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Bans on Lifesaving Program for People Who Use Illegal Drugs Violate the Americans with Disabilities Act

The Modesto Needle Exchange on Daly Ave in Modesto.
Syringe Service Programs provide access to crucial health services to people with substance use disorders. The ACLU is fighting against bans that limit these lifesaving programs.
The Modesto Needle Exchange on Daly Ave in Modesto.
Joseph Longley,
ACLU Disability Rights Program
Malhar Shah,
ACLU Disability Rights Program
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July 29, 2026

J.A.’s life has been impacted by addiction for over two decades, and he needed support. He didn’t have access to clean syringes, so he reused used syringes and contracted countless skin infections and as well as Hepatitis C. But he finally got the support he needed: A Washington syringe service program (SSP) ran by Gather Church provided him not only with sterile syringes that helped him stay healthy, but wraparound services to support him in nearly every aspect of his life.

These programs not only reduce communicable disease, but they also reduce the risk of fatal overdose and reduce illegal drug use by connecting individuals to lifesaving resources, like low barrier access to medication for opioid use disorder. But the same SSP program that saved J.A. got banned by Lewis County in Washington in April 2024. He was back where he started: without the support he needed to be healthy. The ACLU and the ACLU of Washington, along with the law firm Kaplan & Grady, sued Lewis County last year on behalf of Gather Church. J.A. remained anonymous in the case out of fear of being targeted by police.

While the Americans with Disabilities Act (ADA) generally does not cover individuals who are currently using illegal drugs, there is an important exception to this rule that protects health services or services connected to drug rehabilitation. Yet too often, states and municipalities, like Lewis County, enact laws that target SSPs, one of the most effective tools to prevent overdose death and link individuals to treatment. The programs are also known as needle exchanges. By passing laws that target SSPs, these jurisdictions are violating the ADA by targeting health services designed for people with the disability of substance use disorder

Here at the ACLU, we are fighting to ensure that SSPs can operate and that people who need their services are able to access this lifesaving healthcare. A federal court held that the Lewis County ordinance that banned mobile SSPs, put distance requirements on brick-and-mortar SSPs, and prohibited the distribution of public health supplies like fentanyl and xylazine test strips likely violated the ADA because the ordinance targets health services designed for people with substance use disorder. As part of the resulting settlement agreement, the discriminatory ordinance was fully repealed, and the jurisdiction agreed to pay $500,000 in attorney’s fees. We are watching other jurisdictions who enact similar restrictions and are prepared to litigate if necessary.

SSPs Are Lifesaving Health Services for People with Substance Use Disorder

For people with substance use disorder, SSPs can be the difference between life and death. SSPs offer two primary public health benefits. Firstly, they reduce the incidence of potentially deadly communicable diseases like HIV and Hepatitis C. They also increase the likelihood that people who use illicit drugs enter and stay in evidence-based treatment for their substance use disorder.

Jurisdictions that have lifted restrictions on SSPs have seen major public health and public safety benefits. And those that have erected barriers to SSPs have seen the repercussions. For example, after establishing SSPs, Washington, D.C. saw a 70 percent drop in new HIV diagnoses attributable to injection drug use over just two years. New York City saw HIV rates decline 80 percent in people who inject drugs. In contrast, shortly after restricting operation of SSPs in 2018, Cabell County in West Virginia saw more new HIV diagnoses in one year than it did in the previous ten years combined. Similarly, then-Indiana Gov. Mike Pence slowed an HIV outbreak in Scott County of 2014 and 2015 only after authorizing an SSP, which caused a rapid reduction in HIV transmission. Without easy access to SSPs, the rates of these diseases go up, risking lives and costing taxpayer money. SSPs reduce syringe litter compared to communities without the program, and they do not increase criminal activity.

One study also showed that users of SSPs are five times more likely to enter drug treatment and about three times more likely to stop using drugs than those who do not use the programs. SSPs serve many individuals who currently use drugs, many of whom are either not ready for treatment or do not trust the traditional health care system. SSPs often serve as a low-barrier first point of contact to connect their participants to lifesaving health services at SSPs and other health services, including treatment for substance use disorder.

Discriminatory Laws Make SSPs Harder to Access

The success of SSPs as an intervention hinges on the ease of their availability. Difficulty obtaining syringes can lead to syringe reuse, syringe sharing, and longer periods of syringe circulation, which can all cause increased disease transmission. Patients commonly face barriers traveling to SSPs: their lack of housing and transportation, symptoms of their substance use disorder, mobility disabilities and mental health disabilities, and their skepticism of medical professionals and strangers.

That’s why laws that hinder SSPs from reaching participants are so damaging. Laws that target SSPs are counterproductive to public health, public safety, and fiscal responsibility. By making SSPs harder to access, these laws force taxpayers to spend more combatting the consequent rise in HIV, Hepatitis C, and overdose.

Instead of fighting SSPs, governments should embrace this evidence-based practice as we fight to reduce overdose deaths and ensure that people with substance use disorder get the health care that they need.

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