The Overwhelming Evidence in Favor of Harm Reduction

Recently, in Bucharest, I visited one of Romania’s few programs left for providing methadone, an essential medicine for treating opioid dependence. The people I met explained the significant challenges of providing this service. Police harassment is common and resource shortages mean people are often forced to wait months to commence methadone. For those with a history of drug use, an HIV-positive test means prolonged suffering because of the government’s indifference to treating them.

Despite this program’s resilience in the face of hostility, the services were being pushed out of the building within weeks and staff were racing to find another site and continue medical care for clients. Unfortunately, this experience is not unique—stigma, political reticence and a lack of funding for harm reduction mean this plays out all over the world.

Of the more than 15 million people worldwide who inject drugs, over half live with hepatitis C, and nearly one in five live with HIV. These diseases are entirely preventable with harm reduction programs like needle and syringe programs and opioid substitution therapy. Yet the latest research from the organization where I work, Harm Reduction International, reveals that less than half of the 179 countries where injecting drug use is reported implement these health services. In the two years since we last reported, progress has stagnated.

Harm reduction is not just about responses to HIV and hepatitis C. It covers a range of public health and social interventions that aim to improve quality of life, and to uphold human rights and dignity. The use of amphetamine-type stimulants is reportedly rising worldwide, particularly in Asia, and countries are not adapting to this trend. The availability of information on safer use and safer smoking kits, for example, is scarce.

We also can’t talk about harm reduction without addressing the spike in opioid- and drug-related deaths across several regions—notably Canada, the United States, and the United Kingdom, which all saw record fatalities last year. Naloxone, a powerful medicine that reverses opioid overdose, is becoming more widely available. But pricing and prescribing barriers, along with burdensome regulations on who can carry naloxone mean that in many areas, the people who need it most can’t get it. Only 12 countries around the world allow peer-distribution programs.

Underpinning the gaps in harm reduction is a lack of political or financial will prevalent in most countries. At one end of the spectrum, societal and legal hostility toward drug use can create an environment where people with problematic drug use are unwilling to access services because of the stigma attached. At the other, it manifests in brutal crackdowns like in the Philippines, where at least 20,000 people have been executed in the country’s war on drugs since 2016.

Amidst this gloom, our report does pick out bright spots, breakthrough reforms, and the perseverance of activists, service providers and some policymakers. The number of countries implementing harm reduction in sub-Saharan Africa is creeping up, for example, and a leap in the availability of drug checking services in Latin America supports people to make safer choices. Canada is taking action to address its overdose crisis through the rapid opening of supervised injection facilities and pop-up overdose prevention sites to help keep people alive. At a local level, there are inspiring examples of holistic and gender-sensitive harm reduction programs for women who use drugs in Myanmar, Spain, and Mexico.

So what next? A good place to start, is for countries to redirect money from ineffective drug law enforcement to harm reduction. At least $100 billion is spent annually on drug control around the world (incidentally, in their 2018 report [PDF], the UN Office on Drugs and Crime noted that the drug trade continues to boom). Shifting just 10 percent of these funds into harm reduction could end AIDS among people who inject drugs, cover hepatitis C prevention for this population twice over, and fund enough naloxone to save thousands of lives.

The evidence for harm reduction services is overwhelming. They keep people alive, are cost-effective, and foster healthier, safer communities. It is shameful that these facts are ignored by many. Until prejudice and fear stop ruling when it comes to drug policy, our health will continue to be undermined.

Learn More:

4 Comments

Hide

What i would to add on is big up for fighting on drug abuse, khat has lead tomorrow 's youth being unproductive materials where by community has fail to control it.This habits increases generation to be forgotten on the society because of addicted non reproduction. If we can focus on banning drug, then cure capitalization could have funding projects for employment.

It is very sad and indeed shameful that people with apparently big intelligent brains like those at our policy making tables are not understanding the real necessity and in fact the urgency of harm Reduction. We have been doing supply reduction, chasing dealers and imprisoning users for years and years and still drug consumption is not going away and in fact still 'booming'...Policy makers need to understand that drug use is a reality albeit to them, an unpleasant one to face and to admit yet the best people to help create realistic policies that work for the health and well-being of communities are people who use drugs and who want to be safe. Law enforcement need to be also involved in demand reduction efforts and harm reduction programmes. For things to begin to look brighter, there is a need to consider the issue as a whole 'Harm Minimization' package and not separately as in 'police does supply reduction' while 'health does harm reduction' and 'demand reduction is left to education and advocates'...we need to understand that we cannot dream of tackling supply reduction without considering demand and harm reduction...and if our governments are really sincere and not just politically motivated then they would show commitments tor reality and dignity...

Harm reduction is like giving candies to a diabetic.
Your numbers show a decrease in deseases related to the syringe usage, however it doesn't shows how are this people doing in life as a whole.
Addicts have the right to receive treatment, and there is not a single serious treatment that involves methadone in it's pharmacopeia

I'm a resident of Ireland which has the fourth highest overdose rate in the world among opoid injectors. Ireland has failed to open its first safe injecting center as of yet and Fentanyl has yet to enter the drug market. Politicians are ignoring the facts about harm reduction and safe injecting clinics. Countries with progressive drug policies like Portugal, Switzerland and Holland have done the ground work. Enough data is on record. Politicians need to listen to the experts and the people paying their salaries.

Add your voice