North America - Harm Reduction Programmes

Key harm reduction interventions – including needle and syringe programmes (NSP) and opioid substitution therapy (OST) – are available in both the US and Canada, as illustrated in the maps and table below. In addition, Canada has a highly successful safer injecting facility. However, huge areas of both countries remain uncovered by NSP and OST programmes. In addition, strict drug law enforcement acts as a deterrent from accessing services for many people, whilst also increasing the region’s prison population.

The US has the largest prison population in the world – in large part 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 prisons. Needle and syringe programmes for prisoners remain unavailable in both countries. Most Canadian prisons provide opioid substitution therapy but it remains rarely accessible for prisoners in the US.

The following table indicates which countries have a) one or more needle and syringe exchange sites operational both in and outside prisons, b) prescription of opioid substitution therapy for maintenance in and outside of prisons c) one or more drug consumption rooms in countries of the region.

A Y in this table does not indicate the scope, quality or coverage of services. Also it should be noted that in some countries, harm reduction services, NSP in particular, are NGO-driven and may be operating without government support.

The map below shows which countries have operational needle and syringe programmes and opioid substitution therapy programmes within and outside prisons. Countries which have drug consumption rooms are also indicated.

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