Results from the 2025 WA State Syringe Services Program Health Survey

Demographics

24 organizations in 24 counties participated. Some SSPs offer services across multiple counties, while some counties have multiple programs operating. (See Appendix for a map of survey responses.)

Table 2. Demographics

Over half of respondents identified as men (59%), 34% as women, and the remainder as non-binary, trans man, or trans woman.

Ages ranged from 19-78 with a mean of 42 and a median of 41.

The majority of respondents identified as white (70%). However, Black people and American Indian/Alaska Natives were over-represented compared to state demographics.

Notably, over half of respondents identified as being homeless (53%), with another 25% reporting temporary or unstable housing, such as couch-surfing. Only 16% identified themselves as having permanent housing, and 7% were in “housing with rent help and supportive services.”

Most respondents reported having sex with partners of another gender, though 5% of men reported having sex with other men, and 7% of women reported having sex with other women. A quarter of men (26%) reported having no sexual partners in the past year, as did 17% of women.

Table 3. In the last twelve months have you had sex with. . . (Percents are by row)

Drug use

Participants were asked about their past-week drug use, how many days each drug was used, and how many days the drug was smoked or injected.

Figure 1. Which of these drugs have you used in the last 7 days? and mean days used

A substantial majority of participants reported using stimulants in the past week (96%), and well over half had used opioids in the past week (61%). Sixty percent reported using both opioids and stimulants in the past week.

Table 4. Which of these drugs have you used in the last seven days?

Methamphetamine was the most frequently used drug in the past week (90%) and a quarter (26%) had used cocaine. Methamphetamine and cocaine are used quite differently, with the median number of days used for methamphetamine being 7 (i.e., daily) compared to 2 for cocaine. Fentanyl was the second most commonly used drug, reported by 58% of respondents, while only 9% reported past-week heroin use,  a substantial shift from the 2021 survey, when 69% of respondents reported using heroin in the past week. Another notable difference in these data is that the median days of use for fentanyl was seven compared to two for heroin.

Cannabis use was prevalent among participants, with half (51%) reporting past-week use. Alcohol was used in the past week by a quarter of respondents.

Half of participants (53%) reported using both fentanyl and methamphetamine in the past week, and 37% reported using methamphetamine only and no fentanyl. Five percent of people reported using fentanyl and no methamphetamine, and another 5% reported not using either in the past week.

Figure 2. Fentanyl and methamphetamine use

Participants were asked to identify a “main drug”; this could be the drug they used most frequently or the drug they prefer. Methamphetamine and fentanyl were identified as a “main drug” by 37% and 41% of people respectively. Cannabis was identified by 9% of participants as their “main drug,” all of whom also used opioids or stimulants.

Figure 3. Which of these is your MAIN drug?

There were large differences in patterns of use based on participants’ main drug. Among those whose “main drug” was fentanyl, 92% had also used methamphetamine in the past week. Among those whose main drug was methamphetamine, 27% had used fentanyl.

Figure 4. Methamphetamine and fentanyl use by main drug

Route of ingestion: Smoking and injecting

Smoking was the most commonly reported route of ingestion, followed by injecting, though proportions varied by substance.

Ninety percent of respondents reported smoking opioids or stimulants in the past week.

Forty-four percent reported injecting a drug in the past week, and 53% had injected in the past three months. Among those with past-three-month injection, 17% reported sharing syringes.

Figure 5. Route of ingestion by drug

SSP visits and supplies

Most people (80%) had first started using the SSP in the past five years.

Figure 6. When did you first use this program?

Most participants (66%) had used the program at least twice in the past month. Programs vary by how many days they are open, ranging from 1-5 days a week, so these numbers may not reflect the demand for services.

Figure 7. How many times have you used this program in the past 30 days?

People obtained a wide range of supplies at their SSP, including safer use supplies, as well as other supplies related to health.

Figure 8. Which of these supplies have you gotten from this syringe exchange in the past month?

*Survival supplies include clothing, tents, backpacks

Popular supplies included syringes and other injection supplies, smoking supplies (at sites that provided them), hygiene supplies, naloxone (Narcan), food and drinks, and survival supplies.

Figure 9. What are the top two things you get at this program?

Participants were asked about the top two “most important things” they “get” at the SSP in the past month. Top responses were smoking supplies (at sites that provide them), syringes and other injection supplies, hygiene supplies, naloxone (Narcan), food and drinks, and wound care. Social support and positive interactions with staff were also identified as important, for example, “People are dedicated and make me feel welcome.”

Smoking supplies

Smoking supplies are provided at many SSPs throughout Washington State. Learn more about how smoking supplies support public health in our Distribution of Safer Drug Smoking Supplies as a Public Health Strategy brief (2022, revised 2025).

Among the SSPs that participated in the survey, several do not currently provide smoking supplies. However, receipt of smoking supplies is high at sites that do provide them, and interest is high at sites that don’t. To gauge interest in these supplies, we asked separate questions of sites that do or do not provide safer smoking supplies.

Sites with smoking supplies

At sites that provide safer smoking supplies (1,262 participants at 13 programs), almost all participants (89%) reported obtaining those supplies (Figure 8), and they were identified as one of the most important supplies at the SSP (Figure 9).

Fifty-nine percent of participants said smoking supplies were the reason they first came to this program, among those who first visited the program in the past 5 years. (This time frame was selected because smoking supplies have only become widely available in the past five years in Washington State.)

Sites without smoking supplies

At sites that did not provide smoking supplies (432 participants at 11 programs), 87% of respondents said they knew someone who would “come to this program if smoking supplies were available.”

Eighty-three percent said they would “like to get free, clean pipes or foils to smoke opioids, cocaine, or meth.” Of those who were interested in safer smoking supplies and injected, “75% said they would “inject less often” if smoking supplies were available.

Injection and smoking rates at sites with and without smoking supplies

Participants at sites without smoking supplies were more likely to have injected in the past week (70%) than those at sites with smoking supplies (35%); this finding is important in the context of the paragraph above. The difference in smoking rates was smaller, 78% at sites without smoking supplies, and 70% at sites with safer smoking supplies, perhaps because alternatives such as aluminum foil are readily available elsewhere.

Table 5. Comparison of route of ingestion at sites with and without smoking supplies

Figure 10. Past week injection by whether the program offers safer smoking supplies

Drug checking services and self-administered test strips

People can do their own drug testing with test strips that indicate the presence or absence of a particular drug; fentanyl test strips are most commonly distributed. Community drug checking services are done by trained staff using a combination of drug testing tools.

Community drug checking services can include:

• Use of multiple drug test strips to check for the presence of fentanyl, xylazine, or other drugs.
• Fourier-transform infrared (FTIR) spectroscopy machine which can identify thousands of compounds. The machine is used by drug checking staff to identify what substances are in a sample brought in by participants.
• Sending samples to an outside lab for mass spectrometry testing which can identify almost any compound even at very small concentrations.

Information about what is in their drugs can help people make informed decisions about whether and how to use a particular drug.

Participants were asked about their use of self-administered test strips and community drug checking services. Forty-two percent of participants had used test strips themselves in the last three months to “check what’s in your drugs.”

Interest in the use of drug checking services was high, with 52% of respondents overall expressing interest. Interest in drug checking services was higher at sites that already provide it (59%) than those that do not currently provide it (45%).

Table 6. Would you be interested in having your drugs tested here with a machine or test strips?

Twenty percent (n=173) of participants at the six sites that provide drug checking with an FTIR machine had used the program in the past three months.

Of those who had used drug checking, 67% had used the program to check a substance they thought was methamphetamine, 64% fentanyl, and 15% cocaine.

Table 7. Have you used these services in the last 3 months to check drugs you thought were... (among people who use drug checking at sites that provide it)

Opioid overdose and naloxone

Among people who used opioids, 19% had an overdose in the past three months. This compares with previous years when heroin was the dominant opioid and 22% of participants reported an overdose in the past 12 months (UW ADAI, 2021).

Figure 11. In the past 3 months how many times have you overdosed on opioids?

Naloxone access was very high among SSP participants; 83% reported carrying a naloxone kit at some point in the past three months, and 75% had obtained a kit at their SSP in the past month.

Health and healthcare: Insurance, HCV, HIV

The large majority of participants (92%) had health insurance, primarily Medicaid (85%).

Table 8. What kind of health insurance do you have?

Half (50%) of participants reported that there was a time in the last 12 months when they thought they “should see a health care provider for a serious issue” but they did not go.

Figure 12. Hepatitis C testing and treatment cascade

Nearly a quarter (23%) of participants had been diagnosed with hepatitis C; of those, 62% had been treated, and 52% of untreated participants had been offered treatment.

HIV testing was prevalent among participants; 50% had been tested in the past year and 39% had been tested over a year ago.

Table 9. How long ago was your last HIV test?

Emergency department visits

Most participants (57%) had been seen in the emergency department (ED) in the past year, 36% reported going to the ED two or more times.

Table

Table 10. In the last 12 months, how many times have you been to the ER?

Of all participants, 31% had only been seen in the emergency department, and 30% had received no healthcare in the past year.

Figure 13. Emergency department and other health care utilization

Table 11. In the last 12 months, how many times have you been to the ER?

Participants who had been to the emergency department were asked additional questions about their experiences. Among those who used opioids, 23% were offered “to start or continue Suboxone (buprenorphine)“ the last time they were in the ED, and 26% were offered “Narcan (naloxone) before you left.” One consideration: participants may not have disclosed their opioid use to healthcare providers in the ED or may have visited due to medical issues unrelated to their opioid use.

Table 12. Provision of buprenorphine or naloxone in the ED, among participants who used opioids and had been in the ED in the past year (n=569)

SUD treatment use

Fewer than half (45%) of participants had received “drug treatment in the past 12 months.” Methadone was the most frequent treatment participants had received (21%).

Figure 14. In the past 12 months, what types of drug treatment, if any, did you get?

Among participants who used opioids, 20% were currently receiving methadone, 4% oral buprenorphine, and 1% injectable buprenorphine.

Participants were asked “In the past 12 months, was there a time you tried to get help to reduce your drug use but didn’t/couldn’t get it?” Twenty-six percent of participants responded yes and were asked “What got in the way of that happening?” Top reported barriers were: availability/access issues, personal motivation, being homeless, continued access to drugs, transportation, and family or personal barriers.

Table 13. "What got in the way" of trying to reduce or stop drug use? (N=415)

Desired services - SUD treatment and other help

There was a high level of interest in receiving mental or physical health care services at the SSP. Seventy-five percent of all participants would see a healthcare provider at the SSP, and 69% would see a provider for mental health. Low barrier health supports for people who use drugs at SSPs are available in some locations and a Health Engagement Program Resource Kit (UW ADAI) is available online, along with other resources.

Most participants who used opioids (72%) or stimulants (62%) were interested in reducing or stopping their use.

Figure 15. Interest in reducing or stopping use by drug type

Participants who used opioids were asked “What help for your opioid use would you want if it was free and easy to get?” The top services desired by this group were: methadone (42%), followed by detox (32%), outpatient (29%), inpatient (26%), and Suboxone (buprenorphine) (26%).

Figure 16. What help for your opioid use would you want it if was free and easy to get? Select all that apply, (Among participants who used opioids)

Among participants who used stimulants, the most wanted “free and easy to get” supports were: “meds the might help reduce my use” (38%), “rewards for reducing/stopping stimulant use” (i.e., contingency management) (37%), outpatient care (37%), and “meds that might help with my mental health” (33%). A little less than a quarter were not interested in any services for their stimulant use.

Figure 17. What help for your stimulant use would you want if it was free and easy to get? Select all that apply. (Among participants who used stimulants)

Notably, many of the services that people were most interested in for their stimulant use are not widely available, such as contingency management, an evidence-based treatment that can help people reduce their stimulant use.

Participants were asked about non-drug-related ”help or services” they would want “if they were free and easy to get.” Top responses were: housing (79%), transportation (62%), job/employment support (55%), help with legal issues (warrants or fines) (48%), and help getting identification (42%). The percent of people who wanted help with legal issues was higher than the percent who had been incarcerated in the past year (37%), reflecting that people may have lingering legal issues they need support for.

Figure 18. What other help or services would you want if they were free and easy to get? Select all that apply.

Incarceration and MOUD

Thirty-seven percent of participants had been incarcerated in the past year; 36% had been in jail, and 2% in prison. There was overlap among those who had been in prison and those who had been in jail. Thirty-two percent of participants who had been in jail and used opioids were provided naloxone upon release from jail; note that people may not have mentioned their opioid use while incarcerated

Jail: Medications for opioid use disorder

MOUD in jail can help reduce opioid withdrawal, support recovery, and lower overdose risk on release. Most SSPs (19 out of 24) asked additional questions about participants’ experiences with MOUD in jail. Participants had been at jails across the state, and the length of stay ranged from 1-225 days.

Among participants who were regularly using opioids before jail (n=277), 23% were on MOUD, and 64% of those were offered a chance to continue their medication in jail.

Figure 19. Jail MOUD experiences

Among participants who were not on MOUD when they went to jail, 37% were offered buprenorphine, and 86% of those accepted it.