From the beginning of the pandemic, people who inject drugs (PWID) were identified as a key population at significant risk of HIV infection. However, despite evidence of the effectiveness of harm reduction, many countries failed to respond adequately or in a timely manner. Embedded in prohibition and punitive approaches, Malaysia’s initial resistance to harm reduction led to a large, concentrated epidemic amongst PWID. Although now more widely adopted, to date very few countries have achieved targets for opioid agonist therapy or met the recommended number of needles and syringes distributed per year. With less than 1% of total HIV spending allocated to programs for PWID globally, it is no surprise that PWID continue to be left behind in access to prevention and treatment programs.
Far from its intended aim of protecting individuals and society from the harm of drug use, punitive drug laws and prohibition continue to result in diseases, deaths from drug overdoses, prison overcrowding, violence and a cycle of poverty.
Drug use is often seen through a moral lens, with users stigmatized as criminals or morally deficient rather than individuals in need of help. This stigma makes it challenging to build public support for harm-reduction policies and programmes. Many fear that alternative approaches, such as legalization or decriminalization, could lead to unintended consequences, including increased drug use or addiction, despite evidence from countries like Portugal demonstrating otherwise.
The “War on Drugs” relied on fear-based narratives and racialized rhetoric that continue to shape public opinion. This is compounded by global treaties, such as the 1961 Single Convention on Narcotic Drugs, which tie nations to prohibitionist policies and make reform on an international scale more difficult.
Despite these challenges, there is a growing recognition of the failure of prohibition and increasing momentum for reform. The success of alternative approaches, such as decriminalization and harm reduction, highlights the potential for treating drug use as a public health issue rather than a criminal one. However, overcoming the entrenched political, economic, and cultural barriers to change requires sustained effort, evidence-based policymaking, and a shift in public perception toward compassion and practicality over punishment. By leveraging evidence, building partnerships, and engaging in public discourse, the scientific community can challenge outdated drug policies and push for reforms grounded in science, equity, and compassion.