The Middle East and North Africa Harm Reduction Association (MENAHRA) is a regional network on Harm Reduction covering 20 countries in the Middle East and North Africa (MENA) region. MENAHRA’s mission is to prolong and improve the quality of life of injecting drug users in the region. It seeks to promote humane, tolerant policy and practice for people who use drugs, with particular respect to their health, human rights and freedoms. Through its activities, MENAHRA seeks to empower this marginalized population, and to promote increased government effectiveness with relation to the HIV response in the region. Recognizing the crucial role of the civil society in delivering health services to key populations at increased risk, MENAHRA’s key strategy is strengthening the role of the civil society in implementing harm reduction in the MENA region.

La Asociación de Reducción de Daños de Medio Oriente y África del Norte (MENAHRA) es una red regional sobre reducción de daños que cubre 20 países en la región de Medio Oriente y África del Norte (MENA). La misión de MENAHRA es prolongar y mejorar la calidad de vida de las personas usuarias de drogas inyectables en la región. Busca promover políticas y prácticas humanas y tolerantes para las personas que usan drogas, con especial respeto a su salud, derechos humanos y libertades. A través de sus actividades, MENAHRA busca empoderar a esta población marginada y promover una mayor eficacia del gobierno en relación con la respuesta al VIH en la región. Reconociendo el papel crucial de la sociedad civil en la prestación de servicios de salud a las poblaciones clave en mayor riesgo, la estrategia clave de MENAHRA es fortalecer el papel de la sociedad civil en la implementación de la reducción de daños en la región MENA.

L'Association pour la réduction des risques au Moyen-Orient et en Afrique du Nord (MENAHRA) est un réseau régional sur la réduction des risques couvrant 20 pays de la région Moyen-Orient et Afrique du Nord (MENA). La mission de MENAHRA est de prolonger et d'améliorer la qualité de vie des personnes usagères de drogues injectables dans la région. MENAHRA cherche à promouvoir des politiques et des pratiques humaines et tolérantes pour les personnes usagères des drogues, dans le respect particulier de leur santé, de leurs droits humains et de leurs libertés. Par ses activités, MENAHRA cherche à autonomiser cette population marginalisée et à promouvoir une efficacité accrue du gouvernement en ce qui concerne la riposte au VIH dans la région. Reconnaissant le rôle crucial de la société civile dans la prestation de services de santé aux populations clés à risque accru, la stratégie clé de MENAHRA consiste à renforcer le rôle de la société civile dans la mise en œuvre de la réduction des risques dans la région MENA.

The Middle East and North Africa Harm Reduction Association (MENAHRA)

Drug Law Reform Should Be Among the Priorities of The Lebanese Parliament

On the occasion of the “Support Don’t Punish” Global Day of Action, which falls on June 26, the signatories of this Joint Statement address the Lebanese Parliament to demand the reform of local drug policies, specifically the revision of the Lebanese Drug Law (673/1998), in order to effectively respond to drug use and addiction. While the Lebanese Law on Drugs recognizes the use of illicit substances and addictions as public health matters, it continues to criminalize people who use drugs.

To that effect, the statement signatories would like to highlight the following:

First, the Lebanese state arrests 3000 individuals a year on substance use charges and interrogates another 2000 to 6000 people a year on the basis of the same charge.

Almost 80% of the individuals charged with substance use are aged between 18 and 35 years. Since the promulgation of the law in 1998, an estimated 100,500 individuals have been sentenced by a court of law for their use of drugs, and have thus been deprived of their right to treatment and to support, and have seen their chances of employment and education hindered as a result of their conviction.

Second, in 2016, the Inter-ministerial Substance Use Response Strategy for Lebanon was launched by a number of key ministries; five years after its launch, the majority of its objectives have yet to be met, notably the objective related to the revision of the Lebanese law on drugs.

Finally, the reform of drug policies can constitute a part of the solution to the many challenges currently faced by Lebanon, and that by:

Decreasing the number of files for non-violent offenses before an already overburdened djudiciary.

Creating job opportunities for young people by removing criminal penalties attached to the use of illicit substances which facilitates access to employment and thus allows young people to contribute to economic growth, noting that 60% of young people are currently unemployed in Lebanon.

Diverting resources spent on repressive drug policies into a health-oriented response aimed at preventing chronic illnesses that often accompany drug use and that constitute considerable costs to the state.

Reducing the incidence of human rights violations, notably violations to basic fair trial rights.

The co-signatories of this statement call on the new members of Parliament to prioritize drug policy reform and to revise the Lebanese Law on Drugs, taking as a starting point the draft law submitted to the legislative body in 2016, and revising it in line with global developments and the Lebanese State’s own commitments and strategy, notably towards the decriminalization of drug use.

The Middle East and North Africa Harm Reduction Association(MENAHRA)

MENA Network of People who Use Drugs(MENANPUD)

Society for Inclusion and Development in Communities and Care for All(SIDC)

Association Justice et Miséricorde(AJEM)

Drug law reform should be among the priorities of the Lebanese parliament

Drug use is one of the phenomena prevalent in various degrees all over the world and the numbers of people who use drugs (PWUD) have increased in the last years. States have therefore begun to build community immunity to reduce the violations that PWD face. Special treatment has been granted to this group to ensure the development of their behavior through rehabilitation and social integration, as an alternative for persecution and sanction. The use of justice to deter people who use drugs is a complex and costly process for the judiciary. It also leads to prison overcrowding, in addition to increasing the social challenges and the social stigma against PWUD.ç

Legal systems in various countries have convergedtodifferentdegreesby creatingalternatives for punishment by granting judges and public prosecutors the discretionary powers to use these alternatives before or during judicial prosecution and enforce “treatment and care as alternatives for punishment and conviction”; as advocated by all legal experts. This report will highlight the rights of PWUD and the legal systems that concern them in Jordan, Tunisia, Lebanon, Morocco and Egypt while showing the violations that these people encounter in society, and which will be discussed at a later stage. In addition, the existing social issues facing PWUD in our Arab societies will be clarified by conducting interviews with legal experts and activists from the five countries mentioned on the rights of PWUD, and identifying legal procedures and their consequences in all five countries in order to recognize to what extent treatment and care are considered as alternatives for sanctions.

Rights of people who use drugs - Report by the Middle East and North Africa Harm Reduction Association

By István Gábor Takács / Rights Reporter Foundation

Organisations in Lebanon providing Opioid Agonist Treatment ask for international help to maintain the programs. Watch our short video and take action!

OAT, Opioid Agonist Treatment Program was legalized and launched in Lebanon in 2012 within the Harm Reduction Program, after years of advocacy from harm reduction actors in the country.

In light of the compounded and ongoing crises that have hit Lebanon since 2019, today organisations are facing the risk of yet another health crisis with the imminent shortage of Opioid Agonist Treatment medication. Organizations providing the treatment in Lebanon have learnt of the upcoming shortage of OAT medication which leaves the lives of over 1200 individuals hanging in the balance.

Watch this short video with Elie Aaraj, Executive Director of the Middle East and North Africa Harm Reduction Association, explaining the problem:

Opioid agonist treatment shortage in Lebanon – Call for support!

Most countries fail drug policy test according to new Index

First-ever accountability tool assesses and ranks countries’ drug policies against key UN-system recommendations

Norway tops the Index; Brazil comes in last

 -- Norway, New Zealand, Portugal, the UK and Australia are the five leading countries on humane and health driven drug policies according to the inaugural edition of the Global Drug Policy Index released today by the Harm Reduction Consortium. Brazil, Uganda, Indonesia, Kenya, and Mexico are the five lowest-ranking countries.

However, Norway, despite topping the Index, still only managed a score of 74/100. And the median score across all 30 countries and dimensions is just 48/100.

“48 out of 100 is a drug policy fail in anyone’s book,’ said 

, Executive Director of the International Drug Policy Consortium which led on the development of the Index with the partners in the Harm Reduction Consortium.

“None of the countries assessed should feel good about their score on drug policy, because no country has reached a perfect score. Or anywhere near it. This Index highlights the huge room for improvement across the board.”

For decades, tracking how well - or badly - governments are doing in drug policy has been an elusive endeavour. In no small part, this is because data collection efforts by both governments and the UN have been driven by the outdated and harmful goal of achieving a ‘drug-free society.’

Most governments continue to employ a repressive approach to drug control based on this skewed data, which in turns means they cannot be held accountable for the damage their policies inflict on the lives of so many people.

The success of drug policies has not been measured against health, development, and human rights outcomes, but instead has tended to prioritise indicators such as the numbers of people arrested or imprisoned for drug offences, the amount of drugs seized, or the number of hectares of drug crops eradicated.

The Global Drug Policy Index is the first-ever data-driven global analysis of drug policies and their implementation. It is composed of 75 indicators running across five broad dimensions of drug policy: criminal justice, extreme responses, health and harm reduction, access to internationally controlled medicines, and development.

“The Global Drug Policy Index is nothing short of a radical innovation,’ said 

, Chair of the Global Commission on Drug Policy and former Prime Minister of New Zealand.

“Good, accurate data is power, and it can help us end the `war on drugs´ sooner rather than later.”

“What’s clear from the results is that no government can be complacent,” said 

, former Director of the Prison System of the State of Rio de Janeiro. “Even in the highest-ranking countries, progress is sorely needed. Governments worldwide must abandon the idea of drug policies as instruments of “war” and understand them as means to promote human rights and citizenship.”

The Index’s first iteration evaluates the performance of 30 countries covering all regions of the world and is illustrated by real life stories, including of people who use drugs, from around the world.

The militarised and law enforcement approach to drug control continues to prevail: 

Some level of lethal use of force by military or police forces was reported in half of the countries surveyed, with widespread cases in Mexico and Brazil.

The disproportionate impact of drug control on marginalised people on the basis of gender, ethnicity and socio-economic status

 was reported to some extent across all dimensions, and across all countries.

Drug law enforcement targets primarily nonviolent offences, and especially people who use drugs: 

Only 8 out of the 30 countries surveyed have decriminalised drug use and possession, and out of those, only 3 managed to truly divert people away from the criminal justice system.

The funding gap for harm reduction remains highly concerning:

 Only 5 out of 30 countries have allocated ‘adequate’ funding to harm reduction, and of those countries, funding is considered secure in only one (Norway).

There is a huge gap between government policies and their implementation on ensuring access to controlled medicines

, especially in countries like India, Indonesia, Mexico, and Senegal which score high on policy, but score 0/100 for actual availability for those in need.

Alternative development programmes in areas of illegal cultivation remains entrenched in interdiction and eradication

,with Colombia scoring particularly low (23/100) due to its militarised strategy focusing on forced eradication and the harmful use of aerial spraying.

, including its companion analytical report and real-life stories of individuals’ experiences with drug policies from across the globe, will be available on Monday November 8 through an interactive web-tool accessible through this link: www.globaldrugpolicyindex.net

The Global Drug Policy Index is a project of the 

, which includes the following partners: the European Network of People Who Use Drugs (EuroNPUD), the Eurasian Harm Reduction Association (EHRA), the Eurasian Network of People who Use Drugs (ENPUD), the Global Drug Policy Observatory (GDPO) / Swansea University, Harm Reduction International (HRI), the International Drug Policy Consortium (IDPC), the Middle East and North Africa Harm Reduction Association (MENAHRA), the West African Drug Policy Network (WADPN), the Women and Harm Reduction International Network (WHRIN), and Youth RISE.

 (English / Spanish)
GDPI Media Relations
Mob. +34 655 792 699
Email: michael.kessler@intoon-media.com
Twitter: @mickessler

 (French/Spanish)
IDPC Head of Research and Communications
Mob: +44 7807 077 617
Email: mnougier@idpc.net
Twitter: @ marienougier

By Marie Nougier and Adria Cots Fernandez (IDPC) / Harm Reduction Consortium

The Global Drug Policy Index is a unique tool that documents, measures and compares national-level drug policies, providing each country with a score and ranking that shows how much their drug policies and their implementation align with the UN principles of human rights, health and development. As such, the Index provides an essential accountability and evaluation mechanism in the field of drug policy. It is composed of 75 indicators running across 5 broad dimensions of drug policy. This first iteration evaluates the performance of 30 countries covering all regions of the world.

Key takeaways from the Global Drug Policy Index

The global dominance of drug policies based on repression and punishment has led to low scores overall, with a median score of just 48/100, and the top-ranking country (Norway) only reaching 74/100.

Standards and expectations from civil society experts on drug policy implementation vary from country to country.

Inequality is deeply seated in global drug policies, with the top-ranking 5 countries scoring 3 times as much as the lowest-ranking 5 countries. This is in part due to the colonial legacy of the ‘war on drugs’ approach.

Drug policies are inherently complex: a country’s performance in the Index can only be fully understood by looking across and within each of the dimensions.

Drug policies disproportionately affect people marginalised on the basis of their gender, ethnicity, sexual orientation and socio-economic status.

There are wide disparities between state policies and how they are implemented on the ground.

With a few exceptions, the meaningful participation of civil society and affected communities in drug policy processes remains severely limited.

The Global Drug Policy Index is a project of the Harm Reduction Consortium, which includes the following partners: the European Network of People Who Use Drugs (EuroNPUD), the Eurasian Harm Reduction Association (EHRA), the Eurasian Network of People who Use Drugs (ENPUD), the Global Drug Policy Observatory (GDPO) / Swansea University, Harm Reduction International (HRI), the International Drug Policy Consortium (IDPC), the Middle East and North Africa Harm Reduction Association (MENAHRA), the West African Drug Policy Network (WADPN), the Women and Harm Reduction International Network (WHRIN), and Youth RISE.

The Global Drug Policy Index 2021 - Analytical report

In October 2021, an exciting new resource will be launched: the Global Drug Policy Index (GDP). The Index will score and rank countries on how their national drug policies align with the international best practice in terms of health, criminal justice, access to medicines, and development. In its first year, the GDPI will focus on 30 selected countries from all around the world. For each country, data from more than 60 indicators will feed into the overall score - and local civil society partners will be supported to use the results in their advocacy work.

As we prepare for the global launch, MENAHRA and IDPC invite their members and other allies involved in drug policy advocacy in Ghana to come and learn more about the Index. This workshop will explain the GDPI project and methodology, prepare participants for the launch, and provide space for discussion and questions.

The workshop will last for 90 minutes, followed by dedicated breakout group discussions for partners from selected GDPI countries: Afghanistan, Lebanon, and Morocco.

Getting ready for the Global Drug Policy Index (GDPI) - MENA region

The 2020 MENAHRA situation assessment has presented a comprehensive review on the situation and development of the harm reduction response of drug use and its harms in the Middle East and North African region during the timeframe 2010-2020. Key situational factors hamper the harm reduction prioritization and response in the region. The current situation of drug production, trafficking and consumption (including harmful use) is exacerbated by political and economic instability, protracted conflict in some countries, security issues, weak cross border cooperation, the relationship between weapons, human and drug trafficking, the absence of alternative livelihoods for drug producers, and migration and displacement of almost 11 million in the region. We present here an overview of the regional situation generated by the MENAHRA 2020 situation assessment followed by regional prioritisation and country specific data and advocacy briefs.


Surveillance and academic activity on drug use trends, size estimates of key populations and treatment characteristics, and BBV prevalence in community and prison settings differ per MENA country and in some countries remains scant or dated, making it difficult to assess extent and trends in the MENA region. This hampers advocacy for harm reduction and the development of effective evidence-based drug and public health policies at country and regional level.


Over 600,000 people are deprived of their liberty in the MENA region, the vast majority of who are male and detained on drug related charges (Al-Shazly and Tinasti, 2016). Repressive and punitive approaches to drugs including corporal punishment and death penalty, criminalization, coercive drug treatment mandated by the courts and aggressive policing continue to discourage health care seeking by PWUD. Some countries have reported the rise in private drug treatment and rehabilitation centers using methods which are not evidence based. This reinforces marginalization and stigmatization of PWUD/PWID and perpetuates unsafe/high risk use of drugs in the region.


Although the MENA region is primarily a drug trafficking and transit region, there are notable production and consumption trends in Captagon (commonly fenethylline), opium, heroin, cannabis, ATS and Khat. Cannabis remains the most commonly used substance. Increased use of synthetic cannabinoids, ATS, and pharmaceutical drugs in a number of countries in the region has been observed through shifting trends of drug use. A concerning rise in synthetic cannabinoid use has been noted in Jordan, Kuwait, Egypt, and Palestine. ATS use has increased in Afghanistan, Kuwait, Iran, Iraq, Lebanon and Palestine. The rise in pharmaceutical drug use however, is the most widespread and noted among 15 of the 20 MENA countries (Afghanistan, Algeria, Egypt, Iran, Iraq, Jordan, Kuwait, Pakistan, Palestine, Qatar, Saudi Arabia, Syria, Tunisia, UAE, and Yemen). The World Drug Report 2020 has identified the trafficking and non-medical use of Tramadol and Captagon as one of the key challenges faced within the region.

Harm reduction advocacy brief for the Middle East and North Africa region

MENAHRA would like to invite you to join our upcoming webinar to discuss the 

"Religious Leaders Guide on Harm Reduction"

: Rana Haddad, Public health and development consultant

: Thursday, May 20, 2021, 1:00 Pm Beirut time

Kindly note that the webinar will be in Arabic

Religious leaders guide on harm reduction in the MENA region

The global drug market is expanding and becoming more complex. Globally, opium production and cocaine manufacture remain at record levels (despite declines observed in some regions), with synthetic opioids and their analogues (for example fentanyl, Tramadol) continuing to pose a serious threat to health (UNODC Global Drug Report, 2019; 2020). Heroin continues to reach the market despite declining opium production in 2018 in Afghanistan and record levels of seizures (UNODC Global Drug Report, 2019; 2020). Methamphetamine use and related harms are of rising concern across several regions (South East Asia, North America). There has been observed diversification of cannabis products (with increased potency) consumed in some jurisdictions that permit the non-medical use of cannabis.

IDU continues to represent a key global public health issue of importance due to the associated elevated risks of drug overdose, dependence, and BBV transmission (Degenhardt et al., 2016; Larney et al., 2020; Hines et al, 2020). An estimated 15.6 million people aged 15–64 years inject drugs (Degenhardt et al., 2017). Untreated chronic HCV and opioid use disorders are responsible for most of the deaths and disability attributed to the use of drugs (UNODC Global Drug Report, 2019). Of those injecting drugs, some 1.4 million live with HIV and 5.6 million live with HCV. Patterns of HIV infection among PWID also have wide regional variations (UNODC Global Drugs Report, 2019). In 2017, 40.5 million people were dependent on opioids and 109 500 people died from opioid overdose (Degenhardt et al., 2019).

Harm reduction approaches are underpinned by the principles of pragmatism and public health, alongside dignity and human rights and focus on reducing the health, social, and economic harms associated with drug use (Harm Reduction International, 2019; Sander et al., 2019). The provision of harm reduction both in community and in prison is widely recognized as a legally binding human rights obligation (Puras, 2015).

We report here on the 2020 assessment of situation and response of drug use and its harms in the MENA region for MENAHRA. These countries are diverse in terms of geography, population size and demographics, characteristics of key populations, nature and extent of the BBV problem, and scale of harm reduction implementation. They included Afghanistan, Algeria, Bahrain, Egypt, Iraq, Iran, Jordan, Kuwait, Lebanon, Libya, Morocco, Oman, Pakistan, Palestine, Qatar, Saudi Arabia, Syria, Tunisia, UAE and Yemen.

The Middle East and North Africa Harm Reduction Association (MENAHRA)

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