CND Intersessional, 26 September 2017: Chapter 1 on demand reduction

CND Chair Ambassador Bente Angell-Hansen. I welcome participants to the CND intersessional. She reconfirmed that the extended bureau have confirmed the dates for the reconvened session of the 61st Session of the CND as the 6th – 7th December.

Source: @UNGASS2016 tweet

Ahead of the reconvened there will be a report from UNODC Executive Director on gender balance & geographical representation within UNODC. The UNODC strategic framework for will be reviewed during FINGOV that takes place before the reconvened.

The extended bureau has also confirmed that there will be no special UNGASS segment ahead of the CND Reconvened and the CND will limit its work to the operational items in December. At the reconvened, the 61st Session of CND will be opened to elect the new officers. Regional groups will hold the following seats:

  • Chair – GRULAC
  • 1st Vice Chair – Africa
  • 2nd Vice Chair – Asia Pacific
  • 3rd Vice Chair – EECA
  • Rapporteur – WEOG

The Chair calls for nominations from the regional groups. Chair updated those present of the contribution to the ECOSOC during the summer. The Council welcomed the updates from the CND and CCPCJ.

In addition, during the summer there was a roundtable on the gender implications of the SDGs at the HLPF. The Chair thanked the secretariats of UNODC and UNWOMEN for organising the roundtable which focused on the contribution of the functional commissions to Agenda 2030 on gender. It was an important opportunity to highlight the concrete work that the CND is doing towards this end.

In opening the thematic discussion on implementation of the UNGASS outcome document, the Chair welcomed the Portuguese Ambassador who is the UNGASS facilitator. Important work has also been taking place on the way forward and preparations for the 62nd Session of the CND. Chair notes she has been working with the regional groups on this and she is in a ‘listening’ mood.

Post-UNGASS Facilitator. Looking forward to this discussion which will be fruitful and successful. This 3rd round of these thematic discussions. 1st round in Oct 2016, focused on lessons learned and concrete activities. The 2nd round focused on forward looking approaches and this 3rd round focuses on international cooperation and technical assistance needs in implementation. Each day will be devoted to one chapter on of the UNGAS OD. There will be panel discussions followed by an interactive debate. Today we focus on chapter 1. All panellists to limit interventions to 5-7 mins and focus on implementation of the outcome document. Longer contributions can be shared on the UNGASS website.

UN entities and specialised agencies, international and regional orgs have been invited. He extends a warm welcome to those joining us today and to the panellists.He introduces the representatives from each of the regional groups and the other panellists:

  1. UNODC: Gilberto GERRA, Drug Prevention & Health Branch, UNODC
  1. AFRICAN GROUP: Roli BODE-GEORGE (Nigeria), Director General of the Nigerian Law and Enforcement Agency (NDLEA)
  1. ASIA PACIFIC: Timothy LEO (Singapore), Chief Psychologist, Singapore Prison Services
  1. GRULAC
  1. EEG: Aljona KURBATOVA (Estonia), Head of Infectious Diseases and Drug Abuse Prevention Department, National Institute for Health Development
  1. WEOG: João GOULÃO (Portugal), President of SICAD – General Directorate for Intervention on Addictive Behaviours and Dependencies, Ministry of Health Portugal
  1. UN/IOG/IO,etc: Dr. Mariangela SIMAO, Director, Community Support Department UNAIDS
  1. CIVIL SOCIETY: Kristof BRYSSINCK, Free Clinic Belgium

Gilberto Gerra, UNODC. The rate of dependent use has increased since 2009-10. In Australia (where the data is good), there is worrying increased use of methamphetamine in general, as well as among drivers. This is an emergency. Mentions problems of injecting drug use and the link to the spread of HIV and HCV. Highlights the overdose crisis in the USA. Poly drug use in USA – says that those using heroin, prescription drugs and methamphetamine use (apparently because of globalisation as this is the drug of choice in Asia Pacific) are at three times greater risk of overdose.

Child drug use globally is increasing and problematic. Children as young as 12 are using drugs such as marijuana and crack cocaine.

How do we solve this in the context of the UNGASS outcome? We also need to ensure the availability of substances for medical and scientific use.

One third of countries have the Ministry of Interior taking care of drug use issues which is not in line with the call in the UNGASS outcome document to ensure this is considered as a health issue.

Academics need to look more closely at ‘individual vulnerability underlying drug initiation and alcohol use’. We need to work on causes of vulnerability rather than dealing with the consequences. In terms of the link to the SDGs, poverty and stress during childhood reduce the ability of the frontal cortex, which makes one more vulnerable to drugs and other risky situations. Childhood stress will undermine executive function of self-regulation. Social deprivation shows a higher prevalence of genes that contribute to addictive behaviours – people are passing these onto their children. The absurd connection needs to end in terms of prevention messaging – such as ‘love yourself, be drug-free’ – when these people have never known love. We need to use science based methodologies for drug prevention. Inequality is clearly an important factor. There is strong link between parents having a low education and adolescent depression. Love is crucial and we cannot give this love in prison, if people are chained to the floor or locked in containers. Psychosocial support and pharmacological treatment in China has been shown to work well. In one project, nurses in China were trained to do cognitive behaviour therapy which helped to reduce drug use among patients.

Here is a Naltraxone study from Russia – Vivitrol – which demonstrates reduced use of heroin  as well. There are enormous range of tools for reducing addiction which we need to make use of.

Medication such as dexamphetamine can reduce methamphetamine dependence. We need to start considering such approaches even though member states are resistant to substitution treatment.

Clean needles have been found to effective in reducing HIV but there less evidence for HCV. Clean needles need to be part of a comprehensive approach and not implemented in isolation. PREP is also effective but is currently expensive. HIV treatment is effective. HCV treatment is currently very expensive for low income countries. Naloxone saves lives as well and should be considered.

The recovery process – patients who have recovered still need support. The UNGASS outcome document notes that drug addiction is a chronic health disorder  and as such those in recovery need lifetime attention. “Broken glasses should not be put in the garbage… from broken glasses something extraordinary can come out.” Broken lives can produce something extraordinary too.

Roli Bode-George, Nigerian Law and Enforcement Agency, representing the African Group. I realise that our strategy has not worked. We don’t have the resources in Nigeria to reach out to people who need our support. We have introduced a programme through social media. People continue to be stigmatised, people don’t know what addiction is. We need to ensure that people can get help without being stigmatised. We started to use instagram to show pictures of the harms. Each time, people who come to rehab come back later on. We looked at the root causes of the problem. Almost 90% came from a dysfunctional family, housing problems. You don’t have to be made to go to rehab. We realised we needed a platform to deal with the issues. We also realised that people used drugs to deal with stress and other problems. We put together programmes for people to play sports, football. We also organised telephone counselling to avoid people being confronted to stigma – on the phone you can remain anonymous. If a person has a craving and wants to talk to somebody, they can do so too via this phone line. We also have a school-based programme for children: if we sensitise the children when they are young, it will be best. It was based on a European study. We looked at interventions that were close to the reality of children in Nigeria. There was a 30% reduction in smoking daily among children. We used evidence-based interventions. We did the first phase and the second phase and did a pilot study. This is cheap and can be replicated easily for teachers to get the results we are looking for. In addition, we speak to school committees and technical working groups to introduce drug education into the school curriculum. We did a national curriculum programme in secondary levels, as well as early interventions.

One of the things we dealt with was AIDS education. AIDS committees couldn’t reach out to populations like sex workers. So we encouraged treatment. We developed a master plan in the area of health, we ran a pilot study on capacity building for law enforcement officers. It takes a lot of time, people should be patient and ensure that those who need it can get help. We also worked with judges as a lot of young people get into trouble because of drugs. We are working on a law with public hearings. In the meantime, we are trying not to criminalise people who use drugs. So far we have trained 168 law enforcement officers.

NACA is the agency dealing with AIDS. The issue here is that of sustainability. But so far, we deal with people with HIV and vulnerable groups.  All those dealing with demand reduction have to be sensitised. It’s very new for people to understand drug addiction as a health issue. We are also upgrading the facilities, and doing capacity building. This is for all people to be exposed to the same knowledge.

I also wanted to discuss our challenges. In the last session, we discussed ‘Listen First’. But people that are dependent are always in denial, especially with high poverty levels, with few jobs and in a developing economy. We don’t have a buffer. People going to treatment often have to go back to rehab centres. We need vocational space. It’s easier if you are upper class, but most people don’t even know what a vocational centre is. Another issue is political will. A country can focus on violence, terrorism, and it’s easy to ignore drug addiction as a side issue. Countries struggle with political will so it is important we are meeting here at the UN to sensitise governments on these issues. We also need to focus on relapse, it’s part of the journey for people dependent on drugs. This is a message we need to tell family members.

I want to leave you with one final thought: we always talk about ‘Listen First’. But we need to look into people with drug dependence and their pain. While we listen, we need to take their hands and help them make it, the journey is not that long. When we send our message out, we really need to listen, and we need to care. Thank you.

Mexico. We congratulate you for your work and your presentation. One quick question: you have mentioned coordination mechanisms between different authorities focusing on health and criminal justice. But what caught my attention was the housing services – is there a mechanism for housing? In Mexico, there is a group in the Ministry of Interior to implement the UNGASS outcome document, focusing on development. So I’d be interested in getting more information on this.

Roli Bode-George. We have now plans, blueprints, for the setting up of educational centres. The question is that we don’t have the commercial and economic capital we need to provide housing and respond to urban migration. What we’re trying to do is find vocational activities to ensure youth can participate. We need to be honest, pragmatic and practical. In new cities, this is possible, but in old cities, the balance is not yet there.

Timothy Leo, Singapore Prison Services, representing the Asia Pacific. I am a psychologist, I provide assessment and interventions for drug treatment and education and develop our own evidence-based programmes. Thanks to UNODC for this session on UNGASS implementation and for the opportunity to share Singapore’s experience. The UNGASS document calls for an integrated harm prevention strategy: public education, tough law enforcement and structured and evidence-based rehabilitation so that people lead drug-free lives. Overcoming addiction requires commitment to a life without drugs, but also support to support the journey towards being free from drugs. Rehab is carried out in the community and in residential centres.

We believe that evidence-based research is necessary. We study how people get engaged in drugs, we try to understand the profiles of users and motives of drug use. For assessment instruments, we use those tools developed oversees and adapt them to our local context. For prevention we use social learning, relapse prevention models, etc. We help abusers to examine their lives and goals and learn new skills to abstain from drugs. We support growing knowledge, especially in the area of neuro-plasticity. We focus on emotionally supportive environments, allowing former drug users to function without drugs. We provide rehab services. We assess the level of dependence and severity, we match interventions to the level of severity with most dependent users receiving most support. This is vital to ensure that interventions are given to the right people. We also differentiate by age and gender. We also focus on ensuring people can continue education, work and lives/activities. People are supervised regularly and receive council. Parents can then continue to be part of their children’s lives and part of their journey.

We have also focused on women drug abusers. Women drug offenders are involved in use to enhance their relationships, others to overcome past traumatic experiences. We have experts from the field to develop gender sensitive rehab programmes.

Good rehab can only be achieved through a supportive system based on evidence. We use the practices and recommendations from science, translating research findings and evidence based recommendations into policy and programmes. Without effective implementation of evidence we won’t achieve what we wish. Process evaluation ensures fidelity in implementation and ensures practices can be refined. Rehab has lowered relapse rates. This is a strong signal that our programmes are going the right way, but we are still improving our programmes.

Successful reintegration to achieving a drug free society includes employment, housing and strengthening family relations. We need to address stigma and social barriers for people returning to society. Beyond skills acquisition we work with companies to find work placements. Evidence shows that being employed is a protective factor for preventing relapse. We partner with community groups, religious groups and NGOs to help people go back to a job and their lives.

Drug abuse is not only affecting individuals using drugs but their families as well. People undergoing residential rehab will have a better chance if they are out of their family environment. Affected facilities are visited by local people, allowing them to have some of their basic needs met: housing, employment, education. We had a middle aged woman whose brother was undergoing rehab. She had 7 children. Her husband was trying to support all of them. The community volunteered to support them, a family which had been living in 12 years of darkness. We saw many chronic drug affected families to live a fruitful drug-free life. We are encouraged by these success stories.

The UNGASS outcome document focuses on cooperation. ASEAN tells countries to commit to prevention, treatment and rehabilitation. Recently, as an example of our shared cooperation, we have developed a shared training and counselling programme, with joint meetings.

Rehab should go alongside prevention and education. Every drug abuser should be provided with support. We develop a comprehensive rehab system. This has worked for us. We believe in continuous shared practice and experiences to control the scourge of drugs.

Philippines. One of the problems in the fight against drug abuse is a gender programme. We would like to learn more about the Singapore experience here to use this best practice in the future.

Timothy Leo. This has been a journey for us. When we tried to translate our best practices for women, a lot of issues came up: stress, aftercare services, etc. When we ask women to come in aftercare services, they cannot because they are looking after their kids. In Nevada, there is a women’s needs assessment programme we have used. We use the concept of responsibility, repackaging our programmes to address the specific needs of women.

Aljona Kurbatova, National Institute for Health Development in Estonia, Eastern European Group. We have been affected by NPS in Estonia for the past 10-15 years. When we are talking about implementation of different demand reduction measures, we must admit when we start drug policies: we have to step aside from traditional prevention. We have governmental prevention committees coordinating policies in various bodies with police, the health system, the Ministry of Interior. We are right now building our work on evidence-based approaches described in the UNGASS outcome document. Two main areas of work for us are: life-skills, social skills to young people so that they’re strong enough and are able to work with different life situations, not only drugs, but being also able to evaluate their own behaviour and not yielding to peer pressure. Another approach in prevention is teaching parents.

Coming back to the issue of synthetic opioids, I want to go to more detail here. When Estonia was hit by NPS, we didn’t have demand reduction measures we have now. We had to learn that fentanyl addiction is even more complicated than heroin addiction. There is higher injecting frequency. We need to adapt evidence based experiences and situations. We developed new treatment programmes, and diversified. We have programmes for women: women do have specific needs, for example if there is sexual abuse. What is important is that treatment programmes are structured to ensure support for people who need it. We teach people to understand their risky behaviour, what is addiction, how it influences it and how they can deal with it. We ideally want people to be drug free but it may not be true for everybody – so we teach skills to deal with drug use. We also support harm reduction: substitution, NSPs, and all sorts of new approaches such as naloxone programmes. This has enabled us to have the number of overdose related deaths reduced. We now see a certain increase in deaths, so we should be vigilant when we’re starting to feel comfortable about the services already in place.

Cooperation is important between health and police services. For young people who use drugs, we don’t want to punish them but provide education and support for their needs. This is not easy as drug use is still prohibited. We need to provide treatment, but also harm reduction for people who need it. If a person is prosecuted for drug use for 99 times, then this is not effective. So we are focusing on cooperation between health and judicial system to find solutions on a health-centred approach.

To summarise, we sometimes ask that when we are not showing the results we should, should we not be trying to do something else? We need to be radical: we should fully implement what we have committed to. In the outcome document, we have a lot of things here to take into account the needs of specific groups. So long as we do it in a way that is not efficient, or not in the right manner, we will always be struggling with inefficiency. What we have learned is that we can implement interventions that are evidence based. We need supportive environments at society level. We must talk about ethical principles. The social cost of the problem is huge. By supporting the person, we are also making society better. A good colleague has said: the only person that cannot be helped is a dead person, until he is, we can support them to be a member of society again. We now welcome a formal organisation of drug users who are no longer afraid to speak out, showing us what is the need out there, and what should be the link between drug users and the authorities. We can involve drug users communities. We can never underestimate the role of people who use drugs.

Joao Goulao, General Directorate for Intervention on Addictive Behaviours and Dependencies, Ministry of Health of Portugal, WEOG. I am a family doctor acting as the head of the drugs agency in the Ministry of Health. My role is to ensure the participation of all government ministries in drugs issues. One of the key achievements of UNGASS was the recognition to rebalance drug policies towards health and human rights. Portuguese policy is based on the assumption that drug use is a health issue and dependence is a multifactorial health disorder which should not be punished. We focus on deterring drug use with health and social approaches. In Portugal, evidence-based knowledge acquired over the past decade has focused on prevention, treatment, risk and harm reduction and decriminalisation of drug use. The idea is to reinforce resources in the context of demand reduction to refer addicts to treatment, and refer those who are not addicted towards social and health interventions.

We focused on risk and harm reduction, focusing on reducing the consequences linked to addiction. leaving behind people is not an option. Reducing drug use and its consequences is a pragmatic element of Portuguese drug policies, with particular attention to vulnerable people: youth, poly-drug use. The availability of diverse forms of treatment and harm reduction and social reintegration are key measures in our policies to protect DUs and society as a whole. Harm reduction measures should help prevent diseases, but also delinquency and social stigma.

A network of harm reduction programmes and structures including NSPs, OST, testing blood borne diseases, peer support, etc. has been consolidated. We welcome the reference made to these crucial measures in the UNGASS outcome document, and ask member states to consider these recommendations as priority.

Scientific evidence shows the remarkable benefits to be gained to overcome harms and social reintegration. Drug use levels in Portugal are still below European average, with a slight increase in adolescents. In the past decade, this has reduced the number of problematic users, decline in HIV among injecting drug users, a huge reduction in overdose deaths, and an increase in cannabis users in treatment.

We consider the UNGASS outcome document as a pivotal reference document for discussions on international drug policies. We reiterate our commitment to implementing the UNGASS outcome document and promote the public health dimension of the world drug problem.

Mariangela Simao, UNAIDS. I am happy to speak at this panel, which has a gender balance too! I will divide my intervention in two parts: one for UNAIDS, and one for the Strategic Advisory Group on HIV and drug use (SAG).

1.6m of the 12m people who inject drugs live with HIV, and 81% live with hepatitis C. The data tells us that PWUD are 24 times more likely to live with HIV than the general population. In prison its 50 times higher. New HIV infections are coming down in the world, but they are increasing in some groups – that’s the case for PWUD, increase by 33% between 2011 and 2015. Hepatitis C infections have passed HIV in terms of death among PWUD. Today, it is preventable and curable. Epidemiologists tell us we are not doing good with our policies.

Why is this happening? it’s not because of lack of evidence. Coverage of harm reduction is not sufficient, and policies that criminalise drug users makes it worse. Only 3% of HIV prevention funds were used for PWUD. This is disturbing because we’ve shown that harm reduction works and is cost-effective. Not all is bad news – I was preceded by Portugal showing that countries who do not criminalise PWUD and provide harm reduction have had positive results. Wider social benefits are also yielding good results.

What can be done? We need to refocus investment. If we increased funding towards AIDS by 2020, we would achieve our commitment to reduce AIDS by 2030. This is a tiny fraction of the 100 billion used for drug control. And it is a no brainer. We need to move from discourse to action. We need a concrete, actionable framework for HIV. I was interested in Dr. Gerra’s data this morning – we need Ministers of Health to take more action in using the agenda forward. And we must put in place accountability mechanisms for the implementation of the UNGASS outcome document. We must improve transparency. When it’s all said and done, let it be more done than said.

Now I will read a statement on behalf of the SAG: The SAG was established in 2014, and is comprised of representatives from UN agencies, donor governments, networks of people who use drugs, and civil society networks from around the world, all with a specific interest and focus on ensuring a scaled up and sustainable harm reduction response that is effective in preventing HIV transmission among people who inject drugs, implemented within a supportive and enabling legal and policy environment, and firmly rooted in human rights principles.

The SAG would like to take this opportunity to welcome the UNGASS Outcome Document as a forward-looking and progressive “blueprint for action”, that reiterates the commitment to end, “by 2030, the epidemics of AIDS and tuberculosis, as well as to combating viral hepatitis and other communicable diseases…among people who use drugs, including people who inject drugs” (Pp 24). This commitment is reinforced by the call on member states to introduce measures towards “minimising the adverse health and social consequences of drug use” including critical harm reduction interventions (Op 1(o)) and overdose prevention in the form of naloxone (Op 1(m)).  Member states are further encouraged to make these interventions available in prisons and other custodial settings.

The SAG notes with grave concern that HIV transmission amongst people who inject drugs has continued to increase. The 2011 Political Declaration on HIV and AIDS committed to reducing transmission of HIV among people who inject drugs by 50 percent by 2015. Yet, UNAIDS estimates that the number of new cases among this population has risen by 33% during a period when governments committed to cut transmission in half. The commitment to end AIDS by 2030 and to reduce the number of new infections among PWUD by 90% will only be achieved through a fully funded, scaled up and sustainable global harm reduction response that ensures universal access to the critical interventions set out in the UNGASS Outcome Document.

However, the coverage of proven harm reduction services remains woefully low. Harm Reduction International’s 2016 report on Global State of Harm Reduction shows that among countries reporting injecting drug use only 56% (90 out of 158) have NSP and 51% OST (80 out of 158) with almost no progress since 2014.

Secondly, funding for harm reduction continues to be severely limited. In March, at the 60th Session, the CND adopted Resolution 60/8 that urges member states and other donors to continue to provide funding for the “global HIV/AIDS response, including to the Joint United Nations Programme on HIV/AIDS, and to strive to ensure that such funding contributes to addressing the growing HIV/AIDS epidemic among people who inject drugs, and HIV/AIDS in prison settings”. The SAG welcomes this resolution and the political will to ensure adequate funding for the AIDS response for people who inject drugs. As UNAIDS stated in 2015, “public health programmes can be fully funded for a fraction of the current investments in the criminal justice system related to drug offenses and they will produce significantly higher health and social benefits”.

Finally, the evidence that new HIV infections fall dramatically when people who inject drugs have unhampered access to harm reduction services is now indisputable. Ensuring alternatives to criminalisation and incarceration facilitates access to such services, resulting in improved health outcomes for people who use drugs). The UNGASS Outcome Document, as well as the UN drug control conventions, encourage member states to adopt alternatives to conviction and punishment in cases of an appropriate nature (Pp 4 (j)).

The current period of UNGASS follow-up, alongside the preparations of the 2019 high-level meeting, provide the global community with an opportunity to act on the important commitments made at the UN General Assembly, as well as here at the CND. In tandem, the Sustainable Development Goals encourage a people-centred approach that reinforces the need ensure that the health and social needs of people who use drugs are met. Target 3.3 pledges to end AIDS and combat hepatitis, but we will only achieve this – as well as Target 3.5 to strengthen drug treatment – if we treat drug use as a health issue that prioritises human rights and dignity.”

The SAG remains committed to bringing attention to these concerning issues and will continue to provide strategic advice and guidance to the UN to ensure that people who use drugs are not left behind.

Source: @UNGASS2016 tweet

Canada. Could you tell us more about the needs of special populations, especially those in prison?

UNAIDS. There are two entry points: addressing sexuality and the need for harm reduction programmes in settings with high rates of HIV among PWUD. This requires a strong collaboration between the Ministry of Health and the prison authorities. There are several examples: Moldova and others have developed this relationship within the government to overcome the barriers of treating sexuality among PWUD which have yielded good results.

EMCDDA. The EU drug strategy is based on an evidence based and balanced approach towards drugs. The approach is at the origin of the EMCDDA which I represent here. In its new strategy, the EMCDDA reinforced its commitment to contribute to a healthier EU, and we encourage EU states to share good practices and provide better responses to drug problems. I will name a few examples of progress on demand reduction.

First, prevention. Based on research, EU member states are moving from less effective interventions (standalone campaigns) towards community-based programmes and skills building, supporting youth to improve thinking and reduce risky behaviours.

Second, treatment. Evidence has successfully contributed to improvement. Rejecting ideological approaches which have proved to be harmful is crucial.

Third, harm reduction, including safe injection facilities.

The EMCDDA wishes to support the implementation of the UNGASS outcome document through our best practice portal to facilitate access to evidence. Second, the European Responses Guide to facilitate exchange of knowledge across EU member states, with information on target groups, settings and implementation issues. The Guide will be launched in October at the 2nd Addictions Conference.

Drug related problems are multifaceted and require health, social responses, and requires cooperation between government, NGOs, professionals. Europe has made enormous advances in this framework. Drug related problems are dynamic, we must respond quickly and effectively. together we will dismiss ideological positions and focus on the required measures for the safety of our citizens.

Kristof Bryssink, Free-clinic, Belgium. I was reading the UNGASS Outcome Document before coming here. We all, as mankind, are part of the problem, so we all must be part of the solution. I want to emphasise prevention and treatment – they need each other. They can treat and cure, and prevent worse, especially with harm reduction. All this needs our best efforts. We cannot take one strategy and ignore the other. To improve effectiveness, we should widen the scope to facilitate treatment, health, law enforcement and policy making. Most important considerations should be the timeframe of the interventions.

Delay of age of onset is important as it is a predictor. The biggest mistake is to treat youth as adults. We should treat them as cocreators of their own responses and involve them in design and implementation. And yes, we need evidence based actions, but it is not enough. We should promote new initiatives, and they will require trial and error. We need to provide good practices with different approaches and angles. We need to know what is not working. Harm reduction and treatment should be freely available for all groups, and also for minors. We cannot leave anyone behind, and avoid ideology. We should always go from Do No Harm. Since OST is more widely accepted, we must involve heroin assisted therapy. It will be the best solution to connect society and keep them safe. We must be more pragmatic. This will contribute to preventing infections and the adverse effects of drug use.

NSPs are the cornerstone of drug policy. We need to offer paraphernalia for all drug use to avoid harms. We must also ensure access to naloxone. From an economic perspective, this strategy is much cheaper. NSPs are also important as early intervention: the first 3 months of IV use are predictive. At the end, the question is where to use drugs: drug consumption rooms sort a lot of problems. These require political courage, be pragmatic and solution oriented.

But the issues are much wider: healthcare, law enforcement. Policy making is an essential area. I invite good practice for comprehensive treatment for hepatitis C. Partners are NSP programmes, clinics and pathologists. They support PWUD from the first screening to the treatment to post-treatment care, ensuring successful completion of treatment. Not treating PWUD is not an option. It is critical to decriminalise people who use drugs to do so.

With decriminalisation, you bring drug problem solutions away from prison and back into the community. There will be direct benefits for people who use drugs, will also be less costly. Ex users will then stand a chance for normal life. Prevention based on scare tactics is not effective. We need solutions.

Regarding international cooperation, all information is often lost in an overdose of information. The best dissemination of good practice is from person to person, in real life. In our daily practice, we have tools through a coordination network. These networks are often surviving on temporary funds. We are currently applying for EU funding, which is time consuming – and this is paid by our clients who cannot benefit from our time while we are going through these lengthy processes. We need more sustainable funding in a time of austerity. The EU and UN are indispensable for these matters. Remember one thing: Support. Don’t Punish. Click here to read the full statement.

Canada. I want to acknowledge the fact that Canada is undergoing a public health crisis with overdoses and numbers expected to increase. This unfolding tragedy makes our experience all the more important to share. Effective interventions require evidence. In December 2016 we announced a new national drug strategy being transferred from the Dept of Justice to the Dept of Health, considering drug use as a health issue, compassion. We reintroduced harm reduction as a formal pillar of our approach. Our government works closely together with the provinces and territories. We are making some progress which I would like to share today. Nationally, we are increasing evidence based treatment, allowing doctors to prescribe heroin for treatment, and made naloxone available on a non-prescription status to make it more available to health personnel. We are also reviewing methadone prescribing.

A secondary focus has been a legislative change: passed legislation of Good Samaritan Act, to streamline application process for establishing safe injection rooms. On demand reduction, we go beyond opioids, going to legalise cannabis markets with strict regulations. Canadians use cannabis at a very high rate and we are trying to reduce demand and risks for this substance and reduce revenues for organised crime.

We are supporting data and surveillance, funding for research and public education. We have also launched a cannabis survey for baseline data to measure future public health interventions. A key piece of knowledge includes national guidelines and national treatment guidelines based on the work already done in British Colombia. We are doing public awareness campaigns on cannabis and other drugs, including on drug-impaired driving. Finally, we focus on reducing stigma for people who use drugs, and reducing marginalisation. These are some examples we’d like to have recognised here.

On prevention, we focus on skills based services at school. On treatment we focus on removing barriers to access and on allocating more resources. We also address challenges of social exclusion and marginalisation among PWUD. I reiterate that the future Canadian health policy is grounded in health, compassion, respect and dignity of PWUD. PWUD deserve our compassion and access to appropriate medical care and support. We have embarked on this path now. Ongoing international cooperation and technical assistance is essential to move towards more effective and humane drug policy.

Venezuela. UNGASS operational recommendations are part of our national strategy. Organised criminal groups use our territory for the drug trade. The anti-drugs office in Venezuela has demand reduction as a main pillar directed at children and young people, promoting healthy lifestyles through sport and community activities. Venezuela is proud tohave a system of youth and children’s orchestra which according to research by the intra-American development bank, that participation in orchestras reduces incidence of drug problems in young males. We grant economic resources to communities to build sports and community centres as part of a comprehensive prevention approach, with support from UNODC. This entails social learning in all facets. We continue to have a national addiction treatment system as well as strategies for rehabilitation and recovery. Care, recovery and treatment are part of a standardised and free system.

Russia. We recently demonstrated that absinence helps to overcome the negative consequences of drug abuse. Prevention, treatment and rehab is under the supervision of the Ministry of Health. We have in-patient departments located in the districts of each administrative constituency of Russia. We have care patient services, hospitals also have rehab centres providing in- and out-patient care. 160,000 people were receiving free addiction care in 2016. More than 3000 beds provided free rehab care in in-patient centres. 62.5% of those completed treatment and care. We provide free care for people with substance use disorders, right away without being on the waiting list. This helps reduce prevalence of drug use in Russia with positive effects on demand reduction.

Malaysia. We all wish to achieve a vision of a drug-free Asia, counter the world drug problem through a balanced and comprehensive approach. We have striven in Malaysia to address both demand and supply. We focus on demand reduction through 3 categories: prevention at school, community based programmes, treatment programmes. We promote prevention skills via education, in collaboration with the drug agency to develop this in the school curriculum, including in higher level education. In 2016, the Deputy Prime Minister launched a campaign against drugs, involving communities in the combat against drugs, with integrated law enforcement authorities, entry in treatment and mass media campaigns. In January 2017, activities were implemented for more than 36,000 students and youth. We have undertaken comprehensive social media campaigns on the risks of drug abuse, including ATS.

We have continuously stepped up our efforts for treatment to make addicts free from drugs and integrate them into society as productive, drug-free individuals. We have a comprehensive treatment programmes in line with cultural and social norms. We have implemented harm reduction programmes with OST and NSPs. In line with national drug strategy, this programme has contributed to the reduction of HIV infection rates. However, the objective is to minimise the adverse health and social consequences of drug abuse, including HIV and other blood borne diseases.

We are committed to participate in initiatives to address drug issues, with professionalism. We have introduced a post-graduate diploma on drug abuse in Malaysia. We offer a series of trainings to educate professionals and we focus on scientific practice on drug prevention and tons. But the emergence of new drugs, new consumption patterns and new user groups make it difficult to establish evidence on time. To address these challenges is important. We have to increase cooperation and make good use of evidence at national level. Cooperation with WHO and UNODC and international standards play an important role. We should make good use of instruments on demand reduction, including harm reduction, prevention, treatment and rehabilitation should be adopted. In 2016, we adopted evidence-based treatment guidelines for amphetamines including substitution treatments and management of dependence, relapse prevention and co-morbid psychiatric disorders in post-acute settings. This is being translated and will be share with other member states soon.

Estonia, on behalf of the European Union. The EU concentrates and invests in different projects to improve knowledge of drug use. We brought together 200 scientists from 29 disciplines. The EMCDDA plays a crucial role in collating evidence and best practice to feed it in the decision making process. Its online best practice portal is an important database of knowledge. Addiction is complex and multifactorial characterised by its relapsing nature. The EU addresses it as a health priority with cost-effective interventions in line with UNODC standards. Using a balanced approach, the EU pays attention to a full range of measures: prevention, harm reduction, treatment, care, social reintegration and recovery, prevention and care of HIV and other infectious diseases. We take account of age, gender and other characteristics. We adhere to WHO recommendations on the comprehensive package of health services for PWID. Interventions are most effective if tailored to the needs of target groups and delivered by trained professionals. WHO agreed that health systems should be made more responsive to the needs of the target population.

Many member states in the EU have a good experience of risk and harm reduction measures: NSPs, OST, peer-based interventions, testing and counselling, overdose management. Six EU states provide highly targeted services for key affected populations: safe injection facilities and take home naloxone. Evidence shows that risk and harm reduction doesn’t only improve health outcomes, it also saves lives. Thanks to these measures, new infections among PWUD have declined: 41% between 2007 and 2015. We take this opportunity to stay alert to the emergence of new trends, especially in light of the epidemic of NSPs.

We support the CND to advocate for internationally recognised standards on prevention and treatment, but also on harm reduction. We request member states to implement the UNGASS outcome document recommendations on harm reduction and welcome good practices in this field, and are willing to share our experience in this area. We welcome the increased collaboration between UNODC and WHO. This cooperation contributes to the implementation of the UNGASS recommendations and we hope similar tools will be adopted for other UN agencies.

Germany. Effective scientific evidence based strategies should be at the basis of our interventions. But the emergence of new drugs, new consumption patterns and new user groups make it difficult to establish evidence on time. To address these challenges is important. We have to increase cooperation and make good use of evidence at national level. Cooperation with WHO and UNODC and international standards play an important role. We should make good use of instruments on demand reduction, including harm reduction, prevention, treatment and rehabilitation should be adopted. In 2016, we adopted evidence-based treatment guidelines for amphetamines including substitution treatments and management of dependence, relapse prevention and co-morbid psychiatric disorders in post-acute settings. This is being translated and will be share with other member states soon.

Peru. We have put in place a follow up procedure of the UNGASS outcome document. The 2009, 2014 and 2016 documents are mutually reinforcing. We have recently adopted a new drug strategy and have used international instruments as our basis. We have a coordination mechanism among different ministries, we address human rights, rule of law, etc. On Chapter 1, we have established programmes to prevent drug use, education system, strengthening protective measures among students. We work with families to strengthen children’s ability to stay away from drugs. The aim is to provide people with psychiatric and psychologic treatment.

UN High Commissioner on Human Rights. The Office of the United Nations High Commissioner for Human Rights (OHCHR)  welcomes today’s thematic discussion on Chapter 1 of the  UNGASS outcome document that deals with operational  recommendation on demand reduction and related measures, including prevention and treatment, as well as other health related issues.

Article 12 of the International Covenant on Economic Social and Cultural Rights provides for the right to health of all individuals. Under articles 2 (2) and 3 of the Covenant, States are required to implement all economic, social and cultural rights, including the right to health,on a non-discriminatory basis. People who use drugs and people who are dependent on drugs have the same right to health as everyone else, and this right cannot be curtailed, even if the use of drugs constitutes a criminal offence. However, consideration should be given to removing all obstacles to the right to health, including by decriminalizing the personal use and possession of drugs.

Furthermore. while addressing the drug problem, States should protect the right to health  and public health programmes should be increased, and states should  ensure, that persons who use drugs have access to health-related information and treatment on a non-discriminatory basis. Outreach information and education programmes can minimize harm to individuals who use drugs and encourage drug dependent persons to seek treatment.

In its general comment No. 14 (2000) on the right to the highest attainable standard of health, the UN Committee on Economic, Social and Cultural Rights stated that ensuring access to essential drugs, including opioids, is an essential element of the right to health and that States must comply with this obligation regardless of resource constraints. In accordance with general comment 14, harm reduction programmes, in particular opioid substitution therapy should be available and offered to persons who are drug dependent, especially those in prisons and other custodial settings.  The right to health requires better access to controlled essential medicines.

The rights of the child should be protected by focusing on prevention and communicating in a child-friendly and age-appropriate manner, including on the risks of transmitting HIV and other blood-borne viruses through injecting drug use. Children should not be subjected to criminal prosecution, but responses should focus on health education, treatment, including harm reduction programmes, and social re-integration.

Norway. It’s worth remembering that the protection of health is at the heart of drug control treaties. Norway is pleased to see that we are moving forward on Resolution 60/1 on data collection. We will contribute financially to cover the costs of the expert group next year. We should now focus on implementing the UNGASS recommendations and promote health and human rights. On HIV prevention and increasing financing of the global HIV response, a resolution was adopted at the 60th CND. With Sweden, we also presented a CCPCJ resolution on prevention of mother to child HIV infections in prison settings. We call on member states to ensure political commitment to countering HIV among PWUD in line with the SDGs. The resolution also calls on member states to make budgetary commitments to the HIV unit of UNODC. The CCPCJ resolution addresses the issue of gender inequality in accessing HIV prevention and treatment. We call for an increased cooperation among law enforcement and health services. Lastly, the resolution requests UNODC to develop a technical guidance document to prevent mother-to-child HIV infections. We call for more cooperation among member states and between UNODC/WHO/UNAIDS. We spend limited resources on interventions that have never proven to do so. UNODC standards are important in this regard. We should also look at other guidelines developed by other parts of the UN family on overdose prevention and treatment. Leaving no one behind is key, drug policy should aim to save lives. This should be at the centre of the drug policy debate. Civil society should also be at the centre of the debate and holds governments responsible for implementing evidence based and effective programmes.

Spain. I want to focus on recommendation 0, focusing on risk and harm reduction. In Spain, we focus on a public health approach. We have been at the forefront of implementing harm reduction programmes for PWUD. Strategies in place seek to address the needs of those who would normally not go to treatment centres. The goal is to address the adverse impacts of drug use on health. We have emergency centres to deal with marginalised individuals and provide for their basic needs: NSPs, prevent deaths, and the spread of HIV, hepatitis. In 2016, there were 61 emergency centres. Psychological, social support is provided. MMT is also offered. 22 ambulatory services are in place. Other centres provide for professional oversight and provide MMT. On education programmes, in 2015 there were 15 safe injection rooms. OST is provided as well as NSPs. In Pharmacies, syringes can also be exchanged. There are also support services for people living in the street, and in prison. We also provide prevention and treatment programmes. These are processes part of the national policy. They are outlined in our action plan extended on 2017. In the next few days, we will adopt the next action plan 2017-2024 which mentions harm reduction measures, early warnings for youth, recreational centres for marginalised communities. There are also programmes for drug addicts in prison. We seek to strengthen treatment through the focus on harm reduction. We intend to strengthen this approach and methodology to reach youth. We wish to take into account other addictions as well. I will provide more details at future meetings.

Algeria. We place much importance on demand reduction. Drug use is a threat to the physical and mental health of our communities. We have adopted measures to combat this scourge. We have undertaken action to prevent and treat addiction.

On prevention, we have awareness raising campaigns carried out by various ministries: interior, military, justice and health. Awareness raising campaigns target all the population thanks to the law enforcement agencies, as well as schools. We organise workshops and courses at school, activities in the community. We attach attention to the flourishing Algerian youth and give them ways to fulfil themselves.

Care of drug users is also a major area of our national drug policy. Our 2014 law on prevention and support provides for treatment, with addictology treatment centres, and detox centres. These establishments provided 41,500 consultations in 2016. We provide doctors with the necessary tools to care for drug addicts, so we have a new branch focusing on addictology. We focus on reducing demand, especially for cannabis, opioids and coca. Other countries should also focus on reducing demand.

Netherlands. We do not focus on individual aspects of drug use but aim to recognise the public health aspects of drug policy, as articulated in the UNGASS outcome document, including treatment, care, recovery, reintegration, harm reduction and prevention. This should be based on evidence and best practice. The use of GHB in the Netherlands has proven to be highly addicted, similar to heroin but much cheaper. It’s mostly in rural areas and isolated communities, having an important impact. Addressing this issue is difficult and we are not there yet. Together with local governments, universities, addiction specialists, we are developing a new piece of research to understand the root causes of GHB use and preventive programmes, as well as social reintegration of former addicts. I want to conclude on our goal here – despite the UNGASS and the high level meeting of HIV, there is a decline in HIV funding. We need to commit to leaving nobody behind. In 2018, we will host the International HIV/AIDS Conference.

UK. Thanks to all the speakers until now for sharing their experiences. We align ourselves with the Estonian statement. We remain committed to demand reduction, which is at the core of our drug policy. Our recent drug strategy has a balanced approach which includes law enforcement, NGOs, international partners. Treatment should be based on the best evidence, with support for recovery, e.g. access to employment, housing and health services. We develop our treatment to respond to emerging trends, especially NSPs. The continued emergence of NPS, especially synthetic opioids, has created dangers to vulnerable groups like youth, prisoners, homeless people. We remain committed to the implementation of our NPS Act from 2016. We have developed an NPS system for effective treatment responses. There are 2 key components: collect information on harms caused bah NPS use, NPS clinical network and other drug intelligence responses for appropriate clinical responses. We reaffirm our continued support to the recommendations of the UNGASS and will continue to share best practice.

Turkey. Under our strategy, a High Ministerial Council: ministries justice, family, social justice, ministry of health, etc. A national action plan was adopted. Our main prevention activity is focused on raising awareness, involving NGOs like the Turkish Green Crescent Society. I underscore our support for these intercessional meetings.

Dazogbo Agossou Ulrich, Perle Sociale, Benin. On today’s topic, I want to discuss practical arrangements and what can be done in practice. What I care about most is figuring out what can be done to ensure that our commitments bear fruit. On demand reduction and related measures, we focus on prevention and treatment, as well as health – all fields where we have to take action. I want to urge everyone to focus this discussion on demand reduction and related measures. The context we should be thinking about is local, national and international. Our strategy should be based on international cooperation. We must pull our efforts, resources, scientific progress, advocacy, policies, reforms, all of these should come together under a global approach, taking into account needs, problems, and the serious situation that drug users live in, both in poor and developed countries. We must take into account youth. Benin’s actions should be promoted. It would help our government understand that human rights are universal. It’s important that whatever the US, Spain, Indonesia, Cuba does in dealing with drug use, reintegration, rehab, dealing with HIV and hepatitis, should be supported by Benin. I wish to conclude with a few ways of taking action: reflect on how to establish international cooperation with children and youth. We are the present for our societies, we are committed to improving standards of living in the short and medium term. Children need to understand we are all a part of this. I call upon you to create children’s global networks against drug abuse. I remain committed to sharing my experience with you. Thank you.

El Salvador. On demand reduction and related measures, we are implementing the UNGASS recommendations. In implementing our national drug strategy adopted by our drug commission, following intense consultations with 15 national experts and bodies. The impact of this matter on health is obvious. Our goal is to improve the health of populations through measures to reduce consumption and abuse, as well as reduce crime. We are drawing up measures for prevention and treatment, with trainings. I want to share certain practices used by my country. We are setting up programmes based on data and facts from recognised organisations and studies on demand and drug use trends in populations, aggregated by gender, with a cross-cutting approach. We are participating in the ad hoc group of experts on demand reduction and public health in the South American Centre. We cooperate with CICAD, PAHO, UNODC and COPOLAD.

56% of the population in El Salvador is below 30 years old. Many are without a job. We are currently undertaking prevention measures, especially the Ministry of Health and Education. I will give you some examples: series of documents for heads of families, studies on health and the environment, information on the risks of drugs. We have set up 6 prevention programmes in private and public education. We have established 10 programmes for primary prevention. The national anti-drug commission is offering a university diploma for addiction prevention, with the Evangelical University of El Salvador and funding from the OAS. There is a group of professionals undertaking the course online thanks to COPOLAD and UNODC. We are also in consultation with other bodies. We talk about challenges, share these problems as they are not unique to El Salvador and could help other countries. We raise awareness through public officials on the benefits of prevention.

We focus on treatment, looking at drug addiction as a disease. In treatment and rehab, we continue the work of agencies that have experiences in drug use, for example the National Psychiatric Hospital which provides treatment services, NSPs, ambulatory hospital services. We take into account the issue of drug addiction, there is training for staff on early warning and psychological support, taking into account all cases. On good practice, there are centres for prevention and addiction treatment, dealing with people with drug and alcohol issues.

Pakistan. This meeting provides a fresh opportunity to learn from each others’ experiences and good practices. We pay particular attention to international cooperation. UNGASS has boosted and reinforced the well established approach to demand and supply based on the principle of shared responsibility, with the 3 conventions at the centre of the global drug control. We also reinforced the targets set out in 2009. It underscored the importance of placing people and families at the centre. We are committed to working closely with member states on UNGASS implementation, as well as the 2009 political declaration and 2014 Joint ministerial statement. We are committed to our obligations. We ensure collaboration with all sectors including health and law enforcement sectors. We adopted a comprehensive approach: prevention, treatment, reintegration, recovery and social reintegration. Efforts are intensified on drug control. This includes seminars, workshops, sports events, awareness efforts with electronic media, alongside civil society and sports associations. We strive to ensure people say no to drugs. We focus on youth, with the National Youth Ambassador Programme to raise awareness of drug abuse harms in schools. This is to encourage youth to lead a life through talent. We expand the network of treatment facilities, including counselling, technical education to help addicts reintegrate. We set up dedicated treatment facilities in hospitals including for women, as a top priority. We seek close cooperation with all provincial authorities. Efforts are made for developing and implementing treatment services, we are preparing to launch a drug use survey in the country. We will continue our efforts on demand reduction, including with documentaries and videos. We will focus on capacity building with law enforcement and health departments, with model rehab centres. All this is on our agenda. We are one of the most effective transit states because of our geographical locations. The UNGASS outcome document recognises this challenge. In our collective work, we must pay attention to the needs of transit states. In the lead up to 2019, we should enhance our efforts to eliminate illicit drugs, in collaboration with regional and international partners.

Philippines. Demand reduction is one of the key pillars of our strategy. Youth represents the majority of our population so the fight against drugs starts with raising awareness among youth. We have conducted various activities such as peer groups against drugs, a primary trigger for the one using drugs. The students undergo trainings on the ill effects of drugs and how to say no to drugs. Interventions start at the grassroots and community. We focus on participatory approaches. We design programmes focused on the needs of society. Tackling the drug matter requires the community, the power of collective actions, the surrender of drug users, and the power of drug abuse campaigns. We call on drug users to voluntarily submit to drug authorities. We are working towards providing community based treatment to tackle those who surrender. Advocacy and capacity building programmes are in place to provide the necessary interventions. Through the provision of livelihood opportunities and skills building, we afford drug users a chance to become members of society again. For health organisations, there is a manual on healthcare for people affected by drug use, developed by the Ministry of Health and the drug agency in collaboration with UNODC. On NPS, we authorised the dangerous drugs board to include two new NPS based on emerging trends in drug use and trafficking. To sustain our efforts, we look forward to exploring avenues for cooperation with UNODC and member states in sharing best practices, taking into account national specificities and innovation. We have identified the continued training and capacity building of our professionals as a key aspect of our ongoing work.

Mexico. Mexico is of the view that we should have a broad approach to reducing demand. We have 5 key elements: prevention, treatment and care, harm reduction, access to controlled drugs and drug control policies. Drug policies cannot be addressed in isolation. We need a multidimensional approach. This is a good opportunity for us to put together a programme all the way to 2030, not just on drug treatment but also for Target 3.2 on HIV and hep C and other infectious diseases. All the objectives must be addressed comprehensively. Our survey on alcohol/drugs in 2016-17 revealed the need to step up our efforts to combat drug abuse, bringing in the needs of the populations, and adopting a gender approach. We focus on sports and culture to prevent drug abuse. We look at alternatives to prison and treatment for drug users and offenders of minor crimes. We focus on social reintegration as a social approach to prevention. We reiterate our commitment in the outcome document on exchange of information. We welcome the UNGASS model of viewing drug abuse as a medical but also a social issue.

Guatemala. We are in touch with stakeholders on drug policies to implement the UNGASS outcome document. We have a broader approach. The Secretariat is tasked with implementing national policy, as part of a national vision focused on addressing national drug problems. Relevant ministries are involved as well, to have prevention and repression carried out at the same time and to avoid stigmatisation. We also focus on international cooperation, with prevention campaigns targeting schools and adolescents. The idea is to have a multiplier effect by engaging families in the process. We are carrying out activities with a range of specific populations. NGOs are providing assistance on treatment and rehab. We make sure that there is a process in place for psychological support to ensure social reintegration, and access to the labour market. We set up a non-residential treatment centre for patients of all ages. There is a family unit in the centre to enable people to reinsert themselves psychologically but also in the labour market, with their family. We also work with the prosecutor’s office and with NGOs. There is also a crisis centre. We allocate significant resources to education, balancing resources between security and education.

Colombia. The UNGASS outcome document defines clearly that human rights are the definer of drug policies. In this framework, prevention strategies should be more than the goal. It should facilitate building the capacity of people. We need analysis of the interaction between drug users and psychoactive substances. This means a social model for public health. The UNGASS outcome document makes public policy a health approach based on people’s needs. The document broadens the three pillars of the 2009 document. Now we have seven pillars. This broadens the basis of analysis to be taken in public policy and on actions to be undertaken in various sectors. The outcome document incorporates demand reduction items having to do with health. Before it was only incorporated as an economic component of the problem. This should be the basis for all political statements to be made on drug use. We underscore progress made in drug policy. Drug dependency is recognised as undermining public health. This includes the need to continue to update the model list of essential medicines of WHO and the need to focus on harm reduction to prevent the transmission on HIV, hepatitis and other blood borne diseases. The outcome document includes the need to take into account overdose prevention and treatment. There is a role here given to WHO on drug use problems, and for UNODC and WHO to strengthen their cooperation on early intervention, treatment, rehabilitation, etc. through the adoption of a decision of WHO on health and drug use. On prevention, we must have programmes such as ‘Strong Families’ in Colombia. This programme was successful in 24 provinces. To date, certain NGOs have taken action in prevention. They work in cooperation with local authorities. On treatment, capacity building is carried out with experts in this area, and the use of tools and special measures. We have a community strategy based on the Eco 2 model. We listen to individuals and provide training to university students to prevent drug use risks. There are technical guidelines to combat drugs, providing government and NGOs the opportunity to provide a comprehensive solution to drug use based on prevention, bringing on board parents. This is to reduce drug use rates. The Colombian Drug Use Observatory drew some recommendations based on statistical data.

USA. We are in the midst of an unprecedented opioid epidemic. The misuse of opioids is a serious national crisis affecting health and welfare. Statistics are startling. We echo Canada and the Netherlands. Drug overdoses outnumbered all other categories of death. 78.5 billion dollars is the predicted cost to the crisis. We favour a comprehensive approach including prevention, treatment and recovery and encourages support. We remain committed to continue to expand efforts to prevent drug abuse and support recovery. We support research in demand reduction. Each dollar invested in prevention programmes can reduce costs related to substance abuse. We focus on prevention and sensitisation and are thinking of scheduling prescribed opioids in Schedule II. We are reinforcing online drug prescription monitoring. We are also raising awareness on overdose prevention with naloxone and follow up prevention and care. The work we support internationally reflects policy at home: prevention and treatment, professionalising the work force, consolidating networks for research, addressing populations with special needs (children, women, rural populations). International standards on demand reduction are examples of resources that can support this work. We commend these types of interventions and encourage continued cooperation. We look forward to finalising the international treatment standards in 2018 and to field test these standards. We encourage member states to support UNODC’s demand reduction activities as outlined in the UNGASS outcome document.

China. We thank the UNODC expert Mr. Gerra and experts such as Singapore and others today. We support countries promoting community based rehab to achieve a drug free society. We should stick to the objectives of the 2009 political declaration to address the world drug problem. We pursue the policy of prevention and education targeting high risk groups such as young people, using new platforms. We also promote community based treatment and rehab. We support international standards on prevention by UNODC and welcome the new version. We hope UNODC will support the efforts of countries in diversifying treatments on the basis of national realities and national law. On prevention, China seeks to address the root causes of drugs. We promote a healthy way of life and a sound environment in which children can grow up. We focus on youth and carry out various activities including video clips and photo contests, as well as the 2017 debate among college students. These activities involved around 100 million children in China. In addition, we used traditional media: radio, TV, newspapers, as well as new media: websites, we chats and mobile phones and TV shows. Newly reported drug users dropped by 40%. We stick to a human centred approach and a scientific approach on prevention, treatment, care, rehab and social reintegration so that we can carry out community rehab projects. Communities have become the dominant force to provide services to drug addicts. There are 32,000 treatment facilities where 52,000 social workers work. 400,000 drug users are receiving treatment.

The HIV/AIDS infection rate among drug users dropped from  7,5% to 3% in 2015. In February this year, China adopted the 13th new 5-year plan of action against AIDS, which proposed to limit new infection rates to under 0.3%. At the same time, there has been close cooperation among public security, justice and health authorities to offer standard treatment living with HIV in prison and reintegrate them in society.

Subhan Hanonanhan, Rumah Cemara, Indonesia. The implementation of the UNGASS outcome document includes addressing HIV. There has been strengthening in several sectors through the narcotics law, strengthening the national drugs programme, addiction curriculum, addiction council, and sustainable rehab goals to reduce narcotic use and improve quality of life. The government and NGOs should develop cooperation of international partners through strengthening the integration of harm reduction. The national narcotics agency and civil society have adopted an agreement of 1 year on treatment.

Poland. We support the statement made by Estonia. The effective implementation of the UNGASS outcome document is important for my country and is a priority for different institutions in Poland. I will briefly touch on two aspects. One is the quality of prevention and treatment programmes, with guidelines under the national health agency. In 2016, the national bureau developed standards for drug prevention programmes, and developed a new dedicated programme and a brochure on standards for drug prevention. The brochure was shared with all relevant agencies in Poland and education facilities. There is a consideration of increasing access to OST in Poland, in amending the law. This would allow methadone, but also buprenorphine and naloxone administration by psychiatrists, physicians, doctors. This would result in increased access to OST and stimulus to use other substances, in addition to methadone.

Singapore. We use drug prevention as a first line of defence in our prevention approach to target children and adolescents. A behavioural analysis found that youth education should be targeted to enhance effectiveness. We then contextualised the messaging of prevention strategies for primary and secondary students: harms of drugs and implications for their lives. Then it’s focused on analytical thoughts, allowing them to lead a life for themselves. Advocacy in community is key. It allows citizens to get greater ownership of drug issues. We launched United Against Drugs Coalition including government, non-government and private sector working on prevention. We use social media as an important platform for prevention: Facebook, Instagram, etc. to show the harms of drug abuse. It’s a self-discovery approach rather than a top down approach. We reiterate ASEAN’s approach to achieve a drug free Asia. The ASEAN drug education portal is a resource to share practices on drug prevention and education in the region. We emphasise prevention education as a key component. It takes many stakeholders to develop effective prevention programmes, sharing best practices will go a long way to support this effort.

Czech Republic. We support the idea of sharing best practice and strengthening cooperation between UNODC and all UN agencies, not just WHO – especially human rights, poverty, infectious diseases. CND should call on relevant UN agencies and their involvement should be encouraged in the drafting of future CND documents.

India. We are committed to addressing the world drug problem. Justice and empowerment is important for drug abuse prevention, dissemination of information and public awareness. We recognise drug abuse as a socio-medical problem, which can be addressed with the active involvement of NGOs and CBOs. We focus on rehab services, social justice and empowerment. We provide education, rehabilitation and social reintegration of drug addicts. We establish rehab treatment, with a variety of services. We provide education at all levels including at schools. We ensure accreditation of all facilities. On demand reduction, we have prevention programmes for alcohol and drug abuse, hospitals run by the state, 400 rehab centres spread all over the country. The government conducts a national survey on substance abuse. Training is an important component for service providers. This is done by the National Institute on Substance Abuse. Accreditation of de-addiction centres is done regularly, with monitoring of people undergoing treatment. At last, I reinforce our commitment to implementing the UNGASS outcome document.

Bulgaria. We support the statement made by Estonia. Our guiding document is Bulgaria’s drug policy and action plan, and the UNGASS outcome document which represents the most recent global drug control consensus. Our drug policy gives a detailed account of the situation and focuses on health and human rights. We focus on many target groups: young people and children with awareness raising campaigns, informing them of harms caused by drug abuse; training for teachers and help them manage drug occurrences. The plan also focuses on parents. There are special stipulations to address HIV and NGOs are involved in the project. 500.000 syringes are disseminated every year. We also have programmes in prison: prevention, rehab and recovery including group sessions. NGOs are engaged to identify priorities in demand reduction. We look forward to discussions in the next two days.

UN Women. Many demand reduction measures are still gender neutral or focused on men. This does not respond to the needs of women. It is most welcome that the UNGASS document provides recommendations to better respond to the needs of women drug users. This is a key opportunity for a gender-responsive strategy. Discrimination against women is a leading barrier to access to treatment. They face increased stigma and discrimination combined with other gender inequalities. They fear losing custody of their children. Women who use drugs have more limited access to harm reduction services and health care services including for sexual and reproductive care. In prison, they have little or no access to such services. The UNGASS outcome document calls for evidence base and data gathering, including on women. The link between drug use and violence requires more attention. Women who use drugs are more likely to experience violence by male partners and law enforcement. The INCB Annual Report highlights these issues this year as well. Sexual abuse can predict relapse among women as well. We want to help improve data on gender sensitive statistics to inform policy and advocacy. The 2030 agenda for development emphasises the mainstreaming of a gender perspective. This should be an integral part of the 2019 process.

Sweden. We align with the Estonian statement. The public health perspective includes prevention, early intervention, harm reduction, treatment and care and recovery, and these are reinforcing. We have increased mortality rates among PWUD, and it is worrisome. It may be the result of coding and reporting. But we want to share two examples of UNGASS implementation. We commissioned two national agencies to present an action plan to reduce deaths, which includes broad interventions focusing on demand and supply and harm reduction measures. We are currently assessing the proposals. We are also focusing on opioid overdoses and naloxone provision – we are investigating increased availability of naloxone to families and friends in addition to the health services. We welcome the opportunity to share experiences and collaborate with UNODC and the UN family.

Japan. I want to welcome these discussions. I want to thank UNODC and the panellists for their presentations. We have made efforts nationally, regionally and internationally in addressing drug related issues including on drug demand reduction for a balanced approach. I want to touch on some of our efforts focusing on international cooperation and technical assistance in demand reduction. We have studied and contributed to demand reduction projects led by UNODC. One is an evidence based demand reduction initiative in Afghanistan. It aims to facilitate and expand integrated treatment, including joint training for policy makers and public health officers, organising workshops for treatment coordination, developing treatment protocols for drug treatment centres, trainings of trainers on human rights based treatment services. We are also contributing to other projects in Afghanistan and Iran for vulnerable groups, such as women. This will increase access to treatment and rehab services tailored to the needs of women with drug use disorders. We value UNODC’s work in providing technical assistance and promoting international cooperation. We want to increase our cooperation with UNODC and member states based on common and shared responsibility.

Mauritania. We have ratified all international and regional agreements on drugs. Because of the size of our country and our coast/geographical location, we have suffered from being a transit point. We kept track of the methods traffickers used, and focused on reducing demand to educate youth on how to escape addiction. We are no producers or manufacturers of drugs. But use of hashish is a primary problem, as is the use of stimulants and tranquillisers. Our strategy focuses on adequate legislation and providing prevention methods, and a national work plan. According to this plan, we adopted a legislation – law 1993 037 to punish producers, traffickers and users, based on international instruments. We have law 2008 012 to implement the international convention on drugs on money laundering and the financing of terrorism. We have issued other laws on national, regional and international developments. We have another law focusing on drug trafficking and establishes measures to tackle seized assets and funds. We have established a commission to punish traffickers and smugglers operating in our country to reduce demand and supply. On prevention measures and deterrence, we have provided the necessary means and resources, with an increased number of personnel, technical equipment, and opened three branches for our office and will open further branches according to specific programmes. We have carried out courses for the police. We have connected national borders with security and police forces who are highly trained in combatting drug smuggling. We have areas and activities to keep up with combatting the spread of drugs. We have contacts with regional and international partners working in this field. We have facilitated access to the media. We have 45 crossing points with necessary technical equipment to record those who enter and exit, we have a special unit in the national security forces focusing on drugs, we have an aircraft providing round-the-clock monitoring. We have special equipment and boats to prevent smuggling. We have a special office and judges dealing with drug cases and with juveniles who abuse drugs – we have a special law for them, based on international agreements. We have a centre for rehabilitation and another for combatting organised crime and money laundering. We have a supreme council for the youth to deal with threats and dangers for the youth sector. On prevention of drugs, we have asked various ministries to carry out outreach and activities in cities targeting vulnerable groups with the support of religious leaders to address the prohibition of drugs and spread Islamic values. We have used the scientific evidence and skills and experiences to protect the families and youth from this problem. We have a sports ministry to protect youth from idleness. We have support from civil society. We have caught a number of smugglers: we caught a senegalese boat carrying a number of smugglers and tons of cannabis resign. We also caught a number of individuals smuggling 1.5 tons of cannabis. This is a result protecting us from the dangers of drugs. We continue to protect our country and improve our policy. We are keen to exchange our experience and benefit from the experience of others.

Post-UNGASS Facilitator. We will hear about further NGOs and UN entities’ statements tomorrow morning. But I will ask the panel to give a final word on the discussion from today.

EMCDDA. Thank you, it has been very interesting to participate in this panel. After many years of involvement, it was not so common to discuss evidence based policy, it is positive to hear this here. I also want to mention the European Summer School – we are now welcoming students from all over the world and it is becoming a platform for exchanging best practices.

Joao Goulao. An increasing number of delegations consider drug use as a health and social problem, this is important. We also discuss social exclusion here. I also noticed the big number of delegates saying that even though some people are not able to stop using, they still deserve to be supported, this is in the spirit of harm reduction. Several delegates referred to decriminalisation of drug use. Drug use was decriminalised 16 years ago, but it is still prohibited. Sometimes there are misunderstandings about this and it’s important to say. At the margins of UNGASS, our model was considered by the INCB as a model of best practice during a side event. I want to wish you the best for the rest of the sessions.

Aljona Kurbatova. I thank all member states for your interventions today. We will continue our efforts on social and health approaches.

Timothy Lee. I want to thank the CND for this platform to share best practices. We’ve heard about various practices today on gender, community based programmes, preventive education. It is clear that demand reduction is a key component and we have a lot to do still.

Roli Bode-George. Thank you all for a wonderful job. Having been here for a long time, member states have come a long way. One of the things I want to add is the fact that when we do interventions the key element is to restore the dignity of the beneficiaries. And I want to finish focusing on gender and the need to focus on it more.

Gilberto Gerra, UNODC. I will only say two words. I welcome the incredible richness of the discussion today. It’s created a sort of agreement on continuum of care, and moving away from ideology. We could try to create groups of member states in the lead up to 2019 on ‘unresolved issues’ here. For example, why HIV is decreasing but not hepatitis C, or issues where there is no agreement. This could be a good possibility to prepare for 2019. The last thing is that we could work much more on science around substance use disorders and no longer on ideology or punishment. I would like to ask you to translate in concrete actions what we are doing. UNODC is constantly asked to do trainings on prevention, treatment, etc. and we don’t have the resources to do so. A possibility would be for member states to devote some national budget to make this possible.

Post-UNGASS Facilitator. I stress the gender balance here – that how it should always be done. I thank all the delegations. We managed to get through most of the statements, a few last ones will be made tomorrow. Thank you all for sticking to the time limit and addressing the issue of demand reduction. I hope the same thing will happen in the next few days.

[Wednesday 27 September]

Monica Beg, UNODC HIV Section. In the 2016 UNGASS outcome document, member states reiterated their committed to end by 2030 the epidemics of AIDS and viral hepatitis in line with the SDG agenda. As part of this, UNODC supports member states to facilitate HIV-related harm reduction services, ensuring access to services for women and people in prisons, and the meaningful engagement of communities of people who use drugs. We have briefed member states on this work before, on the evidence of treatment effectiveness for people who use drugs, etc.

Today, I want to emphasise a new area – HIV-related harm reduction for stimulant drugs. There are different groups of stimulant drugs, and these can be smoked, inhaled, ingested or injected, and HIV can be transmitted by unsafe injection or risky sexual practices among key groups such as MSM and sex workers. Stimulant drug use have been associated with HIV outbreaks in several countries. To address this critical gap, UNODC undertook an evidence review in 2015, and in a scientific consultation in 2016, experts provided an in-depth analysis of the findings. People who inject stimulants engage in more sexual risk behaviour and higher HIV prevalence than those injecting opiates, and a higher frequency of injecting. There is also evidence of increased HIV prevalence among MSM and sex workers who also use stimulants. In USA and Latin America examples, HIV prevalence among people who use stimulants (non-injecting) was higher than in the general population.

Key challenges: no scalable drug dependence treatment yet for stimulant use, nor any strong evidence of effectiveness of stimulant replacement therapies on HIV transmission. The overlap between key populations is a challenge in terms of access to services, as they face additional stigma. Reaching out to stimulant users, particularly young people and women, is also a major challenge, as services are rarely tailored for these groups. We also need more disaggregated data to better understand the problem. UNODC is working on a new implementation guide on stimulant use and harm reduction, which will build on the existing package. Thank you.

UNODC Prevention Department. If we do treatment and prevention well, we can achieve many of the SDGs. There are a few key building blocks: evidence-based strategies, quality standards, human resources, financial resources, and coordination mechanisms. We know what needs to be done, so we just need to do it. We are currently updating our drug prevention standards – which outline the approaches that have been shown to be effective over time and among different target groups. These include interventions during childhood, adolescence and adulthood. Member states can be overwhelmed by this, though, as there is so much to do. So let us focus on “middle childhood” and early adolescence, and in particular on work with the family unit. If member states need help, we can help. We have a lot of experience in connecting programme managers with researchers and experts, and with other programme managers from other countries. A few of the family and school programmes that show success, and we are currently developing a “Strong Families Program” to build on these – including special attention to misplaced populations and trauma. For treatment, there is a pyramid of needs – with most people able to self-care to an extent, and then at the top, a much smaller number needing more intensive help. Again, we have ample experience of working on overdose prevention, on alternatives to incarceration, and have developed a step-by-step methadone programme protocol for member states to use – working with WHO.

Quality standards for prevention now exist, as well as guides on how to evaluate prevention programmes, and quality standards are now available for treatment too. We work with our partners to support practitioners – there are ample resources out there for member states to use. Coordination mechanisms exist to engage all sectors together on prevention of drug use, and some good models exist for inter-sectoral cooperation at the national level. For treatment, we have to build a connection with people who drug-related disorders too. Financial resources: UNODC needs resources to do this work, and there is never enough money for good prevention programmes. If you take all of the resources that are spent on non-evidence based practice, and move them into evidence-based practice, then this would have an impact. There is a lot that we can do together on this. We all want to do this well, and to promote and support health and well-being for all – particularly children and the most vulnerable.

Bethany Medley Harm Reduction Coalition, USA

Matej Kosir, Institute for Research and Development, UTRIP (Slovenia). In the UNGASS 2016 outcome document, UN Member States committed to “increase the availability, coverage and quality of scientific evidence-based prevention measures and tools”. This can only be done if they align their prevention strategies with available minimum quality standards and allocate adequate resources to prevention measures.

Alarmingly, 97% of health spending across Europe goes on healthcare and treatment as compared to only 3% on prevention. That’s according to the data provided by OECD and the European Commission about 10 years ago. It is probably not much different in other parts of the world.

Different international institutions such as UNODC, EMCDDA, UNESCO and WHO have been putting many efforts in the last decade to develop quality standards in prevention and also in other areas of drug demand reduction – all in purpose to improve the quality of interventions in daily practice. Furthermore, the Council of European Union adopted a political document in September 2015, which politically (but not legally) obliges EU Member States to invest more in implementation of minimum quality standards in drug demand reduction.

However, most of prevention work nowadays in many UN Member States still does not comply with standards and scientific evidence, and many of them still do not link co-funding of prevention with those standards. At the same time, it means many prevention practitioners are not very motivated to change their way of work due to obvious political and professional indifference to change situation in practice significantly.

Our future joint efforts at international level should be focused firstly on disinvestment from ineffective or harmful practices which are still very popular and still often funded by authorities (such as one-off lectures and workshops, scare tactics or fear appeal, ex-addicts testimonials, information-only interventions, say no campaigns etc.). Secondly, we all have to invest more in implementation of minimum quality standards and evidence-based practices. Not just having them on paper (e.g. in the strategies or legislation), but enforcing and financing them in real life.

Some research showed that more than 80% of prevention professionals think that basic knowledge and skills (such as theories and models, needs assessment, logic models, implementation quality, evaluation and ethics in prevention) are important for the prevention workforce, but also report that there is a significant gap in knowledge and skills. The research also showed a strong need to invest in prevention education and training regarding advocacy for quality prevention, funding, management skills and soft skills such as communication, teamwork, collaboration and networking.

Professional development of prevention workforce should be promoted across the world, in multiple sectors, to bridge the significant gap between available and required knowledge and skills. Institutions and organisations (including many civil society organisation) that employ the prevention workforce and give a high value to advanced prevention-related knowledge and skills should be recognised nationally and internationally for their contribution. Amongst the prevention workforce, in multiple sectors, there is a strong need to invest in comprehensive and recognised professional development programmes, such as formal and informal education and training. To reach our goals regarding quality prevention, we have to incorporate minimum quality standards in our daily work, and invest more in knowledge and skills of prevention workforce. Thank you very much for all your efforts towards better and quality prevention! I wish you a successful work at this and other sessions as well.

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