On October 29, Harm Reduction International released its latest biannual report on the status of harm reduction services around the world. The Global State of Harm Reduction 2024 honed in on four themes: hepatitis; Indigenous communities; incarcerated communities; and youth.
The report, last published in 2022, states that 108 countries currently express support for harm reduction practices; 94 countries have at least one program providing methadone and/or buprenorphine; and 93 countries have at least one operational syringe service program. Only 18 countries have at least one overdose prevention center (OPC).
But these numbers often do not reflect the reality on the ground. In Mozambique, professed government support for HIV harm reduction has not prevented police from arresting people for syringe possession. Iran also expresses support for HIV harm reduction, and in 2023 executed at least 459 people for drug-related convictions—the most since 2015.
Across the globe, over-policing and other forms of structural racism have severely impeded access to harm reduction services by Indigenous communities. In Mexico, for example, widespread arbitrary detention as a result of punitive drug policies disproportionately impacts Indigenous peoples.
In Alberta, Canada, the rate of opioid-involved overdose deaths is seven times higher for the Kainai Nation compared to the general population. The vast majority—95 percent—of Indigenous respondents to HRI’s global survey indicated that they had drug-related harms in their communities, but did not have access to harm reduction services. Meanwhile, funding for harm reduction services is at approximately 6 percent of the estimated $2.7 billion needed around the world.
To better understand the impact of these trends, Filter spoke with HRI Deputy Director and Public Health Lead Colleen Daniels, who oversaw research for the report. Our interview has been lightly edited lightly for length and clarity.
“Harm reduction is still a mostly Western and biomedical approach.”
Alexander Lekhtman: Are you optimistic or pessimistic about where harm reduction is heading?
Colleen Daniels: I certainly feel more pessimistic. The increase in the numbers of countries implementing harm reduction is minimal. It’s certainly important, but it should be a lot more than that. There’s been a slight increase in the availability of harm reduction services since 2022, but there are still major regional differences. Together with the stigmatization and criminalization of people using drugs, reduced funding for harm reduction and health services, this impedes access to existing services.
The other issue is, harm reduction is still a mostly Western and biomedical approach. The traditional harm reduction [measures]—opioid agonist therapy, needle programs, naloxone—these don’t respond to the changing trends of drug use. We’re seeing, in Latin America and the Caribbean, more stimulant drugs than opioids. People are not necessarily injecting drugs, yet the access to safer smoking supplies is negligible.
“If you’re not a person who uses drugs, you don’t know what they need. You can only guess.”
AL: Sierra Leone and Colombia have recently opened OPC, your report notes. What is likely to be the impact?
CD: In Sierra Leone, it’s not government-sanctioned. It’s a drop-in center that has an informal drug consumption room staffed by peers. Local police and donors are all aware of the operation, but it’s not officially sanctioned or funded. Sierra Leone has been improving their implementation of harm reduction services in the region. [Meanwhile] Senegal has been doing it for many years, and can be seen as the leader.
In Colombia, the first drug consumption room opened in 2023 in Bogotá, and we expect another one to open this year. This one is a community-based service for people who inject drugs, and they have peers who are involved in the operation as well as the development and implementation of the facility. That’s critical—all the successful [OPC] we see include peers, people who use drugs, in every part of the process. If you’re not a person who uses drugs, you don’t know what they need. You can only guess.
AL: Globally, what are some of the most concerning human rights violations for people who use drugs?
CD: Any countries that still have the death penalty for drug users. We know 34 countries still have a death penalty … as a punishment for someone with a drug offense. [It’s] obscene.
What we’re talking about are structural issues caused by the War on Drugs that uphold racist and colonial structures. So marginalized and racialized communities, especially Indigenous, Black and Brown people, who dissent from what the government is saying, are disproportionately targeted by punitive drug policy.
“When the war began [in Ukraine], it was civil society-run harm reduction that was able to respond best.”
AL: What impact does military conflict—whether between nations, or internal armed conflicts like in Ecuador—have on drug users?
CD: We talk about “internal conflict” in countries like Ecuador and Mexico. This problem was created by the United States. Their Cold War policies became War on Drugs policies. The 75 years of the US meddling in Latin America has brought us here, where we have increased violence related to drug trafficking, increased armed violence against citizens by governments. To delink the issue of migration from Latin America to the US, from US policy in the region regarding the War on Drugs, is shameful.
Russia is a great example of the impact of war on health systems. Russia had a real strategy of going into Syria, to bomb and dismantle the health system … [and] did it again in Ukraine. There’s many reports of how they have targeted health facilities. How you destroy a community and society is not just through invasion, but by removing all their systems and structures, so the path to peace and rebuilding is that much harder.
When it comes to people using drugs in Ukraine—because they had pretty good harm reduction systems in place when the war began—it was civil society-run harm reduction that was able to respond best. They worked with the World Health Organization to make sure things like naloxone, buprenorphine and methadone were available, and those services continued.
“When you decrease HIV funding, you decrease harm reduction [funding].”
AL: Harm reduction funding worldwide is decreasing. Why?
Because so many funders are now reducing funding for HIV. Harm reduction implementation in many low-income countries came about because it is a prevention intervention for HIV. When you decrease HIV funding, you decrease harm reduction [funding]. After COVID-19, there were even more dramatic decreases.
For countries that say there’s no money for harm reduction, that’s a fiction. If you look at a budget, it is a moral statement about what a government thinks is important. When a state says it doesn’t have many for harm reduction …or Indigenous people, actually they do have money. But it’s being put in the wrong places.
Show Comments