This briefing compiles geographically diverse evidence to enable advocates to make the case for the cost-effectiveness of harm reduction.

HIV continues to rise among people who inject drugs, yet harm reduction funding is in crisis. Financial support for an effective HIV response for people who inject drugs in low- and middle-income countries totalled US$151 million in 2022 – just 6% of the US$2.7 billion that is needed annually by 2025.

Compelling evidence from across the world shows that harm reduction interventions are cost-effective and can be cost-saving in the long-term. Advocates now need to make the investment case for harm reduction to donors and governments.

1. Needle and syringe programmes are one of the most cost-effective public health interventions in existence: In Scotland, researchers estimated long-term cost-savings of up to 250% of the original investment.

2. Opioid agonist therapy is cost-effective for individuals and society: A study in Vietnam found voluntary community-based methadone maintenance therapy was more cost-effective than centre-based compulsory rehabilitation, saving an estimated
US$2,545 per person over three years.

3. Combined harm reduction services are significantly more cost-effective than isolated services: In Mexico, a study found NSP and harm reduction education prevented  869 HIV infections between 2015 – 2018, saving over MXN$600,000 (around US$40,000) per infection averted.

4. The peer distribution of naloxone is highly cost-effective: One study from the United States found high distribution of naloxone among peers was cost-effective and prevented 21% more overdose deaths compared with minimum distribution.

5. Drug consumption rooms (DCRs) provide a high return on investment: In 2019, a study in Seattle, in the United States estimated that establishing a DCR would save US$4.22 in associated healthcare costs for every dollar spent on operational costs.

6. Inaction, reducing funds or closing services have negative economic consequences: When the Global Fund to Fight AIDS, Tuberculosis and
Malaria ended grants in Romania and Serbia, programmes were closed and a spike in infections followed.

7. The economic cost of punitive drug policies: A study from Indonesia found that decriminalising personal possession of small amounts of drugs would reduce the spending on prisons and other closed by 40%.