November 16th, 2016
A comprehensive new report from Harm Reduction International—Global State of Harm Reduction 2016—contains a wealth of information about policies and practices around the world.
The headline news is mixed. On the one hand, the authors write, “Since HRI first began reporting [in 2008; their reports are biennial], the harm reduction response has increased globally with harm reduction programs now operating at some level in more than half of the 158 countries in the world where injecting drug use has been documented. Harm reduction is now the majority response in the international community.”
On the other hand, the report states: “Perhaps the most striking statistic to emerge … is that since 2014, there has been no increase in the number of countries implementing [needle and syringe access programs, or NSP]—the first time that this has happened since … 2008. Of 158 countries and territories where injecting drug use has been reported, 68 still have no NSP in place, and 78 have no provision of OST [opioid substitution therapy].”
The map below, taken from the report, shows the current international prevalence of NSP, which has stood still since 2014. The countries in red have some NSP available, and those in dark gray also have such programs in prisons. Countries in light gray have no such programs.
The lack of recent expansion is troubling in a world that needs these services more than ever. According to UN figures cited in the report, 11.7 million people injected drugs worldwide in 2014, of whom 14 percent are living with HIV, 52 percent are living with hepatitis C, and 9 percent are living with hepatitis B.
In prisons, where many people who use drugs are concentrated thanks to punitive policies, there is “woefully inadequate” provision of harm reduction services, the report points out—just eight countries, including Germany, Spain, Switzerland and Azerbaijan, have NSP in at least one prison.
It’s important to note that people who inject drugs aren’t just doing so with opioids—the report shows a global increase in stimulant injecting—but opioids make news in North America for good reason. “The prevalence of opioid use in North America remains high (3.8%) in relation to the global average,” notes the report, “and the region continues to experience the … highest drug-related mortality rate in the world.” Mixing opioids with other drugs is one key factor here. Yet mortality rates would be much worse if it weren’t for the fact that in the US and Canada, gold-standard OST drugs are available in the community and in some prisons—even if access remains unconscionably restricted.
Globally, however, OST is less widespread than NSP. The map below, also from the report, again shows countries with community availability in red, and countries that also have some prison availability in dark gray.
The full report contains a great deal more detailed information and data, and we recommend reading it if you have time. But much of the overall picture, with a stark gap between promises made by politicians and actions taken, is disturbing.
“Behind these numbers remains a landscape of political neglect where harm reduction advocates and people who use drugs are struggling to fill the gap governments are leaving behind,” write the report’s authors. “Civil society is relied upon to deliver services, gather data, advocate for funding and fight for the rights of people who use drugs. Underfunded and politically ignored, it is no wonder that the harm reduction response is facing stagnation and in some cases regression.”