Around the world, despite the COVID-19 pandemic, environmental crisis and warfare, harm reduction services are slowly spreading. Global State of Harm Reduction 2022, a report released by Harm Reduction International on November 1, details many developments, from new syringe service programs (SSP) to new safe consumption sites (SCS), that paint a somewhat brighter picture than in recent years.
Since 2020, when the last Global State report was issued, six countries, all of them in Africa—Burundi, Côte d’Ivoire, Democratic Republic of the Congo, Guinea and Uganda—have opened syringe programs for the very first time. A total of 92 countries now host these vital services.
This marks the first time since 2014 that the total number of countries offering harm reduction services has increased.
Altogether—when you include other key provision like medications for opioid use disorder (MOUD), heroin-assisted treatment (HAT) and SCS—this marks the first time since 2014 that the total number of countries offering harm reduction services has increased.
“We’ve seen a lot of progress in harm reduction services since 2014,” Temitope Salami, public health project coordinator for Harm Reduction International (HRI) and a contributor to the new report, told Filter. “We’re seeing the mention of harm reduction in national policy increase to 104 countries. That’s unprecedented, and it’s the step forward we want to see in getting countries to realize the importance of mainstreaming harm reduction for people who use drugs.”
The United States, despite many severe shortcomings, is on that list: 2021 saw the Biden administration include harm reduction in the national drug control strategy for the first time, and New York City opening the country’s first two sanctioned SCS.
A total of 16 countries now host SCS. Three other countries besides the US—Greece, Iceland and Mexico—have opened their first facilities since 2020. HAT, which was pioneered in countries like Switzerland, remains scarce, but one country—Norway—has now added this service, bringing the worldwide total to seven, all in Europe.
In Africa, as well as six nations opening their first SSP, MOUD like buprenorphine and methadone have become available in three new countries: Uganda once again, Algeria and Mozambique.
But these positive changes are still far too little to meet the needs of all people who use drugs. “Even in countries where harm reduction programmes are implemented, availability, accessibility and quality remain significant issues,” the report’s authors write. “Services are unevenly distributed in most countries. People living in rural areas or outside capital cities, for example, are often poorly served.”
This urban-rural divide certainly exists in the US.
“Around the world,” they continue, “people who use drugs continue to face criminalisation, stigma and discrimination that prevents access to services.”
As one example, harm reduction access in the world’s prisons has seen little change. Just nine countries offer syringe services in prisons, and only one—Canada—has an SCS in prison. The total number of countries offering buprenorphine or methadone behind bars remained the same: While three countries (Kosovo, Macau and Tanzania) added this service for the first time, another three (Georgia, Hungary and Jordan) have cut them.
“The Russian invasion is a threat, because the Russians are in aggressive opposition to harm reduction and human rights-based and person-centered approaches to drug use.”
Serious crises around the world meanwhile continue to threaten harm reduction work and the people who rely on it. Many examples include COVID, monkeypox, the Taliban government in Afghanistan and the Russian invasion of Ukraine.
“The Russian invasion is a threat to harm reduction services, because the Russians are in aggressive opposition to harm reduction and human rights-based and person-centered approaches to drug use,” Naomi Burke-Shyne, HRI’s executive director, told Filter. “There’s a Russian ban on methadone and opioid agonist therapy; notwithstanding decades of science, they don’t believe in it.”
Regarding drug-use trends, the researchers found that methamphetamine use is rising globally, and especially in parts of Africa and Asia. South Africa now has one of the world’s largest demands for the drug, and significant meth markets have developed in Botswana, Eswatini, Kenya, Lesotho, Malawi, Mozambique, Uganda, Zambia and Zimbabwe. This means harm reduction work has to evolve in this specific direction.
“For the first time ever, the [report] tracked safer smoking kit in countries that have a harm reduction measure in place to support non-opioid based drug use,” Burke-Shyne said.
“Nineteen countries around the world now offer a safer smoking kit as part of their harm reduction interventions,” she continued. “They vary widely—including kits developed by É de Lei in Brazil, where they actually work with people who use drugs in the community around them to think about what are the specific harms associated with smoking there, and developed a silicon tube to support use of a crack pipe that doesn’t leave burns, which increase susceptibility to disease infection.”
“It’s enormously detrimental that the US is throwing its political weight and not funding these programs around the world.”
The country that gave the world the War on Drugs has largely failed to step up when it comes to safer smoking supplies. However, Burke-Shyne commended recent signs of progress in the US, like the Biden administration offering the first federal grant program for domestic harm reduction services and issuing pardons to people with federal marijuana possession convictions. But Biden is so far failing to reverse other disastrous drug policies, both within the US and also around the world.
“The US still has a ban on funding needle and syringe programs internationally,” Burke-Shyne said. “The President’s Emergency Plan for Aids Relief (PEPFAR) is the second-largest funder of harm reduction in low- and middle-income countries. Notwithstanding the progress inside America and the Biden administration taking a better position, it’s enormously detrimental that the US is throwing its political weight and not funding these programs around the world. It’s a burden on the very limited international [money] flows we definitely do not need.”