WHO Expert Committee on Drug Dependence

Public health dimensions of the world drug problem and WHO activities in addressing them

Organized by the World Health Organization.

Conference Room M3

Mariangela Simao, Assistant Director General for Access to Medicines, Vaccines and Pharmaceuticals

Mariangela Simao: WHO is UN specialist agency for health, established in 1948. Comprised of 194 countries and works with Ministries of Health. Headquarters is in Geneva, with 6 regional offices. Secretariat staffed by 7500 staff.

We provide technical support for countries, norms and standards development, monitor and assess global health trends, strengthening health systems, promote health security.

WHO is proposing a new strategy in 2018 ‘3 billion targets’ – strong focus on impact at country level, strengthening countries with WHO Country Action Frameworks. We are working with a wider range of partners within the WHO and external to the WHO to strengthen coverage in line with the SDGs.

Dr Shekhar Saxena, Director of Dept of Mental Health Substance Abuse

WHO activities on psychoactive substances and related issues.

• Treaty and convention-based function of the WHO Expert Committee on Drug Dependence – we review substances for their scheduling by INCB and CND
• Not limited to illicit drugs, but include other psychoactive substances such as alcohol and nicotine/tobacco
• Focus on public health and health systems and services
• Implemented by a range of specialised technical programs

• World Health Assembly (WHA) resolutions and decisions on critical public elements in response to the world drug problem:
• 2017 WHA 70/18 Public Health Dimension of the World Drug Problem
  • Keep CND fully informed
  • Joint statement with UNODC, CND and INCB – you can find in your boxes
  • The WHA has considered the erport of the Secretariat and
    • Requested the Director-General to continue efforts to improve coordination and collaboration of the INCB

UN General Assembly resolution (Dec 2016) International cooperation to address and counter the world drug problem

WHO-UNODC MOU:

• Signed between WHO and UNODC in February 2017 – revised from 2009 – explains areas of collaboration that both agencies work on together; the UNGASS Outcome Doc and 2030 SD Agenda being the guiding principles of this MOU

Sustainable Development Goals: Main targets discussed in collaboration between WHO and UNODC – 3.5, 3.3, 3.4, 3,8 3b

Critical public health elements of comprehensive, balanced and inclusive drug policy (WHO):

1. Prevention of drug use and reduction of vulnerability and risks
2. Treatment and care of people with drug use disorders
3. Harm reduction: prevention and management of harms associated with drug use
4. Access to controlled medicines
5. Monitoring, surveillance and evaluation

Andrew Ball, Senior Strategy and Operations Adviser WHO HIV/AIDS Department

• We have a strong focus on harm reduction within priorities for HIV and viral hepatitis – major priorities for next few years, and bring the harm reduction agenda forward
  • Without working in the area of PWUD, the targets to end the epidemics of HIV, viral hepatitis and sexually transmitted infections will not be met by 2030
  • We advocate for implementation and provide technical support for countries – we advocate in countries for evidenec based services and interventions, address structural barriers that impede implementation (and stigma and discrimination) and ensure there is appropriate funding for harm reduction – this is all in key role of not leaving anyone behind, especially people who use drugs, in universal health coverage.
  • Improve indicators and data (systems) to allow analysis for the HIV cascade – we are working to retain PWUD in services
• Ending the AIDS epidemic and combating hepatitis
  • Development of WHO normative guidance that are evidence-based and health promoting. We’ve developed a broad range of normative guidance including: harm reduction, HIV testing services, treatment guidelines for BBVs, looking at integrated service models, guidance on strategic information
  • We work closely with other agencies: UNODC and UNAIDS to fully integrate PWID in guidance on HIV
  • 2009: essential package of harm reduction implementation for HIV epidemics. Since then we’ve expanded to HepC TB and other key affected populations – men who sex with men, sex workers and other vulnerable populations
    • We’ve added opioid overdose, new prevention technologies, and measures to address structural barriers
• To end, and to reinforce our priorities – need for focus on health and structural interventions, need for continued global advocacy and concerted efforts, opportunities in Universal Health Coverage

Dr Gilles Fortes, Secretary of Expert Committee on Drug Dependence.

The Expert Committee on Drug Dependence is composed of experts from different backgrounds and different regions. The work of the committee is on the assessment of scientific evidence.

In order to identify with substances will be reviewed we do a thorough investigation – and carry out a prioritisation process with the support of other UN agencies – UNODC, INCB, EMCDDA. We have annual meetings, and this year there will be an extra meeting to review cannabis. Tomorrow morning we will present the findings from the meeting in November.

Challenges we face: high number of NPS, high turnover, 16 substances were review in November, of which 6 were opioids. There is a lack of qual and quant data for prioritisation and scheduling for NPS. WHO develops a Surveillance and Health Alert System on NPS and harmful psychoactive substances to gather and disseminate information on harm more quickly. We are working with other agencies to collaborate and not replicate. This system is complementary to the work of the ECDD.

Also, we are working to broaden the access to essential medicines globally, through a number of interventions, through the promotion of the safe and efficacious medicines through the WHO Essential Medicines list. This list is updated every two years. We are also developing guidelines and tools for the management of pain, we support countries in the assessment for availability to controlled medicines, and collaborating with low and middle income countries to identify the barriers. The WHO has been mandated by the WHA to move forward and help countries improve access to medicines. We will identify a roadmap on who to address these problems

Vladimir Poznyak, WHO Dept of Mental Health:

• Flag one publication on cannabis – there are many WHO guidelines required at the country level, and we’re not yet able to address this. We need to:
  • Update the guidelines on treatment of opioid use disorders from 2009
  • Create WHO guidelines on management of stimulant use disorders (cocaine, ATS)
  • Create WHO guidelines on identification and management of disorders due to NPS use
  • Create WHO Guidelines on psychosocial interventions in management of drug use disorders
• Last year, first WHO forum on Alcohol, Drugs and Addictive Behaviours

Chair: Powerpoints are available, please leave us your card.

Question from the floor: Do you have any methodology to include people with lived experience at your conference in 2019.

Chair: We certainly want to include people with lived experience, we will be in touch