Time for tailored harm reduction focus on new initiates to injecting drug use.

The risk of drug overdose and disease acquisition is highly elevated for those recently initiated into injecting drug use. Despite this, there are few harm reduction interventions developed specifically for new initiates. Further, international technical documents have historically provided little guidance on how to appropriately meet the needs of what is an inexperienced and difficult to engage sub-population. However, the recently updated operational guide for Needle and Syringe Programmes for People Who Inject Drugs from the World Health Organization (WHO), stresses that reaching new initiates requires "tailored, inclusive approaches". In this commentary, we leverage the updated WHO guide to call for renewed focus on new initiates and the development of tailored harm reduction interventions. We describe our recent experiences co-designing interventions for new initiates in Kachin, Myanmar as a case study for how such work may proceed. Finally, we make two key recommendations; 1) that an accepted international definition of new initiates be developed that accounts for risk and opportunity to engage, and 2) that more explicit highlighting and technical guidance on targeting new initiates is made in international documentation. Engaging people who inject drugs as soon as possible after initiation, when vulnerability to blood-borne infections and overdose is greatest, will likely maximise the preventive impact of tailored interventions, thereby providing enduring harm reduction outcomes across injecting careers. The updated WHO guide is the perfect time to re-frame this conversation and re-focus these efforts.