European Harm Reduction Is Facing a Funding Crisis

Harm reduction has long been a cornerstone of European public health, minimising drug use risks like overdose deaths or preventing the spread of infectious diseases. These interventions have been instrumental in improving the health and wellbeing of people who use drugs (PWUD).

However, in the last few years, the financial sustainability of many harm reduction initiatives has been under serious threat. A growing funding crisis, driven by shifting political priorities and a fragmented approach to drug policy within the European Union (EU), is threatening to dismantle decades of progress.

The current funding challenge

This shifting landscape in harm reduction funding has hit at a critical time. Europe is facing an increasingly complex drug landscape, with hundreds of novel psychoactive substances (NPS) and synthetic opioids increasingly circulating in drug markets.

Speaking to TalkingDrugs, Alexei Lakhov, Executive Director of the European Network for People Who Use Drugs (EuroNPUD) highlighted that “this complexity often increases the demand for specialised harm reduction services”, further straining service providers.

European harm reduction has historically been financed through national health funds, international aid and EU-wide grants. Yet, a 2024 report from Harm Reduction International (HRI) into harm reduction funding has underscored how national and international donors have scaled back many of their financial commitments to harm reduction. European countries, particularly those classified as high or upper-middle income, are no longer eligible for key international funding sources such as the Global Fund to Fight AIDS. While understandable, this shift has left critical harm reduction programmes struggling with severe budget shortfalls.

Political shifts toward right-leaning governments across Europe have further amplified this crisis, as policymakers shift their focus to drug-related security concerns and supply side interventions over harm reduction. While the EU’s official drug strategy continues to support harm reduction, national concerns around drug-related insecurity have prioritised law enforcement-based approaches, leaving many harm reduction services with reduced resources.

Critical dependence on public funding

The Netherlands, a pioneer of European harm reduction since the 1970s, is one of the many countries facing funding cuts that threaten its services’ stability. For over 35 years, Mainline has played a key role in conducting research on harm reduction and providing updated information on drug trends and alerts to PWUD across the Netherlands through their magazine. Now, however, they are facing serious cuts.

“Harm reduction in the Netherlands has a very interesting history because a lot of the civil society initiatives were actually integrated into the city healthcare system. This had a lot of advantages because you could scale up and you could have quality controls” Machteld Busz, Managing Director of Mainline, explained to TalkingDrugs.

“But you also now have a civil society that’s fully dependent on funding streams from the government,” Busz added.

The consequences of this public sector reliance are clear. While a significant portion of Mainline’s funding for example has come from the Dutch Ministry of Health over the past three decades, this will come to an end. In October 2024, Mainline was abruptly informed that its government subsidy would be phased out between 2026 and 2028. While not directly fatal, these cuts threaten long-term sustainability and may in the short-term mean Mainline will have to scale back operations or reduce staff. The Dutch Trimbos Institute is facing serious budget cuts from national budgets as well. Local harm reduction services depend in similar ways on (local) government funding and many have seen reductions in their budgets in recent years. Locally, many services have disappeared or scaled down.

While officially attributed to budget cuts, this decision reflects a broader political and ideological shift. More and more, politicians see harm reduction as “woke or lefty” activism, says Busz; the state is, instead, increasingly prioritising law enforcement and drug market suppression over harm reduction. Rising drug market violence across Dutch cities has shifted the narrative on what drug harms to reduce. The focus is no longer on reducing drug-related health harms, but to combat organised crime.

Frustratingly, policymakers have also been resistant to economic arguments for maintaining harm reduction programmes, despite clear evidence of their cost-effectiveness compared to police-led and market-focused interventions.

“We can prove quite easily how expensive it is to have all this police force out and about all day long to intervene in crisis situations where there’s drugs involved, while both PWUD and society would benefit much more when shelter or services are being offered. And if you look at what that would cost to properly support someone, it’s much, much cheaper than leaving that in the hands of the police”, Busz said.

The State Secretary of Health, Vincent Karremans, reasons that funding for organisations like Mainline should become a local responsibility, with municipalities’ expected to pick up the bill. This is wishful thinking, seeing Mainline has an explicitly national oversight function and cities across the Netherlands face serious budget cuts in 2026. A once coordinated, evidence-based system now risks becoming a fragmented, underfunded, patchwork.

“Harm reduction should be phrased as a proper human right,” Busz said. “Harm reduction should be a baseline for everyone”.

Historical reliance on public sector funding has also meant that the Dutch harm reduction sector has not maintained high levels of grassroots organising and community mobilisation. As a result, civil society organisations need to develop their organising and mobilisation practices, while also scrambling for funding. As Busz put it, “it’s very difficult to focus on solidarity when you’re trying to survive yourself – our voices are very weak”.

Harm reduction forgotten by EU policy

These cutbacks on harm reduction funding and changes in political support are not unique to the Netherlands, but rather a reflection of a broader trend across Europe and at EU level. With the continent increasingly concerned with the security of its borders, harm reduction and public health approaches to drugs risk being sidelined for more security-led policies. While this is a common issue for many civil society spaces, the fact that harm reduction is not recognised as a priority in any EU-level funding programmes means that its future is always dependent on current political will rather than simply being seen as an essential public service.

Katrin Schiffer, Director of Correlation – European Harm Reduction Network (C-EHRN), explained to TalkingDrugs, “We feel that the [European] Commission is not taking the responsibility to make drugs or drug substance use a priority. The point is that drug use is nowhere mentioned as a priority, not in the Citizens Equality, Values and Rights Program, not in the program for the European Social Fund”.

The lack of dedicated funding avenues for harm reduction leaves these essential services chronically under-funded. “There is currently no funding mechanism for drug demand and harm reduction. And there is no program where drugs is mentioned as one of the areas of priority. This is problematic because, in principle, this means that civil society organisations are not able to implement anything which is also mentioned in the drug strategy,” Schiffer added.

The funding that has been stable within the field of drugs, however, has been in combating drug-related crime. The newly reconfigured European Union Drugs Agency (EUDA) has now added security to its mandate; recent European grant proposals have also prioritised security interventions over harm reduction, as seen with the Internal Security Fund. There are no equivalent EU funds for harm reduction; drug-related programmes are only seen through a criminal lens, rather than one focused on the rights of access to health and dignity by PWUD.

Faced with growing financial uncertainty, civil society organisations are calling for governments to protect harm reduction interventions through legislation.

“Governments should explicitly legalise and regulate interventions such as needle exchange, drug consumption rooms, and drug checking services. In many countries these operate in a legal grey area or under temporary pilots,” said Lakhov.

“The overarching goal of these legislative policy changes is to create an environment where harm reduction is not hindered by law, but rather promoted and protected by it,” he added.

“By removing punitive laws, adding enabling ones, and embedding harm reduction into the fabric of public policy, Europe can ensure that harm reduction not only survives but thrives, regardless of changing political winds”.

Governments must also recognise the critical role that civil society organisations play in supporting people on the ground, especially vulnerable populations. Without such institutional backing, the future of European harm reduction will remain fragile, over-reliant on civil society, and vulnerable to political change.

The future of harm reduction in Europe

Europe’s commitment to harm reduction has historically been strong, but the current funding crisis places essential services as well as the health and rights of PWUD under threat. As political landscapes shift and funding priorities evolve, advocacy efforts must intensify to ensure harm reduction remains a non-negotiable aspect of public health policy. By securing sustainable financing, fostering community-led initiatives, and implementing legislative protections, Europe can reaffirm its leadership in harm reduction and protect the health and rights of PWUD.

The defunding of harm reduction in Europe is not just a financial issue – it’s a public health emergency, adding fuel to the already deadly fire of diverse adulterants and potency synthetic opioids contaminating multiple European drug markets.

While sustained investment is key, ensuring that harm reduction is supported at a grassroots level will help legitimise its importance at a national and European level. Governments must recognise that harm reduction isn’t an optional policy – it’s an essential strategy that saves lives, reduces long-term healthcare costs, and upholds basic human rights.

By Noor Vissram

Source: TalkingDrugs