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Forget a Drug Free World, Time to Focus on Harm Reduction

Eighteen years ago, the United Nations General Assembly set an ambitious goal: To rid the world of illicit drugs within 10 years. It adopted the slogan: “A drug free world – We can do it!” We did not do it, of course. But some of the methods employed ostensibly to achieve a drug free world – such as criminalizing drug use – resulted in catastrophic health and human rights consequences in many countries. While the so-called ‘war on drugs’ was wreaking havoc in many countries, an alternative approach to drugs was slowly taking hold, one which saves lives, saves money, and respects the human rights of people who use drugs. This approach is called harm reduction.

The core premise of harm reduction is that the goal of a drug free world is an illusion; there will always be people who use drugs. Rather than jailing them, this approach seeks to reduce the impact of drug use on their health. This involves measures such as distributing sterile needles and syringes to prevent HIV transmission; teaching people who use drugs and their loved ones how to treat and reverse overdoses; and helping people with drug dependence enter into effective treatment.

My organization, Harm Reduction International (HRI), has tracked global data on harm reduction for 10 years. In 2014, we found some form of harm reduction programming, such as needle and syringe programs or opioid substitution therapy, in more than half the 158 countries with documented intravenous drug use. Countries which have implemented these services have seen important public health gains such as reductions in HIV rates and overdose deaths. Where such services aren’t provided, HIV rates and other costly health related harms among this vulnerable population have gone virtually unchecked.

But progress is frustratingly slow. To date, investments in harm reduction have been minimal in most countries: Just US$160 million in low- and middle-income countries, about 7 percent of the estimated need – peanuts compared to an estimated US$100 billion spent annually on drug control around the world.

recent report by HRI using statistical modelling suggests if just 7.5 percent of global drug control funding were to be redirected to harm reduction by 2020, there would be 94 percent fewer new HIV infections among people who inject drugs by 2030, and 93 percent fewer HIV-related deaths among people who inject drugs.

It is time for world leaders to leave behind the misguided approach of pursuing a drug free world. Instead they should commit to a Harm Reduction Decade and all but wipe out HIV/AIDS among people who inject drugs.

By Maria Phelan, deputy director at Harm Reduction International. 

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