Community perspective on access to harm reduction 

At the Lisbon Addiction Conference, Judy Chang was part of the Hepatitis C prevention and treatment among people who inject drugs: Global progress and future requirements discussion. She focused on Community perspective on access to harm reduction.  

• The design of harm reduction services must be evidence based and informed by the lives and needs of people who use drugs.  
• They should prioritise HIV and viral hepatitis interventions.  
• Very few countries provide harm reduction services, and when available it is fragmented and poorly funded.  
• There are instances where hard reduction is used as a form of social control and a coercive tool to get people who use drugs towards abstinence.  
• People who use drugs must be involved in the design and implementation of harm reduction services.  

A comprehensive design of harm reduction services should ensure that people who use drugs can do so safely with their human rights and integrity intact. The availability of harm reduction services globally is quite dismal; 87 countries implement needle and syringe programmes, 86 countries implement opiate agonist therapy programmes and 16 countries have peer-distributed naloxone available to prevent overdose deaths. The exclusion of people who use drugs from the design process can lead to inappropriate services which discourage people from accessing them.  

There are instances where harm reduction services are used as a form of social control to divert people who use drugs towards treatment and abstinence. The control measures put in place for people who use drugs to access drug paraphernalia and substitution medication, where they can consume their drugs, supervised consumption, compulsory medical appointments, and testing are unnecessary obstacles to the availability of harm reduction services.  

Participatory and person-centred care with active involvement of people who use drugs, will expand the services beyond reducing harm. These services will include the choice to consume drugs for better living, with the needs of the person informing the clinical decisions.  

Recommendations for focused, tailored, and prioritised services   

• Normative and technical guidance that has had mechanisms for community input i.e., WHO Consolidated Guidelines on Key Populations, UNODC & WHO OAT (Opioid Agonist Therapies) Operational Tool   
• Meaningful involvement of people who use drugs in priority-setting, design, and implementation of service interventions   
• Avoid ‘expert knows best’ approach to interventions, e.g., Suboxone and long-term use without consultation. User concerns matter more than policy and prescriber concerns, as prioritising latter is what makes care coercive and ineffective