Harm Reduction

Harm Reduction: Current Challenges and Opportunities

The vision of Eurasian Harm Reduction Association (EHRA) is to recognize individual life choices and allow everyone to maintain their health along with the use of psychoactive substances. The foundation of harm reduction philosophy is the respect for the dignity of people, and services based on the needs of the individual, with regards to real life circumstances.

Harm reduction refers to a set of practices, programs and policies which aim to reduce the harms associated with the use of psychoactive drugs among people who use them. The focus of harm reduction programs is on the prevention of harm, rather than on the prevention of drug use itself. Harm reduction programs also provide access to various kinds of drug treatment – if such request comes from the client.

As stated in the WHO, UNODC and UNAIDS Technical Guide for countries to set targets for universal access to HIV prevention, treatment and care for injecting drug users, the implementation of a package of nine harm reduction interventions is essential to achieve progress in reducing HIV transmission and improving lives of people living with HIV (PLHIV):

  1. Needle and syringe programs (NSPs),

  2. Opioid substitution therapy (OST) and other evidence-based drug dependence treatment,

  3. HIV testing and counselling (HTC),

  4. Antiretroviral therapy (ART),

  5. Prevention and treatment of sexually transmitted infections (STIs),

  6. Condom programs for people who inject drugs and their sexual partners,

  7. Targeted information, education and communication for people who inject drugs and their sexual partners,

  8. Prevention, vaccination, diagnosis and treatment for viral hepatitis,

  9. Prevention, diagnosis and treatment of tuberculosis (TB).

In countries with widespread opioid use, naloxone should be provided as part of standard harm reduction package. Intranasal naloxone may soon become available on the European market, and civil society should approach their governments to make intranasal naloxone registered and purchased for further distribution among people who use drugs and their families.

EHRA strives to make harm reduction interventions become accessible to all people in need in the CEECA region and advocate for humane drug policies in each and every country.

The current development of harm reduction in the CEECA region is underpinned by several interrelated processes:

  • During the last decade there has been a continuous reduction of HIV-related funding. The national governments of CEECA countries still fail to allocate sufficient financial resources to scale up HIV and harm reduction programs. At present, the investments to HIV treatment and prevention are inconsistent with the burden of HIV among people who inject drugs in these countries.

  • Although harm reduction is becoming increasingly accepted in the global community, repressive drug policies remain firmly in place, undermining access for people who use drugs (PWUD) to life-saving programs. Repressive drug policies represent a key obstacle to health and well-being of individual drug users and communities.

  • There is a growing international body of evidence, guidelines, and mechanisms supporting a need to focus on human rights. With regard to harm reduction, it is crucial to collaborate with law enforcement agencies and judicial systems, establish dialogue with legal experts and organizations, and encourage them to provide legal support to people who use drugs. Systematic documentation of violations of human rights of people who use drugs, women in particular, is a necessary step in establishing partnerships with human rights organizations and joint advocacy on the national level.

  • In the current environment, the role of community of people who use drugs is becoming increasingly important and also driving harm reduction activities, advocating for justice and equal access to care at the local, national, and international levels. The community sees harm reduction not only as a health issue but as the main component of evidence-based and humane drug policies.

  • The absence of harm reduction in prison settings presents a significant challenge to all EECA countries. Knowing that a large number of the prison inmates are people who use drugs, absence or lack of harm reduction services (such as syringe programs and substitution therapy) is a significant problem when addressing the global targets for HIV and HCV.

  • During the last decade, there has been a growing concern about new psychoactive substances (NPS). The current situation with NPS has become truly alarming in EECA and presents one of the major challenges to the national public health systems, local NGOs, communities and people who use drugs.