The number of countries supporting harm reduction in their national policies is higher than ever, according to the latest Global state of harm reduction survey from Harm Reduction International (HRI).
There are now 108 countries that include references to it in their policies, says the report, which tracks the availability of services like opioid agonist therapy, needle and syringe programmes and consumption rooms. Ninety-three countries now offer at least one needle and syringe programme, with 94 offering opioid agonist therapy like methadone or buprenorphine – up from 88 in 2022. There are also consumption rooms established in 18 countries, most recently Colombia and Sierra Leone, while take-home naloxone programmes are available in 34 countries.
However Iran, which mentions harm reduction in its national HIV policy, executed nearly 160 people for drug-related offences last year, the document points out. There are also reports of police arresting people for possession of injecting equipment in Mozambique, which also includes harm reduction in its HIV plan.
Long-term sustainability for services could also be at risk, the report warns, with the Open Society Foundations (OSF) – once the third largest international funder – halving its support in the last five years. ‘The number of international harm reduction donors remains small, leaving harm reduction vulnerable to their shifting priorities,’ it says, with harm reduction remaining seriously underfunded in most regions and domestic funding ‘even more fragile’.
The 2024 report has a particular focus on young people and indigenous people, and finds that both are being neglected in overdose and HIV responses. ‘Because harm reduction services have been designed for adults, they neglect the needs of young people who use drugs,’ it says. Despite being among the largest demographics of people who use drugs, fear of academic or legal consequences that could affect their future prospects often means young people are reluctant to access services, the document adds.
Meanwhile, indigenous people in the US, Canada, Australia and New Zealand face structural racism when trying to access services, it continues, including lack of funding, over-policing and over-prescription of opioids. Access to harm reduction for people in prison also remains inadequate, despite an ‘estimated one-third to half’ of people in prison having a history of drug use.
‘Policymakers know that a health approach to drugs works,’ said HRI deputy director Colleen Daniels. ‘That’s why so many countries now include harm reduction in their policies. Now it’s time they walk the talk and stop pouring money into failed approaches.’
The global state of harm reduction 2024 available at https://hri.global/flagship-research/the-global-state-of-harm-reduction/the-global-state-of-harm-reduction-2024/