The diffusion of harm reduction in Europe and beyond

This chapter traces the diffusion of harm reduction in Europe and around the world. The term ‘harm reduction’ became prominent in the mid-1980s as a response to newly discovered HIV epidemics amongst people who inject drugs in some cities. At this time, many European cities played a key role in the development of innovative interventions such as needle and syringe programmes. The harm reduction approach increased in global coverage and acceptance throughout the 1990s and became an integral part of drug policy guidance from the European Union at the turn of the century. By 2009, some 31 European countries supported harm reduction in policy or practice — all of which provided needle and syringe programmes and opioid substitution therapy. Six countries also provided prison needle and syringe programmes, 23 provided opioid substitution therapy in prisons, and all but two of the drug consumption rooms in the world were in Europe. However, models and coverage vary across the European region. Harm reduction is now an official policy of the United Nations, and Europe has played a key role in this development and continues to be a strong voice for harm reduction at the international level.