Islam and harm reduction International Journal of Drug Policy Volume 21, Issue 2, March 2010, Pages 115–118 A. Kamarulzamana(a), S.M. Saifuddeenb(b) (a) Centre of Excellence for Research in AIDS (CERiA), University of Malaya, Lembah Pantai, 59100 Kuala Lumpur, Malaysia, adeeba.kamarulzaman@gmail.com (b) Yayasan Ilmuwan, D-0-3A, Setiawangsa Business Suites, Taman Setiawangsa, 54200 Kuala Lumpur, Malaysia Abstract Although drugs are haram and therefore prohibited in Islam, illicit drug use is widespread in many Islamic countries throughout the world. In the last several years increased prevalence of this problem has been observed in many of these countries which has in turn led to increasing injecting drug use driven HIV/AIDS epidemic across the Islamic world. Whilst some countries have recently responded to the threat through the implementation of harm reduction programmes, many others have been slow to respond. In Islam, The Quran and the Prophetic traditions or the Sunnah are the central sources of references for the laws and principles that guide the Muslims’ way of life and by which policies and guidelines for responses including that of contemporary social and health problems can be derived. The preservation and protection of the dignity of man, and steering mankind away from harm and destruction are central to the teachings of Islam. When viewed through the Islamic principles of the preservation and protection of the faith, life, intellect, progeny and wealth, harm reduction programmes are permissible and in fact provide a practical solution to a problem that could result in far greater damage to the society at large if left unaddressed.

1. International Journal of Drug Policy 21 (2010) 115–118
Contents lists available at ScienceDirect
International Journal of Drug Policy
journal homepage: www.elsevier.com/locate/drugpo
Commentary
Islam and harm reduction
A. Kamarulzamana,∗,1
, S.M. Saifuddeenb,1
a
Centre of Excellence for Research in AIDS (CERiA), University of Malaya, Lembah Pantai, 59100 Kuala Lumpur, Malaysia
b
Yayasan Ilmuwan, D-0-3A, Setiawangsa Business Suites, Taman Setiawangsa, 54200 Kuala Lumpur, Malaysia
a r t i c l e i n f o
Article history:
Received 21 September 2009
Received in revised form 9 November 2009
Accepted 12 November 2009
Keywords:
Islam
Illicit drugs
HIV
Responses
Policy
Harm reduction
a b s t r a c t
Although drugs are haram and therefore prohibited in Islam, illicit drug use is widespread in many Islamic
countries throughout the world. In the last several years increased prevalence of this problem has been
observed in many of these countries which has in turn led to increasing injecting drug use driven HIV/AIDS
epidemic across the Islamic world. Whilst some countries have recently responded to the threat through
the implementation of harm reduction programmes, many others have been slow to respond. In Islam,
The Quran and the Prophetic traditions or the Sunnah are the central sources of references for the laws and
principles that guide the Muslims’ way of life and by which policies and guidelines for responses including
that of contemporary social and health problems can be derived. The preservation and protection of the
dignity of man, and steering mankind away from harm and destruction are central to the teachings of
Islam. When viewed through the Islamic principles of the preservation and protection of the faith, life,
intellect, progeny and wealth, harm reduction programmes are permissible and in fact provide a practical
solution to a problem that could result in far greater damage to the society at large if left unaddressed.
© 2009 Elsevier B.V. All rights reserved.
Introduction
It might be thought that adherence to Islamic tenets could
theoretically provide protective benefits against the risk of HIV.
Strict adherence to these tenets which include prohibition of extra-
marital sex and homosexuality which could reduce the risks of
unprotected anal sex could theoretically confer protective bene-
fits against the sexual transmission of HIV. Circumcision which
must be practiced by all Muslim males and which has recently
been shown to reduce the probability of HIV transmission from
an infected female to her uninfected male partner provides fur-
ther benefits against the acquisition of HIV via sexual transmission
(Weiss, Hankins, & Dickson, 2009). Furthermore prohibition against
alcohol and drugs may reduce risky sexual behaviour that is asso-
ciated with these intoxicants. In the only analysis of its kind, Gray
observed that the percentage of Muslims within a given country
negatively and significantly predicts the prevalence of HIV amongst
sub-Saharan African countries (Gray, 2004).
From the perspective of shariah, khamar an Arabic term which
literally means “to shroud” or “to cloud” refers to any substance
that intoxicates the mind causing the person to lose self-control
as a result of the effects of the substance. Aside from alcoholic-
∗ Corresponding author. Tel.: +60 3 79492129; fax: +60 3 79494625.
E-mail addresses: adeeba.kamarulzaman@gmail.com, adeeba@ummc.edu.my
(A. Kamarulzaman).
1
The authors contributed equally to this work.
based substances, khamar may also include drugs. Contemporary
Islamic scholars have now agreed that any kind of substance that
causes intoxication is haram (not permissible) from the perspec-
tive of Islam as the preservation and protection of the mind is one
of ad-dharuriyat al-khams; the preservation and protection of the
faith, life, intellect, progeny and wealth, the fundamental principles
governing the Islamic shariah law (Al-Ghazali, 1937; Kamali, 1991).
Unfortunately Islamic teachings and Muslim beliefs alone are
not enough to prevent against the spread of HIV as can be seen
by the rates of HIV infection in many Muslim majority countries
outside sub-Saharan Africa where risks other than heterosexual
transmission of HIV exist. We examine the extent of the HIV epi-
demic in relation to drug use in the Islamic world and the role that
Islamic teachings and principles have played in the response to this
twin problem.
Epidemiology of illicit drug use in Islamic countries
The Islamic world is home to over 1 billion people which spans
across three continents. Within this, approximately 40% or more
of the populace practices some form of Islam on a background of
differing histories and cultures (Kelley & Nicholas, 2005). Despite
being haram and prohibited, illicit drug use is widespread in many
predominantly Islamic countries throughout South, South East
and Central Asia and increasingly in North Africa and the Middle
East (Mathers et al., 2008; UNODC, 2009a,b). In 2008, there were
between 8.4 and 11.9 million adult opiate users in Asia alone with
an estimated 2.8–4.9 million in East and South East Asia (UNODC,
0955-3959/$ – see front matter © 2009 Elsevier B.V. All rights reserved.
doi:10.1016/j.drugpo.2009.11.003

2. 116 A. Kamarulzaman, S.M. Saifuddeen / International Journal of Drug Policy 21 (2010) 115–118
2009a,b). Indonesia and Malaysia, two countries with large Mus-
lim populations each reported an estimated 170,000 and 219,000
people who inject drugs (PWID), respectively. A further 3.6 mil-
lion PWID were estimated in the South Asian region mostly in
Pakistan, the Islamic Republic of Iran and Bangladesh, all predom-
inantly Islamic countries (UNODC, 2009a,b). Since the mid-1990s
the island of Maldives, with a predominantly Muslim population,
has reported an escalation of heroin trafficking and use as a result
of increased exposure to the outside world through massive expan-
sion of tourism as well as overseas travel by Maldivians (UNODC,
2009a,b). Central Asia’s location on drug trafficking routes from
Afghanistan has similarly led to the growing use of intravenous
heroin and opium. UNODC estimates that the region has 280,000
users of which 220,000 were injecting drug users (UNODC, 2008).
In the Middle East, the extent of the problem of injecting drug
use is difficult to estimate given the absence of data (Mathers et al.,
2008). However UNODC estimated the number of opiate users in
the Near and Middle East Regions to range from 1.6 to 2.9 million
people (UNODC, 2009a,b). A recent study indicated that even the
nomadic Bedouins of the Negev, Muslim Arabs who have inhab-
ited the Negev desert since the fifth century CE, have not escaped
the problems of illicit drug use. In this study 14% of Bedouins
used alcohol and 11% used illicit drugs during the past year with
a particularly high rate seen amongst adolescents (Diamond et al.,
2008).
Injecting drug use and the HIV epidemic in Islamic countries
Unsafe injecting practices associated with illicit drug use have in
turn led to an explosion of HIV infections in several of these coun-
tries. Concentrated HIV epidemics amongst PWID are emerging
from Libya, Uzbekistan, Tajikistan, and Pakistan whilst Indonesia,
Malaysia, Bangladesh, and The Islamic Republic of Iran have large
established epidemics (UNAIDS, 2008; Mathers et al., 2008). In
Indonesia, approximately half of the cumulative reported HIV cases
are associated with injecting drug use (National AIDS Commission,
Indonesia, 2008), whilst in Malaysia 75% of reported HIV cases are
amongst PWID (Ministry of Health, Malaysia, 2008). Pakistan has
moved from a low prevalence country to a concentrated epidemic
amongst PWID with HIV prevalence rates ranging from 9.7% in
Quetta to 26.5% in Karachi (Emmanuel & Fatima, 2008). Rising HIV
prevalence has also been recently observed in Bangladesh with a
significant proportion of the infections due to injecting drug use
(Sharma, Oppenheimer, Saidel, Loo, & Garg, 2009).
Over the last decade Central Asia has reported an average
increase of cumulative HIV cases of 48% per annum (UNODC, 2008).
The continued escalation of the HIV epidemic in Central Asia is
primarily attributable to the spread of opiate use and the high
proportion of unsafe injecting practices amongst PWID (UNODC,
2008). In the Islamic Republic of Iran which shares common bor-
ders with Afghanistan, HIV prevalence of between 15% and 23%
has been documented amongst male injecting drug users who use
drug-treatment services in Tehran (UNAIDS, 2008).
HIV prevalence amongst PWID in the Middle East is largely
unknown with data available only in several countries in the region.
In Egypt for example the HIV prevalence was estimated at 2.5%
whilst Libya reported a rate of up to 22% (Mathers et al., 2008).
Unsafe injecting has also been reported as the main route of HIV
transmission in the Libyan Arab Jamahiriya and Tunisia although
the extent of the HIV epidemic is not known (UNAIDS, 2008). A
combination of injecting drug use and sex work coupled with low
condom use may also be facilitating the spread of HIV in Algeria,
Egypt, Lebanon, and the Syrian Arab Republic, where one-third or
more of surveyed injecting drug users said that they recently either
bought or sold sex (UNAIDS, 2008).
Harm reduction in Islamic countries
Injecting drug use is regarded as a challenging issue in many
countries. The attitudes of leaders of diverse religions to the issue
of injecting drug use and the HIV/AIDS epidemic have been impor-
tant in most countries around the world and this has also been true
in many Islamic countries. The responses of the governments in
Islamic communities to IDU-driven HIV epidemics vary from the
public health approach that has been undertaken in The Islamic
Republic of Iran, Malaysia and Indonesia to the rejection of harm
reduction in Libya, Tunisia, Syria, and Jordan (IHRA, 2009; Mesquita
et al., 2007; Razzaghi et al., 2006; Reid, Kamarulzaman, & Sran,
2007). An examination of some of the principles of Islamic teach-
ing may provide an understanding of the positive responses that
have been undertaken by several of the Islamic religious leaders
and their governments that have enabled the implementation of
harm reduction programmes.
The fundamental objective of Islamic divine laws is the protec-
tion and preservation of the faith, life, intellect, progeny and wealth.
The injunctions of the shariah are therefore stipulated to preserve
and protect the dignity of man, steer mankind away from harm and
destruction and show the way towards success in this world and
the hereafter. In Islam, the Quran and the Prophetic traditions or
the Sunnah are the central sources of references for the laws and
principles that guide the Muslims’ way of life. Whilst the Quran
and Sunnah do not have specific solutions to many social, health
and other issues that have emerged since the Quran’s divine rev-
elation and the teachings and traditions of the Prophet Muhamad
(saw),2 there are general guidelines from these two sources that
could be analysed in coming with an Islamic perspective on con-
temporary issues and problems including harm reduction. One of
the basic guidelines provided in the Quran and the Sunnah allow
for mankind to fulfil the needs of the present day without straying
into the path of destruction.
In looking at harm reduction, one principle that could be used is
the approach of maqasid al-shariah or the “purposes of the Islamic
law” which has a number of advantages as it looks at Islamic prin-
ciples from a comprehensive point of view (Abu Bakar, 2001).
This approach involves the compilation of arguments from vari-
ous verses of the Quran and traditions of the Prophet which are
relevant to the issue at hand. In the maqasid approach, the most
critical needs of mankind are known as dharuriyat. The five aspects
of dharuriyat or ad-dharuriyat al-khams are preservation and pro-
tection of faith, life, intellect, progeny and wealth which are critical
in preserving and protecting the dignity of mankind. Harm reduc-
tion can therefore be accepted as a necessity in order to preserve
the faith, life, intellect, progeny and wealth of mankind which are
threatened by the twin epidemic of drug use and HIV/AIDS. Several
provisions as found in the shariah could be invoked in relation to
opiate substitution treatment and needle exchange programmes.
The principle of injury in Islam (Darar) asserts that no one should
be hurt or cause hurt to others, la darara wa la dirar. Drug addiction
and HIV/AIDS hurt people and their families in their life and health.
Islamic principles require that any injury should be mitigated to
the extent possible. These provisions are in line with the Islamic
dictum that states that “a lesser harm may be tolerated in order to
eliminate a greater harm”. One such principle is al-dharurat tuhibul
mahzurat or necessities overruling prohibition. In situations when
there is great necessity, something that is originally prohibited may
become permissible. In verse 173 of Surah al-Baqarah in the Quran
(Abdullah, 1994), it is stated to the effect that:
2
The abbreviation after Prophet Muhammad (SAW) means “Sal Allahu Allahi Wa
Salam” in Arabic which means “May the Peace and Blessings of Allah (God) be upon
him”.

3. A. Kamarulzaman, S.M. Saifuddeen / International Journal of Drug Policy 21 (2010) 115–118 117
If one is forced by necessity, without wilful disobedience, nor
transgressing due limits, then he is guiltless. For God is oft-
forgiving, Most Merciful.
Another principle is dafu al-dharar wa jalbul manfaat or harm
must be treated and benefits must be brought forth. In Islam, there
is no such thing as giving up. When it comes to tackling whatever
problems being faced by mankind, Islam stresses the importance of
exhausting all possible avenues. Harm reduction provides a prac-
tical solution for an urgent problem. Scientific evidence has shown
that these programmes have been successful in reducing harm and
at the same time have brought forth many benefits to the society at
large (Wodak & McLeod, 2008). This is in line with another princi-
ple, namely dar al-mafasid muqaddam ala jalib al-masalih. In Islam,
public interest should be given priority over personal interest. In
this context a particular harm may be tolerated in order to prevent
harm to the general public, jalb al-masalih or looking after the gen-
eral good. This means that whenever a conflict between personal
and public interests arises, harm to the former may be tolerated
so as to protect the latter and therefore the problem must be tack-
led effectively and efficiently in order to ensure the greater good of
society.
Finally, in Islam life and good health must be protected and
promoted in all circumstances and this includes prevention and
treatment of any illness and disease. In this regard, the numerous
harms associated with drug addiction, a chronic medical condition,
should be prevented through measures that have been scientifically
proven, as Islam also believes that every disease has a treat-
ment known or discoverable by further scientific research. Rahman
(1993), who quoted the renowned Islamic historian and anthropol-
ogist Ibn Khaldun from his famous work Muqaddimah, noted that
dependence on scientifically proven medical treatment has been in
practice in the Muslim world since the time of Prophet Muhammad
(saw). This is further affirmed by the Prophet’s saying which was
narrated by al-Nasa’i, “Allah does not send down a disease with-
out sending its cure. Therefore, seek (and search) for its treatment”
(Al-Bukhari, 1995).
Islamic countries’ responses to harm reduction
Several factors played a role in the shift of harm reduction poli-
cies in countries such as The Islamic Republic of Iran, Malaysia
and Indonesia where both needle exchange programmes and opi-
ate substitution therapy have been implemented. In these three
countries this included the important role that non-governmental
organisations and civil society played in advocacy and the imple-
mentation of successful programmes that reached vulnerable
groups (Mesquita et al., 2007; Razzaghi et al., 2006; Reid et al.,
2007). Secondly, faced with rising HIV epidemics the governments
of each of these countries were forced to adopt the pragmatic
evidence-based public health approach of harm reduction pro-
grammes despite opposition from their communities. The role of
religious leaders in these countries has on the other hand been
mixed. In the Islamic Republic of Iran, religious leaders refer to
tenets in the Holy Quran or Sunnahs to shape much of the coun-
try’s policy and law and many public health issues are considered
first from a health stance and then religious law is used to support
the most beneficial approach (Todd, Nassiramanesh, Stanekzai, &
Kamarulzaman, 2007). This approach was applied to harm reduc-
tion with drug use and HIV/AIDS being defined largely as public
health problems with the central Islamic values of helping patients
and people as described above invoked to support these policies. In
Malaysia on the other hand, which has a long history of criminal-
isation of drug use and trafficking, the support and reaction from
religious leaders were mixed. The religious and political leader-
ship have traditionally opposed harm reduction on the basis that
distribution of needles and condoms would encourage and imply
acceptance of drug use and adultery and that substitution therapy
would compromise the nation’s goal to become drug free (Reid et
al., 2007; Todd et al., 2007). Following the government’s decision
to implement harm reduction in response to the escalation in the
HIV epidemic, there were both protests and support from Islamic
religious leaders and communities in Malaysia. The Institute for
Islamic Understanding of Malaysia (IKIM) pronounced harm reduc-
tion to be a public health issue which did not violate shariah law as
discussed above.
In many of the countries in Central Asia faced by rising HIV
epidemics driven by injecting drug use, the role of Islamic lead-
ers in supporting or opposing harm reduction programs has not
been documented. In these countries increased availability of finan-
cial resource and technical support primarily through the Global
Fund to Fight AIDS Tuberculosis and Malaria seems to have played
a major role in the adoption of harm reduction programmes (Cook
and Kanaef, 2008; Mesquita et al., 2007).
Conclusion
Many countries with large Muslim populations are threatened
by the escalation in illicit drug use and related HIV epidemics.
Harm reduction programmes including opioid substitution therapy
and needle exchange programmes are permissible in Islam in line
with the maqasid al-shariah framework where faith, life, intellect,
progeny and wealth threatened by drug use and HIV/AIDS must be
preserved and protected. The reluctance to implement harm reduc-
tion programmes by many Muslim governments and societies is
less due to the teachings of Islam but rather may have arisen out of
ideological resistance and decades of response to the problem from
a criminal justice point of view.
Islam places great importance on the well-being of the soci-
ety. Drug use and its effects, including the rampant spread of
HIV/AIDS, is a great threat to any society. The Prophet Muhamad
(saw) had said “The believers, in their love, mercy, and kindness to
one another are like a body: if any part of it is ill, the whole body
shares its sleeplessness and fever”.
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