The Global Coverage of Interventions to Prevent and Manage Drug-Related Harms Among People Who Inject Drugs: A Multi-Stage Systematic Review of the Evidence

Author: Samantha Colledge-Frisby Louisa Degenhardt

Theme: Epidemiology & Public Health Research Year: 2022

In 2017, it was estimated that there were 16 opioid agonist treatment (OAT) recipients for every 100
people who inject drugs (PWID), and that each person was being distributed approximately 33
needles per annum1. Since this review was published, there have been efforts to improve on
coverage of OAT and needle-syringe exchange programs (NSPs) and shifts in the availability of other
services that prevent overdose, including take-home naloxone (THN) programs, supervised injection
facilities (SIFs), and drug checking services (DCS).
We updated findings from the previous review employing searches of the peer-reviewed and grey
literature as well as consultation with international experts. Searches were restricted to papers
published after 2017. We summarized the global availability and coverage of OAT, NSP, SIF, THN and
An additional 124 papers were identified. From 189 countries with evidence of injecting drug use,
evidence of OAT and NSP was found in 89 and 91 countries, respectively. There were estimates of
OAT clients and needles distributed from 81 and 84 countries (an increase from 68 and 75 in the
previous review). Globally, it was estimated that there were 18 (12-27) OAT clients per 100 PWID
(total clients=2,662,974) and 35 (24-52) needle-syringes distributed per PWID (total
needles=518,438,236). The estimated proportion of PWID serviced by high level OAT and NSP
coverage increased between reviews, while the proportion not covered by any level of service
decreased. We identified availability of THN programs, SIFs, and DCS in 40, 15, and 19 countries,
Although some of the changes observed between reviews reflect changes in coverage, they also
reflect changes in population prevalence estimates and availability of programmatic data. There
have been some improvements in coverage of harm reduction interventions in certain countries;
however, this does not correspond to major increases in coverage at the global level.
Disclosure of Interest Statement: None to declare.

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