Fargo Public Health staff detail syringe services program impacts, funding and legal oversight

Robin Lisal, a presenter with Fargo Cass Public Health, told the board the agency’s syringe services program (SSP) supplies sterile injection equipment, naloxone and testing, links participants to care and is subject to annual state reauthorization.

Lisal said, “Syringe services programs are proven and effective community-based prevention and harm reduction programs that provide a range of services to persons who inject drugs, including access to sterile syringes and injection equipment, syringe disposal, vaccination, testing, and linkage to infectious disease care and substance use treatment.” She framed SSPs as a disease- and overdose-prevention strategy backed by long-term research.

The program’s local impact, staff said, includes a reported 67% decline in new hepatitis C cases between 2021 and 2024 and a high return rate for distributed syringes: “69% of all syringes that we distributed were actually returned on site,” Lisal said, citing program-collected data. Program staff also reported thousands of naloxone reversals: program slides referenced roughly 2,735 naloxone 'saves' since the program opened (figures presented as program-reported totals).

Funding, oversight and legal context
Fargo’s SSP staff explained that the program is funded through a mix of state grants and settlement funds: staff and supplies are paid from a State Opioid Response grant and counseling/testing grants; naloxone is provided by the North Dakota Department of Health and Human Services Behavioral Health Division; additional safer-use supplies were supported by local opioid settlement funds. Lisal emphasized that Fargo Cass Public Health’s SSP does not use city general-fund dollars.

Lisal said the program operates under state law and oversight: “All of what we do is dictated by state statute,” and she cited North Dakota Century Code 23-01-44 (syringe or needle exchange program authorization) as the authorizing statute and the North Dakota Department of Health and Human Services as the reauthorizing agency that reviews program plans and twice-yearly reports.

Services, models and community concerns
Staff described a needs-based distribution model — where participants receive supplies without returning used syringes — as the best-practice approach linked in research to reductions in HIV and hepatitis C transmission. Lisal listed services the program provides: syringes; safer-injection and wound-care supplies; naloxone (intranasal and intramuscular); fentanyl and other drug test strips; multiple sizes of sharps containers and kiosks; safer-sex supplies; and referral services including medication for opioid use disorder, behavioral health, housing and legal services.

Addressing syringe litter and disposal, Lisal told board members the program provides disposal education, two public sharps kiosks (one at the harm reduction center and one at the public-health office) and noted a range of disposal methods reported by participants, from returning syringes to the program to using municipal take-back options. She also explained a legal complication: a second charge for syringe possession can be a felony in North Dakota, which deters some participants from transporting used syringes to the site.

Evidence and cost claims
Lisal summarized national evidence on SSPs and presented local data: “30 years of research on comprehensive SSPs has concluded that they are safe, effective, cost-saving,” and she reported a program-cited estimate that each dollar spent on an SSP yields roughly $7.58 in societal savings. She also cited program figures that SSP participation increases the likelihood of entering drug treatment and is associated with reduced blood-borne infection rates.

Board questions and operational notes
Board members asked about data trends and the effect of distributing safer-smoking supplies ("pipe distribution"). Staff said broadened supply distribution in 2025 coincided with large increases in visits, unique individuals served and naloxone reversals; after a controversy and the cessation of pipe distribution, those numbers declined again. On the composition of reported naloxone reversals, staff said roughly 11% involved callers who reported 911 was called; 89% reported no 911 call, based on program follow-up data.

On medical staffing for withdrawal management, staff said higher-level, medically staffed detox exists at a regional receiving center (cited as the facility in Morehead) and that the SSP’s withdrawal-management unit is non-medical and refers patients who need higher levels of care.

Why it matters
Staff framed SSPs as public-health interventions that reduce disease, connect people to treatment and save public resources. Lisal noted the layered oversight, annual reauthorization requirements and data collection the program must provide to the state.

Next steps and oversight
Program staff said they submit regular reports and reauthorizations to the North Dakota Department of Health and Human Services and that the board should expect continued program monitoring and annual reporting.