The high road is in harm reduction

The Covid-19 pandemic disrupted life-saving harm-reduction services for people who use drugs across the globe, the latest Global State of Harm Reduction report has revealed. It is the most comprehensive independent analysis on harm reduction policy and practice around the world. 

People who use drugs were unable to access exchange programmes (where they swap their used needles for sterile ones) or opioid substitution therapy (OST) where health workers prescribe legal drugs — such as methadone or buprenorphine — that quell withdrawal symptoms. 

People who inject drugs are at high risk of being infected with HIV, hepatitis B and hepatitis C if they don’t have access to harm reduction programmes. 

A 2011 study published in the Bulletin of the World Health Organisation showed that OST programmes help to decrease the use of illegal drugs, deaths caused by overdose and new HIV infections among people who use drugs. 

The latest report states that movement restrictions during the pandemic made it difficult, and in many instances impossible, for people who use illegal drugs to access these programmes, while service providers had to reduce their number of working days or close entirely. 


“Harm reduction services such as sterile needle and syringe programmes save lives and are cost-effective. Yet the number of countries providing these services has effectively stalled for six consecutive years,” said Naomi Burke-Shyne, the executive director of Harm Reduction International

“Covid-19 has disrupted health services worldwide but it has pushed many governments to successfully implement solutions to the overdose, HIV and hepatitis crises as part of their emergency Covid-19 responses, paving the way for their permanent implementation around the world.”

Researchers found that harm reduction implementation has worsened across the world, with approximately half of the countries with injecting drug users not providing any sterile needles and syringe programmes or OST. 

Most of these programmes in sub-Saharan African countries — except South Africa and Tanzania — require people who use drugs to come to the facilities in person for their treatment and to collect sterile needles and syringes, which meant that services were suspended in some countries during lockdowns to curb Covid-19 infections. 

Experts and activists say the impact of the pandemic restrictions is unclear but an increase in the use of illegal drugs and in people experiencing withdrawals is likely. 

The number of countries implementing harm reduction services has decreased from 86 to 84 since 2018.

Additionally, the use of stimulant drugs such as amphetamines and cocaine is rising worldwide, while punitive drug policies are jeopardising the public health approach  

“Everyone has a right to health and to be treated with respect and equality — regardless of gender, sexuality, race, nationality, legal status or drug use. The compassionate and inclusive approach that guides harm reduction is essential to achieving good health for all,” says Dr Tlaleng Mofokeng, the United Nations special rapporteur on the right to health. 

“Harm reduction can be a model of integrated service delivery that centres the person, takes into account their intersectional vulnerabilities, and provides programmes that help them achieve better health.” 

At the United Nations general assembly, at the Global Commission on Drug Policy presentation, the deputy social development minister, Hendrietta Bogopane-Zulu, called for a review of treatment protocols for drug-dependent people and a move to a “human rights-based” approach.  

She told the world governments that the global war on drugs has failed and that South Africa was considering plans to decriminalise personal drug use while focusing its police resources on dealers and illicit syndicates.

“We need to reduce the punitive, war-based language on the issue of drugs. This has not led to success in the fight against drugs. We need to begin to focus on the social welfare services, so we can focus on putting the drug user at the centre and ensuring they have access to the critical medicines that they need,” Bogopane-Zulu said. 

This strategy forms the basis of South Africa’s drug master plan, published in June, which focuses on “harm reduction” for drug users.

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Pontsho Pilane
Pontsho Pilane is an award-winning journalist interested in health, gender, race and how they intersect. She holds three degrees in media studies and journalism from Wits University

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