The high prevalence of infection with HIV and other blood-borne pathogens in injection drug users (IDUs) is directly related to the lack of syringe access. Needle exchange programs (NEPs), syringe prescription, and syringe deregulation are 3 approaches to increasing access to sterile syringes for IDUs. The benefits of NEPs have been repeatedly demonstrated, but the impact of NEPs has been limited by a lack of federal funding. Syringe prescription for IDUs is a promising new strategy supported by many organizations; legalizing syringe purchase and possession has led to a substantial improvement in syringe access in many states. Because each approach has unique advantages, providing IDUs with a variety of options for syringe access is likely to be most beneficial.