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Please note that the information on this page is based on the EMCDDA Annual report 2011: the state of the drugs problem in Europe. Most statistical data relate to the year 2009 (or the last year available).


Annual report 2011: the state of the drugs problem in Europe
Responding to drug problems — an overview

Published: 15 November 2011

Harm reduction

The prevention and reduction of drug-related harm is a public health objective in all EU Member States and in the EU drugs strategy (1). Reviews of the scientific evidence of harm-reduction interventions, as well as studies showing the combined impact of these interventions, are now available for service planning (EMCDDA, 2010) (2).

Among the main interventions in this field are opioid substitution treatment and needle and syringe programmes, which target overdose deaths and the spread of infectious diseases. Substitution treatment is reported to be available in all countries, and needle and syringe programmes exist in all countries except Turkey. In the past two decades, Europe has seen the growth and consolidation of harm reduction, and its integration with a range of other health care and social services. From an initial focus in the late 1980s on the HIV/AIDS epidemic, harm reduction has expanded into the broader perspective of catering for the health and social needs of problem drug users, especially those who are socially excluded.

In 2009, the number of clients accessing substitution treatment increased in a majority of countries (3). In addition, increases in the use of low-threshold harm-reduction facilities were reported in Bulgaria, the Czech Republic, Greece, Hungary, Latvia, Lithuania, Luxembourg, Poland, Romania and Croatia; and there was a geographical expansion of needle and syringe programmes in Hungary.

Most European countries provide a range of further health care and social services, including individual risk assessment and advice, targeted information and safer-use education. The distribution of injecting equipment other than needles and syringes, promotion of condom use among injecting drug users, infectious disease testing and counselling, antiretroviral treatment, and vaccination against viral hepatitis have increased in recent years. Model projections suggest that delivering interventions with the greatest potential effect (needle and syringe programmes, substitution treatment and antiretroviral treatment) to a significant proportion of the target population and over an extended time, reduces HIV transmission among injecting drug users; they also suggest that the greatest effects are achieved when levels of infection are still low (Degenhardt et al., 2010).

A multidisciplinary investigation of the evidence base for harm-reduction interventions to reduce the risk of infections among drug users was carried out in 2010 by the French National Institute for Health and Medical Research (Inserm). The study reviewed the scientific literature covering the medical, epidemiological, sociological, economic and public health aspects of harm reduction, and organised expert hearings and public debates. The 'Collective expert report' recommends that harm-reduction policies should be considered as an essential part of a broader strategy to reduce health inequalities. Furthermore, services need to be integrated with other drugs services as part of a continuum of care. While the priority remains that both drug use and the transition into injecting use should be prevented, those who inject drugs should be enabled to reduce injecting-related risks. The report recommends that, as with medical and social interventions, harm-reduction measures should be part of personalised assistance plans.


(1) COM (2007) 199 final.

(2) See also the Best practice portal.

(3) See Table HSR-3 in the 2011 statistical bulletin and Chapter 6.

Bibliographic references

EMCDDA (2010), Harm reduction: evidence, impacts and challenges, Monograph, Publications Office of the European Union, Luxembourg.

Degenhardt, L., Mathers, B., Vickerman, P., Rhodes, T., Latkin, C. and Hickman, M. (2010), 'Prevention of HIV infection for people who inject drugs: why individual, structural, and combination approaches are needed', Lancet 376, pp. 285-301.

About the EMCDDA

The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) is the reference point on drugs and drug addiction information in Europe. Inaugurated in Lisbon in 1995, it is one of the EU's decentralised agencies. Read more >>

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Page last updated: Friday, 28 October 2011