Linkage to Substance Use Disorder Treatment Through Syringe Services Programs and the Criminal Legal System: A Cross-Sectional Study.

Abstract

Evidence on how 2 approaches-syringe services programs and criminal legal system interventions-are associated with substance use disorder treatment is needed to inform substance use disorder treatment policies. This paper examines the associations between syringe services programs utilization and criminal legal system involvement with substance use disorder treatment. This cross-sectional study recruited 835 people who use drugs from September 2023 to September 2024 in San Francisco, CA and surveyed their substance use, medical, social, and harm-reduction services utilization, and criminal legal system involvements. Past 3-month associations between any syringe services programs use and any criminal legal system involvement with any substance use disorder treatment were examined. The sample comprised 770 participants. Median (range) age was 42.5 (19-80) years; they were 67% men, 28% women, and 5% gender expansive; and they were 34% Black or African American, 19% Hispanic or Latine, and 57% White. Most (78%) reported recent syringe services programs use, and 48% reported any criminal legal system involvement. About a quarter (27%) reported any recent substance use disorder treatment. Multivariable analyses adjusting for age, Black race, and housing status found that individuals with recent syringe services programs use had higher probability of recent substance use disorder treatment (adjusted prevalence ratio=1.77; 95% CI=1.23, 2.54; p=0.002), whereas individuals with recent criminal legal system involvement had similar probability of substance use disorder treatment as those who did not (adjusted prevalence ratio=1.00; 95% CI=0.78, 1.28; p=0.99). Findings suggest that recent syringe services programs use was associated with recent substance use disorder treatment uptake, whereas recent criminal legal system involvement was not. These findings underscore that syringe services programs remain a vital component linking people who use drugs to substance use disorder treatment.