Mobile harm reduction services come in many forms—each shaped by local needs, available resources, and the creativity of the people providing care. From backpack outreach to vans, bikes, and home delivery, these models offer flexibility, build trust, and reach people who may never visit a fixed site. This section explores the unique strengths and limitations of different mobile approaches.

• Fixed Site Outdoor Spots—Fixed site outdoor syringe access services or other harm reduction supply services may offer services from a vehicle, out of a closet that opens onto an alleyway, or any similar situation. Very often, fixed site outdoor spots don’t offer very much more than HIV or other rapid testing and harm reduction supplies. Rarely, they may often offer low barrier medication assisted treatment and/or medical services; or they may partner with another provider to provide those kinds of services to harm reduction participants.
• Outreach/Backpack/Roving—This is, essentially, walking-based provision of harm reduction supplies and/or syringes. Street outreach is one of the oldest forms of harm reduction, and offers few if any adjunct services like testing or access to MAT. Outreach-based harm reduction service is the original form of harm reduction service provision but is frequently limited in the kinds and amounts of supplies that can be provided. However, outreach can also reach people who simply cannot or will not come to a formal service site and it has the benefit of being more informal and personal, allowing participants to be more open.
• Home Delivery—Home delivery is exactly what it sounds like. Harm reduction workers meet participants in their homes or another safe location such as a parking lot or cemetery. Home delivery is often described by the folks who do it as their favorite form of harm reduction service delivery because it winds up being so intimate and rewarding. One downside is that services are often limited to simply supply provision, but one of the strong upsides is that, because most people feel safer in their own homes, they are more likely to open up and ask for information and support.
• Vehicular—Vehicular outreach is often the widely preferred method of harm reduction service delivery because it combines the flexibility of mobile outreach with the capacity to offer a wide range of services—often comparable to those provided at fixed sites. In fact, many vehicular outreach programs function as mobile fixed sites, returning consistently to the same locations—sometimes for decades—to build trust and provide continuity of care. Vehicular outreach can be loosely divided into large moving truck/RV, or small van or car, with services from the latter generally being the most flexible, and services from the former being most comprehensive.
• Bicycle/Alternative Vehicle—A few programs across the country use bicycles—often with trailers—or other alternative vehicles to deliver outreach-based services in the community. Common challenges include the need for outreach workers to own and have the capacity to operate a bicycle, as well as traffic safety and liability concerns. As with all harm reduction service models, there are limitations—bicycle-based outreach typically covers smaller areas and may carry fewer supplies due to space and distance constraints. At the same time, the benefits, including flexibility, cost, and lower carbon footprint, make them attractive to some programs.