Drug-related offences remain a major driver of incarceration, accounting for 22% of total global prison population. Of those incarcerated for drug offences, 19% are sentenced for possession for personal use. Overall, more people come into contact with the criminal justice system for drug use and possession than for trafficking, however, those accused of trafficking are more likely to be prosecuted and convicted.

The burden of incarceration falls disproportionately on marginalised groups, particularly women. Globally, one in three women are incarcerated for drug offences, rising to 60-80% in some Latin American and Asian countries. A large share of them are in pre-trial detention. In countries such as Bolivia, Panama, Paraguay and Uruguay, the number of women in pre-trial detention exceeds those serving sentences, with drug policies identified as a key contributing factor.

Drug use prevalence is significantly higher in prisons than in the community. This is compounded by poor detention conditions, high-risk behaviours and worse overall health status of people deprived of liberty, that result in heightened risk of acquiring HIV and other infectious diseases. Latest UNAIDS’s data indicates that HIV infections are almost double that of the general population. Over 15% of people in prisons globally are living with hepatitis C virus (HCV) and 5% with chronic hepatitis B.

Despite States’ obligations to protect the right to health of people deprived of liberty and the severe health risks that close settings pose, these individuals remain severely underserved. As of 2025, 61 countries have implemented OAT services in at least one prison (compared to 95 in the community), whereas 11 have NSPs in at least one prison (compared to 93 in the community). Naloxone on release is available in at least one prison in 11 countries mostly in Europe, North America, and one scheme in Oceania (Australia). Only one country (Canada) has implemented at least one drug consumption room in prison. There is no global data on harm reduction services in other places of detention.

Even when services are available, people in prison face many barriers to access services. Harm reduction services in prison are unevenly distributed across countries and regions: Apart from Canada and Iran, all identified NSPs in prisons are in Eurasia and Western Europe. The availability of OAT also varies widely between regions, with most of the services concentrated in Western Europe and Eurasia. In Asia, only five countries provide OAT, while only Puerto Rico provides OAT in prison in Latin America and the Caribbean. No country in West and Central Africa provide OAT in prison, other than Nigeria.

According to HRI’s data, even where services exist, access is undermined by fear of punishment for drug use and possession and loss of rights. In Romania, people that initiate drug treatment in prison are reportedly declared unfit to work, losing their income and access to meaningful activities. In Indonesia, research found people participating in OAT programmes in prison are perceived by both prison staff and peers as engaged in illicit drug use and described in a stigmatising way as “lazy, poor, dirty, unproductive and are presumed to have HIV”. In England and Scotland, people who disclose drug use upon admission are reported to receive health care, while those who disclose drug use later are met primarily with punitive responses and often suspected of selling drugs. Lack of confidentiality and anonymity are also significant factors that hinder people from accessing harm reduction services

Women and gender-diverse people face compounding barriers due to the lack of tailored services to their needs. In Georgia, women requiring OAT13 are temporally transferred to a male facility where they share a psychiatric ward with men population, resulting in low uptake among female population. In Moldova the country’s only therapeutic community in prison is in a male facility. Similarly, in Ireland, the two prisons that have consultant-led in-reach drug dependence services only accommodate men. In Eastern and Southern Africa, civil society organisations have documented extensive barriers for women who use drugs seeking HIV testing and treatment in prison, including humiliating and punitive treatment by prison staff.

We encourage the OHCHR to recommend Member States to:

1. Decriminalise drug use and apply evidence-based and human rights-centred responses to drug use to reduce incarceration rates and promote the right to health;
2. Recognise harm reduction as an essential element of the right to health and incorporate it into prison and other closed settings health programmes and policies;
3. Guarantee equitable access to harm reduction and essential medicines for all people deprived of liberty;
4. Ensure that harm reduction services are tailored to the diverse needs and experience of people deprived of liberty, including women, LGBTQI+ people and migrants;
5. Eliminate all legal and policy barriers and stigmatising and discriminatory practices that limit the access to essential medicines and treatment for people deprived of liberty;
6. Maintain disaggregated data about distribution of harm reduction and essential medicines in prisons and all other places of detention.