Needle and syringe programs (NSPs) are key public health and HIV prevention programs. We sought to compare over time the quality of relationships between NSPs and police, and implementation of best practices. We conducted cross-sectional surveys in 2008 (n = 32) and 2015 (n = 28) with NSP managers in Ontario, Canada. Participants were recruited via e-mail to complete an online survey. Over the period studied, self-reported quality of NSP–police relationships did not change—roughly two thirds of NSP managers reported a positive/mostly positive relationship. In 2015, higher proportions of programs offered training to police about the following: the purpose and goals of NSPs (48% vs. 41% in 2008), NSP effectiveness (55% vs. 34%), the health and social concerns of people who use drugs (52% vs. 40%), and needlestick injury prevention (44% vs. 31%). Few managers reported formal conflict resolution procedures with the police (22% in 2015, 9% in 2008). Our findings show that NSP–police relationships did not deteriorate during a time when such programs fell into disfavor with the federal government. More research is needed to understand if and when formal versus informal agreements with police serve the needs of NSPs.