Ongoing discussions, including among key international donors, have raised concerns within Harm Reduction International and the International Network of People who Use Drugs (INPUD) about the proposed inclusion of mental health within the harm reduction package and more generally about conflating drug use and mental health. This paper aims to stimulate and clarify the discussion around this.

Although there are people who use drugs who may experience mental health issues, drug use and drug dependency itself is not a mental health condition. The concerning conflation of drug use and dependency with mental health issues is inaccurate, stigmatising and might have long term harmful consequences to the community, including removing the agency and capacity of people who use drugs to make decisions about their own bodies and lives. It could reduce resources available for harm reduction and community-led services, and lead to deprioritizing evidence-based, lifesaving public health interventions in national and international guidelines. A lack of political will and insufficient funding are major barriers to implementing harm reduction at scale, and this conflation could seriously disrupt availability, access and delivery of essential services.