Assessment of Policies and Harm Reduction Services for Young People Who Use Drugs in Kathmandu Valley of Nepal: Identifying Gaps and Opportunities

Background: Young people under 30 represent the majority of people who use drugs in the Kathmandu Valley, Nepal. Young people who use drugs(YPWUD) may have particular needs and require different service and policy responses when compared to their older peers. This research examines the strengths and limitations of currently available policies and services; their effectiveness in meeting the needs of YPWUD and identifies gaps and opportunities for their improvement.

Methodology: A literature review,semi-structured interviews(n=9) with key stakeholders and one focus group(n=5) discussion with YPWUD were conducted. Results were analyzed using the Rhodes-Risk Environment framework which considers the ‘physical’,‘social’,‘economic’ and‘policy’ level factors shaping risk at ‘micro’,‘meso’and‘macro’ levels.

Results: Drug use patterns among YPWUD in the Kathmandu Valley, Nepal are changing. Several trends have been identified including increased use of methamphetamine, diverted pharmaceuticals and ‘Southasian-Cocktail’ (a mixture of buprenorphine,benzodiazepine and antihistamines) and move away from drug dealing ‘hotspots’ to online drug purchasing. YPWUD and service providers report range of barriers to accessing services including stigma and discrimination;lack of local services;lack of knowledge of existing services;age of consent legislation and opening hours which may conflict with commitments such as school and college. YPWUD report range of human rights violations including involuntary treatment,arbitrary detention,forced labour and public body searches. Service providers and policymakers report precarious international donor funding of services through HIV prevention programs with little to no youth-specific services for YPWUD.

Conclusion: The findings highlight the importance of youth-friendly harm reduction services that are relevant and responsive to the unique needs and experiences of YPWUD. These services should address current trends including the use of new substances in diverse environments (including online). The perspectives of YPWUD are vital while developing and implementing harm reduction programs to ensure that the programs are effective, efficient and based on the diverse needs of YPWUD.