Syringe and Naloxone Access

Syringe Exchange Programs

As of July 2016, North Carolina allows for the legal establishment of syringe exchange programs. Syringe exchange programs, or SEPs, distribute sterile syringes and other injection supplies and encourage the secure disposal of used syringes to reduce sharing, reuse and public safety risks. Using a sterile syringe and new injection supplies for each injection can prevent infections, abscesses and the transmission of hepatitis C and HIV. Programs also provide overdose prevention and response education, including how to administer naloxone. These programs can help participants access other medical and social services, including treatment for substance use disorder and mental health conditions.

Most syringe exchange programs operate according to the practices and philosophy of harm reduction. Harm reduction is an evolving set of practical strategies that reduce the negative consequences of drug use and other high-risk behaviors. It recognizes a spectrum of drug use between chaotic use and abstinence and promotes ways for people to manage their use and to use more safely. Syringe access services, community naloxone distribution and drug-checking with fentanyl test strips are all harm reduction techniques that reduce the risks associated with drug use. Harm reduction is also a philosophy based on the belief that people who use drugs deserve to protect themselves and their loved ones, whether or not they are seeking treatment. “Meeting people where they are” to provide services allows harm reduction programs to work with participants to address drug use and conditions of use. It is an effective model: people engaged in syringe exchange programs are five times more likely to enter treatment for substance use disorder than non-participants.

Increasing access to syringe exchange services is an element of North Carolina’s Opioid Action Plan to address the overdose crisis. All syringe exchange programs in North Carolina are required to provide the following services:

  • Syringe disposal
  • Distribution of sterile syringes and new injection supplies at no cost and in sufficient quantities to prevent sharing or reusing
  • Education materials concerning:
    o    Prevention of disease transmission, overdose, and substance use disorder
    o    Treatment options, including medication-assisted treatment and referrals to care
  • Naloxone distribution and training, or referrals to these services
  • Consultations/referrals to mental health or substance use disorder treatment

The NC Safer Syringe Initiative at the Division of Public Health maintains a list of syringe exchange programs in North Carolina.
For more information or for assistance in developing and operating syringe exchange programs contact

Additional information about syringe exchange programs and other local resources, including SUD treatment providers and recovery supports, are available via the More Powerful website.

Naloxone Access

A standing order is a medical order that authorizes the dispensing of a medication, like naloxone or the flu vaccine, to any person who meets criteria designated by the prescriber. North Carolina’s standing order for naloxone, signed by the State Health Director, authorizes any pharmacist practicing in the state of North Carolina and licensed by the North Carolina Board of Pharmacy to dispense naloxone to any person who meets set criteria. These criteria include:

  • Being at risk of opiate-related overdose due to medical conditions or history;
  • Being the friend or family of someone at risk of opiate-related overdose, thus being able to respond in case of overdose; and
  • Being in the position to assist another person at risk of opiate-related overdose.

Naloxone is available under the statewide standing order, without a prescription, at the majority of retail pharmacies in North Carolina. It is covered by most insurance policies. First signed in June 2016, North Carolina is the third state in the country to adopt a statewide standing order for naloxone. provides contact information for pharmacies offering naloxone under the statewide standing order. Naloxone is also available through syringe exchange programs and many local health departments. Pharmacies dispensing under the standing order can be added to the map. Contact for more information.