Training Manuals

In recent years and in different parts of the world, the use of stimulants has grown. This development underscores the need for effective strategies to mitigate the harms related to stimulants use. Most harm reduction services focus predominantly on people who inject opioids, and little evidence exists on harm reduction for people who use stimulants (PWUS). Overall, PWUS, and especially those who do not inject, have limited access to harm reduction and other services. Many PWUS experience different health-related harms and problems, do not identify with (problematic) opioid use, and often belong to different (social) networks of people who use drugs. Thus, they may perceive harm reduction services as irrelevant or inaccessible to them. This happens even though PWUS, and especially those in difficult socio-economic contexts, are often marginalised, and face a diverse range of social and health problems. Much like the recommended set of interventions to prevent, treat and care HIV among people who inject drugs (PWID), no single intervention will address the many issues experienced by PWUS across the world. Any comprehensive package of interventions for PWUS will need to consider the effects of specific substances, different routes of administration, groups of users, types of interventions and contextual variations such as social, cultural, political, legislative and religious aspects.

This report presents an overview on harm reduction interventions for problematic stimulant use. In it, we focus predominantly on interventions for people who smoke methamphetamine and freebase cocaine. While we initially aimed at addressing other amphetamine-type substances (ATS), cathinones and cocaine hydrochloride, as well as other non-injection routes of administration, most of the available harm reduction literature and interventions turned out to address smoked meth and crack.

The main contributions of the present study are twofold. First, it provides a worldwide literature review of harm reduction interventions for PWUS. Second, it documents, describes and analyses seven cases of good harm reduction practices for PWUS in different world regions.

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