People Who Inject Drugs


Page last updated August 19, 2022 by Doug McVay, Editor.

1. Injection Drug Use Globally and in North America

"Globally, there are nearly 15.6 million people (aged 15–64) who inject drugs (PWID), with an estimated 2.6 million PWID in North America (Degenhardt et al., 2017). Canada and the United States (US) have both seen significant increases in the rate of injection drug use, as well as a rise in the rate of infections and fatal overdose related to injection drug use (Jacka et al., 2020; Levitt et al., 2020). The risk of fatal overdose significantly increases when people inject drugs alone, and may be prevented with timely intervention (i.e. administration of naloxone, an overdose prevention medication) (Colledge et al., 2019). There is also an increased risk of disease transmission (e.g. HIV, hepatitis) and serious infections associated with injecting drugs, which are often related to using unsterile equipment, injecting in unhygienic settings, or rushed injections (Colledge et al., 2019). The increase in injection drug use and the risks associated with using alone, in unhygienic or unsupervised settings necessitate the need for services that support safe injection practices among PWID."

Sarah J. Dow-Fleisner, Arielle Lomness, Lucía Woolgar, Impact of safe consumption facilities on individual and community outcomes: A scoping review of the past decade of research, Emerging Trends in Drugs, Addictions, and Health, Volume 2, 2022, 100046, ISSN 2667-1182,

2. People Who Inject Drugs and HIV

"This report describes data from 11,437 PWID who participated in NHBS in 2018, of whom 69% identified as male, 30% female, and 1% transgender; 39% were white, 33% were black, and 21% were Hispanic or Latino; 36% were aged ≥50 years (Table 1). Among all participants, 26% had no health insurance, 21% had not visited a health care provider, and the household income of 75% of participants was at or below the federal poverty level.

"In 2018, 6% of participants with a valid NHBS HIV test result tested positive for HIV (Table 2). By gender, HIV prevalence was as follows: 6% among males, 6% among females, and 28% among transgender. By race and ethnicity, HIV prevalence was as follows: 9% among blacks, 8% among Hispanics or Latinos, and 4% among whites.

"CDC recommends that persons at increased risk of HIV infection, including PWID, undergo HIV testing at least annually [10]. Among participants who did not report a previous HIV-positive test result or who had received their first HIV-positive test result less than 12 months before the interview, 55% reported that they had been tested for HIV in the 12 months before the interview, and 90% reported that they had ever been tested (Table 3).

"Among participants who reported being tested for HIV in the 12 months before the interview, 66% reported their most recent test was performed in a clinical setting while 29% reported being tested in a nonclinical setting, such as an HIV counseling and testing site, an HIV street outreach program or mobile unit, a SSP, or at home (Table 4)."

Centers for Disease Control and Prevention. HIV Infection Risk, Prevention, and Testing Behaviors among Persons Who Inject Drugs—National HIV Behavioral Surveillance: Injection Drug Use, 23 U.S. Cities, 2018. HIV Surveillance Special Report 24. Published February 2020.

3. Total Number of People Who Inject Drugs Worldwide

"There are an estimated 15.6 million people who inject drugs (PWID) globally (3.2 million women and 12.5 million men). Among these persons, an estimated 17.8% are living with HIV, 52.3% are Hepatitis C (HCV)-antibody positive, and 9.1% are Hepatitis B (HBV) surface antigen positive [1]. PWID are also at high risk for skin and soft tissue infections and infective endocarditis [2–5]. In addition, injection drug use increases risks for fatal and nonfatal overdose [6–9]. Global estimates suggest that 82.9% of PWID primarily inject opioids, underscoring the urgency of implementing evidence-based response strategies to mitigate the range of adverse consequences associated with the opioid crisis [1]."

Allen ST, Schneider KE, Mazhnaya A, White RH, O'Rourke A, Kral AH, Bluthenthal RN, Kilkenny ME, Sherman SG. Factors Associated with Likelihood of Initiating Others into Injection Drug Use Among People Who Inject Drugs in West Virginia. AIDS Behav. 2021 Jun 2:1–10. doi: 10.1007/s10461-021-03325-6. Epub ahead of print. PMID: 34076812; PMCID: PMC8170059.

4. Estimated Number of People Who Inject Drugs

"UNODC, UNAIDS, WHO and the World Bank jointly estimate that some 11.2 million persons worldwide injected drugs in 2020. There has been no measurable change in the estimated global prevalence of injecting drug use from the previous estimate for 2019, which was also 0.22 per cent of the population aged 15–64. However, any trend data must be viewed with caution as the methodologies used to produce national or subnational PWID population size estimations may have changed.

"Approximately 59 per cent of PWID worldwide reside in East and South-East Asia, Eastern Europe and North America. Injecting drug use remains particularly prevalent in Eastern Europe and, to a lesser extent, Central Asia and Transcaucasia, and North America, with rates that are 5.8, 2.6 and 2.5 times the global average, respectively."

UNODC, World Drug Report 2022 (United Nations publication, 2022).

5. Estimated Prevalence of People Who Inject Drugs (PWID) in the US

"Overall, the number of PWID per 10,000 persons aged 15–64 years varied from 31 to 345 across MSAs [Metropolitan Statistical Areas], median 104.4 (mean 127.4; standard deviation 66.7; percentile range 76–162) in 1992 and from 34 to 324 across MSAs, median 91.5 (mean 103.6; standard deviation 56.4; percentile range 61–125 ) in 2007 indicating an overall decline in PWID prevalence across MSAs.

"Figure 5 shows the overall trajectory of the PWID prevalence rates based on the multilevel model. Trend analysis of the overall results is consistent with a decline in the early study period, followed by an increase in 2000–02, and then remaining stable thereafter over time. On average there has been very little change since 2002 (mean 105.0) to 2007 (mean 103.6). Overall, across the 96 MSAs the mean PWID prevalence mostly decreased during our study period, as did the dispersion of estimates over time."

Tempalski B, Pouget ER, Cleland CM, Brady JE, Cooper HLF, et al. (2013). Trends in the Population Prevalence of People Who Inject Drugs in US Metropolitan Areas 1992–2007. PLoS ONE 8(6): e64789. doi:10.1371/journal.pone.0064789