This piece examines what SSPs actually do and do not do, including their relationship to drug use, treatment engagement, and syringe litter in the community. It also addresses a growing local concern: how to take syringe waste seriously without misattributing its causes or relying on assumptions that are not supported by research.

Disclaimer: The views I express here are my own and should NOT be construed as speaking for the City of Bangor or the City Council of Bangor.

I want to start with something simple.

I understand the concern.

I have kids too. I live here. I don’t want anyone stepping on used syringes in parks or sidewalks. Nobody does. That feeling is real, and it shouldn’t be dismissed.

But good policy can’t be built on discomfort alone. It has to be built on what actually reduces harm.

And on syringe service programs (SSPs), the evidence is far more settled than the public debate suggests.

This is not about “enabling”

One of the most common claims is that syringe service programs “enable” drug use.

That’s not what the data shows.

Across decades of research and multiple large systematic reviews, SSPs are not associated with increased drug use, increased injection frequency, or increased initiation into injection drug use.

What changes instead is concrete and measurable: fewer infectious diseases, reduced risky injection practices, and more consistent contact with health systems that otherwise often do not reach people until crisis.

What actually changes when SSPs exist

The outcomes are consistent across studies and settings:

Lower rates of HIV transmission
Lower rates of hepatitis C transmission
Increased entry into addiction treatment and recovery services

That last point bears repeating: evidence shows people who engage with these programs are more likely—not less likely—to eventually enter treatment.

That is not incidental. It is one of the central functions of how these programs operate.

What SSPs actually are (and what they are often mistaken for)

SSPs are not treatment programs.

They are points of contact in a system where contact is often missing entirely.

For many people, they are the first consistent interaction with any form of healthcare during active addiction. That contact creates the possibility of trust, referral, and eventual treatment engagement.

At the same time, they also change something else: visibility.

SSPs do not create drug use—but they do make an existing reality more visible to the public. That can be uncomfortable. It can create the impression that things are getting worse when, in reality, they are simply being seen more clearly.

Visibility is not causation.

And policy built on visibility alone tends to misread the problem it is trying to solve.

Without structured systems like SSPs, the same population does not disappear—it becomes less visible, and often less connected to any form of care.

The harder truth about “consequences”

There is a common belief that drug use should be met primarily with consequences.

But in practice, the consequences of untreated addiction are already severe and largely indiscriminate:
overdose, infection, long-term disability, and death.

Those outcomes do not function as deterrence. They function as a public health burden.

SSPs do not remove accountability. They do something more limited and more practical: they reduce immediate medical harms while people are still using, and keep the door open for treatment when readiness arrives.

Syringe litter in the community

This is the concern I hear most often locally—and it is a fair one.

People are not imagining what they are seeing. A used syringe on a sidewalk or in a park is real, visible, and unsettling. That concern deserves a direct answer, not a dismissive one.

At first glance, the argument seems straightforward: if more syringes are distributed, wouldn’t that mean more syringes end up on the ground?

The reason researchers have generally not found that result is because syringe service programs do more than distribute syringes. They also provide education on safe disposal, operate collection and exchange systems, and create structured pathways for returning used syringes rather than discarding them in public spaces.

In other words, SSPs are designed to move syringe disposal from an unmanaged system into a managed one.

That doesn’t mean every syringe is returned. No program is perfect. But the goal is not simply distribution—it is distribution paired with collection, education, and safe disposal.

The data from Maine reflects that reality. According to the Maine CDC’s 2025 Syringe Service Programs in Maine Annual Report, Wabanaki Public Health collected 38,702 more syringes than it distributed. Needlepoint Sanctuary reported a return rate of approximately 99%, distributing 1,596 more syringes than it received back.

Those numbers do not mean syringe litter isn’t a problem. It is. But they do suggest that SSPs are not the primary source of the litter people are seeing.

That is why I believe we need a serious conversation about syringe waste itself—not a conversation that begins by assuming SSPs are responsible without evidence.

If there are areas where syringe litter is occurring, we should identify them. If disposal infrastructure needs improvement, we should improve it. If collection efforts need to be expanded, we should discuss that as well.

But effective policymaking starts with accurate diagnosis. We are far more likely to solve a problem when we focus on its actual causes rather than its most visible scapegoat.

Not blaming SSPs is not the end of the conversation

This is where I think the debate often gets stuck.

It is absolutely true that SSPs are not the cause of syringe litter or substance use in our community.

But that does not end the discussion.

We still need a serious, ongoing conversation about syringe waste itself:

where it is occurring
how it is being collected
whether disposal systems are sufficient
and how we reduce public exposure

That conversation is necessary.

In fact, that is part of why I voted against blanket moratoriums on SSPs and MAT-related policies. Because removing tools based on misdiagnosis does not solve the underlying problem—it only limits our ability to manage it.

We can and should address syringe waste and public safety directly.

But that conversation has to start with accurate diagnosis, not scapegoating.

The real policy question

This debate is often framed as if there are only two choices: support drug use or oppose it.

That is not the actual decision in front of us.

The real question is whether we reduce preventable disease and overdose while drug use is ongoing, or whether we avoid interventions that are uncomfortable but consistently shown to reduce harm and increase treatment engagement.

Because the evidence is clear on at least one point:

SSPs do not worsen the problem they are designed to address.

They reduce harm and increase the likelihood that people eventually enter treatment.

They are not a solution to addiction.

But they are part of the system that makes recovery possible.

A final thought

No one is asking Bangor residents to be indifferent to drug use. That is not realistic, and it is not fair.

The harms associated with addiction are real. The question is not whether those harms exist. The question is whether we correctly identify their causes and respond with solutions that actually reduce them.

Addiction is not resolved in a single step.

The question is whether we respond to that reality with evidence—or with wishful thinking.