Harm reduction – the current situation in Europe (European Drug Report 2025)

Harm reduction encompasses interventions, programmes and policies that seek to reduce the health, social and economic harms of drug use to individuals, communities and societies. On this page, you can find the latest analysis of harm reduction interventions in Europe, including key data on opioid agonist treatment, naloxone programmes, drug consumption rooms and more. 

This page is part of the European Drug Report 2025, the EUDA’s annual overview of the drug situation in Europe.

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Last update: 5 June 2025

Harm reduction is faced with increasingly dynamic drug problems

The use of illicit drugs contributes to the global burden of disease. Interventions designed to reduce this burden include prevention activities, intended to reduce or slow the rate at which drug use may be initiated, and the offer of treatment to those who have developed a problem related to their drug use. A complementary set of approaches goes under the general heading of harm reduction and aims at reducing the consequences of drugs for individuals and communities. Here the emphasis is on working non-judgementally with people who use drugs in order to reduce the risks associated with behaviours that are mostly associated with adverse health outcomes, and more generally to promote health and well-being. Probably the best known of these is the provision of sterile injecting equipment to people who inject drugs, with the aim of reducing the risk of contracting an infectious disease. Over time, these sorts of approaches appear to have contributed to the relatively low rate, by international standards, of new HIV infections now associated with injecting drug use in Europe. Nonetheless, gaps in service provision and growing stimulant use pose challenges to Europe achieving its WHO continuum of care targets among people living with HIV (see Drug-related infectious diseases – the current situation in Europe). Over the last decade, as patterns of drug use have changed and the characteristics of those who use drugs have also evolved, to some extent, harm reduction interventions have had to adapt to address a broader set of risk behaviours and health outcomes. Among these are reducing the risks of drug overdose associated with emerging patterns of polysubstance use, including stimulant smoking, and addressing the often-considerable and complex health and social problems faced by people who use drugs in more marginalised and socially excluded populations.

Reducing harms from evolving drug situation requires a range of responses

Chronic and acute health problems are associated with the use of illicit drugs, and these can be compounded by factors such as the properties of the substances, the presence of adulterants and pathogens, the route of administration, individual vulnerability and the social context in which drugs are consumed. Chronic problems include dependence and drug-related infectious diseases, while there is a range of acute harms, of which drug overdose is perhaps the best documented. Although relatively rare at the population level, the use of opioids still accounts for much of the morbidity and mortality associated with drug use. Injecting drug use also increases risks, as does polysubstance use. Correspondingly, working with opioid users and those who inject drugs has been historically an important target for harm reduction interventions, and this is the area where service delivery models have been most extensively developed and evaluated.

Reflecting this, some harm reduction services have become increasingly integrated into the mainstream of healthcare provision for people who use drugs in Europe over the last three decades. Initially, the focus was on expanding access to opioid agonist treatment and needle and syringe programmes as a part of the response to high-risk drug use, primarily targeting injecting use of heroin and the HIV epidemic. Updated joint EUDA-ECDC guidance on the prevention and control of infectious diseases among people who inject drugs recommends providing opioid agonist treatment to prevent hepatitis C and HIV, as well as to reduce injecting risk behaviours and injecting frequency, in both the community and prison settings. The guidelines also recommend the provision of sterile injecting equipment alongside opioid agonist treatment to maximise the coverage and effectiveness of the interventions among people who inject opioids.

The provision of harm reduction equipment typically involves the distribution of sterile materials intended to reduce harms associated with continued drug use, and has evolved as patterns of drug use have changed over time. It is generally part of larger integrated harm reduction programmes, usually low-threshold services, and seldom a standalone intervention. Guidance is usually provided on the correct use of the items, safe disposal and less risky routes of administration. Harm reduction equipment generally includes items needed to prepare drugs for consumption, such as filters, cookers, water and also items for administering drugs, including needles and syringes, pipes and foil. Other items are provided to care for and prevent harms related to drug use, such as wound care kits to address bacterial infections from injecting and naloxone kits for responding to overdoses. Current evidence indicates the effectiveness of needle and syringe programmes and take-home naloxone programmes, while there is currently limited evaluation data regarding other harm reduction items.

In the last three decades, approaches to harm reduction have been broadened in some EU Member States to encompass other responses, including supervised drug consumption rooms and take-home naloxone programmes intended to reduce fatal overdoses (Figure 13.1). Interventions to reduce opioid-related deaths include those aimed at preventing overdoses from occurring and those aimed at preventing death when an overdose does occur (Figure 13.2).

Drug consumption rooms are facilities where people who inject drugs may do so in hygienic conditions under the supervision of trained staff. As well as offering the possibility of intervening directly in overdoses that occur on-site and the provision of sterile injection equipment, drug consumption rooms promote engagement with treatment and other health and social services. Some services provide overdose prevention awareness raising and training, including in the use of naloxone. Current evidence indicates that drug consumption rooms can contribute to reducing drug-related deaths, and the evidence base continues to evolve, reflecting the complex nature of evaluating these services (see also Health and social responses: drug consumption rooms).

Take-home naloxone programmes combine training on overdose risk and management with the distribution of naloxone kits to those likely to witness an opioid overdose, such as people who use drugs and their peers, friends and family members. Take-home naloxone programmes can also target other potential first responders to an overdose, such as frontline service workers who interact with people who use drugs, including healthcare providers, staff in homeless shelters and prison officers. While increasing numbers of individuals in EU Member States have been trained in administering naloxone, coverage and access issues still exist in some countries where it is available. Overdoses involving potent synthetic opioids may require more than one dose of naloxone. In community settings, current guidance advises administering doses stepwise, allowing time to assess the person’s response between doses and providing rescue breathing or cardiopulmonary resuscitation if needed (see also Opioid-related deaths: health and social responses).

In some countries, drug checking facilities have been established with the aim of enabling people to better understand what substances the illicit drugs they have bought contain. Tablets, for example, purchased as MDMA, may vary in strength as the MDMA content can be different from batch to batch and sometimes adulterants and other drugs are present. With many synthetic stimulants and new psychoactive substances now available on the illicit market in similar-looking powders or pills, consumers may be increasingly at risk of being unaware of what particular stimulant or mixture of substances they may be consuming. While not nationally representative, data from drug checking services indicate, for example, that synthetic cathinones are now both intentionally purchased and, to a lesser extent, sometimes found as adulterants or mis-sold. People purchasing these substances are often unaware of which type of synthetic cathinone they are buying, creating some uncertainty about the effects and health risks they may experience. When integrated within drug consumption rooms, drug checking can reach more marginalised groups of people who use drugs and who are at greater risk of overdose due to a more potent or unexpected opioid. Drug checking services can function alongside other leading-edge indicators to provide insights into current drug market trends and consumer preferences, which are important for developing other harm reduction approaches, including targeted risk communications and alerts (see also Synthetic stimulants – the current situation in Europe and MDMA – the current situation in Europe).

The increasing integration of the markets for new psychoactive substances and illicit drugs is creating new public health challenges. Examples include hemp mixed with semi-synthetic cannabinoids; stimulants mixed with various substances, sometimes including synthetic cathinones; ketamine; or new synthetic opioids mixed with or mis-sold as heroin. As poisoning events can evolve rapidly, understanding what constitutes the delivery of effective risk communication has become more important. Although the range of services provided may differ, all drug checking services undertake some form of health risk communication activity, often by issuing alerts on analysed drug products and sharing data with other stakeholders. The aim is to prevent or reduce harm at the level of the individual (the person submitting the substance for checking) and of the population (others who may be exposed to the same substance). Future steps in this field may include moves towards harmonisation and the building of consensus among European drug checking services on the determination of criteria and thresholds for when and how to issue alerts, as well as the adoption of evidence-based standard operating procedures for health risk communication. These issues are explored in a manual produced by the EUDA with the help of the Trans-European Drug Information project on health risk communication strategies for drug checking services.

Some of these interventions remain controversial for reasons that include their legal status and the evolving nature of the evidence base on the effectiveness of the interventions on health outcomes. Coverage of these newer interventions therefore remains uneven within and between countries, and where they do exist, they are often most commonly found in large cities. Overall, coverage and access to harm reduction services, including some long-established and relatively well-evidenced service models, vary considerably between EU Member States, and in some countries, remain inadequate in comparison to estimated needs.

Increased preparedness is needed to meet the challenge of potent synthetic drugs. Potent synthetic substances have a growing potential to cause drug-related harms in Europe, as intentional and inadvertent consumption of these substances in powders or mixtures mis-sold as other drugs can increase the risk of poisonings and deaths. This, together with more complex patterns of polysubstance consumption, adds to the already considerable challenges of developing effective responses to reduce drug overdose deaths and drug-related acute poisonings. An example of this growing complexity is the emergence of the highly potent nitazene opioids in Europe. These substances, which can be more potent than fentanyl, have been involved in localised poisoning outbreaks in parts of Europe and have been driving the increase in the number of drug-related deaths in Estonia and Latvia (see also New psychoactive substances – the current situation in Europe).

Following the detection of clusters of overdoses related to nitazenes being sold as benzodiazepine tablets in community and prison settings in Ireland during June 2024, a rapid risk communication exercise was undertaken. It was supported by low-threshold services and included leaflet drops to open drug scenes and the distribution of information on social media and news platforms (Figure 13.3). This is an example of how services may now need to respond both more rapidly and more intensively to outbreaks of drug poisonings. The presence of such mixtures and mis-sold substances on the market highlights the ongoing need to review and adapt approaches to the delivery of some harm reduction interventions. The EUDA is developing a new European drug alert system that will support EU and national preparedness and response activities to serious drug-related risks by utilising rapid information exchange, targeted alerts and other risk communications.

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More generally, given possible developments in the synthetic opioids market, it would enhance preparedness to review current plans for responding to any possible increase in the availability and use of synthetic opioids or in the harm associated with these substances. This could include enhancing toxicological analysis capabilities, alert messaging and frontline responder preparedness.

Where drug consumption rooms are operational, the possible benefits and risks of also providing drug checking services may be an issue for consideration. Such integration of services is becoming more common. In a survey among drug consumption rooms in Europe, about a third reported providing drug checking services onsite, and a further half provided referral to an external service.

Various stimulant use patterns linked to harm reduction delivery difficulties

Reducing the risks associated with injecting drug use has always been an important target for harm reduction interventions, and the service models are relatively well developed and evidence-based. However, even in this area, changes in drug consumption are creating new challenges for effective service delivery. In the last decade, there have been HIV outbreaks associated with the injection of illicit synthetic stimulants in 7 European cities, across 6 EU Member States. Stimulant use is associated with a potentially higher frequency of injection compared with heroin use, while crushing and dissolving crack cocaine and other tablets for injection also brings with it additional health risks. These consumption patterns raise questions regarding, for example, the type and adequacy of needles and syringes provided to people in street-based open drug scenes, which are now typically characterised by polysubstance use. They also highlight the need for a relatively high level of harm reduction services to prevent and rapidly contain such outbreaks. This is at a time when, for example, needle exchange provision remains inadequate in some EU Member States.

Synthetic stimulants and various other substances are consumed to facilitate and enhance sex in the context of sexualised drug use by various groups, but mainly among a small sub-population of men who have sex with men, when it is known as ‘chemsex’. While this definition is imprecise, it is usually used to refer to settings or events where both high-risk drug taking and high-risk sexual behaviour may occur. The drugs involved can range from stimulants, such as methamphetamine, cocaine and synthetic cathinones, to alcohol, depressants such as GHB/GBL and dissociatives such as ketamine. While it is difficult to estimate the prevalence of chemsex, information from research studies suggests it is an issue that is present, albeit at a small scale and among specific subgroups of people who use drugs, across Europe. Engaging with and providing effective harm reduction responses for people engaged in these forms of high-risk behaviours remains a challenge for various reasons, including a lack of integrated service provision in many places, and the development of tailored harm-reduction interventions is needed. This underlines the importance of strong multi-agency partnerships between those providing sexual health services and those providing drug-related harm reduction.

Evolving threats to public health require further development of harm reduction approaches

Despite cannabis being Europe’s most commonly consumed illicit drug, an argument can be made that it is also an area in which harm reduction advice and interventions are often lacking. Cannabis users in Europe commonly smoke the drug with tobacco, and an area for the development of harm reduction approaches is the consideration of what might constitute effective interventions to reduce smoking-related harm. More generally, as the types and forms of cannabis products available in Europe continue to change, so too have considerations about the implications this has for harm reduction responses. Overall, cannabis products, both resin and herbal, are now of a higher potency – they contain more THC – than they were historically, and high-potency cannabis products are associated with more acute and chronic harms. In addition, the diversity of product types has expanded, with edibles, e-liquids and extracts all now available, alongside increased availability of semi-synthetic cannabinoids. These changes create new challenges to identify what constitutes effective harm reduction interventions and opportunities to implement them to reduce harm.

Cannabis is not the only area in which harm reduction approaches have the potential to play a greater role. As noted elsewhere in this year’s European Drug Report, there are also signs of increasing consumer interest in a broader set of substances. These substances can cause harms, and some patterns of use are likely to increase the risk of adverse consequences occurring, creating potential opportunities for harm reduction approaches.

While setting up and maintaining some harm reduction responses, such as supervised drug consumption rooms, remain controversial in some European countries, it is largely accepted that evidence-based measures to reduce harm are an important component of balanced drug policies. Nevertheless, many countries stand to benefit from scaling up coverage of their harm reduction interventions. The contexts within which harm reduction services operate, the evidence base that supports them, and what constitutes standards for quality of care in this area therefore remain key areas for further development and policy consideration. Looking forward, the evolving threats to public health arising from Europe’s dynamic illicit drugs markets highlight the ongoing need to develop and evaluate new approaches and evolving models of service provision that protect the health of people at risk of adverse outcomes arising from more complex consumption patterns, new substances and mixtures, or associated with particular subgroups or settings.

The EUDA’s Health and Social Responses to Drug Problems: A European Guide contains detailed information for those wanting to find out more about the evidence that exists for the relative effectiveness of harm reduction and other forms of intervention.

Key data and trends

Needle and syringe programmes

• Needle and syringe programmes are a widely available and standard component of harm reduction services. In 2023, needle and syringe programmes were in place in all EU Member States and Norway. Needle and syringe coverage and access remain a challenge, with only 7 of the 25 countries with available data reaching the WHO service provision target in 2023 (Figure 13.4); only 5 of these countries also report data on access to opioid agonist treatment.

Opioid agonist treatment

• Opioid agonist treatment is an effective form of treatment for opioid dependence and is also a service delivery model that addresses some harm reduction objectives. It is a well-established intervention that is implemented in all European countries and is acknowledged as a protective factor against opioid overdose deaths. However, in 2023, only 15 of the 23 countries with available data reached the WHO service provision target (Figure 13.4); only 10 of these countries also report data on access to needle and syringe provision.
• A range of opioid agonist medications are prescribed in treatment clinics in Europe, but methadone is the most widely used, with about 55 % of opioid agonist clients receiving it, while another 35 % are treated with buprenorphine-based medications.

Take-home naloxone programmes

• Up to 2023, the implementation of take-home naloxone programmes, to prevent overdose deaths, has been reported by 15 European countries. In 2024, pilot take-home naloxone programmes were initiated in Croatia and Finland, and a take-home naloxone programme upon release from prison was initiated in Luxembourg.
• Naloxone was available as a nasal spray in 17 of these countries, but not in Lithuania. It was available as a 1.8 mg/ml dose in the 15 countries, and also as a 1.26 mg/ml dose in 5 countries.
• Injectable naloxone formulations were available in 7 countries, with 0.4 mg/ml vials reported in 5 countries and syringes containing 5 doses reported in Ireland and France (Figure 13.5).
• Naloxone is reported as available over the counter in Denmark, France, Italy and Sweden.

Drug checking services

• Twelve European countries report the provision of some type of drug checking service. The services operate in various settings, including festivals, drug consumption rooms and at fixed locations in the community.
• Drug checking services aim to prevent harms by allowing people to find out what chemicals are in the illicit substances they have bought. They also aim to provide access to counselling or brief interventions, although this is not always possible. The analytical techniques used by services range from sophisticated technology that can provide information on the strength and content of a wide variety of substances, to methods that simply show the presence or absence of a particular drug (Figure 13.6). The information collected by the services also provides a leading-edge insight into drug market trends and consumer preferences.

Drug consumption rooms

• While supervised drug consumption rooms are recognised as an innovative approach to risk and harm reduction among high-risk populations in the EU drugs strategy 2021-25, establishing them remains challenging in some countries. In 2024, drug consumption rooms were operational in 13 EU Member States and Norway (Figure 13.7). Some of these facilities provide integrated drug checking services to prevent overdose risks from, for example, highly potent drugs, adulteration or unexpected substances.
• Monitoring the characteristics and needs of the clients of drug consumption rooms at the European level is challenging due to local differences. However, the EUDA and the European Network of Drug Consumption Rooms are collaborating on harmonised data collection. Data reported by 12 drug consumption rooms in Europe indicate that the majority of clients are men aged between 40 and 49 years. Specialised facilities for women and transgender clients exist in some countries.
• In 2023, the 13 drug consumption rooms reported 346 emergency episodes, about a third of which were linked to polysubstance use.

Interventions in prisons

• EUDA data on harm reduction and treatment interventions available in prisons in 2023 show that continuity of opioid agonist treatment was available in all but one EU Member State (Slovakia), and in Norway and Türkiye. Initiation of opioid agonist treatment in prison was not allowed in 3 countries (Bulgaria, Latvia, Slovakia). Needle and syringe programmes were available in prisons in 3 countries: in all prisons in Spain and Luxembourg (1 prison), and 1 prison for women in Germany. Take-home naloxone was available in 7 countries in 2023 (Germany, Estonia, Ireland, France, Italy, Lithuania, Norway) (Figure 13.8).
• In Luxembourg, a programme for the distribution of take-home naloxone upon release from prison was implemented in September 2024.

Source data

The data used to generate infographics and charts on this page may be found below.

The complete set of source data for the European Drug Report 2025, including metadata and methodological notes, is available in our data catalogue.

A subset of this data, used to generate infographics, charts and similar elements on this page, may be found below.