Hawaii has passed legislation authorizing syringe service programs (SSP) to begin distribution as needed, in place of the current model that places strict limits on the number of sterile syringes participants can receive. SB1433 advanced from its final reading in Hawaii’s legislature and was enrolled to Governor Josh Green (D) on May 2. If approved, it would leave Florida as the only state to still require SSP use a “one-to-one” model, rather than some version of the needs-based model recommended by the Centers for Disease Control and Prevention.
SB1433 would also lift a longstanding ban that prohibits SSP from serving people who use drugs but don’t inject them, noting that “individuals who do not inject drugs but are marginalized often seek [out SSP for] harm reduction information, supplies and referrals to other services.” Currently, state law explicitly requires SSP to screen out non-injection drug users during attempts to enroll.
The bill additionally extends immunity from drug possession penalties to SSP participants found with used syringes containing controlled substance residue. This also applies to “authorized objects” such as cookers, cottons or ties; the state health department would update the list periodically.
Though only a few years ago a handful of states still imposed “one-to-one,” Florida may soon be the last holdout.
“Safe disposal occurs most effectively if program participants batch all used injection equipment for safe disposal by syringe services programs,” the bill states. “However, participants may be reluctant to batch used injection equipment for safe disposal if they risk criminal penalties for drug residue found on used equipment.”
The bill appears to describe protection from arrest as well as prosecution. It does, however, note that law enforcement officers “shall not be subject to civil liability for the mere arrest or filing of charges” against an SSP participant for activity protected by the new law.
Hawaii has maintained “one-to-one” since it authorized SSP in 1992. Different states have defined the restriction in slightly different ways, but broadly “one-to-one” requires SSP participants to produce used syringes in order to receive the same number of sterile syringes in return, sometimes up to a certain limit. Though only a few years ago a handful of states still imposed this restriction, it appears Florida may soon be the last holdout.
Delaware lifted the cap in 2023. New Mexico has modified its one-to-one restriction to a “negotiated exchange,” which essentially allows for needs-based distribution while emphasizing the collection of used syringes in return. Maine recently rejected legislation to revert to that model, the latest development in a years-long battle following its transition to needs-based distribution in 2021. West Virginia currently directs SSP to approach syringe distribution “with a goal of a 1:1 model”; Tennessee uses similar language. In some states the restriction is still applied at certain programs or in certain counties, even if not state-wide.
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