Evidence for harm reduction

Many countries were hesitant to endorse needle exchange as a policy, as there was public outcry that it was a way to encourage drug-injecting populations. The policy was, on the other hand, supported by the scientific world, as the evidence for managing HIV among IDUs through harm reduction practices was strong. This led to a "decriminalised" approach in some countries such as the USA, where it is tolerated, but not funded under federal programs.

Evidence also shows that drug policies that have been poorly rationalised have a significant impact on HIV and hepatitis epidemics on a national and regional scale. One study has shown the dramatic increase in illicit heroin use following the enactment of anti-opium laws in Hong Kong, Laos and Vietnam. India is also an interesting case study, where injecting drug use increased following the enactment of the Narcotic Drugs and Psychotropic Substances Act. This led to the increased reversion to pharmaceuticals, which are often produced illegally, and are largely responsible for injecting epidemics in Bangladesh and Nepal. Bangladesh is facing an increase in HIV prevalence in its injecting population and Nepal is facing a severe HIV epidemic among its injecting populations, with prevalence as high as 74 per cent among IDUs in the Katmandu valley.

Harm Reduction is also being adopted in countries that are witnessing cocaine-injecting epidemics, such as Brazil and Argentina. The crisis faced in these countries is that cocaine injectors tend to inject many more times per day than heroin users, and that "substitution" therapies are not available for them.