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 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, provides comprehensive analysis 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.
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.