• The total number of countries that include explicit supportive reference to harm reduction in national policy documents has increased by four, from 105 to 109. New countries are Cambodia, Malawi, St. Kitts and Nevis, and Togo.
• For the first time in 2023, Egypt has commenced implementation of opioid agonist therapy (OAT) programmes taking the global tally to 88 countries.
• One country (Ukraine) began implementing needle and syringe programmes (NSP) in prison. Armenia suspended its prison NSP programme, bringing the total number of countries implementing prison NSP in 2023 to 9.
• Colombia launched a new drug consumption room (DCR) in Bogota bringing the global tally of DCRs to 17.
• Two new countries, Colombia and Moldova, began peer distribution of naloxone.
• There were no reports of countries ceasing implementation of needle and syringe programmes (NSP), opioid agonist therapy (OAT), drug consumption rooms (DCRs), take-home and peer distribution of naloxone, or safer smoking kits distribution.
• In Canada, the United Kingdom and the United States, sharp increases in overdose deaths have been reported in recent years (a trend which has continued in 2023) with the rise in mortality rates due to the toxic drug supply (contaminated drugs, prescription opioids, heroin and fentanyl).

People who use drugs are adversely affected by HIV and viral hepatitis. To respond to this challenge, evidence-based harm reduction services must be adequately resourced. Punitive laws negatively impact the provision of services. Decreasing criminal penalties associated with drugs and making sure the rights of criminalised populations are preserved and protected would positively impact the availability of harm reduction services.

Health, justice and human rights continue to remain inaccessible for key and vulnerable populations. Stigma and discrimination continue to hamper equal access to healthcare for people who use drugs, and women face significantly higher levels of exclusion and barriers to treatment.

Harm reduction policies and programme coverage of services have expanded in some regions. Canada introduced legislative reforms to include support for the decriminalisation of drug use and possession in British Columbia in a 3-year pilot effective January 2023. In South Africa and the United States, harm reduction services, including interventions for viral hepatitis for people who use drugs, increased in 2023. In Australia, Colombia and Iceland, increased access to harm reduction services were reported.

In July 2023, The World Health Organization (WHO) updated the Consolidated guidelines on HIV, viral hepatitis and STI prevention, diagnosis, treatment, and care for key populations which outlines a public health response in five key population categories: men who have sex with men, sex workers, people in prisons and other closed settings, people who inject drugs, and trans and gender diverse people.

Importantly, this policy brief update covers parts of the guidelines specific to people in prisons and other closed settings.

The United Nations Office on Drugs and Crime (UNODC) launched a briefing on gender-based violence and women who use drugs at the International Network of Hepatitis in Substance Users (INHSU) Conference on 20 October 2023.

The Global Fund to Fight AIDS, Tuberculosis and Malaria (The Global Fund) published a harm reduction technical brief in 2022 which updated parameters for harm reduction funding within Grant Cycle 7 (2023-2025), including for hepatitis programming. It considered harm reduction as a ‘program essential’, allowed funding requests for programmes for people who use drugs and their sexual partners, rather than only people who inject drugs, increased the scope for stimulant harm reduction and hepatitis B and C treatment for people who inject drugs regardless of HIV status.

This year, UNITAID pledged USD 31 million investment in harm reduction to prevent hepatitis C amongst people who inject drugs and other at-risk populations.

In September 2023, the Report of the United Nations Office of the High Commissioner on Human Rights (OHCHR) outlined human rights challenges in addressing and countering current attitudes to drugs. It offered an overview of recent positive developments, advocating for a shift towards more human rights-centred drug policies with recommendations on the way forward. It highlights the lack of, and unequal access to, drug treatment and harm reduction services which result in nearly 600,000 drug-related deaths each year from viral hepatitis, HIV, overdose, and injuries. Other major issues of concern include: the failure of the war on drugs and current drug control measures, overincarceration and prison overcrowding, the use of the death penalty for drug offences and the disproportionate impact on groups such as Indigenous peoples, people of African descent, women, children, and young people.

In April 2023, the UN Human Rights Council concluded its 52nd Session, adopting for the third time a Resolution on the human rights implication of drug policy. The resolution, which now makes explicit supportive reference to harm reduction, reaffirms member states’ commitment to uphold human rights for all on the development and implementation of drug policies. It calls on member states to consider alternatives to incarceration, conviction and punishment.

In December 2022, advocates welcomed historic support for UN General Assembly Resolution on a moratorium on the use of the death penalty. In the same period, the Council of the European Union stated its support for a human rights-based approach to drug policies in its outcome document and encourages countries to “strongly oppose imposition of disproportionate and inhumane penalties for drug-related offences, such as the death penalty.”

In April 2023, Malaysia abolished the mandatory death penalty for all offences (including drug-related offences). Indonesia’s new criminal code, enacted in December 2022, which will come into force in January 2026, introduces a system of ‘probation’ for people on death row.

Research for this briefing was led by the Public Health and Social Policy team at Harm Reduction International. Temitope Salami was the project coordinator and research lead; Colleen Daniels provided project oversight.

Harm Reduction International acknowledges the contributions of the following: Wangari Kimemia, Maria Plotko, Carolina Ahumada and Jorgelina di lorio, Ernesto Cortes, Elie Aaraj, Sandra Hajal Hanna, Michala Kowalski, Kunal Naik and Robert Csak, Sam Shirley-Beavan, Andrew Scheibe, Simon W. Beddoe, Memory Mahaso, Daniel Rojas, Sandra Ka Hon Chu, Mat Southwell, Gillian Shorter, Mat Curtis, Christos Anastasiou, Zoe Boyer, Leo Deniau, Fadi Meroueh, Yolaan Andrews, Said Slim Parasan, Peter Krykant, Aura Roig, Alfonso Chavez, Jaime Arredondo Sanchez Lira, Rick Lines and Hassan Turaif.

Thanks also to the following colleagues for input and guidance: Naomi Burke-Shyne, Catherine Cook, Ajeng Larasati, Marcela Jofre, Gaj Gurung, Suchitra Rajagopalan, Anne Taiwo, Giada Girelli, Lucy O’Hare, Maddie O’Hare and Cinzia Brentari.

The Global State of Harm Reduction benefits from the generous support of the Robert Carr Fund for Civil Society Networks and the Open Society Foundations.

The information presented in the Global State of Harm Reduction 2023 Update has been gathered with the support of regional and national partners who provided quantitative and qualitative data updates. A desk review of the relevant literature was conducted scanning research papers and reports from relevant stakeholders including from harm reduction and drug policy colleagues, technical partners, civil society and networks of people who use drugs.

To report any inaccuracies, please contact us at office@hri.global.

Suggested citation: Harm Reduction International (2023) Global State of Harm Reduction: 2023 Update to Key Data. London: Harm Reduction International.