Overdose, HIV and hepatitis C crises surge as global harm reduction response stalls

Date: 10 December 2018

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Major new report finds less than half of countries with injecting drug use implement services to prevent blood-borne viruses and drug-related death  

Use of amphetamine-type stimulants reportedly increasing, yet countries failing to adapt harm reduction services

LONDON (11 DECEMBER 2018) – The number of countries providing harm reduction interventions to prevent drug-related death, HIV and hepatitis C has stalled since 2016, according to a new report today from Harm Reduction International (HRI). Of the estimated 15.6 million people who inject drugs worldwide, over half live with hepatitis C, and nearly 1 in 5 live with HIV.

The report, The Global State of Harm Reduction 2018, is the most comprehensive independent analysis to date on harm reduction policy and practice around the world. It reveals that just 86 countries provide needle and syringe programmes (NSP), despite injecting drug use being present in 179 countries. This marks a fall from 90 countries in 2016, with NSPs cut in Bulgaria, Laos and the Philippines. 

The number of countries providing opioid substitution therapy (OST) rose slightly from 80 to 86 in the last two years, while the number of drug consumption rooms (DCRs) globally increased from 90 to 117 in the same period. However, OST provision is well short of what is required for an effective public health response, and DCRs are confined to just 11 countries in Western Europe, Canada and Australia. 

Katie Stone, Harm Reduction International’s Public Health and Social Policy lead, said: “The lack of progress in implementing harm reduction measures is a major concern and stunting progress in global health. Harm reduction is cost-effective and proven to promote healthier societies. It is disgraceful that governments continue to ignore the evidence in favour of demonising people who use drugs. This is a crisis in need of urgent response.”

Ruth Dreifuss, former president of Switzerland and chair of the Global Commission on Drug Policy, said: “The prohibition of drugs, combined with the lack the capacity and effective health care coverage, means that life-saving and cost-effective harm reduction services are disregarded by health authorities in low- and middle-income countries where the burden of the drug-related health issues is the greatest.”

Alongside mapping access across nine regions to HIV and hepatitis C treatment, and naloxone (a medicine to reverse opioid overdose), the report provides the first global mapping of harm reduction for amphetamine-type stimulants (ATS) and cocaine, such as drug-checking, safer smoking kits, and housing programmes.

There are approximately 35 million ATS users worldwide, yet programmes for these drugs are severely underdeveloped, the report finds. Drug checking programmes exist in five regions (Western Europe, Latin America, North America, Oceania and Eurasia), but are largely confined to nightlife and festival settings. 

Harm reduction in prisons remains in a worse state than in the community. Despite the fact that up to 90% of people who inject drugs may be incarcerated at some point in their lives, only 10 countries implement NSP in prisons, and 54 provide OST. Prisons are high-risk environments for the transmission of blood-borne infections and tuberculosis, and harm reduction interventions are effective in mitigating this risk. 

Harm Reduction International’s July 2018 research found that funding for harm reduction in low- and middle-income countries was just 13% of what is needed annually for an effective HIV response among people who inject drugs. 

The Global State and other cutting edge research will be showcased in April 2019, at HRI’s 26th international conference in Porto, Portugal, which will bring together over 1,000 delegates from 70 countries working on drugs, health and human rights. 


Edward Fox - Email: ed.fox@hri.global; Tel: +44 (0) 7414 010188


  1. Harm Reduction International is a leading NGO dedicated to reducing the negative health, social and legal impacts of drug use and drug policy. We promote the rights of people who use drugs and their communities through research and advocacy to help achieve a world where drug policies and laws contribute to healthier, safer societies. 
  2. The Global State of Harm Reduction 2018 is a coordinated effort of over 100 harm reduction practitioners, academics, advocates and activists from around the world, and is the only report to provide an independent analysis of the state of harm reduction globally.
  3. Harm Reduction International will present the findings of The Global State of Harm Reduction 2018, in Bangkok at the Foreign Correspondent’s Club of Thailand (FCCT) on Monday 17 December from 3:00pm-4:00pm (Bangkok). The event will feature speakers from UN agencies, civil society and European government, and will be livestreamed on Facebook.

© 2019 Harm Reduction International.

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