While drugs policy in many countries moved decisively in a harm reduction direction in response to the threat of HIV/AIDS during the 1980s and 1990s, demand reduction has remained an important pillar in national policies. The emphasis that these policies place on demand reduction activities such as prevention and recovery, the subjects of a number of articles in this issue of Drugnet ireland (61), is probably due more to support from the general public and policy-makers than to the availability of the type of high-quality evidence underpinning harm reduction practice.

The prevention of substance misuse by young people, or actions that can help delay or reduce such activity, is an essential part of any overall strategy to reduce substance-related harm. Yet, demonstrating the effectiveness of prevention interventions is problematic, as the non-occurrence of an event is the intended outcomes of such interventions. Similarly, while most English-speaking countries have adopted recovery-focused drugs policies, the recovery field has not yet built a body of evidence approaching that which supports more conventional interventions such as substitution treatment or needle exchange.

Despite the strength of the science underpinning harm reduction interventions, the approach has been criticised by those who seek more ambitious outcomes than stabilisation and retention in treatment. Recent data on drug-related deaths, presented in this issue’s cover story, demonstrate that the level of mortality from both drug overdose and drug-related medical causes has changed little over the past few years. Opiate prevalence and the numbers in long-term treatment for opiate misuse remain high, giving some weight to the critique of harm reduction from the recovery perspective.

Recovery advocates emphasise the role of the individual in overcoming his or her dependency and the social context in which this dependency and recovery from it develops. There is a place for harm reduction and clinically supported treatments, but community-based groups, abstinence-based therapies, peer-led support and mutual aid all have roles to play in overcoming dependence. Recovery-focused strategies continue to support well-run and effective harm reduction interventions, but are pluralist in regard to the approaches to deal with or prevent the problems associated with dependency. Greater public understanding of the nature of effective demand reduction work, and willingness to provide resources to study it, may present the opportunity to evaluate this work more effectively in the coming years and develop the evidence base underpinning prevention, recovery and other demand reduction responses.