People who inject drugs (PWID) have increased risk of preventable morbidity and premature mortality compared with the general population.1,2 It is recognised and recommended by multiple agencies (eg, WHO and the UN) that a comprehensive combination of harm reduction interventions is required to reduce drug-related harm among PWID, and in the population, by addressing personal and structural risks and risk environments.3 There is strong evidence that opioid agonist treatment (OAT) for opioid dependence is effective in reducing blood-borne virus transmission and mortality risk, and improving a wide range of other health outcomes.4–6 Needle and syringe exchange programmes (NSPs) have been shown to reduce HIV and potentially hepatitis C virus (HCV) transmission;5,6 other interventions that might reduce risky behaviour or improve structural factors include community distribution of naloxone, supervised consumption facilities, and drug checking services.7 Monitoring coverage of these and other interventions is crucial for service planning and setting appropriate public health policies in response to drugrelated harm.
In our updated series of systematic reviews, we have estimated that there are approximately 14·8 million (95% uncertainty interval [UI] 10·0–21·7) PWID globally, and that there was evidence of injecting in 190 countries.8 Our 2017 review concluded that OAT and NSP coverage was poor in most countries.9 Since publication, there have been disruptions to funding and capabilities of harm reduction and treatment services. For example, there is evidence of service closures, reduced operating hours, and reduced client capacity due to the COVID-19 pandemic.10 Also, broadening the focus of the previous.
