Table 3. FUTURE (program growth and expansion) themes.

Theme	Categories	Classification	Illustrative Quotes
7. Supply and Demand	a. Funding shortages exacerbated by the federal government’s prohibition on using funds to purchase needles (SUPPLY)	Barrier	.. . .the more clean syringes that are out there the better. We don’t make the person come themselves. There are people who come in to pick up for other people. Other people are working or can’t get here so we do encourage that. But we do limit it to 40 because we don’t have an unlimited supply of syringes. We don’t have unlimited resources in that area. (Health Department NEP Director) We can see that we need to expand this, that we are overwhelmed by the volume of patients that we’re seeing.. . .But we don’t have funding to go on with that. And we don’t have sustaining funding beyond the first year when you get right down to it. (Health Department NEP Director) At the time the federal government would not allow funding for syringe exchange and we felt hesitant to ask our donors to right off the bat start donating to that. So we found two, well we found one basically, one foundation that was willing to give us money and we got the letter that we were confirmed the day before we started the syringe exchange. We had intended to start no matter what. (Free Clinic NEP Director)
	b. Unanticipated and overwhelming numbers of program participants (DEMAND)	Barrier	Well we anticipated only having 75 clients in the first year, which was my naïve thinking I guess, our belief that the situation wasn’t as bad as it really is. And it was also based on thinking that most of these folks would be people we knew. (Free Clinic NEP Director) We initially planned for about 500 participants for a year. So September 16 [2016] we expected to be at 500. We were at 500 in about nine weeks. So we immediately knew that we made a small error in judgment. (Health Department NEP Director)