Linkage to substance use disorder treatment through syringe services programs and the criminal legal system: A Cross-Sectional Study.

Introduction: Evidence on how two approaches-syringe services programs (SSP) and criminal legal system (CLS) interventions-are associated with substance use disorder (SUD) treatment is needed to inform SUD treatment policies. This paper examines the associations between SSP utilization and CLS involvement with SUD treatment.

Methods: This cross-sectional study recruited 835 people who use drugs from September 2023 to September 2024 in San Francisco, California, and surveyed their substance use, medical, social, and harm reduction services utilization, and CLS involvements. Past 3-month associations between any SSP use and any CLS involvement with any SUD treatment were examined.

Results: The sample comprised 770 participants. Median [range] age was 42.5 years (19-80); 67% men, 28% women, and 5% gender-expansive; 34% Black or African American, 19% Hispanic or Latine, and 57% White. Most (78%) reported recent SSP use, and 48% reported any CLS involvement. About a quarter (27%) reported any recent SUD treatment. Multivariable analyses adjusting for age, Black race, and housing status, found that individuals with recent SSP use had higher probability of recent SUD treatment (adjusted prevalence ratio [APR] 1.77, 95% CI 1.23-2.54, p=0.002), while individuals with recent CLS involvement had similar probability of SUD treatment as those who did not (APR 1.00, 95% CI 0.78-1.28, p=0.99).

Conclusions: Findings suggest that recent SSP use was associated with recent SUD treatment uptake, while recent CLS involvement was not. These findings underscore that SSPs remain a vital component linking people who use drugs into SUD treatment.