CND Plenary: Item 5 Implementation of the Political Declaration and Plan of Action on International Cooperation towards an Integrated and Balanced Strategy to Counter the World Drug Problem (Tuesday, March 14, 2017 – Afternoon)

Item 5. Implementation of the Political Declaration and Plan of Action on International Cooperation towards an Integrated and Balanced Strategy to Counter the World Drug Problem:

(a) Demand reduction and related measures;

(b) Supply reduction and related measures;

(c) Countering money-laundering and promoting judicial cooperation to enhance international cooperation.

Director of Operations: Health is the utmost priority – we are scaling up evidence based treatment. It is of enormous concern that only 1 in 6 drug users are in treatment. Prevention and treatment are often limited and the UNGASS outcome document seeks to address this as an alternative to punishment. We have the tools to eliminate HIV/ AIDs by 2030. We are ready to support countries to implement programmes for people who use drugs in communities and in prisons. We look forward to hearing from the scientific community.

Dr Nora Volkow: We have made significant strides in understanding how drugs affect the brain. All drugs increase dopamine in the brain, but it is now clear that by increasing dopamine they hijack the motivation part of the brain to seek drugs over other behaviours. The more a person takes drugs the less motivated they become, but the brain remembers that drugs will activate this motivation part of the brain when addicted. Genes also play a part in addiction, but we do not yet know what genes play this part. And environments are also a large influence. This is why prevention is key because children and adolescents are the most vulnerable to addiction. We cannot prevent genetics, but we can prevent environments. Treatment of drug addictions can work, but addiction needs constant treatment as a chronic disease. If done right, a patient can recover. You can prevent them from relapsing but from also other diseases such as HIV through treatment. We need to prioritise treatment and treat addiction as a disease and remove the stigma. Thank you for your attention.

Dr. Don Des Jarlais: There are 0.9 – 4 million people infected with HIV among people who inject drugs. Hepatitis C is spreading rapidly among this group. Absence of knowledge of the threat of Hepatitis C among the injecting community and limitations of access to safe equipment. An end of HIV epidemic only means that HIV is prevalent in less than 5% of a population. Currently there is not adequate care for people with HIV. We need to focus on reaching high risk populations with right interventions. Drug policy fuels HIV spread through criminisation, over regulation of harm reduction and restriction of medicines used in HIV treatment, and registration & surveillance creating stigma for drug users. In the US some police forces interfered with syringe exchange programmes and many did not report this to authorities due to a lack of faith in law enforcement. Recent outbreaks of HIV are in wealthy countries due to a lack of programs or changes in drugs. Women are at high risk through sexual transmission and drug use. They are more likely to share equipment due to it being more difficult to obtain safe equipment. They may be abused in a relationship. Stimulants lead to higher risk due to high frequencies of injection, expectations for increased sexual pleasure, a disorganised lifestyle, and a lack of scaleable treatments for stimulant use all contribute to high risk. Harm reduction in prison works and the evidence shows this. It is crucial to implement what we know works: harm reduction services need to be implemented into policies and law enforcement that currently undermine this. New interventions are needed and to reduce the stigmatisation of people who use drugs.

Angela Mair, Chief of Research and Analysis branch of UNODC: We will talk about social science research now. Every year we try to present the situation: where do to stand in terms of drug use globally. We have estimated that 250m people have used drugs in previous year, but there is large uncertainty around number of global drug users. The darker colour you see at the bottom is the number of drug use disorders. PICTURE Beyond numbers of which drugs have impact on health and where. We can see that in different regions, different drugs effect people’s health. In Europe and Asia, opioids are the most dangerous drugs, and there is an increase in people in people in treatment for ATS (WHAT?). In North America, cannabis is the need for concern, though there are also lots in treatment for opioids. In South America, the issue is cannabis and cocaine.

Globally we have 200,000 deaths that are drug related. This is believed to be an under estimation because it covers only the most direct causes. 12m people inject drugs every year, and 1.6m injectors live with HIV and 6m live with Hep C.

Opioids remain main drug of concern in terms of associated harms. There is some indication that heroin use is increasing in Europe. There has been a serious increase in opioid overdoses in both women and men, but particularly drastic for women. There is a seven-fold increase overall.

There has been a sharp increase in amphetamine use in Asia and Africa.

There is not a huge amount of increase in cocaine use. In Europe, use is mainly decreasing or stabilising (Italy is an outlier where use is increasing).

The data on cannabis shows how much data we have missing.

New Psychoactive Substances remain a threat although we don’t have so much data on health impact. When we study NPS we need to study which substances are persistent and which are transient. We need to check what kind of substances they are, stimulant, synthetic cannabinoid etc.

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