FDS Insight Magazine Nov - Dec 2022

13 also increased. Changes in definitions and research strategies make year-on- year comparisons difficult, but the Global State of Harm Reduction 2022 finds there are 35 countries where take- home naloxone is available, and 21 countries operating peer-distribution naloxone programmes. However, these programmes are often on a very small scale and highly vulnerable to regulatory or funding changes, especially those in low- and middle- income countries such as Iran, Kenya and South Africa. The overall increase in the commitment to and implementation of harm reduction is a testament to the dedication, resilience and strength of community, civil society and international organisations, which have successfully advocated for a health and human-rights based approach to drug use despite extremely limited resources. Unequal resources, unequal progress Nevertheless, the harm reduction movement cannot be complacent. The coverage and scale of harm reduction is still limited, and great inequalities remain within and between regions and countries in terms of access. While the vast majority of countries in Eurasia, North America and Western Europe implement both NSP and OAT, these programmes are more absent than they are present in all regions of Africa, Latin America and the Caribbean, and the Middle East. Only North America, Oceania, Western Europe, and Mexico have officially sanctioned DCRs, and even in these countries support may be from local or state government rather than the national level. Even in countries where harm reduction programmes are implemented, availability, accessibility and quality remain significant issues. Services are unevenly distributed in most countries. People living in rural areas or outside capital cities, for example, are often poorly served. Harm reduction in prisons has seen little expansion since 2020. Still, only 9 countries operate NSPs in prisons: Armenia, Canada, Germany, Kyrgyzstan, Luxembourg, Moldova, Spain, Switzerland and Tajikistan. Canada has the world’s only prison based DCR. The number of countries providing OAT in prisons is unchanged at 59. While OAT programmes are now operating in prisons in Kosovo, Macau, and Tanzania, this is balanced by new data indicating that prisons in Georgia, Hungary and Jordan only offer opioid agonists for detoxification. Harm reduction in times of crisis Since 2020, the world has experienced several acute crises which have tested the resilience of harm reduction services. The COVID-19 pandemic has continued to have a dramatic impact on harm reduction and public health. Many services were forced to close or reduce their operations during the worst of the pandemic, while lockdown orders and emergency powers resulted