Soon thereafter Johns Brooks from the CDC's HIV epidemiology team reported that prevention and treatment interventions had largely controlled last year's injection-related outbreak of HIV and hepatitis C in rural Indiana, but sporadic new cases continue to appear and many other communities may be at risk for similar outbreaks.

In November the Department of Health and Human Services released another report, Facing Addiction in America: Surgeon General's Report on Alcohol, Drugs, and Health, showing that nearly 21 million people in the U.S. struggle with substance use disorders. Surgeon General Vivek Murthy emphasized the important of viewing drug addiction "not as a moral failing but as a chronic illness that must be treated with skill, urgency, and compassion."

Results from a survey by Beth Israel and the North American Syringe Exchange Network published late last year showed that there are not enough syringe service programs to meet the needs of people who inject drugs, especially in rural and suburban areas. This December a CDC Vital Signs report showed that although syringe exchange and distribution services had increased substantially over the past decade, still only a quarter of drug injectors use sterile needles all the time, and a third reported sharing a needle within the past year. While HIV diagnoses among people who inject drugs decreased by nearly half, they still account for 1 in 10 new cases.

"The science is clear: SSPs reduce HIV risk and are not associated with an increase in injection drug use," wrote CDC's Jonathan Mermin and Eugene McCray. "They are a powerful tool that can help us avoid new HIV infections, reduce injection drug use in our communities, and address other health problems faced by people who inject drugs."

At the end of 2015 Congress passed a bipartisan omnibus budget bill that effectively lifted a ban instituted in the 1980s that prohibited federal funds from being used to support syringe programs. The new rules allow the federal government to support operational aspects of syringe services, but not pay for needles or syringes themselves, according to guidance issued in March. States and cities must provide all funds directly used to purchase syringes.

The Surgeon General has determined that syringe programs are an effective way to reduce HIV transmission among people who inject drugs, and there is ample evidence that these programs encourage access to drug treatment and medical care without increasing illicit drug use. But advocates fear that the new public health orientation toward drug use and addiction is at risk under the incoming Donald Trump administration.

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