program Health Survey

Number of participants: 955

Special topic questions


  • The last time you used fentanyl, was it on purpose? What did that fentanyl look like?

    Drug smoking:

  • Would you like to get free, clean pipes or foil to smoke opioids, cocaine or meth? If you could get pipes or foil, do you think you would inject less often?
  • How many people do you know right now who smoke opioids, cocaine or meth but don’t inject them?
  • What’s the MAIN reason you’ve smoked opioids/stimulants rather than injecting?


  • Been diagnosed? Been vaccinated? Want to get vaccinated?

Results and publications

Final report and webinar.

2019 WA State Syringe Exchange Health Survey

Number of participants: 1,269

Special topic questions

  • How interested are you in reducing or stopping your opioid/stimulant use? What types of help would you want if they were easy to get?
  • Acute methamphetamine health symptoms. Serious psychiatric symptoms due to methamphetamine?

Results and publications

2017 WA State Syringe Exchange Health Survey

Number of participants: 1,079

Special new topic questions

  • How interested are you in reducing or stopping your stimulant use? What types of help would you want if they were easy to get?
  • In the last 12 months, was there a time when you thought you should see a health care provider for a medical/physical issue, but you did not go? What were the main reasons you did not go?

Results and publications

2015 WA State Syringe Exchange Health Survey

Number of participants: 1,036

Special topic questions

  • How interested are you in reducing or stopping your opioid use? What types of help would you want if they were easy to get?
  • What are you MOST likely to do when you run out of brand new syringes?
  • What is your single biggest concern about your health right now?
  • Before you began using heroin, were you hooked on prescription-type opiates?
  • When you use heroin or opiate medications, how often do you use alcohol, benzos, or downers within a couple hours before or after?

Results and publications

Qualitative Interviews

To bring a real-world, human perspective to quantitative data, we conduct qualitative interviews with diverse groups of people who use drugs. Interviews are an opportunity to enrich our understanding of results from previous surveys and to identify new questions for future surveys.

Below is a compilation of these surveys and interviews, including content notes and links to published results.

2023 - Perspectives of People Who Use Fentanyl in WA State

Number of participants: 30 syringe services program (SSP) participants in WA State who reported recent fentanyl use

Key findings

  • People had complex reasons for using fentanyl including: physical pain, mental health issues, withdrawal, and availability of fentanyl.
  • Most participants were interested in stopping or reducing their fentanyl use, but saw significant barriers to doing so.
  • What does ideal care look like: accessible, non-judgmental, holistic.

Many participants lacked stable housing, employment, transportation, childcare, and primary health care and programs should work to address these needs.

Results and publications

2021 - Perspectives of People Who Use Methamphetamine on Reducing or Stopping Their Use

Number of participants: 27 Eastern Washington SSP participants who use methamphetamine)

Key findings

  • Most participants saw both benefit and harm from their methamphetamine use.
  • Interest in stopping or reducing methamphetamine use was fluid throughout the interviews.

Many participants lacked stable housing, employment, transportation, childcare, and primary health care.

Results and publications

2018 - SSP participants talk about why they use drugs and what services would help them stay healthy

Number of participants: 24

Key findings

  • participants appreciate the services available through the exchange and are interested in expanded services at these locations.
  • Participants reported that they used methamphetamine because it was very available and to increase energy, cope with mental health issues, lessen physical pain, and handle symptoms of opioid withdrawal.
  • Participants reported they used heroin primarily to avoid opioid withdrawal, “numb” their emotions, and manage physical pain.
  • Lack of housing and the consequences of drug use were top concerns for interviewees who also identified a range of services that would be helpful to improve their overall quality of life.

Many people had previous experience with medications for opioid use disorder and had faced barriers in accessing or staying in a treatment program so they could stay on medications.

Results and publications

Overview & Perspectives of Syringe Services Programs in WA

Syringe services programs (SSPs) have been operating in Washington State for over three decades. This 2022 report describes how these SSPs operate, the services they provide, the challenges they face, and their untapped potential. Information in this report was gathered by staff from the University of Washington’s Addictions, Drug & Alcohol Institute (ADAI) from interviews (using a semi-structured guide) with 38 front line SSP staff, volunteers, and department/agency administrators. The perspectives of these individuals were supplemented with information from staff of the Drug User Health Team at the WA State Department of Health.

Read the report here. (pdf)

This work is funded by the WA Health Care Authority, Division of Behavioral Health and Recovery.