In this project we examine which harm reduction services that exist in Danish municipalities for people with a problematic use of illegal drugs.

Purpose

The purpose of the project is to map which harm reduction services Danish municipalities make available for people who use drugs, e.g. distribution of Naloxone (medicine to reverse overdoses), substitution treatment, needle and syringe programmes, supervised injection sites or drop-in centers. We investigate how such services are implemented in the individual municipalities (e.g., opening hours, target group, professional background of employees). Furthermore we do case studies of five municipalities where we investigate how local harm reduction policies are made in order to understand how local policy processes influence which harm reduction services are made available for people who use drugs. 

Background

Harm reduction and harm reducing services entered the political agenda in Denmark during the 1980’s when the now abolished Alcohol and Narcotics Council (Da.: Alkohol og Narkotikarådet) asserted that drug treatment should apply ‘graduated goals’ and work to reduce the vulnerability and increase the resources for people who use drugs -  even if they continued to use drugs. This led to the opening of more substitution treatment facilities, establishing of needle exchange programmes, low threshold services and outreach work among people with a problematic use of illegal drugs. Even though Denmark initiated harm reduction early on, not all types of harm reduction services were implemented. For example, it was not until in 2012 that municipalities legally could establish supervised drug injection sites while other European countries already did that in the 1990’s. 
While Denmark does have a long tradition of offering harm reduction to citizens with a problematic drug use, research on these services has until now focused on the biggest cities in Denmark, Copenhagen and Aarhus. All though drug use is most widespread in these cities, there are still citizens outside the major cities who need help to avoid and/or minimize drug-related risks. This is, for example, documented by the geographic distribution of drug related deaths in Denmark. 
In general, not much research exists on harm reduction and harm reduction services in rural areas and/or minor provincial towns – neither internationally nor in a Danish context. The aim of the project is therefore also to contribute to the Danish and international literature on local drug- and harm reduction policy.

Data and Methods

Overall, the project involves four components:

1. a survey among key informants in Danish municipalities in order to map which harm reduction services that are available for people who use drugs in each municipality. This part of the project is conducted with first a pilot to test the survey in 20 municipalities, before we roll out the survey to all municipalities in Denmark. 
2. case studies of the local drug- and harm reduction policies in five provincial municipalities. This part of the project focus on policy processes that are involved in the making local drug policies, and what harm reduction services become part (or not) of these local policies. 
3. a survey among people who use drugs in order to map the key features of the local the risk- and enabling environments in Danish municipalities, with a particular focus on harm reduction and harm reduction services. 
4. qualitative interviews with people who use drugs about their experiences of everyday life and use of harm reduction services. 

The project runs from September 2021 until August 2024.