Side event – The public health elements of drug policy

Side event organised by the World Health Organization.

Marie-Paule Kieny, director of health systems and innovation – In January this year, the issue of a public health approach to drug problem was on the agenda of the WHO Executive Board for the first time since 1990. The report that followed emphasised the need for a five-pronged approach: prevention of drug use and reduction of vulnerability and risks; treatment and care of people with drug use disorders; prevention and management of the harms related to drug use; access to controlled medicines; monitoring and evaluation.

Representative of Norway – Drug use is a comprehensive challenge, to be met with a holistic response. A broad population-based approach is preferable to one that targets individuals. People with a healthy lifestyle are less vulnerable to drug problems. The drug conventions seek to protect the health and welfare of mankind. A public health approach is probably the best response to the problems caused by drug consumption.

In preparation for UNGASS, we have noticed an increasing demand for a health-based approach. It’s almost impossible to think of the word “health” without also thinking of the World Health Organization. The WHO’s profile therefore means it needs to take a coordinated approach to tackling the world drug problem. We welcome more involvement from WHO, not just in issues around drug classification, but also in providing guidance on evidence-based drug policy.

Dr Katherine Pettus, Advocacy Officer for the International Association for Hospice and Palliative care (IHPC) – Many controlled substances are used not just for pain and palliative care, but also for a lot of other vital medical purposes. The WHO calls for these medicines to be affordable and accessible in a public health system. But 5.5 billion people do not have sufficient access to the substances they need. There is a problem with how to prescribe these medicines under the drug conventions. The drug control system tells member states how to control the supply of these drugs, but not how to prescribe them at the same time.

IHPC has been holding opioid availability workshops in Latin America, which include government representatives and doctors, among others. WHO must hold these kinds of workshops in Africa, Asia and Pacific Rim countries. The issue of unavailability has been off the radar of member states. But Human Rights Council has helped change this.

Correct prescription of controlled substances can be life-changing, providing many benefits. I’d urge you to come to our side event tomorrow, where you can hear how this is done in parts of the world.

Fay Watson, Secretary-General of EURAD – EURAD is a european drug policy network, mostly working on prevention, drug policy, and treatment. It played role in the civil society taskforce. We strongly welcome WHO’s report on the public health dimensions of the world drug problem. It reflects our priorities. The definition of health is often quite limited, but the WHO’s is broader, including the social and economic determinants of drug use. We are glad WHO have paid sufficient attention to supply reduction, and we hope that alternative development will be seen as key to this process.

Sometimes in the UN, prevention often skips from universal to indicated measures. In our consultation, many NGOs thought prevention should be a central part of drug policy. We also hope the UNGASS outcome document will insist on the inclusion of prevalence reduction indicators to assess policy success.

Representative of India HIV/AIDS Alliance – My organisation advocates for the rights of people who use drugs to access the services they need, in particular harm reduction interventions. In my opinion, the WHO’s comprehensive package is the most rigorous tool we use in our advocacy. But I think we can make it even more comprehensive. There are gaps in OST, ART, and in hepatitis C diagnosis and treatment. I have several recommendations for WHO: defend and promote harm reduction, despite the “war on drugs” positions of many governments; work with governments to track gaps in provision and get better data or services; take a more active role in supporting civil society; and lead a global campaign for access to harm reduction services.

Representative of Nigeria – Clearly a lot is expected of the WHO across the world – particularly in developing countries. When WHO speaks about health, people tend to listen. Drug policy is very important, and an area where WHO hasn’t intervened enough in the past. Changes have taken place in the drugs field – there is growing concern among policy makers about what to do about demand and supply reduction; and concern that drugs are becoming a significant public health problem. Lack of data is one thing everyone agrees on – it is a perennial problem in African countries in particular. Hardly anywhere in Africa conducts population surveys – maybe only South Africa. There is a need for more targeted surveys.

The other concern in parts of Africa is why should supposed best-practice interventions apply to us, given there is so little data from this region. There are lots of things the WHO can do. Data is the most important. We know the WHO isn’t very rich – but it has previously supported small projects, and there could be more to help collect data. We need more support for monitoring systems – maybe a consortium of academic centres.

WHO can also target the thoughts, beliefs and confusions about a number of issues that concern us in the region. Cannabis is one example that causes lots of confusion – it’s being decriminalised or legalised in many places, while its dangers are still highlighted in research.

WHO can provide normative guidance on treatment and prevention, as well as tools for evaluations. Need to strengthen country offices, too. WHO must expect that places will depend on them to do important work on the issue of health and drugs.

Professor Jason White, University of South Australia – On the WHO Expert Committee on Drug Dependence, we look at how drugs affect the body, and how they might then cause adverse effects. These can be direct effects – on mental health, for example – or indirect, like on driving ability, which can subsequently cause harms.

Clinical evidence – case studies of dependence to a substance – or laboratory studies, which attempt to predict likelihood of dependence. Also often rely on mechanisms of action to assess likely problems.

We look at geographical distribution of use and dependence of substances, seeing whether it is simply a localised problem or not. Therapeutic use of a substance is taken into account. Diverse expertise is important for the committee.

It is hard to get good evidence on NPS, compared to other, more “traditional” drugs. Periods of use are often too small. Variety of substances used is so vast, too. We may be underestimating the public health impact of these substances, due to testing and laboratory limitations.

The Expert Committee on Drug Dependence does rely on data from various UN agencies like UNODC and WHO, as well as member states. Need to expand the evidence base on the potential harms of NPS.

Ernesto Navas, Mexico – The Expert Committee on Drug Dependence is recognised for its important contribution to evidence and science, and its role in the evaluation of substances that could pose health risks. The protection of human rights and the economic and social development of countries must be ensured – drug policies must be developed to have a comprehensive approach. For Mexico, the UNGASS represents a great opportunity to move forward and address the balance of drug policy approaches. An integrated and balanced approach is crucial to allow member states to identify problems and improve the global drug control system.

 

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