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Syringe Services Program (SSP)

Brief History of Syringe Exchange in Hawai‘i   |  Current Services  |  Legal Protections

Brief History of Syringe Exchange in Hawai‘i

Since 1990, the Hawaiʻi State Department of Health (HDOH) has supported syringe exchange to reduce the spread of HIV, hepatitis B, hepatitis C, and other bloodborne infections among people who inject drugs (PWID) and their partners, and to link PWID to health and social services. In 1992, the state legislature passed Act 152, codified as Chapter 325, Part VII of Hawaiʻi Revised Statues (HRS §325-111 through §325-117), allowing HDOH to operate a program of one-for-one syringe exchange statewide.

On May 29, 2025, Governor Josh Green signed Act 106 SLH 2025, amending Chapter 325, Part VII, HRS to improve the safety, effectiveness, and cost savings of the syringe exchange program. Act 106 SLH 2025 removes the prior one-for-one limitation and permits needs-based distribution of syringes and needles to syringe exchange participants. Compared to one-for-one exchange, needs-based syringe distribution is associated with less syringe sharing and reuse, lower risk on infections, and is not associated with increased unsafe syringe disposal.

Access to sterile syringes reduces the risk of contracting and transmitting blood borne infections, especially among PWID and their partners. SSPs also protect the public and first responders by promoting the safe disposal of used needles and syringes. Over 35 years of research have shown that SSPs are safe, effective, and cost-saving, do not increase drug use or crime, and reduce the transmission of viral hepatitis, HIV and other infections. Learn more about the effectiveness of SSPs.

The current SSP provider in Hawaiʻi is Hawaiʻi Health & Harm Reduction Center (HHHRC), which in 2023, exchanged 599,683 syringes statewide. From 1993 to 2023, the program exchanged a total of nearly 18 million syringes statewide. See the Hawaiʻi Syringe Exchange Program 2023 Annual Report.

Current Services

HHHRC operates five mobile vans and partners with other agencies to cover each of Hawaiʻi’s four counties. SSP outreach workers establish contact and trust with participants to encourage safer practices that reduce risks related to injection and sexual behaviors. Depending on availability, outreach workers provide:

  • sterile syringes and needles;
  • safe disposal of used injection equipment;
  • injection-related harm reduction supplies, such as cookers, cottons, and ties, to reduce the risk of infections and injuries;
  • health education; 
  • rapid HIV and HCV testing;
  • linkage to low-threshold HCV testing and treatment;
  • HCV treatment care coordination and support;
  • linkage to low-threshold access to medications for opioid use disorder (OUD);
  • care coordination and support for people ready to access treatment for OUD;
  • linkages to housing navigation and other services;
  • street-based wound care; 
  • overdose prevention (including naloxone training and distribution); and
  • harm reduction supplies, such as condoms and hygiene kits.

For more information, go to Hawaiʻi Health & Harm Reduction Center (HHHRC)

Chapter 325, Part VII of Hawaiʻi Revised Statues (HRS §325-111 through §325-117) permits the operation of a sterile needle and syringe program. The purpose of the program is to prevent transmission of bloodborne infections such as HIV and viral hepatitis and to link people who inject drugs to other health and social services. Through a competitive procurement process, an entity is selected to operate sterile needle and syringe program on behalf of the Department of Health. The Hawai‘i Health and Harm Reduction Center is currently designated to operate the program. Ongoing support and oversight of the program is performed by the Department of Health. Together with Department of Health, the Syringe Exchange Oversight Committee, with members appointed by the Director of Health, monitors progress and effectiveness of the program and examines data compiled by the program. The Syringe Exchange Oversight Committee currently meets four times per year. Meetings of the Syringe Exchange Oversight Committee comply with Chapter 92, HRS, with advance public notice of meetings posted on the State of Hawai‘i Public Meetings Calendar, and meetings open to the public. 

Chapter 325, Part VII, HRS, permits exchange of needles and syringes between syringe exchange program staff and syringe exchange participants.  

Possession or delivery of needles or syringes shall not constitute an offense under section 329-43,5 for program staff acting in the course and scope of official duties; provided that delivery is limited to other program staff or to syringe exchange participants pursuant to this part. Possession of needles or syringes shall not constitute an offense under section 329-43.5 for syringe exchange participants participating in a program visit. (Section 4, Act 106 Session Laws of Hawai‘i (SLH) 2025, to be codified under section 325-114(a), HRS) 

Effective May 29, 2025, Act 106 SLH 2025 permits the Department of Health to authorize objects that the state’s syringes exchange program may distribute, in addition to sterile needles and syringes, to syringe exchange participants for the purpose of reducing infection and injury related to injection drug use.  The syringe exchange program is permitted to distribute these “authorized objects” even though such objects may be considered drug paraphernalia under Section 329-43.5, HRS.  

“Authorized objects” means objects authorized by the department for dissemination to syringe exchange participants for the purpose of reducing infection or injury; provided that the objects are incidental to syringe exchange. “Authorized objects” may include but is not limited to cookers, cottons, or ties. (Section 2, Act 106 SLH 2025, to be codified under section 325-111, HRS) 

Possession or delivery of authorized objects shall not constitute an offense under section 329-43.5 for program staff acting in the course and scope of official duties; provided that delivery is limited to other program staff or to syringe exchange participants pursuant to this part. Possession of authorized objects shall not constitute an offense under section 329-43.5 for syringe exchange participants participating in a program visit. The department shall establish a specific list of authorized objects, which may be updated from time to time as needed. (Section 4, Act 106 SLH 2025, to be codified under section 325-114(b), HRS) 

Effective September 10, 2025, the Hawai‘i Department of Health authorizes the following objects for distribution by the syringe exchange program to syringes exchange participants for the purpose of reducing infection and injury related to injection drug use. 

AUTHORIZED OBJECTS LIST

Object Rationale 
Cookers. 
A container used for heating and mixing drugs for injection.  		Single-use cookers reduce exposure to contaminants, including infectious agents. Contaminants, including infectious agents, can be introduced by heating or mixing drugs in a non-sterile household item such as a spoon or bottle cap, or by sharing or reuse of any container in which drugs for injection are heated or mixed. 
Filters. 
Material used to remove contaminants and undissolved particles from a drug-containing solution as it is drawn into a syringe. A filter may be a pellet of cotton or similar material, sometimes referred to as “cottons” or cotton filters, or a single-use device containing a filter membrane. 		Use of an appropriate filter removes solid materials and impurities that may otherwise cause soft tissue and vein injury, emboli, or infections. Injecting without using a filter or use of common inappropriate filter materials, such as a cigarette filter, can introduce contaminants and undissolved particles. Sharing or reuse of filtering material can introduce contaminants, including infectious agents. 
Foil. 
A small square or rectangular sheet of aluminum foil used as a cooker for heating and mixing drugs for injection. These are sheets of aluminum foil that are manufactured for drug use; they are heavier than and do not have oil or other coating common on household foil. Some syringe exchange participants prefer foil to other types of cookers.   		Disposable foil, in place of a cooker, reduces exposure to contaminants, including infectious agents. Contaminants, including infectious agents, can be introduced by heating or mixing drugs in a non-sterile household item such as a spoon or bottle cap or by sharing or reuse of any container in which drugs for injection are heated or mixed. Using foil intended for drug use in place of household foil reduces harm because when heating drugs on household foil, coating on the foils can burn and release chemicals that can be harmful to inhale.  
Sharps disposal containers.
A container specifically designed to store used needles, syringes, and other sharp medical instruments until the container and its contents can be safely and properly discarded. Sharps containers are puncture and leak resistant, fitted with a closed puncture-resistant lid, and clearly labeled with a hazard warning.  		Use of a sharps disposal container can reduce needle-stick injuries and the spread of bloodborne pathogens. Improper disposal and storage of used syringes and needles outside of a sharps disposal container increase the risk of needle stick injuries to both syringes exchange program participants and other members of the public. 
Sterile water.
Sterile water, labeled “for injection” and packaged in single-use ampoules may be used in the preparation of drugs for injection.  		Use of sterile water can prevent bacterial infections associate with non-sterile injection. 
Tourniquets.
A strip of rubber or other elastic material tightened around a limb to dilate veins to assist in correct placement of a hypodermic needle. Sometimes referred to as “ties.” 		Contaminants including infectious agents can be introduced through sharing or reuse of a tourniquet; use of a tourniquet can reduce soft tissue injuries that may result from repeated unsuccessful attempts to place a needle into a vein. 

Link to the Director of Health’s September 10, 2025 notice: Designation of “Authorized Objects” Approved for Distribution by the Syringe Exchange Program (September 2025)

In order to reduce the threat to the public of needle stick injuries related to improperly discarded needles and syringes, effective May 29, 2025, Act 106 SLH 2025 extends limited protections for syringes exchange program participants to possess used needles and syringes, including those containing residue of illicit drugs, until the syringe exchange participant is able to return the used needles and syringes to the syringe exchange program or otherwise safely and properly dispose of the used needles and syringes. 

Possession or delivery of used needles or syringes containing residue shall not constitute a drug possession offense under section 712-1242 (1) (c), 712-1243, 712-1245(1) (c), 712-1246.5, 712-1248 (1) (d) , or 712-1249 for syringe exchange participants within two months  after their last participation in a program visit; and shall not constitute an offense for  program staff acting in the course and scope of official duties; provided that any delivery, whether by syringe exchange participants or by program staff, shall be made only to program staff pursuant to this part.  (Section 4, Act 106 SLH 2025, to be codified under section 325-114(c), HRS) 

Effective May 29, 2025, Act 106 SLH 2025 extends limited civil liability protections to law enforcement officers. 

A law enforcement officer who, acting in good faith, arrests or charges a person who is thereafter determined to be exempt from an offense pursuant to this section shall not be subject to civil liability for the mere arrest or filing of charges. (Section 4, Act 106 SLH 2025, to be codified under section 325-114(f), HRS)