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Public Health Aspects of the World Drug Problem

Organized by the World Health Organization.

ON UNGASS website and hard copy available

Showed short film. 

Introduction by Shekhar Saxena, Chair.  Why is PH approach needed in this area of work.  Drug use is a risk factor associated with poor health and other behavioural risk factors.  Preventable and treatable health conditions.  Ensuring access to controlled meds for med an scientific purposes.  Prevention and treatment of blood borne infections associated with drug use.  Monitoring drug exposure and impact of drug use on population health.  Enhancing implementation of PH approach.

Drug use gives rise to death.  Estimated number of deaths….global health problem.  per 10K per annumEstimated number of deaths due to drug use disorders.  Numbers increased significantly.,  Increasing over a period of time.  Growing problem worldwide.  Disease burden attributed to drug use disorders 15-30 year olds bear the brunt to drug use disorders and deaths. 

Vladimir Poszniak.  
Everyone should have access to treatment without experiencing financial hardship. Universal health coverage concept.  Health system with services for drug use disorders.  Financing mechanism should ensure treatment and not marginalise.  Access to essential medicines and technologies.  Competent and motivated health workforce.
WHO Guidelines.  Treatment of opioid dependence.  Screening and brief interventions.  WHO ASSIST>  mhHGAP Intervention guide.  Substance use and substance use disorders in pregnancy  community management of opioid overdose.

reality is far from idea.  Recent who atlas survey shows that the coverage is far from acceptable in most countries surveyed in the exercise.  Far from 80% coverage of health services.  At best it reaches 40% but best in very few countries.  Partnership with UNODC treatment of drug dependence treatment and care. 
Capacity building activities on drug policy and public health
Information products on drug policy options and public health
Support for early identification and management of drug use and drug use disorders in health services
Dissemination and implementation of tools.

Nicholas Clark
Country example Albania.  Predominantly heroin and cannabis problem but no one really sure of extent of problem.  Clear that it was a trafficking route but lack of data about how to plan a treatment program.  Treatment fragmented.  Government and then harm reduction and a faith based NGO providing abstinence treatment.  Lack of substitution treatment program.  Worked with various government departments and stakeholders to
•   focus intentions on National action plan on drugs. 
•   provide new treatment facilities
•   training in drug treatment
•   essential medicines for drug treatment
•   drug epidemiology and health system assessment

Gilles Forte
Access to controlled meds.  Works within international conventions.  WHO is a party and by mandate we have the obligation to carry out risk assessments and critical reviews of substances that are candidates for international control.  ECDD meets every two years to review substances.  Harms to use and therapeutic usefulness.  Then issue recommendations to CND.  On Friday will be discussing and MS will decide whether to accept MS recommendations or not.  Very important mandate for WHO to carry out this work as part of the conventions.
We also have the mandate to improve access to medicines.  In Preamble stated that they are important and that access is achieved for populations.  WHO is also mandated by WHA Resolutions and commitments to initiatives.
2005 Resolution WHA 58.22 on Cancer Prevention and Control
2014 resolution 67.22 Accessing EM
2014 resolution 67.19   Strengthening PC
2015 126/27 Strengthening surgical care.

In terms of work on access.  Consensus to identify disparities on access to controlled medicines and gaps in various regions.  Slide on gap.  Consensus on the problem, but how to address it?
Controlled meds used to manage moderate to severe pain, emergency obstetrics.
WHO a normative organisation.  Mandate to produce tools and guidelines , done through expert committees, and robust evidence based guidelines.  WHO Guidelines — ensuring balance in national policies and controlled substances.  Assists countries in review and development of polices that takes into consideration access to CM in a balanced way meanwhile preventing diversion and trafficking.
Guidelines on management of pain and opioid dependence, management of persisting pain in children, in progress on palliative care.  Developed by independent expert using robust methodologies. 
WHO model list of Essential Medicines — reviewed every second year according to trends and scientific evidence.  Includes about 12 controlled medicines for pain, PC , obstetric surgical conditions.  Meant to be a model for countries, low and high income — which to prescribe, which have demonstrated efficacy and safety and real public health need.  Next one will be April 2015.

Collaborate with countries to ensure standards and norms — ATOME programme in Europe, development of a Joint Global Program to improve access to controlled medicines.
Development of a Model Law related to availability and accessibility to controlled medicines
WHO — UNODC Expert working group on data collection and tools for NPS
UN Task Force for UGNASS 2016

Annette Verster.
35 million people living with HIV
10-22 million people inject drugs
10 million with HCV (77 countries)
900, 000 -4.8 million with HIV
158 countries reported injecting drug use 123 (78% reported HIV among PWID. 

Public health response needed.  HIV prevalence among PWID and in the general population in selected LMIC countries.  Great disparity.  28x more likely to be infected than general population.  In some countries goes up to 50x more.

WHO normative guidance.
Definition of harm reduction.  WHO, UNODC, UNAIDS 2009.
9 interventions accepted and endorsed on a global level and political level — ECOSOC and WHO resolutions, and CND

needle and syringe programs, OST, HIV and ART, etc.

Where are countries with implementing interventions?
•    NSP — 200 needles/person/year — 60% reached.
•   OST — 40% on maintenance
•   HIV and ART — all those in need

Prevention, vaccination and treatment of viral hepatitis and TB
Guidance for HIV prevention, diagnosis, treatment and care for key populations: a comprehensive package.
Need to address structural barriers:
•   ensures an enabling environment for implementation of effective interventions.  Support legislation, decriminalisation, alternatives to punishment, policy and financial commitment
•   Addressing stigma and discrimination
•   Addressing violence
•   Empowerment
Only 40% of priority countries address PWID in national plans and programs.  Still a lot of advocacy to be done.  We also know that 43 % of countries report laws and legislation that inhibits access to health services.  Continue advocacy and work on countries to provide guidance to implement comprehensive package.

Maria Renstrom 
Put more focus on prevention.  Can deter if based on available knowledge and adjusted to age and targets relevant factors.  Families and parents always mentioned. 

Warmly parenting gives prosperous, supportive future.  Targeting risk and protective factors.  Integrated in several WHO areas of work.  Upstream. 

Complex issue.  Cannot be done ad  hoc or with media campaigns standing alone.  Must be implemented with a package of comprehensive preventive issues.   National, regional,local, and global.  

Drug use and road safety.  Road traffic fatalities per 100K population.  Slide on morbidity and mortality of driving impaired.  WHO had a technical consolation with experts all over the world. 

Monitoring, surveillance and evaluation.  ATLAS reports on resources for prevention and treatment of substance use disorders.  WHO Global Information System on prevention/treatment resources. 
WHO Surveillance Tools and Activities
WHO STEP wise approach to Surveillance
Global School-based Student Health survey
Assessment of treatment systems for substance use disorders

Evaluation of effectiveness of policy options. 

Three key messages
Protection of public health is the ultimate goal of drug control
Public health perspective should be given greater consideration in drug policy

Katherine Pettus: Two Comments — to do with stigma — Praising all the presentations and work.  But Gilles language stigmatises medicines and prevention program stigmatises parents.

World Hepatitis Alliance speaker — so under represented in slides.   

In order for health based approach to drugs to be more than just a soundbite, money has to change — law enforcement funding has to go into health 10×20  can WHO get behind this/

Kenya — NGO what are 7 member states doing about infected drug use on the roads. We have so many deaths coming from use of alcohol — control measure?  I didn’t really understand the question.

Annette hepatitis drug use smaller smaller — totally agree doing our best,  hepatitis is getting more momentum and we had a resolution last year — still struggling to rename the HIV department.  Moderator.

Chair.  Investments.  Rebalancing also means rebalancing investments.  Member states must decide.  We are looking for rebalancing of investments also. 

Gilles.  Agrees on controlled medicines language.  Stop using the word “drugs”.  Continuing to look at affordability of Hepatitis medicines.

Maria.  Not just showing one example of things.  Done.  Best ways of strengthening families and parent universal.  Offered to all parents, not only parents with parents.  All parents should have the opportunity to handle…just an example of what has been done so far.  Drug use and road safety.  Alcohol is the main issue.  Several countries have seen that there are more drivers than expected also had other substances in the blood when tested.  Increasing problem, but should not take over from alcohol as the main problem.

Slide on further resources and links to WHO website.

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