"New Normal:" Opportunities and Challenges Faced by Syringe Service Programs Following the Effects of the COVID-19 Pandemic.

Syringe services programs (SSPs) provide critical evidence-based public health services that decrease harms from drug use for people who use drugs (PWUD). Many SSPs have experienced significant and evolving COVID-19-related disruptions. We aimed to characterize the impacts of COVID-19 on SSP operations in the United States approximately two years into the pandemic.

Participating sites, selected from a national sample of SSPs, completed a semi-structured interview via teleconference and brief electronic survey evaluating the impacts of COVID-19 on program operations. Data collection explored program financing, service delivery approaches, and perspectives on staff morale two years into the pandemic. Interview data were analyzed qualitatively using Rapid Assessment Process. Survey data were analyzed using descriptive statistics and triangulated with qualitative findings.

Twenty-five SSPs completed the interview and survey between April - June 2022. Triangulation of qualitative and quantitative data characterized the dynamic ways that demand for SSP services has evolved throughout the pandemic, and how approaches to care delivery have increased in flexibility and participant-centeredness. However, SSPs expressed worry about longer-term barriers to program participant and staff engagement, and a mismatch between available programmatic resources and the "new normal" of service delivery needs.

The COVID-19 pandemic has had lasting impacts on multiple facets of syringe service delivery. While SSPs consistently meet barriers with ingenuity, greater programmatic and staff support is needed to ensure SSPs can continue to meet the changing public health needs for PWUD.