Harm Reduction Interventions for People who Inject Drugs

Injecting is a high-risk method of drug use due to the possibility of transmission of blood-borne diseases, such as HIV and viral hepatitis, when contaminated injecting equipment are used. There are an estimated 14·8 million people aged 15–64 years who inject drugs (PWID) globally. About 2·3 million PWID live with HIV, while 5·8 million live with hepatitis C (HCV). Injecting drug use accounts for an estimated 9% of new HIV infections, and 23% of new HCV infections globally. In addition to HIV and HCV transmission, injecting drug use is also associated with the risk of other health harms, including fatal and non-fatal overdose, vein damage, and bacterial infections.

There are a range of evidence-based interventions for reducing harms and preventing disease transmission among PWID, which have been recommended for implementation by the World Health Organization (WHO) in all settings where injecting drug use is known to occur. These include needle and syringe programmes, opioid agonist therapy, and take-home naloxone. Other interventions, such as safe consumption facilities and drug checking services are also known to be effective in reducing health and social harms linked to drug use. WHO (along with UNAIDS and UNODC) have set target indicators for coverage of harm reduction services for PWID. Estimating the coverage of services based on these target indicators could inform planning and resource management.

Researchers performed a global systematic review of peer-reviewed and grey literature to examine the prevalence of injecting drug use; the sociodemographic characteristics of people who inject drugs; patterns of drug use among people who inject drugs, both injecting and via other routes; engagement in various risk behaviours; exposure to physical and structural risk environments, including homelessness, arrest, incarceration, and sex work; and current blood-borne virus and other health harms, including non-fatal overdose, injection-related diseases, and mental health problems among people who inject drugs.

The full systematic review, published in The Lancet Global Health, can be accessed here.

An accompanying comment can be accessed here.