Injecting drug use among legal minors and the best interests of the child: Lived experiences, support and policy frameworks in high income countries

Approximately 11.3 million people inject drugs globally, but within this population injecting drug use among minors under the age of 18 is a blind spot in research, policy and practice.

Most countries have no prevalence estimate for this age group, little understanding of the dynamics of initiation, or the lived experiences and service needs of these young people.

Harm reduction services for people who inject drugs, such as needle exchanges, have largely been developed based on evidence from adults.

The theoretical, practical, ethical and legal challenges for service provision for legal minors, taking into account their ‘best interests’, remain obscure. We propose a mixed methods study in three high income European countries – Sweden, Switzerland, and Wales.

Through an integrated mix of quantitative and qualitative methods, as well as comparative legal and policy analysis, we will invetigate the following questions:How many legal minors inject drugs, what is the average age of debut, and what kinds of drugs and injection practices are involved?What personal and social factors affect early debut in high income settings, and what health and social harms are experienced?What support needs are evident, and how can services be delivered taking into account ‘the best interests of the child?’In what ways may the legal and policy environments be conducive to, or act as barriers to realising the needs and rights of young injectors?The main outcome will be to identify challenges and best practices across similar socio-economic settings, but with differing laws and policies, as well as treatment and social systems.

We aim to open up the possibility to improve both policy and practice in these countries and beyond.