Russia and Ukraine combined are home to 90% of the region’s injecting drug users, but the two countries have employed quite different responses. Ukraine has rapidly increased access to NSP and OST, but Russia prohibits the use of opioid substitution for drug treatment and the coverage of needle and syringe exchange sites is poor. Young people make up a large proportion of those who inject drugs in the region, but are neglected by public policy and underserved by harm reduction and drug treatment services, leaving them extremely vulnerable to HIV, hepatitis C and other drug related harms. In many countries, there remains an emphasis on drug law enforcement over drug treatment and harm reduction. Rapid increases in HIV prevalence within prison populations have led a number of countries to begin prescribing opioid substitution therapy to prisoners, but access to sterile injecting equipment remains a rarity.

Although policy wording is not necessarily indicative of the implementation of effective harm reduction measures in a country, it does indicate governmental commitment to tackling drug related harms and is therefore an important advocacy target.