UNGASS Special Segment Day 2 – Interactive discussions on demand reduction

Chair. This will include health, HIV, access to essential medicines. The format will include introductory remarks from the chair, as well as 7 minutes presentations from each panellist.

Mr. Gilberto Gerra, UNODC. Introductory statement. First question to launch the debate – is it really accepted that young people, people affected by drug use disorder, people affected wit HIV, should receive health care and support instead of stigma and discrimination? In some countries service providers have no clear knowledge about people they are treating. In other countries, prevention is not based on scientific evidence. And finally, people in need of treatment don’t have access to it, or do not access treatment based on evidence. Again, the UN comprehensive package on HIV is still poorly available worldwide. Opioid overdose still kills 100,000 people which could be prevented with distribution of naloxone, why is this still not available widely? And again, 80% of the world’s population is not treated for severe or moderate pain. There is huge disparity between high and low income countries. I want to present 3 slides:

  • what happens if we put together prevention interventions in schools including life skills – why is this not implemented?
  • In Australia, a study was conducted on treatment – OST, residential treatment and detox. Patients were followed for 11 years. This showed very positive results.
  • Regarding HIV – NSP programme in Amsterdam: decrease by 50% of HIV infections.

If you put together NSPs and OST, you have extremely good results. We must be ready to take action with what works.

Youth forum 2015. We, as youth, acknowledge that there is not one single reason why young people start using drugs. Many factors can make people vulnerable to start using drugs: family difficulties, easy availability of substances, marginalisation, escape from stress, pressures or mental health issues. We have spent 2 days sharing experiences, and there is a lot we can do. We ask you to support our efforts. We need you as policy makers to invest in prevention. We urge you to base your policies on scientific evidence, and not on popular opinion. We must prevent substance abuse with scientific understanding. We must develop social skills for our youth, with career possibilities. It is understood that the availability of substances must be restricted. We must be more accepting of people who partake in drug abuse, and those in our commmunity who have already suffered – treatment, not punishment; support, not exclusion. We must provide opportunities to openly discuss this complicated matter, explaining scientific aspects to young people, save space for youth to seek advice. We must aid and support those in need. Drug use should not be seen as a solution to personal issues. Pairs, schools, community should provide youth with confidence and skills to overcome these vulnerabilities. Services should be easily accessible in society. Opportunities to learn from young people must be extended, we must empower them and support their health and advocate to different stakeholders. Although we have a lot of capacity and experience, we ask you to work with us, share our passion and commitment in this important cause. Give us the tools and opportunities for us to become meaningful participants. We can and will change the situation in our communities and truly support the health and well being of our communities.

Nora Velkov. Consensus of the scientific network and recommendations. Our statement is based on the recognition that the development of substance use disorders is based on neurological, societal factors. We ask for the elimination of stigma and discrimination as they are roadblocks to effective interventions. Criminal sanctions are not to be used. We encourage member states to collect and analyse patterns of substance use and related problems, to guide policy making in prevention and treatment. Substance use disorders are preventable. Effective programmes do exist, and member states should implement these programmes as early as possible, as early as childhood. Addiction should be treated as a health issue. People should receive the state of the art treatment services, not those based on belief. We can combine pharmacological and psychosocial interventions. These are chronic conditions with a tendency to reoccur. Treatment, rehab, recovery management and harm reduction are important interventions in the continuity of care. Treatment of individuals must be integrated into mainstream public healthcare. We are grateful to the UN, the CND, UNODC, civil society and member states for reaching out to the scientific community to bridge the gap between science, policy and practice. The Scientific Network is willing to provide expertise and support in the lead up to the UNGASS.

Mr Tawfik Zid, African Group. We must give greater importance to prevention and raise awareness on the dangers of drug abuse. We must give young people the tools to protect themselves from drug addiction. We must also tackle the real causes – poverty, unemployment, social marginalisation and despair – with socio-development programmes, education standards and raise living standards. We also need monitoring mechanisms to protect vulnerable groups. We must promote health clubs in schools, promote social protections, bolster our family systems, our child protection centres. We must also strengthen the role of teachers, educators, promote family dialogue, create programmes to improve psychological help. We must use technologies to this end, improve treatment and care centres, provide proper information for people who work in drugs interventions based on scientific knowledge. We must fight drug addiction involving all actors, including NGOs. We must also focus on risk reduction strategies including for HIV/AIDS and viral hepatitis C. In case of social reintegration, we must reintegrate people who have opted for treatment, we must provide social protection to prevent them falling back into drug use and social marginalisation. We must also establish statistical and research centres on drug use. We must not focus only on a punitive approach, we need an integrated approach allowing for all the circumstances leading to drug abuse to be addressed. We must take into account attenuating circumstances for drug use – first time users should benefit from early treatment. There should also be substitution therapies. Incarceration carries the risk of transforming users into criminals. They may even become dealers for example. The National Committee on Drugs in Tunisia looks after the health aspects of this issue.

Mr. Peregoza, Representative of the Asian Group. Demand reduction aims at reducing drug abuse. This is a threat that knows no borders. In the Philippines, this is a national concern, for security, for health, social and economic well being in the country. We are strongly implementing the 2009 political declaration and plan of action with prevention, treatment, rehab and reintegration. 6.7 m philippinos are estimated to be using drugs in 2004. Now, 2012, they are only 1.3 m. For a holistic, balanced approach, we have been involved with the support of other government entities and the private sectors to reduce demand for drugs. To avoid the incidence of drug abuse, we conduct random drug testing in schools. The department of health has also institutionalised drug testing interventions and gathered data. We have also implemented peer-group against drugs programmes to act as catalysts for promoting a drug-free life-style. To tap the religious sector in advocacy against drugs, a programme was created to provide assistance to the government with the implementation of drug-based interventions. Prevention has been integrated in school curricula. The use of police officials is also important so that students can interact with them in friendly situations, developing positive attitudes towards the police. There is a special drug education centre to support initiatives to prevent drug abuse, a family drug abuse prevention programme. Educators are given trainings on the effects of drugs. We give workshops on how to implement the law. Online drug prevention trainings were also created. This shows our commitment on anti-drug campaigns and drug abuse prevention.

Mr Jože Hren. EEC. There are many factors that place people at risk of using drugs. But there are also many interventions that can prevent those risks. For a number of years, Slovenia has developed drug interventions, policies and practice. Since 2009, Slovenia decriminalised possession for personal use. Treatment should always come first. We are discussing our new action plan. It emphasizes a balance in demand and supply. It has been widely agreed that prevention and treatment should be rooted in science and human rights. Demand reduction is cross-cutting, horizontal and vertical, involving many ministries, local communities and CSOs. It is essential that a wide range of prevention activities are provided. Risk and harm reduction services, social reintegration are vital. Especially with regards to preventing HIV and hepatitis, this includes NSPs, diagnosis, ART, etc. In Slovenia, methadone, suboxone, buprenorphine and slow release morphine are used for OST. In addition, since 2012, it is allowed to provide drug consumption facilities.The HIV epidemic has been slowing down. Harm reduction has made an important contribution to health and HIV prevention. In the last 5 years (2009-2013), there were 3 cases of new HIV infections among people who inject drugs. We must adapt to the new challenges posed by NPS, cannabis addiction, etc. I now wish to focus on cannabis – it is the most widely used substance in the world. The cannabis of today can be much more potent than in the past. But despite growing evidence based, uncertainty remains around cannabis’ effects on the health of the population. Cannabis use an increase mental health problems, led to car accidents, etc. Changes in social norms will have significant problems, especially for young people. Prevention activities cannot be stressed enough. Guidance by UN bodies can be useful tools. At the same time, it is necessary to mention that in some parts of the world some countries have allowed for the use of medical cannabis. Recently we have rescheduled THC to make it available for medical use. This plant seems beneficial to treat some ailments.

INCB President – 5.5 billion people have no or limited access to opioid pain relief treatment. Around 92% of morphine used worldwide is consumed by 17% of the global population primarily concentrated in the developed western world.

In 1961, the international community committed to making sure access to medicines was secured. At the same time, the convention preamble recognised the issue of addiction.

The problem does not seem to be a problem of a lack of raw material; the global production of opiates has exceeded demand. There are impediments which include regulatory ones adversely affecting availability. In recent years, there’s been an increase in drug-related deaths due to opiate consumption in countries where there is a high prevalence of use.

I would like to mention an often neglected problem on this issue – the availability of substances controlled under the 1971 convention. There hasn’t been sufficient attention paid to medicines controlled under this convention and issues concerning lack of access to them.

The INCB will prepare a report on availability to controlled medicines to be published in early 2016. It will be offered to the international community before the UNGASS.

The overall goal of the drug conventions is a well functioning system that ensures the safe and rational delivery of affordable drugs while at the same time preventing the diversion of drugs for the purpose of abuse.

Robert Campa, Latin America and Caribbean states representative – As has been said on a number of occasions, the global drug problem is a complex challenge. It’s a transnational phenomenon. We share the concern of those who have raised the need to address drug use. We are obliged to respond to the message delivered by youth at the beginning of this interactive session.

Mexico’s system is a federal one. We have a specific program of action that has been implemented. Our national network that provides centres for addiction is the largest in Latin America. There are also services provided by civil society. Our model rests on prevention, detection, guidance and early treatment.

Mexico recognises the challenges posed in guaranteeing access to pain medication. The administrative procedures are costly, but efforts are under way to improve access. All of these are issues previously addressed by the panel.

Many have suffered from or lost their lives due to addiction. Communities affected by violence have high criminal indices. We must make efforts to tackle criminal groups, but not target the most vulnerable. We must avoid stigmatisation and criminalisation of users.

There are 6 vulnerabilities we focus on; teenage pregnancy; family violence; the issue of addiction, among others. Prevention is the best practice in addressing these issues. We have extended access to full time schooling, helped develop social productive projects, and provided counselling services.

The incarceration rate has risen markedly in Mexico over recent years. In 2014, 17,000 adolescents were held behind bars. Six of every 10 of these were drug users. The least effective measure to combat drug use is criminalisation.

We believe it is time to explore alternatives. The first mechanism we’ve implemented are a system of courts to address addiction. These are being established in a step by step manner. They currently operate in 5 states and we plan to add 5 more this year.

The struggle against drugs has so far been a lost battle in many countries, above all when it comes to reducing demand. Mexico has a commitment to identifying alternative approaches in this area.

Michael Botticelli, ONDCP, US – Much has changed since the last UNGASS on drugs. Thanks to advances in research, we now know that drug misuse is a disease that people can recover from.

Think about the potential that exists to bring the fruits of this knowledge to more of our citizens. The way to reduce demand for drugs is through evidence and science-based policies.

The finalised international standards developed by the UNODC on substance use disorder will be presented at next year’s CND.

Many of us talk about the importance of a public health based approach. But these all require political will. Screening patients for substance use is a starting point as a point of early detection.

Another part of public health is the use of medically assisted treatment. OST is the most highly effective intervention for people dependent on heroin. Medication assisted therapies is also being integrated into AIDS programs in the US. OST not only reduces heroin use but combats associated diseases.

We know how important it is to support peace and stability across the world, which is why the US is committed to a balanced approach addressing supply and demand. A punitive approach in and of itself does not work. By finding alternatives to incarceration we offer a way to keep people out of jail and help them develop.

Every day in the US, 110 people die from an overdose. These are not dispensable people. There is not enough naloxone available across the country to combat this, but we’re taking steps to address this by increasing provision.

We know that treatment availability is not enough, though. We have much more work to do to eliminate the stigma of drug use and ensure people don’t face barriers when accessing treatment. We must prioritise eliminating stigma, shame and judgement.

We know we cannot rely solely on supply reduction and control measures. Please join me in ensuring that the UNGASS sends a clear message; time for talk has ended and the time for a public health approach to drugs is now.

World Health Organization. The WHO has the directing and coordinating role for health. Apart from our advisory function on substances for scheduling, we offer guidance, monitoring and evaluation. We will have a strong focus on health and access to essential medicines at the UNGASS. People dependent on drugs should be provided with the same level of treatment and care as any other person with a health condition. There needs to be comprehensive treatment. Health systems and services have a key role, it is a cornerstone for the response against drug use disorders. We must ensure that all people access the health services they need. Unfortunately, for these people, treatment is not available, or when it is, treatment is too expensive, leading families to poverty. Achieving universal health coverage requires:

  • a strong health system with services capable of identifying people who use drugs and providing care
  • assistance for funding health services
  • access to essential services
  • well trained health workers

Addressing the world drug problem requires a comprehensive multidisciplinary approach. We must work with the criminal and education sectors. Interaction between drug control, law enforcement and health is necessary.

Prevention and management of HIV, hep and other diseases is another important area of intervention – see the WHO, UNODC, UNAIDS technical guide. This has been endorsed widely in the UN and beyond. This also includes addressing stigma and discrimination.

With regards to availability to controlled substances for medical purposes, the issue is complex and we are working with UNODC to address barriers to access. In May 2014, the World Health Assembly adopted a new resolution for palliative care. This area is of a complex nature.

Promoting a public health approach to the world drug problem includes balancing policies, prevention, treatment, harm reduction and addressing the social determinants of drug use, monitoring society responses to drugs, cost-effectiveness of interventions.

For millions of people suffering from drug use, the absence of such services means death. We must continue sharing experiences, capacity building activities, research to rebalance the global drug control system.

I recall the statements made by the youth forum and the scientific network around the need to base policies on science. We work at WHO to contribute to provide the science we need.

In conclusion we work with governments, UN agencies and NGOs to conduct a comprehensive strategy towards the world drug problem, towards the UNGASS.

Mr Diederik Lohman, Human Rights Watch. Ladies and gentlemen, good afternoon. I am grateful to the Civil Society Task Force which has invited me to participate in this discussion today based on my expertise in my field. As civil society views on this topic are broad and diverse, my statements should not be taken as representative of civil society as a whole. I hope that my input will help generate broader discussions about the issue of drugs and health.

I would like to make four specific proposals for the consideration of member states. These proposals are based in more than a decade of work on drug policy issues, covering HIV/AIDS, TB and hepatitis C, drug dependence, pain treatment and palliative care.
 
My first proposal concerns medical access to controlled substances. The UN drug conventions do not just deal with so-called illegal drugs. In fact, they recognize that controlled substances are indispensible for the relief of pain and suffering and they obligecountries to ensure the adequate availability of controlled substances for medical purposes. I emphasize the word “oblige.” Twelve medications that contain internationally controlled substances are currently on the World Health Organization List of Essential Medicines. These medications are used in extremely varied fields of medicine: analgesia, anesthesia, drug dependence, maternal health, mental health, neurology, and palliative care. Yet in much of the world access to these medicines is very limited. The INCB annual report published last week offered a grim reminder. It concluded that about 5.5 billion people still have little or no access to opioid analgesics, leaving 75% of people worldwide with no access to pain relief. These people face horrendous suffering. I have personally interviewed hundreds of them. Like torture victims, many of them say that their suffering is unbearable and they would do anything to make it stop. Some even commit suicide.

This is happening because many countries impose draconian regulatory requirements on these medicines that severely complicate or discourage their use in medical practice. For decades, the Commission on Narcotic Drugs ignored this problem. The 1998 political declaration on the world drug problem proclaimed drugs “…a grave threat to the health and well-being of all mankind” without any acknowledgement of the importance of controlled medications.
 
The 2009 political declaration made fleeting reference to the issue but did not call for any specific action from member states. Last year’s Joint Ministerial Statement finally expressed concern about the limited availability of these medicines in many countries but the paragraph was placed at the very end of a long section on Demand Reduction.

Yet, availability of controlled medicines and demand reduction are two completely different things. One deals with illegal drugs, the other with licit pharmaceutical products. At present, controlled medicines do not fit under any of the current pillars of the global drugs policy framework. 
 
The UNGASS is an opportunity to rectify this. As a core obligation under the drug conventions, access to controlled medicines deserves its own pillar, a pillar that should deal both with ensuring adequate availability as well as with preventing diversion and misuse. My second proposal concerns evidence-based approaches to drug policy.

We have more and more scientific evidence about what drug policy approaches work and do not work. It is high time that this evidence becomes the basis of global and national drug policies and program. Yet, we still see a significant resistence to embracing evidence-based approaches at CND and many countries continue to implement policies that run directly counter to the evidence.
 
Let me give you some examples: Countless studies in every region of the world have shown the effectiveness of needle exchange and opioid substitution treatment programs in, among others, countering the spread of HIV and hepatitis C. Yet, many countries ignore this evidence in national policies and CND still does not embrace the words “harm reduction.”
 
The 2011 High Level Meeting on HIV set a target to reduce HIV incidence among people who inject drugs by 50% by 2015. This target is likely to be missed by around 80% because of completely insufficient investments into harm reduction services.
 
Many countries continue to use criminal penalties for mere drug use even though the evidence shows this practice drives people who use drugs away from health services and fills prisons. People with problematic drug use need support, not punishment.
 
Multiple countries run drug detention centers where drug users are forcibly held for months purportedly for treatment purposes but without any access to evidence-based treatment. Other countries allow private drug treatment providers to operate programs that have no basis in science and are rife with abusive practices. To be effective in tackling the issue of drugs it is essential that we commit to evidence-based approaches.
 
My third proposal: UN health agencies need to be much more closely involved in global drug policy discussions and decisions. Agencies like the WHO and UNAIDS lead the UN system on questions of health and HIV/AIDS. For them to provide effective guidance at CND they need a seat at the table, alongside UNODC and INCB. In past years, I have often seen WHO representatives being relegated to the back of the room, making statements after all countries have spoken plenary or Committee of the Whole even in discussions that directly concern health. How can CND expect to effectively deal with the health matters when the lead UN agencies on health have to sit at the back of the room and cannot make an opening statement?

CND also needs to draw on the work that happens at other UN agencies. Last year, for example, the World Health Assembly adopted resolutions on essential medicines, palliative care and hepatitis, all of which are directly relevant to discussions here. But somehow these resolutions, adopted by the same countries represented here, do not appear to inform the discussion here. It’s as if Vienna and Geneva are two different universes that have nothing to do with each other. That has to change.
 
My final recommendation concerns setting ambitious, realistic and measurable targets and indicators.
Targets and indicators are essential for generating action, measuring progress and ensuring accountability. Sadly, the Commission on Narcotic Drugs does not have a good record in this area. The UNGASS is an opportunity to develop effective targets and indicators that reflect the complexity of the world drug problem and will propel real, measurable progress. I’d like to see health targets related to, among others:

  • Reduction in HIV and hepatitis transmission rates
  • Access to controlled medicines
  • Scale up and resourcing of evidence based drug treatment and harm reduction programs

Such targets and indicators will help guide and focus future efforts and ensure real results.

UNAIDS – We believe that as the UN our strength lies in what we can collectively achieve, both with governments and civil society. UNODC has a critical role to play as a co-sponser of UNAIDS in combating HIV among key populations.

The international community agreed in 2011 to reduce HIV by 50% among people who inject drgus by 2015. Much has been done on this issue, as well as others including the transmission from mother to child. However, progress has not been even and critical groups are being left behind. Injecting drug users and prisoners are among these.

Injecting drug users are significantly more likely to contract HIV and die young. 1.5 million lives are lost annually because of HIV. Imprisoning drug users only exacerbates these health issues.

Efforts to eliminate the use of drugs has had at best mixed results.

The challenges for government is that drug control remains largely within law enforcement while HIV is very much a health issue. The upcoming UNGASS represent an important opportunity for health and law officials to learn from each other and work together on a public health based approach.

As a matter of urgency, harm reduction provision like needle exchange and OST must be scaled up around the world. Decriminalising drug users will remove barriers to treatment and combat spread of diseases in prisons. We believe public health is the missing link in the current approach to drugs.

Australia – We’re concerned about the issues surrounding access to controlled substances for medical purposes. The fundamental basis for the UN drug treaties is to ensure access and there needs to be greater provision of pain relief medication that is currently controlled.

Low and middle income countries, which comprise 83% of the global population account for only 8% of global opioid consumption for pain relief.

Pilot programs we’ve worked on in Ghana show it is possible to overcome the obstacles to accessing pain medication. No one here today would like to think about the possibility of a family member dying in pain when pain relief could be provided.

We can work toward providing access to these medicines while still combating diversion for illicit use. I pose the question: what can we as member states collectively do together to ensure greater access to pain medication while combating diversion?

UK – I’d like to support the previous speaker and panelists on the issue of accessing pain relief medication.

2015 has come and we’re not at the goals set to combat HIV among people who inject drugs. This is depressing because we know very well what works. Harm reduction is a globally underfunded package. We need policies and procedures that also encourage drug users to access services. In countries that have done this, they have seen a reduction in the rate of HIV among drug users.

We should also focus on the issue of HIV among female drug users.

As we prepare for the two UNGASS next year, it’s crucial countries adopt a human rights and health based approach to this problem.

Iran – 90% of all drug demand reduction services in Iran have been provided by NGOs and/or private sector.

Regarding the prevalence of HIV among injecting drug users. 10 years ago it was more than 25% among this population. Now, the prevalence is at 9% thanks to the high coverage of harm reduction services in the country.

Accessibility to essential drugs is a right for all people in Iran. I want from you, that drug treatment and harm reduction are put at the core for all regional approaches and that NGOs are encouraged and brought into work on this issue.

There are many barriers to accessing treatment. Therefore, we should make harm reduction and demand reduction high priorities for governments.

It’s very important in Iran that we offer methadone and OST to key affected populations, in particular women and prisoners, whom we have incorporated into these programs.

Japan – Counter measures against drug use should be based on social background of each country. Each country should choose options independently based on their situation. It is not appropriate to suggest one for all countries, particularly concerning harm reduction.

Brazil – We will concentrate here on HIV and hepatitis. I would like to echo Australia’s comments on access to medicines.

Brazil has a comprehensive approach to combating HIV and viral hepatitis. The background is based on the right to better healthcare and human rights. We have strong data that we’ve halted HIV epidemic among people who use drugs. My main question, though, is that we have a recent study among crack cocaine users among which there is HIV prevalence of 5%. We keep hearing speakers talk about opioid substitution therapy, but we need treatment for stimulant addiction.

Therefore, Brazil is considering how to broaden its response to HIV and hepatitis by looking at the situation of stimulant users, and we encourage the WHO and UNAIDS to look at this.

Latvia – I am speaking on behalf of the EU. We note with appreciation the information prepared by the secretariat with regard to this agenda item.

There are worrying trends concerning poly-substance use and NPS, and a continuing high incidence of hepatitis C and blood borne diseases among drug users.

We should pay special attention to family and schools, and vulnerable and marginalised groups in our prevention strategies. Prevention measures should include early detection.

We support risk and harm reduction interventions. The impact and outcome of our policies show that harm reduction interventions have been successful in combating the spread of diseases and overdose deaths. Risk and harm reduction measures are also successful around the world, and we hope this is acknowledged.

The EU is currently developing a 3 year project on HIV with a focus on harm reduction measures for people who inject drugs, including those in prison settings.

We are committed to ensuring the accessibility and coverage of harm reduction measures.

Republic of Korea – We believe that demand reduction is as important as supply reduction. We also echo that any demand reduction measure should be based on human rights and scientific evidence.

I would like to suggest that we explore the discrepancies between production and consumption of drugs. This could be done through international cooperation.

Harm Reduction International – My intervention is on behalf of harm reduction organisations around the world. As we move toward the UNGASS, we must recognise the success of harm reduction. This practice saves lives and money. Yet, official recognition of harm reduction is lacking in this forum.

The world will miss the target of halving HIV among people who inject drugs by 80% in 2015. We need leadership on harm reduction which means increasing political support and funding for harm reduction.

$100 billion is spent annually on drug law enforcement, yet only $160 million is spent on harm reduction; 7% of what is needed.

A 10% reinvestment of resources by 2020 would fund harm reduction’s needs four times over, and we call on governments to divert resources to bridge this gap.

From the evidence, it is clear middle income countries will not automatically step in to keep harm reduction services going, and donor withdrawal represents a serious concern in this area.

Harm reduction leadership also means halting the criminalisation of people who use drugs.

Indonesia (Civil Society) – We echo the need for evidence-based policies that are humane. Lack of harm reduction services around the world is a concern.

We call on member states to implement treatment and harm reduction services that are voluntary and humane.

Lastly, if you want to succeed in providing treatment and services for people who use drugs, you need to involve civil society.

EURAD – We would like to urge member states to support a wide range of drug demand reduction measures, which should include prevention, early detection, treatment, harm reduction, and recovery, among others.

Recovery focuses on strengths of the person, not weaknesses, and is about helping people to rebuild their lives and contribute to society. Recovery-oriented systems of care in the community are needed.

Indonesia – Treatment and rehabilitation for drug addicts are designed to help reintegrate drug addicts into society. These services have grown rapidly in our country. These centres are both government and non-government based.

We are committed to saving drug abusers from incarceration by providing treatment and rehabilitation. In order to design and implement our program, we recognise the importance on evidence gathering and data sharing.

Every 30 minutes one person is infected with HIV in our country. 1 of 5 if below the age of 25. This epidemic is sparked by sexual transmission and injecting drug use.

HIV is an internationally shared responsibility; no country can tackle it alone. Combating this involves a balance between supply and demand reduction strategies.

Our legislation ensures supply of controlled drugs with medical uses while preventing their diversion. Indonesia has enacted to pieces of legislation on this issue.

Finally, Indonesia believes the conventions should serve as a foundation for the international system concerning access to drugs.

Switzerland – We’re deeply concerned about the lack of access to essential medicines. This shames us all. We need to recognise this suffering as an unintended side effect of drug control.

It’s the obligation of member states to promote harm reduction and public health approaches. Drug injecting sites are important components of this, and have a number of benefits.

Harm reduction, health and supply reduction are closely inter-related. We should not forget that the consequences of supply-side interventions can put the health of drug consumers at risk.

Norway – I commend the representative of Human Rights Watch. We know what to do. There is evidence. Why have we not implemented what we know works? That means we do a lot of what we know doesn’t work, and this is a waste of money.

I noticed the WHO described the drug problem as substance use disorder while other panelists describe it as a disease. I prefer the WHO description.

I would like to see comment on awareness, for example, warning about drugs.

My speech is about what we know does work, and what we know doesn’t, and the need to address this in the lead up to the UNGASS.

Tanzania – People who inject drugs are at dangerous risk of contracting infections. We will miss our Millenium Goals if we continue to neglect this group.

In our country, we’re scaling up methadone centres from 3 to 9. We’re training law enforcement and judicial system to work with harm reduction so that addicts can go to rehabilitation instead of incarceration.

Albert Einstein said “We cannot solve the problems of today by employing methodologies of the past.”

Drug Policy Futures – Drug use has a wide range of negative outcomes. The first task of a health-based approach is to prevent the negative consequences from occurring. Drug use begins young, so preventing use among the youth is key.

There is a need for a comprehensive approach to drug related harm that incorporates, prevention, treatment and recovery. We don’t believe there is a necessary opposition between law agencies and health, and believe they can work well together.

Tackling the world drug problem requires international cooperation. More can be done to address unintended consequences of the current drug control regime, and ensure access to medicines.

We are committed to ensuring voices of grass roots organisations reach the UNGASS. We would like to see a space for civil society input next year.

International AIDS Society – I want to talk about the need for doctors to become engaged in risk reduction. Because of criminalisation, access to care and harm reduction is difficult for drug users. We feel there’s a need to work toward outreach; we must work with these people based on a relationship of trust.

We feel we’ve been able to help drug users enhance citizenship. Current medical knowledge on the brain rejects that drug use is related to morality or belief. We do not believe in prohibition.

We wish to make sure that health is made a priority and put an end to criminalisation so as to remove the harm created by prohibition. Drugs have always existed and will continue to. A war on drugs is a war on people.

Our message for 2016 is to focus more on risk prevention and healthcare.

Algeria 

Implementing programme implemented by Ministry of Health, establishing 300 healthcare centres, some of which are specifically for people who use drugs. Provided treatment to some 400,000 users already. Don’t propose OST but plan for seminar on use of OST to gather experience from other countries. Committed to providing healthcare for people who use drugs.

To enable access to medicine, Algeria has also established centres to ensure adequate access to pain relief.

Ministerial decree in 2013 to classify substances to strengthen drug control and precursor control, including new psychoactive substances.

Sweden

Many issues, but I will focus on prevention. Multi-sectoral strategies can support prevention as well as supply reduction. There is a lot of evidence in this area amongst UNODC and WHO, encourage collaboration amongst these agencies to support member states and to scale up implementation of programmes into long-term evidence-based programmes.

Russia

Want to dwell on an aspect not discussed much, but mentioned by Brazil. We want to see scientific approach, which excludes dogma but based on different approach to tackling challenges. When treating drug use, important to avoid dogmatic approach because many different types of drug addiction. Now seeing increased dependency on cannabinoids, NPS especially amongst cannabinoids, cocaine, methamphetamine – together their volume is much greater than number of drug users of opiates. Replacement therapies have not been developed for all these types of addictions. The only way of providing assistance to these people is to cold turkey. This has been implemented in many countries including the US, where treatment programmes are based on complete cessation of drug use. We are doing disservice to scientific community if we do not mention this.

There is broad spectrum of medical approaches to drug treatment, not limited to replacement therapies, but diverse range including abstinence programmes. These programmes should not be forgotten but developed. Should not neglect abstinence programmes. These are priority programmes taking on board structure of addiction, see shift towards substances being used that cannot be treated with replacement therapies.

Active (civil society)
Last year, we adopted new narcotics policy, with 4 main aspects to drug use, including prevention, legal, and political. Prevention is crucial if we want to minimise harms caused by drugs. Young people are widely exposed to drugs, also one of the most vulnerable user groups. Recommend prevention programmes targeting youth. Youth have active role at grassroots level, and recommend including them in development and implementation of those programmes.

This will contribute to better world for tomorrow’s youth.

World Health Alliance (civil society)

Estimated 16 million people who inject drugs worldwide are infected with Hepatitis C, large portion of people infected with Hepatitis B as well. Recommend programmes to diagnose and treat people with hepatitis. We ask that hepatitis is no longer considered a footnote to harm reduction programmes, diagnosis and treatment for which is of similar route to harm reduction programmes. Co-infection is massive between HIV and hepatitis and they should be tackled hand in hand.

Thailand

Government has placed drug problem as one of the top priority of national agenda. Under demand reduction, Thailand has emphasised on prevention and creation of good environment, encourage human-centred approach targeting childhood group (instilling immunity against drugs), 7 – 12 years (lifeskills), teenagers, and adults to take part in prevention activities in their communities. Also support local participation in prevention programmes to raise public awareness. Also, we use social media outlets for sharing of good practice on drug prevention, based on UNODC youth programmes. These programmes help to prevent diversion into undesirable environments such as computer shops.

We have developed our drug strategy on the basis that people dependent on drugs are to be treated as patients, and can voluntarily enter into treatment. We also offer reintegration to those who have completed treatment to offer opportunities for education, employment and micro-financing. Encourage people who use drugs to voluntarily enter into treatment, improving treatment services, and entering communities such as encouraging faith and family based programmes.

Diversion in juvenile court proceedings promotes access to treatment, after completion of which they are released with no criminal record so they can return and reintegrate into society without stigma.

Despite these efforts, much needs to be done. Prevention costs less than treatment and so it remains significant at all levels and needs to be prioritised ; need to work closely with all stakeholders.

CLOSING STATEMENTS FROM PANELLISTS

Gilberto Gerra, UNODC

Intention of member states to guarantee availability of medicine for pain relief is obvious, after having been neglected for several years. Now taking action in terms of legislative, financial and mentality barriers. Interventions such as harm reduction should be provided as part of continuum of care. We have a lot of evidence from science on what we should do, as Russia mentioned, so we know what to do. States are oriented towards prevention, lifeskills, families, voluntary treatment based on evidence already. Member states should not just leave drug treatment to NGOs.

There is neglect of ATS and cocaine in developing tools for substance use disorders for those drugs. There should be research to fill this terrible hole.

Norway mentioned need for parental capacity to care for child, including monitoring and supervising them, this will help to reduce drug use. Schools, with help of UNODC and WHO, should work to implement these programmes in their country.

Tawfiq, Tunisia

Requires material support, bilateral and multilateral, to implement good practices. Need to involve judicial and health stakeholders. Need to deal with addicts as a human being so that we can recuperate him in society.

Philippines

Hopefully working together will ultimately solve the problem.

Mr Jože Hren. EEC

There has been mentioned by delegates that there are sufficient programmes in prevention and treatment of addiction. Knowledge about addiction has improved and become widely available. More needs to be done by international organisation in terms of monitoring.

Many speakers spoke about concern for inadequate access to essential medicines. Palliative care constitutes right to medical care, one of the elements of the Universal Declaration of Human Rights.

Roberto Campa

To answer question from Australia and ties in with comments by Diederik Lohman, there are 4 elements involved in ensuring adequate access to essential medicines: costs, control mechanisms, awareness-raising among medical community and effectiveness of models used.

More needs to be done in the latter few elements, especially in sharing effective models.

Debate today underscores relevance of such debates and shows how rich discussion can be at UNGASS. Many young people worldwide need to be heard and we can do more to help them.

Michael Botticelli, US

Thanks for statements on need to ensure access to essential medicines. I believe lessons can be learned from US in ways that are responsible and minimise opportunities for diversion. Also echo Mr Gerra that government has key role to play. In US, many NGOs implement programmes based on government funding so there is a role for both.

In response to Norway’s comments about language, agree need to change language to destigmatise people with substance use disorders, in lead up to UNGASS>

Refer to statements mentioning key role of recovery and importance of involving peers in promoting long term recovery.

WHO

Fully committed to implementing resolutions of World Health Assembly, especially the 2 recent ones on non-communicable diseases and palliative care.

WHO is also working to promote data sharing on rates of people dependent on drugs etc.

On the terms used, we deliberately use the term ‘substance use disorder’, endorsed by member states to WHO. We prefer to use terms that are scientific and non-stigmatising. Fully acknowledge statements by US that in run up to UNGASS we can sort out our own house to ensure language we use is not harmful.

On prevention, i note larger demand for it and willing to work with member states to step up our activities on prevention, noting support offered by Norway, not only in terms of secondary prevention which we already do but also in terms of primary prevention.

Lastly, mention CD we have been distributing on role of WHO, messages in which are also distributed in a publication here.

Diederik Lohman, Human Rights Watch

Return to question asked by Australia on what can we do together to try to remove barriers to access to controlled medication as well as questions around preventing diversion and misuse. Key is to create space where discussion can take place. We have a lot of technical guidance from WHO and INCB on how countries can make progress in this area. Also have examples of countries that have been making significant progress in this area. Eg. India, Morocco, Ukraine, Mexico, Viet Nam have changed laws or implemented programmes to improve access. We have examples on what could work and need a space to share those experiences, including from US on what could go wrong with prescribing of medications and how we make sure those mistakes are not repeated elsewhere. My fear is as long as issue of essential medications is folded into demand reduction, space for that discussion will not exist.

UNODC is planning publication on access to essential medication before UNGASS that will hopefully contain discussion on how we can solve barriers to access.

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