Needle-exchange programmes (NEP), a form of harm reduction policy, provide new needles to persons addicted to drugs in exchange for used ones in order to help control the spread of disease. In the United States, there are three distinct prohibitions on needle exchange programs at the federal level — the Ryan White CARE Act, the Substance Abuse and Mental Health Services Administration (SAMHSA) authorization,[2] and the 1997 Labor-Health and Human Services (HHS) Education appropriations legislation. However, many states still provide the service despite the federal legislation, especially in large cities where intravenous drug use is a major health concern.