Syringe litter did not increase after a needle exchange ban was overturned in Pueblo, Colorado
Critics of needle exchange programs often express concerns about syringe litter. Spencer Platt/Getty Images The City Council of Pueblo, Colorado, voted to ban the distribution of syringes through syringe service programs starting in May 2024.
In May 2024, the City Council of Pueblo, Colorado, voted to ban syringe service programs, also called needle exchanges. These programs are community-run initiatives that provide healthcare services, including clean syringes, to people who use drugs. The ban was motivated by concerns about syringe litter—used needles improperly discarded in public spaces. The ban was overturned three weeks later by a Pueblo District Court judge, who ruled it violated state law. The American Civil Liberties Union (ACLU) argued that the ban conflicted with a 2010 Colorado state statute authorizing syringe exchanges. During the brief ban, the two needle exchanges in Pueblo remained open but stopped distributing syringes while continuing other services.
Needle exchanges, or syringe service programs, have operated in the U.S. since the 1980s and now number over 400 nationwide. These programs provide clean syringes to reduce the spread of infectious diseases like HIV and hepatitis C by preventing needle sharing. They also distribute naloxone, a medication that reverses opioid overdoses, and connect individuals to treatment for opioid use disorder. In Colorado, syringe exchanges were legalized in 2010, and Pueblo’s two programs began operating in 2014 and 2017. Research shows that needle exchanges reduce HIV transmission, increase treatment entry, and do not typically lead to higher crime or more syringe litter.
When Pueblo’s syringe ban took effect, one of the city’s needle exchanges saw a weekly decrease of about 2,400 syringes distributed. The amount of syringe litter collected from public spaces, such as parks and parking lots, also dropped by roughly 120 units weekly. Despite the ban, the needle exchange continued operating and providing other services. After the ban was overturned, the number of discarded syringes in public spaces did not increase, even as syringe distribution returned to pre-ban levels. This suggests that either demand for clean syringes had been building up or that proper disposal practices had improved during the ban.
During the three-week ban, the number of weekly visits to the needle exchange and the distribution of naloxone kits fell below expected levels. Over the 20 weeks after the ban was overturned, the needle exchange distributed about 125 naloxone kits weekly instead of the expected 150. Researchers estimate this resulted in 900 fewer naloxone kits distributed in the community. Prior studies indicate that one overdose death is prevented for every 230 naloxone kits distributed, suggesting the ban may have led to several preventable deaths. Fewer visits also meant fewer opportunities for people to access treatment, HIV and hepatitis C testing, and social services like housing assistance.
Pueblo’s experience reflects a wider trend in the U.S., where cities such as those in California and West Virginia have cut funding or restricted syringe service programs. At the federal level, an executive order issued in July 2025 prohibited federal funds from being used to purchase syringes, ending a key funding source for many needle exchanges. Despite these setbacks, overdose deaths in the U.S. have been decreasing in recent years, partly due to public health efforts like naloxone distribution, which is widely supported by Americans. The findings from Pueblo suggest that restricting harm reduction services may undermine these life-saving efforts.
