Global State of Harm Reduction: 2019 updates

The 2019 update to Harm Reduction International’s flagship publication, the Global State of Harm Reduction, includes updates to some of the key data in the report, including the opening of new drug consumption rooms, availability of needle and syringe programs, and references to harm reduction in national policy documents, among many other things. 

The Global State of Harm Reduction is a biennial report from Harm Reduction International. First published in 2008, it involves a coordinated effort across practitioners, academics, advocates and activists to map global data and responses to drug-related harms. 

It is the only report to provide an independent analysis of the state of harm reduction in the world and has become the go-to source on global harm reduction developments for researchers and advocates in our sector and beyond.

In November 2019, the Public Health and Social Policy team at Harm Reduction International worked to provide an update one year on from the publication of the Global State of Harm Reduction 2018. 

We found that the spread of harm reduction services is still stalling globally in a continuation of a trend we have observed since 2012. 

We also found that:

Notably, two new countries have implemented drug consumption rooms since the Global State of Harm Reduction 2018: Portugal and Ukraine. 

In Portugal, a mobile drug consumption room is now operational in Lisbon, while in Ukraine a fixed-site facility opened in late 2018 in Sumy. While these are undoubtedly positive developments, in other countries well-developed political and social movements in favour of drug consumption rooms have been unsuccessful so far. This includes Ireland, Scotland and the United States of America.

The data presented here has been gathered over the course of 2019 from publicly available sources and in cooperation with our partners around the world. To report any inaccuracies, please contact us at office@hri.global.

Global Availability of Needle and Syringe Programs (NSP) in the Community and in Prisons

*Colour indicates that at least one NSP operates in the country.

Opioid Substitution Therapy (OST) in the Community and in Prisons

*Colour indicates that at least one OST programme operates in the country.

The Global Harm Reduction Response

Countries or territories employing a harm reduction approach in policy or practice

Country or territory Explicit supportive reference to harm reduction in national policy documents At least one needle and syringe programme operational At least one opioid substitution programme operational At least one drug consumption room Take-Home Naloxone Programme OST in at least one prison NSP in at least one prison
Asia
Afghanistan
Bangladesh
Bhutan
Brunei Darussalam
Cambodia
China
Hong Kong
India
Indonesia
Japan
Laos
Macau
Malaysia
Maldives
Mongolia
Myanmar
Nepal
Pakistan
Philippines
Singapore
South Korea
Sri Lanka
Taiwan
Thailand
Vietnam
Asia Subtotals 10 15 15 0 2 6 0
Country or territory Explicit supportive reference to harm reduction in national policy documents At least one needle and syringe programme operational At least one opioid substitution programme operational At least one drug consumption room Take-Home Naloxone Programme OST in at least one prison NSP in at least one prison
Eurasia
Albania
Armenia
Azerbaijan
Belarus
Bosnia and Herzegovina
Bulgaria
Croatia
Czech Republic
Estonia
Georgia
Hungary
Kazakhstan
Kosovo
Krygyzstan
Latvia
Lithuania
Macedonia
Moldova
Montenegro
Poland
Romania
Russia
Serbia
Slovakia
Slovenia
Tajikistan
Turkmenistan
Ukraine
Uzbekistan
Eurasia Subtotals 26 28 26 1 6 16 5
Country or territory Explicit supportive reference to harm reduction in national policy documents At least one needle and syringe programme operational At least one opioid substitution programme operational At least one drug consumption room Take-Home Naloxone Programme OST in at least one prison NSP in at least one prison
Western Europe
Andorra nk nk nk nk nk nk
Austria
Belgium
Cyprus
Denmark
Finland
France
Germany
Greece
Iceland nk nk
Ireland
Italy
Luxembourg
Malta
Monaco nk nk nk nk nk nk
Netherlands
Norway
Portugal
San Marino nk nk nk nk nk nk
Spain
Sweden
Switzerland
Turkey
United Kingdom
Western Europe Subtotals 20 20 21 10 10 19 4
Country or territory Explicit supportive reference to harm reduction in national policy documents At least one needle and syringe programme operational At least one opioid substitution programme operational At least one drug consumption room Take-Home Naloxone Programme OST in at least one prison NSP in at least one prison
Caribbean
The Bahamas
Dominican Republic
Guyana
Haiti
Jamaica
Puerto Rico
Suriname
Caribbean Subtotals 3 2 1 0 0 1 0
Country or territory Explicit supportive reference to harm reduction in national policy documents At least one needle and syringe programme operational At least one opioid substitution programme operational At least one drug consumption room Take-Home Naloxone Programme OST in at least one prison NSP in at least one prison
Latin America
Argentina
Bolivia
Brazil
Chile
Colombia
Costa Rica
Ecuador
El Salvador
Guatemala
Honduras
Mexico
Nicaragua
Panama
Paraguay
Peru
Uruguay
Venezuela
Latin America Subtotals 6 2 4 0 2 0 0
Country or territory Explicit supportive reference to harm reduction in national policy documents At least one needle and syringe programme operational At least one opioid substitution programme operational At least one drug consumption room Take-Home Naloxone Programme OST in at least one prison NSP in at least one prison
North America
Canada
United States
North America Subtotals 2 2 2 1 2 2 1
Country or territory Explicit supportive reference to harm reduction in national policy documents At least one needle and syringe programme operational At least one opioid substitution programme operational At least one drug consumption room Take-Home Naloxone Programme OST in at least one prison NSP in at least one prison
Oceania
Australia
Fiji
Kiribati
Marshall Islands
Micronesia
New Zealand
Palau
Papua New Guinea
Samoa
Solomon Islands
Tonga
Vanuatu
Oceania Subtotals 2 2 2 1 1 2 0
Country or territory Explicit supportive reference to harm reduction in national policy documents At least one needle and syringe programme operational At least one opioid substitution programme operational At least one drug consumption room Take-Home Naloxone Programme OST in at least one prison NSP in at least one prison
Middle East and North Africa
Algeria
Bahrain
Egypt
Iran
Iraq
Israel
Jordan
Kuwait
Lebanon
Libya
Morocco
Oman
Palestine
Qatar
Saudi Arabia
Syria
Tunisia
UAE
Yemen
Middle East and North Africa Subtotals 7 8 7 0 0 5 0
Country or territory Explicit supportive reference to harm reduction in national policy documents At least one needle and syringe programme operational At least one opioid substitution programme operational At least one drug consumption room Take-Home Naloxone Programme OST in at least one prison NSP in at least one prison
Sub-Saharan Africa
Benin
Burkina Faso
Burundi
Côte d’Ivoire
Democratic Republic of the Congo (DRC)
Ghana
Kenya
Lesotho
Liberia
Madagascar
Malawi
Mali
Mauritius
Mozambique
Nigeria
Rwanda
Senegal
Seychelles
Sierra Leone
South Africa
Tanzania
Tanzania (Zanzibar)
Togo
Uganda
Zambia
Zimbabwe
Sub-Saharan Africa Subtotals 11 8 8 0 0 3 0
TOTALS 87 87 86 13 23 54 10

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