Syringe exchange programs and safe injection services are outside-the-box interventions increasingly being used by governments, nonprofits and citizens to address dire issues percolating in tandem with America’s burgeoning opioid epidemic. People who inject drugs (PWID)-almost a million Americans annually-commonly use painkillers such as heroin and fentanyl, as well as methamphetamine, benzodiazepines, barbiturates and cocaine. Yet the users themselves are often obscured or marginalized by the bigger picture. This collection of essays covers policies and practices aimed at preventing both opioid-related deaths and related infections of hepatitis and HIV.