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.