Harm Reduction Scorecard

A look at drug strategies worldwide.

A fascinating study released earlier this year by the International Harm Reduction Association (IHRA) provides a snapshot of the staggering country-by-country variations in drug law and policy across the globe.

While Western Europe and North America have in place a solid base of operational heroin substitution therapies, such as methadone, these same Western countries have fallen behind in prison addiction programs, including all-important needle exchanges.

Countries lacking widespread access to heroin substitution programs include Russia, Afghanistan, Pakistan, Cambodia, and most of Latin America with the exception of Mexico. These are also, coincidentally or not, all regions of substantial opium cultivation.

As it turns out, every major nation except South Africa—where the ravages of HIV are all too evident--has put in place needle and syringe exchange programs of one scope or another, in at least one location in the country.

Interestingly, the IHRA report, titled “Harm Reduction Policy and Practice Wordwide,” finds that some of the countries with the most active needle exchange programs in prisons include Armenia, Kyrgyzstan, Romania—and Iran, which also offers heroin substitution therapy in prisons. Notable countries lacking widespread needle exchange programs in prisons include the United States, Latin America, and portions of Western Europe.

Finally, regarding the most radical category in the harm reduction arsenal—drug consumption rooms, also known as safe injection facilities—the world has been significantly slower to adopt this approach to the public consumption of injectable drugs. The document lists the existence of drug consumption rooms in Canada, Australia, Germany, Norway, the Netherlands, Spain, and Switzerland.

The report, prepared by Catherine Cook, a Research Analyst with IHRA, notes that the listings do not indicated “the scope, quality or coverage of services.” And while almost all countries have national policy documents that make reference to harm reduction policies for health or drug-related policy, strategies vary widely.

“Of particular interest here is the US,” the report notes, “which includes harm reduction in its national HIV and hepatitis C strategy documents, but not in those relating to drug policy.”


Graphic Credit: Bristol Drugs Project


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