Side event – The public health elements of a comprehensive, balanced and inclusive drug policy.

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Side event organised by the World Health Organisation.

Dr Shekhar Saxena: welcome and thank you for coming. First question question to WHO: in the draft outcomes document, member states requested more involvement from the WHO, how is the WHO planning to do this?

Marie-Paule Kieny, WHO. WHO warmly welcomes the push for the public health approach. It supports countries to implement programs to treat and care for those using drugs, who advocate for the greater involvement of health services in drug policy. Health services need to be able to identify drug use at an early stage.

5 areas WHO is working in to address the world drug problem:

  1. Prevent drug use and reduction of vulnerability and risks
  2. treatment and care of people with drug use disorders
  3. Prevention and management of the harms associated with drug use (harm reduction is crucial)
  4. Access to controlled medicines
  5. monitoring and evaluation

NPS – WHO plays an important role in whether these substances should be scheduled and assessed. We can provide data collection for harm from these substances, I will be speaking more about this at a side event on Thursday.

Saxena: Colombia has been very active in drug policy discussions – what is the most critical element of the WHO’s 5 areas for Colombia, and what do you expect WHO to do?

Dr Alejando Gaviria, Colombian minister for Health and Social Protection. I will describe key elements of our drug policy then what we expect from WHO.

UNGASS2016 is a time to look back – the public health approach to drug policy didn’t use to be a priority in Colombia, we focused of supply and demand reduction. In the previous decade we focused almost exclusively on preventing cultivation of cocaine. Now Colombia has changed. We have chance our speech to say in a straightforward way – problematic drug use is a public health issue. Prevention of drug use is difficult, evidence is lacking. Prevention should focus on problematic use, rather than drug use in general.

There is a need for intersectoral approaches. Drug consumption is rapidly climbing in Colombia, but we have substantially lowered tobacco use by regulatory measures. We have made progress in regulation of treatment centres, but treatment availability is still low in small towns. We need to mention harm reduction. We have implemented needle syringe programs. Also the need to access to controlled substances – we have put guidelines into place to strengthen this.

We strongly believe all UN agencies especially the WHO have an important role to play in drug policies. We have the need for promotion of public health practices and the implementation of appropriate metrics to evaluate these practices.

Saxena: we now turn to civil society – what are the critical public health issues you feel you can contribute, to help the member states with the outcome document?

Heather Hasse, Co-chair of Civil Society Taskforce. The civil society taskforce have produced a report with the results of consultations with civil society organisations.

In terms of problems/issues  – we all all behind the move to a public health approach – all civil society members recognise this. Including prevention and evidence based policies. The biggest challenge is funding, in particular for harm reduction services being made available to all. There should be informed consent and more access to treatment services also,and greater access to essential medicines is needed. There is also the need for reinforced commitment to prevent the spread of diseases and overdose in prison environment, and the need to promote information around drugs to be made available to youth to keep them informed.

We we really welcome the heightened engagement of the WHO in this issue, and for their collaboration of other agencies eg, UNODC. We ask for support for funding of more civil society services. It is good to see its not just rhetoric, and there are actually actions to move towards this as a public health issue.

Saxena: Thank you, we now turn to academia. You represent the scientist community.

Dr Isidore Obot, Nigeria. Most of the time I work with very little resources, enough to contribute to evidence base. Things are changing a little bit but there’s not enough data, and evidence base is lacking in most countries. A major part of problem is the lack of resources. I think that the situation is changing very fast, and things might change, with the supply side and law enforcement. The prevalence of drug use is increasing in Nigeria, and it’s a problem that people are noticing – many people are talking about the public health approach to drugs but there is a very strong  resistance by many, and this is a challenge to the scientific community. This is why this event (UNGASS) is such a good opportunity.

What the WHO can do – with not too much money, they can continue to support research – small grants can go a long way in low income countries. WHO should support scientists to make information available, and they are taken very seriously in developing countries – the WHO can make sure that countries implement all strategies. In the reform debate, it is really distressing to see medical professionals not support moving towards the public approach to drug strategy. It’s also necessary to get the international community involved to enshrine public health perspectives.

Saxena: What does Norway expect the WHO to do? Are there any suggestions to fulfil demands in Norway?

Mr Torbjørn Brekke, Norwegian Minister. We need to take time – when you talk about prevention you talk about public health. The answer is simple. Public health programs help keep people alive, millions are alive thanks to these programs. Good health is central to human welfare, it also makes an important contribution of economic progress of a country. An unacceptable number of drug users lose their lives every year – we need to recognise that drug use is a public health issue requiring humane and evidence base policy. Interventions aimed at the while population are the most effective.

The goals of the drug conventions is to help the health of humankind – this is why it should be a public health issue. Clear mandate and leadership has been missed for a long time. In preparation for UNGASS there has been a push for WHO to coordinate leadership for drug strategy and strengthen coherence. The recently agreed sustainable development agenda shows commitment to leave no one behind, and we welcome more involvement of who in drug policy.

Saxena: We hope we will get more clarity about what member states want WHO to do. I want to emphasis who is not just headquarters, but regional offices.

Dr Hennis, Director of Noncommunicable Disease and Mental Health, Pan American Health Organisation. We’ve had great examples today. There are large information and evidence gaps I public health and the universal prevention of substance use. Other challenges we face is stigma and limited availability of harm reduction in the area.

Despite recognition, adoption of WHO recommendations in this area is slow.

Saxena: Thank you, and now opening up to the floor –

Doctor from Vietnam, works for NGO: in work for public health approach to drug policy , what force including medical training will be used to effectively engage in harm reduction and treatment – we would appreciate WHO engagement.

Doctor of natural medicine in USA, has clinic in Costa Rica – WHO controls scheduling – I use medicines in my clinic to assist people to stop using heroin and other drugs – but these medicines are also listed on schedule 1. I ask the WHO to review the scheduling of ayahuasca, and I challenge the member states to find someone addicted to these medicines.

Nick, Quakers: We need checklists. In Zimbabwe, they’ve introduced training for therapy volunteers, in North Carolina 50% of funding is spent on law enforcement, and in Britain 35% of people are in prison for drug related offences. We’ve got to get health and justice to work together.

Steve Goldner, Forensic Toxicologist, invented methadone. There are people all around the world that are looking for new natural medicines, when I invented methadone no one had heard of it. Invite who to look into new uses of natural drugs.

Morocco – the issue is with cannabis use in young population there are a lot of problems with psychosis and suicide. What will WHO do if they authorise it – will it be available to youth?

Gaviria, Colombia: Norway you said something very nice – public health is about keeping people alive. Why if we all agree are we making a slow progress? This is a big challenge.

Obot, Nigeria: I acknowledge comment on Zimbabwe – there is also a big project in Kenya for volunteers with mental health an substance abuse. These are great programs.

Saxena: WHO recently published a document on the effects of cannabis use.

Kiemy, WHO: WHO departments used to be split, substance abuse and HIV, but now we are trying to adopt the sectors together. There is no doubt we need to change the way education can help to address problems. To address the question on scheduling – it’s difficult to bring down scheduling, we have to wait for strong evidence to do this. We are working on more evidence of the medicinal advantages of cannabis and hope to bring this forward soon. Nobody has all the answers, with NPS currently there is lack of evidence – any evidence and research coming from member states is encouraged.

Saxena: We are 3 mins overtime, thank you for attending this side event.

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