In 2023 an estimated 316 million people used drugs, of whom 14 million injected drugs in the past year.  The risk of acquiring HIV is 34 time higher for people who use drugs than for the general population. They also face increased risk of contracting tuberculosis (TB), and viral hepatitis B and C (HBV and HCV), in addition to overdose and other health complications. The global HIV prevalence among people who inject drugs is 5.0%, compared to 0.7% among the total global adult population. Unsafe drug injection drives an estimated 43.6% of the new HCV infections globally, and the prevalence of current HCV infection among people who inject drugs is 38.8%, approximately 5.8 million people.  

Harm reduction is a cost-effective and evidence-based approach endorsed by the whole UN system7 and recognised as an essential element of the right to health for people who use drugs, including for those deprived of liberty, requiring States to ensure availability, accessibility, acceptability and quality of harm reduction services. The World Health Organization (WHO) has recognised methadone and buprenorphine, as well as naloxone10, as essential medicines, reflecting their proven effectiveness in reducing overdose, HIV and hepatitis transmission, and other negative consequences that might arise from drug use.

However, people who use drug continue to have limited access to those essential medicines and harm reduction services. As of 2025, injecting drug use has been documented in 190 countries, however, only 93 countries provide at least one Needle and Syringe Programme (NSP) and 95 countries provide at least one Opioid Agonist Therapy programme (OAT). At least one drug consumption room (DCR) is present in 19 countries and take-home naloxone programmes are available in 34 countries. Despite some progress in recent years, stimulant prescription or substitution treatment remains limited, with only 6 countries reporting availability, however, most of them are pilot programmes or off-label prescription of already available medications (typically obesity and ADHD medication).  

Availability does not guarantee access to timely, quality and voluntarily harm reduction services. Coverage of harm reduction services remain uneven across regions. Only Oceania (Australia and Aotearoa New Zealand) has high NSPs coverage. Central Asia and Western Europe have moderate coverage, while NSP coverage is low in all other regions. In the case of OAT provision, it is reported to be particularly low in Central Asia, Eastern Europe, Eastern and South Africa and West and Central Africa, where fewer than 2% of people who inject drugs have access to services.    

Stigma and criminalisation of people who use drugs hinder access to harm reduction services and undermine the political and financial support needed to implement and expand services. At least 153 countries criminalise drug use and possession14, and 36 countries retain the death penalty for drug offences. Punitive approaches to drug use have been shown to be ineffective at reducing drug use while worsening health outcomes by limiting the provision of and access to life-saving harm reduction services. Criminalisation is associated with higher HIV and HCV prevalence among people who inject drugs, lower syringe distribution, and increased sharing injecting equipment. 

Some people who use drugs face multiple, intersecting vulnerabilities, which further impede access to harm reduction services, including women, LGBTQI+ people, migrants, Indigenous people and people deprived of liberty. Women are significantly less likely to access harm reduction services and other treatments due to the lack of gender-sensitive interventions, heightened stigma and discrimination, restrictive social roles and expectations, and fear of losing custody of their children. Young people also face significant barriers, including age restrictions and services not adapted to their needs. Evidence also shows that drug-related harm rates are disproportionately high for Indigenous People. For instance, opioid overdose deaths are seven times higher for Kainai peoples in Alberta, Canada than for the general population.

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. Consider the responsible regulation of internationally controlled substances to ensure better access to essential medicines and reduce harms associated with a toxic drug supply18; 
3. Recognise harm reduction as an essential element of the right to health and ensure availability, accessibility, acceptability and quality of comprehensive harm reduction services, including naloxone, including in prison and other closed settings;
4. Ensure that harm reduction services are tailored to the diverse needs of people who use drugs, including youth, women, LGBTQI+ people, migrants, ethnic minorities and Indigenous Peoples;
5. Remove legal, policy and administrative barriers that prevent access to harm reduction services and essential medicines for people who use drugs, including youth, women, migrants, ethnic minorities and Indigenous population;
6. End coercive, compulsory and discriminatory drug treatment practices and ensure all services are voluntary, evidence-based and grounded in informed consent;
7. Collect and publish disaggregated data on access to, and availability of, harm reduction services, essential medicines, overdose, HIV and hepatitis outcomes and public expenditure related to drug policy and health responses;
8. Ensure the meaningful participation of people who use drugs and other affected communities in the design, implementation and evaluation of laws, policies and programmes affecting them.