Drug laws and their enforcement are too often focused on people who use drugs, rather than those who are engaged in other harmful criminal activity in the context of commercial drug trafficking. Punitive drug laws and their enforcement practices do not lead to the reduction of drug supply or demand, but do result in the increase of prison populations, massive violations of human rights, and growing epidemics of HIV, viral hepatitis, drug-resistant tuberculosis and, in some settings, overdose from increasingly toxic illegal drug supplies.

There is considerable variance in how countries in four regions – Eastern, Central and Southern Europe, as well as Central Asia and Transcaucasia – are affected by “the world drug problem” and their responses to this public health challenge. However, what they face in common is a high prevalence of injection drug use and serious epidemics of HIV and hepatitis C affecting people who inject drugs.

With the notable exceptions of Russia, Uzbekistan and Turkmenistan, all countries in these four regions have embraced harm reduction in principle and, to varying degrees, in practice. Harm reduction efforts have yielded impressive results even in some countries in which people who inject drugs have been most heavily affected by HIV, such as Ukraine.

However, these achievements would likely have been greater if not for the negative impact of criminalization of drugs and people who use them.