Harm reduction for opioid injectors

Historically, harm reduction strategies were initiated to address the risks of contracting infectious diseases (namely HIV) among injecting drug users. The majority of evidence-supported interventions still address this target group.

What works?

  • Infections caused by HIV and Hepatitis C among people who inject opioids can be prevented with opioid substitution treatment and the provision of clean needles and syringes
  • People have less risky behaviours when they are in opioid substitution treatment, i.e. they inject less, and even when they continue to inject drugs they take less risks when participating in services such as a needle and syringe programmes, outreach and education programmes and/or injecting in drug consumption rooms
  • Death among drug users is reduced by keeping them in opioid substitution treatment.
  • Hepatitis C treatment is effective in active drug users and opioid substitution treatment is not a contraindication to the treatment
  • There is some evidence that education and training interventions with take-home naloxone provision decrease overdose-related deaths
  • Intranasal administration of naloxone appears to be effective in treatment of opioid overdose when naloxone injection is not possible
  • There is also some evidence that safer environment interventions (i.e. syringe exchange programmes, peer-based interventions and drug consumption rooms) help to reach, stay in contact with and foster safer environments for highly marginalised target populations
  • Pre-exposure prophylaxis (PreP) of HIV in adults at high risk is effective in reducing HIV acquisition in high-risk people who are HIV-negative. However, issues relating to uptake, adherence, sexual behaviour, drug resistance, prioritisation for prophylaxis and cost-effectiveness are also important to consider, especially at a population level.

What's unclear?

  • Is not clear if being in opioid substitution treatment can help patients adhere better to Hepatitis C treatment or achieve better results
  • It is also unclear whether drug consumption rooms can reduce HIV and Hepatitis C infections

What doesn't work?

  • We are not aware of interventions for injecting opioid users that cause harm

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