The State Of Harm Reduction Around The Globe

By Keri Blakinger 12/27/18

A new report breaks down the status of harm reduction programs around the world. 

inside a safe injection site that's part of a harm reduction program
Photo via YouTube

Even as opioid use continues wreaking havoc on some parts of the globe, the availability of harm reduction measures worldwide are relatively stagnant, as documented in a massive new report released this month.

The number of countries with needle exchange or opioid substitution treatment has stayed relatively stable over the past four years, and a lack of funding in middle- and low-income countries has stunted the growth of service options available in some of the places most severely impacted, according to the “Global State of Harm Reduction” 2018 report issued this month by Harm Reduction International

But there’s a significant exception to that trend: North America. Here, as opioid overdose figures rise, the harm reduction response is blossoming. Naloxone access, fentanyl testing strips, and needle exchange programs have become more common in the US and Canada – all possible signs of forward-thinking responses to a well-documented crisis. 

“The US now has the fastest annual percentage rise of drug-related fatal overdose ever recorded,” the report notes, “with an increase of 21.4% between 2015- 2016 alone.” 

Currently, the United States has 335 needle exchanges – a 37% increase since the last harm reduction report. Meanwhile, Canada has taken harm reduction efforts a step further, opening a total of 26 supervised injection sites. That sort of progressive action is still barred by federal law in the US, though some communities have considered addressing it both legislatively and in local action plans.

There are, of course, still significant gaps. The availability of harm reduction in prisons is “woefully inadequate, falling far short of meeting both international human rights and public health standards,” according to the report. 

And, despite the response in North America, service offerings worldwide have stayed more stagnant.

“While our coverage of harm reduction policies and services has evolved and broadened in scope, the same cannot always be said for harm reduction in practice around the world,” the report notes. “Despite [the] heavy burden of diseases, effective harm reduction interventions that can help prevent their spread are severely lacking in many countries.”

Currently, 86 countries offer some sort of needle exchange program – down from 90 in 2016. Bulgaria, Laos and the Philippines have shuttered their exchange programs in the face of punitive drug policies, while Argentina and Brazil have stopped offering such services as the number of injection drug users falls in those nations. 

While the number of countries that offer exchanges has fallen slightly, the number with opioid substitution drugs available has gone up a bit. Since 2016, Cote d’Ivoire, Zanzibar, Bahrain, Kuwait, Palestine, Argentina and Costa Rica have all introduced or re-introduced medication-assisted treatments. 

Overall, methadone is still the most commonly prescribed of those treatments, with buprenorphine falling into second place. Despite research espousing the use of heroin-assisted treatment as a harm reduction option, it’s only available in seven countries: Belgium, Canada, Denmark, Germany, the Netherlands, Switzerland and the UK. Though that’s still considered a radical option in many countries, it’s just one of the solutions experts have increasingly examined as more potent drugs continue appearing in underground supply chains.

“The rise of illicit fentanyls themselves is just about the clearest case one can make for harm reduction: despite a literally poisonous supply, millions of people are still taking street opioids in an underground market that lacks quality control,” journalist Maia Szalavitz wrote in an introduction to the report. “It’s hard to argue that anything short of providing a safer supply – both through traditional medications like methadone and buprenorphine and via prescription heroin, hydromorphone (Dilaudid) and perhaps others – will be able to end the crisis, if done to scale.”

And, aside from the continued toll of opioid use, amphetamine use is on the rise as well – but harm reduction options for speed users “remain underdeveloped,” according to the report. Safe consumption sites – in the regions where they’re available - continue to focus largely on injection use, leaving out those who smoke or snort their drugs. And, free drug testing services are limited mostly to festivals and clubs. 

“While this all paints a bleak picture of harm reduction worldwide, there are examples of innovation and perseverance in this report that give hope and demonstrate that progress is possible,” the report’s authors wrote. “It is important, too, to not overlook the fact that harm reduction has come a long way over the past two decades. The evidence is clearly in favour of harm reduction. It is time that more countries acknowledge this and implement the services that are proven to advance public health and uphold human rights.”

Please read our comment policy. - The Fix

Keri Blakinger is a former drug user and current reporter living in Texas. She covers breaking news for the Houston Chronicle and previously worked for the New York Daily News and the Ithaca Times. She has written about drugs and criminal justice for the Washington Post, Salon, Quartz and more. She loves dogs and is not impressed by rodeo food. Find Keri on LinkedIn and Twitter.