Centering lived experience: bridging drug policy and prison reform through peer‑led care

In this expert blog written for PRI, author Alexei Lakhov argues that the meaningful involvement of people with lived experience is essential to creating effective drug and prison policies. There is a fundamental need to move beyond tokenism toward genuine partnership in decision-making, ensuring diverse voices shape agendas and recommendations grounded in lived experience. The author points out how punitive drug laws drive imprisonment and calls for decriminalisation, health-based services and peer-led continuity of care inside and outside prisons.

Meaningful participation of people with lived experience in the EU and UN spaces is not a “nice extra” – it is the only way to make drug and prison policies genuinely people‑centred, effective and rooted in the realities of those most affected. For people like me, who have depended on peer‑run harm reduction to literally stay alive, receive treatment and stay connected to the community, this is not an abstract principle but the fabric of everyday life.

From being spoken about to speaking for ourselves

In many regional and international spaces, discussions still too often happen about people who use drugs, about people in prison, rather than with us. Entering these spaces as someone with lived experience of drug use, contact with criminal justice systems, and navigation of frequently hostile services, I am acutely aware of both the progress that has been made and the fragility of the space that has been created.

When I share stories of friends lost to overdose or preventable infections, I am not “adding colour” to a policy debate; I am filling in what neat indicators leave out. Hearing lived experience directly changes the “temperature” in the room: officials who are used to speaking in technical language suddenly start asking grounded questions.

Like the research highlighted in other PRI blogs, my experience confirms that co‑producing policy with those most affected does not just feel more ethical – it produces better evidence and more honest conversations about harm.

Representation without tokenism

Over the last years, I have been part of drafting committees, multi‑stakeholder consultations and advocacy spaces linked to the Pompidou Group, the Programme Coordinating Board (PCB) of UNAIDS and the Global AIDS Strategy. These moments showed me the difference between being included as a mere token and being engaged as a genuine partner.

Being flown in to tell a powerful story and then quietly sidelined when the real drafting begins is a familiar pattern, and it leaves both the person and the process exposed to burnout and disillusionment. By contrast, when people with lived experience shape the agenda, co‑author recommendations, and are embedded within decision‑making structures – such as the NGO Delegation to the UNAIDS PCB, –  personal stories are transformed into expertise that carries both weight and consequence.

Representation also has to be plural. The experiences of women, queer and trans people, migrants, racialised communities and people with disabilities in drug and prison systems are not interchangeable. In my own work, I have seen how easy it is for one “acceptable” lived experience voice to be repeated on panels, while those facing the harshest forms of criminalisation remain unheard.

Where drug policy and prison reform meet

Punitive drug laws remain one of the main drivers bringing people into contact with police, courts and prisons across Europe (and globally), however liberal drug policies in some countries may appear to be. The link between a minor possession charge, a suspended sentence that is subsequently activated, and a period of imprisonment is painfully common and is almost always rooted in the lack of accessible, respectful services within the community.

Decriminalising drug use and possession, alongside the expungement of past convictions, would have changed personal trajectories of many peers who today continue to live with the enduring consequences of a criminal record: restricted employment opportunities, limited access to housing, and travel bans. At the same time, any serious prison reform must confront drugs honestly: without Opioid Agonist Maintenance Treatment (OAMT), HIV and hepatitis care, mental health support and overdose prevention, talks about “rehabilitation” ring hollow.

People who have moved in and out of prison because of drug use are uniquely placed to show how these systems intersect. In consultations, I often find myself tracing the full arc: from the first stop and search, through court and imprisonment, to release – and highlighting every point where a health‑based, rights‑based approach could have replaced punishment.

Peer‑led continuity of care: what it looks like in practice

My own path into advocacy began in community rooms and drop‑in centres, not in conference halls. It was peers – people who used drugs, people who had done time, people living with hepatitis and HIV – who walked with me through chaotic moments and kept me connected to care when systems failed.

In my work today with the European Network of People who Use Drugs (EuroNPUD), the HIV Justice Network and the International Liver Cancer Movement, I see this pattern on a constant basis

– Community‑led, peer‑run services that provide HIV and hepatitis testing, safer‑use information, OAMT literacy and naloxone, often become the only stable point of contact for someone moving in and out of detention.

– Peer networks that support people inside prison to understand their rights, access available health services, and plan for release – and then meet them again at the prison gate to reconnect them to OAMT and HIV care so treatment is not cut off at the worst possible moment.

These forms of continuity of care rarely show up in official budgets in the way they should. Yet, for many of us, they are the difference between returning to prison and finding some stability; between surviving an overdose and becoming another statistic. When Council of Europe standards and national strategies recognise and resource peer‑led models, they effectively acknowledge that those most affected are already doing the work – and deserve power, not just praise.

What the Council of Europe and other bodies could do differently

If institutions are serious about “nothing about us without us”, they have to redesign how decisions are made.

For the Pompidou Group of the Council of Europe and other bodies, this could mean:

– Establishing standing advisory groups of people with lived experience of drug use and imprisonment, with a clear mandate, resources, and direct lines into ministerial and expert‑level decision‑making.

– Making co‑designed work the norm: pairing academic or institutional experts with community and lived‑experience experts as equal partners in drafting recommendations, monitoring implementation and evaluating impact. 

– Ensuring ethical, sustainable engagement: fair pay, trauma‑informed support, clear agreements on how stories and data are used, and regular feedback on how input has changed policy or practice.

My story is only one of many, and that is exactly the point. When people who use drugs – including those who are, or have been, in prison – move from being invited to tell their stories to being recognised, resourced and trusted as experts, systems begin to shift from punishment towards dignity, health and real safety for everyone.