Written by Molly Ogbodum, our International Working Group member from Nigeria.
“We cannot keep building policies around the assumption that some lives must first become ‘respectable’ before they are worth saving.”
Across sub-Saharan Africa, the alarm bells are ringing for opioid-related harms. The United Nations Office on Drugs and Crime (UNODC) 2025 World Drug Report describes an increasingly diverse African drug market, characterised by rising non-medical tramadol use across the region, and with new drug mixtures such as “kush”, which seems to contain synthetic opioids like nitazenes, spreading across West and Central Africa.
As a whole, Africa is a key region in the global movement of opioids: 57% of all pharmaceutical opioids seized in the world between 2019 and 2023 were captured across the continent. This movement of substances is increasingly translating to greater use: in West and Central Africa, opioid use was estimated at 2.35% of the population aged 15–64 in 2023, higher than the regional estimate of 1.4%. Among adolescents and young people, this ranges from 3.2% to 15.9%, with tramadol, heroin and codeine among the most frequently used opioids amid major gaps in harm reduction and other forms of support. The figures are staggering and place young people squarely within how drug harm reduction efforts should evolve to equip them, their communities, and the services around them to recognize and respond to overdoses and other drug-related harms.
For this year’s International Overdose Awareness Day, we’re reminded that we can no longer feign ignorance about the growing harms of uncontrolled opioid markets and the risk of overdoses. We must take action to prevent harms from escalating, and from losing more lives to preventable accidents.
Public conversations on what needs to be done to prevent overdose deaths from escalating have not kept up with rising prevalence. If the contents of a drug are uncertain, the difference between a dose and an overdose becomes microscopic. Despite this, overdose remains unobtrusive in Africa’s drug policy discourse as we are much more accustomed to talking about seizures, arrests and criminalization than about what happens when someone stops breathing. A drug control system is not, by itself, an overdose response system. Only about one in 100 people injecting opioids in sub-Saharan Africa are accessing medication for opioid use disorder, with young people missing in this representation of use.
Naloxone can rapidly reverse an opioid overdose and restore breathing when administered in time. The challenge is making sure it reaches the people who may actually witness an overdose. The World Health Organization (WHO) recommends for naloxone to be available to not just those using opioids, but people likely to witness an overdose, including consumers, their families and community members. And while past WHO and UNODC interventions like Stop Overdose Safely initiative have distributed take-home kits of naloxone and trained potential first responders in Eastern Europe and Central Asia, similar interventions are few and far in between in sub-Saharan Africa.
While take-home naloxone is available in at least 34 countries globally, it remains virtually inaccessible across sub-Saharan Africa. A combination of restrictive prescription laws, high costs, and institutional stigma keeps this medication locked away on hospital shelves or simply not marketed within Africa. In South Africa, naloxone requires a medical prescription, effectively barring community-based take-home distribution programs from scaling up. Whereas Kenya has a take-home naloxone and peer distribution. Countries like Mozambique, Nigeria, Uganda, and Tanzania have either ceased or reduced community-led services, with funding cuts ending their operations.
Right to Health – Even in the Margins
Harm reduction cannot be treated as an optional add-on to drug policy, but should be a key pillar of activities in public health responses to drugs – one that reflects the diverse habits and preferences of the various groups that consume drugs. A 2025 study from Nigeria found that women who inject drugs face several barriers including stigma in health facilities, gender-based violence, childcare responsibilities, poverty, housing instability, police harassment and legal risks from criminalisation. Its proposed harm reduction package included human rights-based interventions, gender-responsive services and training outreach workers in naloxone administration. Even where basic programs exist, coverage is skewed as research among women who use heroin in Tanzania have directly linked incarceration history, stigma, and violence to overdose harms, underscoring the need for interventions that extend beyond prison walls and into re-entry and community care. This becomes important because having naloxone on a shelf does not translate to making overdose prevention accessible. Along these sidelines is where young people face unemployment, psychological distress, daily stress, peer influence and easy access to opioids as factors shaping use leaving them vulnerable. For young people already on this margin, the fear of contact with the criminal legal system may be enough to keep them afar from needed services.
A woman afraid to approach a drug treatment clinic for fear of judgement, someone leaving prison with no drug tolerance, or a young person living with HIV – all may need harm reduction integrated within healthcare settings. People who use drugs do not lose their right to access healthcare because of the legality of the substances they use. They should not have to decide if seeking help exposes them to punishment or discrimination, pointing to the recognition that punishment is not a remedy to overdose.
In June 2025, Ghana made a commendable stride by launching its national harm reduction guidelines which include overdose prevention and management with naloxone, alongside other evidence-based interventions. Nonetheless, policies only become meaningful when they translate into services that people can actually reach because across sub-Saharan Africa, access to evidence-based treatment and harm-reduction services remains limited.
We cannot keep building policies around the assumption that some lives must first become “respectable” before they become worth saving.
As we honor the lives lost on this year’s International Overdose Awareness Day, awareness must lead to preparedness. We know overdose can be prevented, naloxone works, community-based harm reduction can reach people conventional services miss, stigma and punitive approaches create barriers to care and we know that people who use drugs have a place in designing the policies that affect their lives. What remains is to put that knowledge into practice: communities must be informed about the drugs in circulation, how to respond to an overdose, and given the tools to keep themselves safe and alive. This includes wider naloxone distribution through community-based services and peer networks that people who use drugs already trust – including the integration of inclusive and youth-friendly services. Without that combination of knowledge and access, an otherwise preventable death can become a matter of geography, timing and luck.