this is a picture of Naloxone, which can reverse the effects of an opioid overdose
Naloxone, which can reverse the effects of an opioid overdose. Officials say it isn't effective on xylazine. Arielle Levin Becker /

“Can I get some Narcan?”a regular client at one of Connecticut’s largest syringe services programs recently asked.

“No, we’re out,”I said in response, as I watched them walk out the door for what could be the last time.

Theirs was a reasonable request, given that the United States is in the midst of one of the most volatile opioid epidemics globally, with over 100,000 deaths across the country in 2020 alone. This is the equivalent of a Boeing 737-400 crashing every day for a year straight.

Naloxone, under the brand name “Narcan,” is a lifesaving antidote to reverse overdoses. The recent rise in overdose deaths is driven by an influx of powerful synthetic opioids, like fentanyl, into the drug supply. Naloxone works by blocking receptors on the brain so that opioids cannot attach and cause nervous system depression, which leads to hypoxia (lack of oxygen) and eventual death.

In cities across Connecticut, naloxone distribution is becoming increasingly important as the overdose crisis makes substantial shifts into urban, Black communities.

Despite its effectiveness, the availability of naloxone in communities that need it has not met the level of need. As of writing this piece, the Connecticut Department of Public Health (CT DPH) and syringe service programs around the state have been out of naloxone for several weeks. Though some programs have made informal arrangements to get supplemental supplies of naloxone from pharmacies and private partnerships, these week-by-week agreements are not sustainable. 

In the absence of naloxone in syringe service programs and their surrounding communities, we run the risk of heightening the overdose crisis in Connecticut.

The scale-up of such programs in the U.S. has been severely limited; currently, only 39 states have laws explicitly authorizing their use. Even after decades of evidence that show syringe programs are a cost-effective strategy for decreasing the risks of drug use, including infectious diseases and overdose, the locations that need them most have disregarded their benefits for primarily political reasons.

In this country, we have disinvested in public health, as shown by the failures we’ve seen during the COVID-19 pandemic. This has led to an overall lack of funding for harm reduction services, which includes syringe service programs and community-based naloxone distribution. Though the Biden administration has made a small stride toward providing funding to address the overdose crisis, his platform still largely relies on the failed methods of the “War on Drugs,” while only a small fraction of the fiscal year 2023 budget is dedicated to harm reduction services.

As a result, naloxone distribution within syringe services programs remains challenging. In many states, only individuals at risk of overdose can receive a prescription for naloxone; however, we know this does not work systematically. Getting naloxone into drug users’ social networks is one essential step toward ending the overdose crisis.

We need to flood the community with naloxone to ensure that people at risk for overdose will be able to be revived by their loved ones if they begin to overdose. Integrating naloxone distribution into syringe services programs is, therefore, necessary to decrease the number of deaths caused by the growing overdose crisis.

Connecticut is one of only seven states that permits community organizations to distribute naloxone. Yet, the funding necessary to sustain these lifesaving programs is insufficient. In 2021 alone, one program in New Haven gave out 374 naloxone kits (with two doses in each kit) and many more overdose education sessions to its hundreds of clients ­– but unsurprisingly, their budget does not speak to its success.

Despite being affiliated with Yale University, funding is scarce for the syringe services program in New Haven. Like many others throughout the state, their program operates almost exclusively with money from the CT DPH and one-off grants, which is simply not enough.

For example, of the total FY2020 budget of the CT DPH, needle and syringe exchange programs only received ~$450,000, a fraction of a percent of the overall DPH budget. Though this number shows the gross underfunding of syringe services programs, the debate here is not whether another vital program should have money shifted away from it. Like many other health departments, the CT DPH is too underfunded and overwhelmed.

We need a change in how these lifesaving programs are prioritized and funded. Funding needs to meet demand – data from the Substance Abuse and Mental Health Services Administration (SAMHSA) in 2020 found that 40.3 million people aged 12 or older had a substance use disorder in the past year .

As it stands, syringe service programs throughout Connecticut regularly run low on supplies such as clean syringes and naloxone. We are urging the state government and relevant private entities (e.g., Yale University) to help further sustain these programs and their naloxone supplies.

Having sustainable funding that can meet the daily needs of our communities is essential for the future operation and success of syringe programs in addressing the overdose crisis. In Yale’s case, not only does the New Haven program provide lifesaving services to its community, but the program has had substantial benefits for the university. Since its inception in the early 1990s, the New Haven syringe program has been a pioneer in service delivery, leading to the renowned success of many faculty and the Yale Program in Addiction Medicine.

As the drug supply becomes further contaminated and deadly, people need these critical services to survive. If your brother, sister, mother, father, cousin, or uncle walked into the needle exchange last week, you would have wanted them to access a medication that could save their life regardless of how you feel about their drug use. So, why should anyone else’s family or friend be walking away with anything less?

William Eger, MPH, is a Postgraduate Associate at the Yale University School of Medicine, Department of Internal Medicine, Section of Infectious Diseases. Francesca Maviglia, MPH, is a Postgraduate Associate at the Yale University School of Medicine, Department of Internal Medicine, Section of Infectious Diseases.