28 October 2025
At INHSU 2025 in Cape Town, Dr Frederick Altice of Yale University delivered a powerful, data-driven plenary on harm reduction in prisons, highlighting the global state of care in carceral settings and the urgent need to close the gap between evidence and implementation.
Drawing on global data and systematic reviews, Dr Altice showed that while the burden of drug use and infectious diseases remains disproportionately high among people in prisons, coverage of proven harm reduction interventions — such as opioid agonist therapy (OAT), syringe services programs (SSPs), and naloxone distribution — is still minimal.
Evidence from multiple meta-analyses confirms that OAT significantly reduces opioid use, injection risk behaviours, and all-cause mortality during and after incarceration, while SSPs reduce needle sharing and unsafe injecting. Yet only a small proportion of prisons globally provide these services — a striking disparity between what works and what’s delivered.
Dr Altice emphasised that the challenge is not a lack of evidence but a failure of implementation. But, as we are seeing throughout this conference, there is hope.
Drawing on examples from around the world, Dr Altice highlighted Moldova’s gradual rollout of OAT and SSPs as evidence that sustained commitment and system-level adaptation can deliver national-scale success. He also pointed to work in England and the United States expanding naloxone provision upon release, showing how practical implementation — from training and policy frameworks to distribution logistics — determines real-world impact.
Looking ahead, Dr Altice called for more resilient and sustainable models of harm reduction that can withstand shifting funding and political priorities. He emphasised the importance of community leadership, implementation science, and continuity of care, reminding delegates that harm reduction must begin the day a person enters prison and continue throughout incarceration and into community reintegration.
Quickfire Q&A
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What was the core message of your talk? Harm reduction is an evidence-based strategy to improve the health of people who use drugs. The challenge is that coverage, reach and quality of these programs restrict access, and what is needed is better implementation of these programs to sustain them
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Why is this urgent right now? Prisons are places where people who use drugs are concentrated due to the legal landscape and the failure of community systems to support health. Until the community landscape favours decarceration and decriminalisation, there is a need to provide equity in services – both in prison and the community
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What challenge are you trying to shift? I hope to shift to ways to better implement harm reduction in prisons – how we can do it faster, more affordably and better so that other settings will be more likely to adopt and sustain it
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What change do you hope to see in the next five years? Better implementation of harm reduction services to improve adoption and reach within prisons, and strategies to sustain them during the dangerous transition to the community
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What’s the one idea you want people to remember from your presentation? Harm reduction starts with the day that a person enters prison and should be sustained throughout their periods of incarceration, with strategies to sustain their access to these services as they transition to the community
