North America - Regional Overview

Canada and the United States are home to more than one-tenth of all people who inject drugs worldwide. Both countries have key harm reduction programmes in place and support harm reduction in some aspects of national policy. However, in both countries, service provision is inconsistent and influenced by local law and policies – which in many cases have historically favoured drug law enforcement and abstinence-only approaches to drugs.

In 2009, the Obama Administration in the US lifted the 21 year ban on federal funding for needle and syringe programmes. However, NSP and OST provision in the US remains geographically inconsistent. In Canada, a law enforcement approach to illicit drugs has predominated since 2008 at the expense of evidence-based health policy. Recent developments include the introduction of mandatory minimum sentencing for drug offences and continued legal challenges to Insite, the region’s only safer injecting facility, by the federal government.

In both countries, it is ethnic minorities and indigenous populations that are particularly affected both by drug related harms such as HIV and hepatitis C, as well as punitive drug law enforcement. The US has the largest prison population in the world – largely due to the mandatory minimum sentencing for drug offences. The overwhelming majority of those incarcerated on drug related offences in the US are African-American or Hispanic. Neither the US nor Canada has implemented a comprehensive harm reduction response in prison settings, where NSP remains unavailable in both countries. Most Canadian prisons do provide opioid substitution therapy, but it is rarely accessible for prisoners in the US.

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