CND intersessional meeting, 25 september 2018: Demand reduction and related measures

Chair: Good Morning. I invite the floor to adopt the provisional agenda. No comments from the floor – adopted. Welcome to the third intersessional period of the Commission of Narcotic Drugs’ sixty-first session, the thematic segment of the Continuation of preparations for the ministerial segment of the sixty-second session of the Commission on Narcotic Drugs, to be held in 2019. During the previous intersessionals, as you might recall, the commission held a number of informal consultations to develop a work plan in preparation for the High-Level Ministerial Segment (HLMS) and I would like to express my appreciation for the flexibility for adopting this schedule in June. The present and upcoming intersessionals are dealing with practical issues, with the implementation and sharing of good practices as well as with the preparations for the HLMS. The thematic segments will follow a similar way as UNGASS did in 2016 and during these segments, we will have presentations by various relevant UN entities, followed by a panel discussion by the regional groups and speakers from civil society that were selected by the Civil Society Task Force (CSTF). Today we focus on demand reduction and related matters.

Before we start, let me reiterate the intention of these meetings. To get the most out of the sessions, panellists are requested to limit their presentations to the minutes we agreed upon beforehand so that we leave enough time for discussions and I ask delegations to deliver statements from the floor within the 3-5 minutes frame and I strongly encourage member states to ask questions and interact with the panellists. All efforts will be made for the presentations will be eventually posted on a subpage of the CND website but the secretariat is not in the position to prepare summaries.

At noon, we are scheduled for a video conference with the WHO in Geneva where the 5th WHO – United Nations Office on Drugs and Crime (UNODC) Expert Consultation on New Psychoactive Substances (NPS) is taking place to focus specifically on the non-medical use of opioids – both medicines and new psychoactive substances (NPS) with opioid effects. Frank discussion and candid comments are an important part of our work and the next few days are an opportunity to enhance our knowledge. I am looking forward to a fruitful discussion and, again, I encourage you to ask questions, share thoughts, make the most of having so many experts in one room.

Dr. Gilberto Gerra, Chief of Drug Prevention and Health Branch, UNODC: Drug Conventions and the UNGASS outcome document: an innovative, health oriented, balanced approach.
Thank you, I am happy to be here among colleagues from other UN agencies, experts and civil society representatives on this panel. In the afternoon, we will give you more technical practical recommendations based on the outcomes of 2016 and the declaration of 2009 but let me start with the basis for policies, not a philosophical topic. The first thing I want to discuss is the issue of the conventions – most of you in the room are young and when you think of these documents from so long ago as 1961, you might think of it as an archaeology of control. It is an old document, but the validity of these documents has been many times reiterated, and in the mainly unanimously adopted documents of 2016 as well. We have to remind ourselves that the real issue we deal with is the protection of people from the threat of controlled drugs and protect those who are affected by the danger of drugs. We tend to forget that there are medicines among the scheduled drugs, and that there are drugs that are not under control. The conventions call for the control of substances and any kind of critical approach sees that these substances should be utilised for medical purposes only. On the other side, the fathers of the conventions knew that these are indispensable substances for the relief of pain and the provisions state that the availability of medicines for treatment MUST be insured. A disparity still exists among countries… 70% of countries utilize 90% of the morphine. The conventions are concerned about the dangers of non-medical use and its true – we are facing an epidemic. We had a first person dying in Italy from fentanyl last week, so this is not just relevant to North America. There are serious physical dangers of several controlled drugs and so the conventions are protecting mankind. But who is more affected? The privileged with social advantages? No, it is the poor and the children living in concerning conditions who at age 12-13 are using opium, benzos or cocaine to cope with their life. So I have some doubts about us making decisions given our socioeconomic statuses, but what I would like to get more in-depth about is social inequality. To implement our conventions in a useful way, let’s think about minorities in lower socio status. They have been shown to use more marijuana in the past year, more frequently in low educational levels, and are more at risk than people with higher academic levels.  There was a French research that showed how rich affluent children are using more marijuana, they try it, experiment with it, but the people who continue using it after the experimental phase are the children of the poor and they eventually move to other drugs. The young people from high socioeconomic statuses are better able to regulate their consumption, so when we have a drug on the market, we have to take in mind that availability is not the main issue.

As a doctor I am passionate about the SDGs, especially, commitments 3 and 10. We are speaking many times of an epidemic (overdose, HIV) but there is a silent epidemic: addiction – an attachment disorder that may be caused by insecurity, disorganised relationship in the family. What the UNGASS solution suggested was a science-based intervention rooted in evidence […] but the conventions didn’t explicitly say that. It says promote the training of personnel. The fathers of the conventions were already concerned with the quality of what we provide and didn’t want to let the problem take care of itself. The UNGASS outcome document spoke of equal access to education and this is the first step for prevention AND towards the well being of society as a whole. When, the preliminary things are done, then we can go into science, supported parenting, teachers and parents working together for the children, integrated mechanisms of treatment including psychosocial treatment and pharmacological response. We have a big job to do together. We have to start implementing these things, of the people who need treatment only 39% are recognising this need and only 61% made a visit and only 29% of that 61% have exposure to such services at all. Going back immediately to inequalities… in low income countries 1% has access to such services. The UNGASS outcome document emphasises that we have to proceed with voluntary programmes, we need consent to interfere with people’s lives, we need to respect them as humans and only so can we minimize adverse public health consequences of drug use. We need alternatives to conviction and punishment. Prison is not a good place for people with drug problems: it says so in the conventions, not the 2016 document, not me but the 1988 treaty, paragraph 16: social reintegration, care, treatment.
The WHO and UNODC have addressed this before. Along the SDG 3 and 16 we have to understand that treatment of drug use disorders is a long-term process, in which users have to be involves. I have to also remind you that people who are affected by mental health disorders are also often affected by drug misuse and vice versa. More than half the world is using stimulants and we should give time to figure out what pharmacological response would be appropriate to this. I can’t conclude without addressing the issue of gender. Women often face a double stigma and we should make an effort to respond to the specific needs of women and children. I would like to make an appeal to ministries to health – they have to take leadership in coordinating with the other agencies. The World Drug Problem is an issue of health. I have one depressing slide for you – there is a study in 2016 that the only 22% of doctors are prepared to screen substance use disorder, 7% are ready to discuss and 31% felt that a substance use disorder are not their area of concern because it’s a choice. So, we are operating in full ignorance and we are accusing the patients to be guilty for being affected by a disorder which in my opinion is crazy. So, governments should be investing in this on the local level. Thank you for your attention.

Pakistan: We also have to look at how our responses have been, how we were increasing the services regarding drug abuse prevention – how does Dr. Gerra see the UNODC’s work in the past 10 years, since 2009 specifically eliminating drug demand, and the support of Member States (MS) and what can be done to improve the situation?

Dr. Gerra, UNODC: We don’t have responses on the global level, but we also don’t see reports of increase in dependence in the World Drug Report (WDR). UNODC and WHO has the position to invest in training, increase the level of engagement, expertise and the knowledge of professionals. These are also good measures and we publish results regularly, for example in HIV, we have countries where they discover HIV in addicts on a lower rate than in the general population. The program of family prevention in many MS shows that use of drugs and risk off affiliation to criminal gangs is improving as a result of better parenting. We will have a snowball effect so that you won’t see immediate results but if every country understands that we are talking about health and so we need non-discriminative approaches, will see big results..

Nigeria: You mentioned that the use of drugs is used to cope with life conditions and this is relevant for the scourge of drug addiction among women, especially for my country. We witnessed a case of increase in addiction as women are excluded in many cultural practices and suffer from a double stigma so most of them don’t speak up. I appreciate your comment, but I am wondering how UNODC can provide more support.

Dr. Gerra, UNODC: The problem of stigma is crucial… not only because “dirty drug addict” is common in our language but women face the good mother expectations as well. So, women are often left alone, so we can speak about hidden addiction. I don’t believe money should be invested on the global level, MS have national budgets for metabolic disorders…. they should dedicate money for addressing drug use disorders as well.  We have resources but can’t replace the governments in managing this.

USA: I use this opportunity for a brief national statement. Appreciations to the UN agencies, the US is grateful for this engagement opportunity and to share lessons learned in the past 20 years. Together we have a lot of experience to share to effectively respond to the world drug problem. We saw among the MS who responded to the ARQ that many use non-effective approaches, this demonstrates a possible theme for our future focus, understanding the science behind the response and understanding science more. Knowing what to do is only part of the change, we are painfully aware of the growing world drug problem. Opioids devastated communities and frustrated law enforcement, but this is only how it’s seen through our lenses – overuse of prescription medicines while many die because of the inaccessibility of those same drugs. It is certainly a multifaceted problem. With the evolving realities, working with the commission and MS is vital. We spent 20 years to see what works and what not, time to turn to concrete action and think pragmatically using lessons learned from national.
It is for this reason that president Trump convened leaders in New York yesterday and it is why that is relevant to this intersessional. President Trump and the 120+ countries underscores the issue as a public health issue, focusing efforts specifically to reduce demand, ensuring due access to treatment, recommitting to the conventions as cornerstone of international drug control and the role of UNODC and CND as leading entities. We know many of our colleagues have concern to circumvent these meetings or favor one approach over the other, but the intention of the meeting was to reiterate need for national implementation of evidence-based policies addressing this problem. This call to action is not a drug policy document, it was not aimed to influence the upcoming discussion in 2019 as we think we already have enough relevant and competent documents. We don’t need a new policy document, but we do need to commit to our words. This is our view, but we know there are other views. For finding our way beyond 2019, my government has a strong and unwavering support for the Vienna based structure of international drug control. We are committed to the spirit of Vienna and we know that expertise is here, and we call everyone here to action to intensify our efforts. So, I am addressing Dr.Gerra: we’ve seen that national action plans exist but most of those don’t reflect the evidence based suggestions we identify here – what can do the UNODC do to help MS to develop these. Do you see the UNODC having a role in developing plans building on the commitments? In my country we have seen the opioid crisis begin with doctors not understanding how to prescribe opiates to properly respond to patients, so should we start at universities, changing curriculums?

Dr. Gerra, UNODC: Yes, we must create a system for proper understanding. It is a multifactorial issue, but I think we have to create systems that engage policy makers. It is my impression that when action plans are written, these correspond to the most recent information and not so much to evidence, so it is our role to call attention to this and connect professionals and policy makers. As per training of doctors: I have a daughter who studies psychiatry and in 5 years she had 2 hours of training on this issue … ignoring drug use disorders as prospective mental health professionals… I feel this is not far from the global reality.

Chair: I remind the room that we will have time for national statements during the afternoon, now please focus on interaction with the panellists.

Brazil: We are welcoming the important focus on social economic development in regard to addressing the World Drug Problem. I have two specific points, (1) there was a study conducted recently on HIV and hepatitis of non-injecting users in Brazil to elaborate our policies. We found that there was an equal prevalence among injecting and non-injecting users (among users of crack cocaine its higher) so we need to change responses to curb these infections. (2) Medical assisted treatment of users of stimulant drugs: interesting for us as research shows that more people use stimulants than opiates. What’s the broad medical finding or suggested UNODC, WHO response?

Dr. Gerra, UNODC: People are indeed at risk equally, injecting or not. There exist psychosocial issues regarding stimulants prevalence, so a psychosocial intervention would be good. We have to offer incentives for users to seek treatment, social protection and medication that helps them alleviate problems related to use. If there is not enough of this, many of the treatment centres are empty and the affected people are without protection scattered in society.

Egypt: In response to the US that we need to focus in implementation – What is your evaluation of our objectives on the global level when it comes to prevention and rehabilitation? Could we be more effective focusing on implementation or shall we revise the targets? Another question concerning socioeconomic inequalities: can we say that given this background information, developing countries are more at risk and if so, what would be a good global response?

Dr. Gerra, UNODC: I don’t think I have the permission to respond to the first, but my informal opinion is you should stop to speak for 10 years and apply what was written in UNGASS, in full continuity of what was said in 2009. It is time to move from brain to hands. I have shown you 4 books today and I think if you bring these books to your government and tell them to start applying this, medical and social interventions would bring real results.

In low income countries, a lot of people are affected by dramatic situations, are more at risk while family skills and capacities are changing. In refugee camps for example, people are locked in a limbo with nowhere to go, so parental styles are changing. They are a whole population without a voice, their lives are considered not relevant for international media, so kids can suffer emotionally, physically, forced to work illegal and have no one to listen to them.

Slovenia: Do you see the connection of different programs on the global and local level and their operations a network of different approaches? I think it is important for cooperation that we respect to each other. Many people think that the public health system will solve everything but how do you see the importance of local communities?

Dr. Gerra, UNODC: Yeah, global programs from Vienna should be distributed to local segments, adapted to relate to local needs and network is an important aspect indeed. If law enforcement is not trained for example, they don’t understand what is going on the global level and they won’t be able to respond in accordance to the global goal. About local communities: what we are doing now should be transmitted and yes, we have to take into account that importance of bonding to a community, it is a protective factor.

Uruguay: I am not going to comply with Madame Chair’s request of pure questions. I think last week’s event in NY is important as we saw the waging of the 2nd war of drugs by the US and Colombia. Here, in these rooms, no such unilateral statement was made, not since Nixon! I believe we all understand that that war was ended in 2016 once and for all… the war on drugs ended because we lost that war as everyone admitted. The president of the USA doesn’t see it that way… with an increase of use and trafficking, what is losing the war if not that?! If we spent the last 15 years losing the war on drugs what could be the possible objective of waging a second? This is not the position held multilaterally, but by the two presidents whose countries suffered the highest level of damage overall, similar perhaps only to Mexico. So, Colombia serves as a reference the global eradication of drugs and plants, well…. it’s a move that we had to sit through once before and turns out, 45 years later, the movie ended in a resounding failure. I have to quote Einstein’s saying that if you keep applying the same recipe, you will see the same results. It is deeply regrettable that while we sit here with progressive posited alternative approaches, it’s the same old language of the war on drugs there. It is not compatible. Can we have a drug free world? It is extremely harmful to have this as the desired impact… we can’t keep doing that. It is worrying that statements are made in these meetings that commit to progress while Trump declares war. We can’t sit here pretending as if nothing happened, I thank the US delegation for bringing this topic up. So to have a question to Dr. Guerra, if we embark on the 2nd war on drugs, do you think we’ll see different results?

Dr. Gerra, UNODC: I think the question was for everyone in this room. I think the language “war on drugs” was never adopted by the UNODC so it does not belong here. On the other hand, personally, I liked this statement “society free of drug abuse” is an aspirational sentence not “free of drugs”… we can dream of this for future generations, but clearly everyone understands this can’t be done quickly, nobody is that childish. I think to indicate a direction is important, but this is not a war. I believe that until the demand doesn’t go down, supply will not go down.

Colombia:  I don’t have instructions to respond to Uruguay directly, it was not planned to talk about this, but I reserve the right to come back to this later after I receive firm instructions to do so. My question for Dr. Gerra: going through 1961, this 57 year old agreement, one finds two paragraphs in the preamble stressing the promotion of the moral and physical wellbeing of humankind and recognizing medical use is indispensable & necessary measures have to be taken for their availability – so what have we done wrong over the past decades that led us to the current situation where people die of abuse of pain medications and others die of the lack?

Dr. Gerra, UNODC: I joined the UNODC in 2007 and I noticed that at certain point, MS completely forgotten about medical use around 2010 and 2011. We started to work with more agencies, so simply, the attention was polarized. We were focusing on diverting use, not really paying attention medical use. On the other hand, it’s nobody’s fault really. We developed a lot of systems that were based on free initiatives of people who asked for money to follow their own paths. In absence of national interventions, we had to give them space but their methodologies were often ineffective and not based in science, so we ended up with a disconnection between theory and execution and we wasted resources.

Vinay P. Saldanha, UNAIDS: In preparing for the HLMS and CND in March, this meeting is a precious opportunity to take stock the remaining massive challenges. We are honoured to be part of this discussion and coordinate with the UNODC to fast-track a global response to AIDS. Our vision is promoted by MS to end AIDs as a health threat by 2030. The SDGs call to end the epidemic and we have a new sense of urgency of making sure no one is left behind. If we really want to do that, we must focus on people who use drugs (PUD) who are still being left behind. What we learned so far is that we must address underlying factors of vulnerability and the most effective responses we saw have scaled up evidence-based treatment and used HIV as an entry point to end inequities. We recognise that this forum goes beyond AIDS and we note efforts to ensure consistency between today and the event in NY yesterday. We aim to secure health while respecting human rights at all times as PUD are at the highest risk and remain marginalised. The latest global statistics show little improvement, millions inject and one in 7 PUD have HIV and more than half are living with hepatitis C, a total of 1 million live with both. According to the 2017 WDR, annually we have thousands of deaths that are preventable. The evidence for prioritising PUD is clear. As a community, they are 20 times more likely to be affected then the general population. We a saw of increase in infection from 2011 to 2015 among PDU, particularly where harm reduction mechanisms are not in place. The evidence on the effectivity of harm reduction is great. Harm reduction works. Harm reduction saves lives and makes communities safer, yet coverage remain woefully inadequate. 53 MS explicitly reported such. Only 44 MS said opiate substitution therapy is available while, for example in 2010 to 2014, 3.3% HIV prevention founding went to PUD. This is inconsistent with the findings that harm reduction that prioritises health and human right is effective. UNAIDS reports that what helps is increased support for harm reduction as it significantly reduced HIV outbreaks and improved overall public health. This is imperative to reach SDGs. This is not a new message but a message we will continue to share. A comprehensive package of interventions, including needle exchange and opiate replacement prevents infections and reduces deaths. Putting in place services without changing policies will not work. Law reforms must be based on what works – ending punitive approaches will guarantee greater access to services for people who are most in need. Despite the evidence, things are standing still or moving in the wrong direction. Only very little funding for harm reduction is available and mostly they come from the global fund. Without greater commitment from MS, the current crisis will turn into a catastrophe. We need more leadership and a change in policy towards evidence informed, human rights base, people centred approaches and extrajudicial killings must end. UNAIDS remains in support of MS who contribute to more inclusive and productive societies.

Chair: No questions, we connect to Geneva.

(Panellist) WHO: Good Morning. We are here to talk to you about the the 5th WHO – United Nations Office on Drugs and Crime (UNODC) Expert Consultation on New Psychoactive Substances (NPS). It started yesterday and is still proceeding. The expert committee was established in 2013 to join forces and effectively address a growing problem. Today we are discussing specifically the challenges of the non-medical use of opioids. According to the 2017 WDR, about 35 million people misuse opiates and 70% of deaths and diseases are attributed to opioid use. This imposes increasing concerns for law enforcement and public health officers, while overprescribing and non-medical use has been reported in various regions, mostly in high income countries. Fentanyl and analogs are driving the unprecedented number of deaths. The main opioid in Europe is heroin but methadone and fentanyl are also reported. In the Middle East and West Africa, tramadol (not under international control) emerges as a concern. So what we do is (1) take stock of trends of use of harmful opioids, (2) share information and experiences globally, regionally, on the country level to to curb non-medical use, (3) agree on a set of best practices for tackling harmful use, (4) explore synergies among various stakeholders to improve global health. This meeting is expected to have important contribution to the CND’s work, enhancing international cooperation. The consultation consists of 45 experts from countries, CSOs and professionals of different disciplines, while the INCB, the EMCDDA, the EU Commission and Interpol are present, as well as subject matter experts from MS.

Following the discussion over the course of yesterday and this morning, it is clear that non-medical use of opioids is more complex than we previously estimated. There is a problem with fentanyl and analogues, in Africa tramadol, in Asia mainly codeine, in South America, heroin. We talk about a truly global problem. We identified new paradigms: dark net, express mail & couriers, falsified medicines. In terms of responses, all three international organisations (INCB, UNODC, WHO) have developed programs to support countries to aid methodologies. Synergy and cooperation among the 3 agencies and partner agencies is needed. Experts are finalising discussion on a comprehensive multifaceted solution, but we don’t want come up with anything that impedes medical access. Regarding supply, enhanced surveillance systems and improved reporting is needed as well as improved treatment and recovery services, cutting edge research. CND in resolution 61/8 requested UNODC and INCB with the WHO requested an intergovernmental expert group meeting and we are pleased to inform you that a report on the current meeting will be shared before December.

Egypt: I know our delegation is quite active in Geneva and my question is regarding the few points you mentioned, specifically: what is being discussed as ways to not impede access while ensuring the abuse is being prevented? Were there any prior discussions to enhance cooperation?

WHO: We’ve outlined the priorities in addressing the world drug problem. We are encouraging balanced policies that ensure availability while taking necessary actions against abuse and trafficking. This was the overarching concept, but we are focused on interventions related to demand and supply reduction. Although deliberations at this time are addressing non-medical use of opioids, an important part of this meeting will be outlining principles and best practices for reducing supply and demand while not impeding medical access. All this having in mind different roles and responsibilities of MS and international entities. For not impeding access for treatment, we look at a number of issues, like innovative national legislative controls. We also look at law enforcement interventions, providing countries with special skills. During multilateral discussions, we aim to find ways to implement international control measures.

Slovenia: Why have we been waiting so much time to respond to the opioid epidemic? What can the UNODC do to respond to the alarming statistics of the WHO? What can we do to avoid a cannabis epidemic?

WHO: Better use of medicines is key on the access agenda. We have been developing programs for norms and standards as per UNGASS in 2016 emphasised certain priorities. There are a number of normative documents and tools for addressing drug use disorders, including opioids, but as you said, time has come to intensify advocacy & strengthen capacity. Best practices come from health practitioners who work with patients on a daily basis, so we have to focus on improved communications with them and help them understand risks and benefits.

It is known that crises of these nature are not new to society, we came out of the 1980 crisis through education and thanks to a strong regulatory environment, but what we see in the new crisis is that there new paradigms, new elements. We are looking at an interplay among these. So we live in different times & new paradigms. Our integrated strategy to address opioid crisis is bring in experts, early warning systems and build counter-narcotic capacity, while we ensure access to medication, and have measures for prevention, treatment and rehabilitation for victims of these drugs. We are hoping that with this angle of international cooperation, future generations won’t have to worry about such epidemics.

Russia: We talk a lot about the opioid crisis and how we can respond from the public health and, since we have WHO on the line, what is the scientific work being done to cope with pain using different tools? We know there is new generation of pharmaceuticals that alleviate pain and not cause addiction, what is being done along these lines?

WHO: We are interested in research and development of new medication. One of the priorities that came up for experts was to engage in understanding pain, addiction and overdoses. It is an important stream of work and together with international agencies and health professionals, we will pay more attention to this. Having said that, I’d like to promote better advocacy and capacity building for already existing medicines on the market. We look at the future but also need to be in the resent and do the best with what we have (it takes 15 years to safely intro a new substance to the market). In the case of well communicated risks, health professionals can address pain and work safely. So, yes for continued efforts and encouraging investment in research but at the same time, we collectively have to work on what’s already existing, there are a number of effective medicines already available.

Uruguay: We are fully aware of the crises and I would like to touch on the comments by Slovenia, stating that we came into the problem a bit too late and referring to cannabis – my question is: is there a difference to be made in the WHO between hard drugs and soft drugs? Here in CND, we don’t make this differentiation, while c.a 20 years ago, it was prevalent in scientific community.

WHO: Our role is in different streams of work. We mean to protect health and whatever we do, including this present expert committee, we do in this pursuit. We don’t classify drugs by soft and hard, but we are following the guidance of the scheduling system so therefore we issue recommendations according to that. We are mandated by the conventions to use that system, so we don’t use other terminology other than what is found in the conventions.

USA: Thanks for bringing focus to PUD who are in need of services for HIV prevention. How can we insure health services are coordinated with drug services?

UNAIDS: The very nature of the question is fundamental to why a multi-sectoral strategy is needed to address the problem appropriately. Verticalized or parallel approaches is too common and won’t work. As has been said, it is the official stance of UNAIDS that we have to build health systems that put the client in the center. We need holistic, continuing care to ensure PUD have access to life saving services. Broad policy approaches require governments to reach beyond the usual borders and deal with things beyond their comfort zones. In practice too few countries take this approach.

Uruguay: The issue of harm reduction seems to be a taboo here at CND, we have been talking about it up until 2015 and this phrase simply could not be included in 2016 – why? many countries here in this room are of the view that handling people who use drugsthis way would promote drug use which is a contradiction. We haven’t resolved this and we won’t be able to do it until next March but it is good to get this out on the table once and for all. There is a strong trend, particularly in European countries, where there is a clear emphasis on harm reduction. Can you help us resolve this contradiction?

UNAIDS: If I could, I wouldn’t have this job. We coordinate many agencies, we are involved in many areas of work. Looking at the evidence of impact of harm reduction services: one thing we have NEVER seen is any evidence that a harm reduction program triggered an increase in the use of drugs. A rapid and positive improvement of the situation has been reported however. That’s why we are comfortable using the term. If there are any MS where there is evidence of the opposite, we would be interested in looking at that, but we have so far seen that harm reduction works. Evidence showed HR to be safe and effective.

Dr. Gerra, UNODC: I would like to support what my colleague just said. We also have to incentivise the use of these services.

Chair: …moving on.

(panel) EMCDDA: the European public health approach hasn’t come out from nowhere, all the capitals have dealt with overdose and other dire health issues, so our current approach, combining supply reduction and treatment is based on experience. Something we identified really quickly as a priority in 1989 is the need of monitoring, reliable data, scientific data to guide decisions. We lacked serious robust information that would have helped our decision makers orient. So the consensus we reached was the need to understand the situation and analyse the need, design intervention and evaluate … therefore EMCDDA has been established. The agreement on more interdisciplinary collaborative approach (not top bottom) is probably the strongest asset of the EU on drugs. These are not imposed but implemented together and evaluated regularly. The role of the European Commission is important to be coordinated. What developed in the last 25 years is a result of exchange of knowledge and best practice that takes place on a monthly basis. If you look at some of the press clippings, we only had strong statements. We don’t discuss ideology, we share experience and state questions, then according to a better knowledge coming from EMCDDA, member states can take action in a way that responds to actual issues locally. All MS have a national strategy & are evaluated – it is a long-term investment. We also emphasise a balanced approach: one of the cornerstones (highlighted by our commissioner) is that charter for fundamental rights that is applicable to everyone including PUD. These experiences led to decriminalisation of possession in Portugal and more importantly, convergence among MS as we found punitive strategies to be counterproductive. One size doesn’t fit all, but depending on the MS, the toolbox can be used according to political priories. Point is the long-term political consensus and commitment: build capacity for monitoring and analysis that is supported by the action plan(s). In the EU, the regular external evaluation of action plans aims to improve, not replace. This is a cooperation between 28 MS, so the system is binding but allows MS to act in full sovereignty, made possible by continuous investment. The priority is to seek to provide added value. In conclusion, thanks to the balanced approach and cooperation on policy making, there is a tremendous increase of availability of treatment in Europe; dramatic reduction of drug related deaths; decrease in the number of new HIV patients and hepatitis (this is via distribution of clean paraphernalia); progress in identifying minimum quality standards for social responses. In closing, I would like to mention the European new early warning system …the first legal tool, we monitor 650 NPS and do risk assessments continuously. We are proud to serve the EU and its member states for a more secure Europe.

Pakistan: I would like to briefly go back to the remarks on the practice of consumption rooms. I understand that on different occasions the INCB shared observations… can the panel share perspectives responding to that. What is the overarching goal with consumption rooms? How does that reduce the demand in the long run?

EMCDDA: I think indeed we do not consider that rooms are already a mainstream instrument… There are around 80 facilities operated, if we include Switzerland 90, some of them have been established for a long time so we have scientific evidence available.
First of all, the INCB president 2 years ago outlined the minimum conditions not to be in contradiction with the conventions. Without entering into a scientific presentation, I will just say that consumption rooms are one tool in the set of instruments that can be applied to reduce the harm and reduce death by overdose as well as reduce social nuisance.

Brazil: You mentioned the importance of syringe exchange programs and impact on infection reduction. Please elaborate on policies possible for non-injecting drug users.

Russia: We highly appreciate the work of the EMCDDA. We have a very constructive dialogue with the center, our delegation recently visited and we took away a lot to aid us in or practical ongoing work. We are interested in having this dialogue continued. What is the most important issue in regards to the spread of drugs that’s within your coverage and how do you see the future of the spread of drugs in Europe?

USA:  Can you be more specific on NPS data? How is that data shared?

EMCDDA: Brazil asked an important question and it is an important conclusion: the concept of harm reduction can’t be limited to needle exchange. In some countries, harm reduction addresses alcohol as well.
To respond to Russia, we also appreciate the dialogue that we started, what is the most important challenge for the future, it is the 5 million EUR question, we launched a forecast exercise we conclude in October 2019. What we can see right now is the combination of increasing availability of many substances, eg. cocaine. There is a reduction in NPS but at the same time, fentanyl family members are more prevalent and I’d say an other challenge is that poly drug use has become standard practice and there is also an increase in potency.
To the USA, we have 2 systems, We combine long term routine data collection with complementary methodologies to monitor emerging trends and we share it on or respective online outlets.  One is through the death registries of member states, we also register all events that have been recorded and shared among MS 24/7. We have protocols for sharing information that is confidential but what we shared with the WHO last year had tripled their data. So, we combine long term routine data collection with complementary methodologies to monitor emerging trends and we share it publicly on or respective online outlets.

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AFTERNOON SESSION

(panel) Tanzania:  Despite the limited resources, we are one of the countries with unwavering commitment. Drug use is a significant threat to the social and economic well-being of people, especially in big cities but the problem is spreading to smaller towns. We used to be a transiting country, but local problems are now emerging. The most consumed substances are cannabis, […], heroin, usually coming from the Far East and South America. Non-prescribed use of opioids: estimated that 30 thousand are affected as per 2015, prevalence of HIV is 20.51%, hepatitis C is 75%. Drug use is highly associated with resistance to treatment. So far Tanzania has achieved significant progress in the fight against drugs and a lot has been achieved in 2015 as a new drug control system was adapted by the parliament.  The Tanzanian drug control agency is a body overseeing demand reduction, control, and harm reduction, so everything is under one authority. In the pursuit to control and divert medicines with psychotropic effects, further amendments to the initial act have been made, so that individuals with a drug use disorder have alternative options to imprisonment. We collaborate with law enforcement and government agencies as well as CSOs. We have numerous efforts in implementing strategies, we run a forum for communities, academia, and police, so national policies are part of a comprehensive balanced approach. We have special programs for key groups with increased risks and run drug prevention programs in schools.  Harm reducing interventions, including provisional education, detoxification and drop-in centres are part of the project. We are the 1st country with medical assisted therapy with the use of methadone. We looked at the UN comprehensive model and by the end of 2018, we had a total of 7500 clients. We confirm our commitment to 2009 and 2014 in efforts to address the world drug problem. We work with communities, families and individuals with a view to promote security and well-being of humanity. Finally, in preparation for the HLMS, Tanzania recognises that successfully addressing and countering the problem, an integrated balanced approach is needed, including a close cooperation on all levels – education, health, justice, law enforcement sectors with respect to their competences and coherence within the UN system.

Chair: No questions from the floor

(panel) Singapore: Preventive drug education in Singapore. We always view drug addiction as a serious social problem. We are a small country without natural resources, so we depend on workforce for survival. We can’t afford our population to be contaminated by drugs. We believe in using primarily prevention, rehab and aftercare to reduce demand for drugs, prevention is our way of defence. We are the lead law enforcement agency but also coordinate efforts across the country.
Early childhood influences are important in the development in one’s character, so participating in the education system is mandated for 6-15 year olds. Schools are therefore important partners. We incorporate our messages in the school syllabus to empower students to be more conscious of choices and the consequences. We also offer complementary programs such as exhibitions, shows to raise awareness on the harms of drugs and we have in place an anti-drug ambassador activity. Nuancing of messages is also important, ‘say no’ has not proved to work. We had a behavioural study and concluded that messages should be customised to the age group – older ones are more into being engaged as opposed to the upfront ‘say no’ doctrine. We involve NGOs and other government, agencies to promote the messages, we meet with stakeholders annually to share data and discuss strategies. After-school activities engage 5000 students that go through the scheme an learn about the harm of drugs and they even earn a badge after completing elaborate workshops. We coordinate multi-agency effort to tackle juvenile issues and organize activities, sports, camps. We conduct a National Youth Perception Survey to measure effectiveness every 2 years, to understand attitudes and awareness of the harms. Last time we had 3000 respondents and we learned and adapted strategies – for example youth whose parents talk to them are more deterred, so we engage parents more now and produce parental handbooks. Social media is a good platform for outreach: bite size info, youth centric engaging videos to promote messages. We have community partners in developing community activities: bring on board organisations that are aligned with our cause and help promotion. We have a youth wing which involves young people and we hope to develop more ambassadors that can reach their peers. We visited the Icelandic research Centre to learn about effectively addressing youth where the director said, it is easiest and most expensive to do nothing… we believe in that sentiment as well. It is not an option for us to overlook preventive education. We call the international community to advance their efforts along these lines.

China: The preventive measures mentioned are really impressive, but I would like to know whether you have evidence to show the effectiveness of the policy and what data based recommendation would you have?

Singapore: With the survey we see if youth are aware, if they don’t use drugs and why. 80% of respondents have awareness of drug issues and they share that one of the reasons they abstain are the law consequences and penalty. This shows deterrence measures are successful in keeping youth away from drugs.

US: How are other sectors of society, especially local communities, engaged?

Singapore: The way we go about it is as inclusive as possible, school is a captive platform but as you mention, we try to engage other partners in the kids’ lives. We have parent groups and other NGOs that explicitly work with parents. We do community events, roadshows in community areas, involving key populations. We are always on the lookout for more ambassadors who we can train, and they can help us better share the msg.

Russia: We are captivated by the success. Singapore demonstrated enormous achievements. We believe these experiences should be studied closely. Is there is a division in the national policy into serious and minor drugs or are they a single scourge? There are 3 UN cornerstone conventions: how important are these in your anti-drug policies?

Singapore: We don’t make that differentiation, drugs are equally harmful. We believe and try to uphold the conventions always, we have a comprehensive strategy from enforcement to education in accordance with the conventions. Thanks for the compliments, we are always ready to share.

Pakistan: Drug abuse and educational settings is a challenge for several countries, as is an emerging thing for us. On the issue of trafficking, can you share good practices? Do you have special measures to address abuse prevention in educational settings?

Singapore: The trend of youth abuse is going up so engagement has to be more customised and calibrated – that helped us, we still have a problem but we are more tailored in the way we address it. As they grow older, we involve them in different ways. They might create content, videos so they are involved in the process. We are always ready to learn from others, that’s why we visited Iceland for example.

(panel) Russia: We use naltrexone to treat opioid addiction in Russia. People who inject drugs thus decrease frequency of use and enjoy a special attention. A lot of the patients have blood borne viruses so our aim is not only to treat opioid addiction but infections. Adding treatment is a good approach in reaching people with HIV for example. We conducted a lot of clinical trial since the 90’s that were published in international medical journals. At the moment, we have 3 naltrexone formulations that prevents euphoria via it’s effect on opioid receptors. There are three ways of administration: oral, injectable (1 month effect) and an implant (3 months) that requires a minor surgery. Some results of this recent trial demonstrate the efficacy of Naltrexone. Patients were observed for 6 months and randomised. More patients that used injections abstained from opioids use. We look into HIV behaviour and check associated behaviour with injecting as well as sex risk behaviour. Our treatment reduced drug risk behaviour. Another study we conducted with patients living with HIV and opioid addiction simultaneously – we wanted to see addiction treatment having an effect on HIV. One group used oral naltrexone for a year, the other used implants. The 2nd group showed more abstinence compared to the first. In the late 90s, patients were younger and were supervised, now they are older, so oral administration is not so affective because they don’t live with family to take care of them. In summary, these were the evidence-based indicators for the effectiveness of naltrexone.

Iran: I am not a doctor, but when I read the report on harm reduction, I saw many protocols exist. Are there any international standards for the treatment of these drugs or do all MS develop this individually?

Russia: Naltrexone is approved in the US same as methadone treatment.

Dr. Gerra, UNODC: The UNODC in 2016 issued guidelines for opioids treatment together with the WHO. Naltrexone is shown to be effective for a subpopulation, but for people with different situations, dramatic situations, this medication is not applicable.

United States: I saw that the slopes on the charts are very similar for placebo and naltrexone – so the difference ultimately in the patients who maintained abstinence is explained by what? Is there a difference in the rate of overdose among those who used naltrexone and the placebo group?

Russia: Our analysis shows significant difference between patience who stayed in care with injectable naltrexone and the placebo group. Fatal overdose results: no difference but it wasn’t the focus of the approach.

Norway Good numbers … Syringe exchange programs: do you have any research on that?

Russia: We had needle programs in place several years ago and didn’t see any positive influence on the HIV epidemic, so we don’t have such in place now. Our national expert will provide more details about that.

Chair: CSO nominated by the Civil Society Task Force.

(Panel) Olga Szubert, Harm Reduction International: Thank you, Mme. Chair, for the opportunity to make this statement on behalf of Harm Reduction International.

The 2016 UNGASS outcome document contains the strongest international endorsement of harm reduction in a drug policy document. Member states committed to “initiatives and measures aimed at minimising the adverse health and social consequences of drug use,” which includes considering the introduction of medication assisted therapy, injecting equipment programmes, antiretroviral treatment and naloxone for the prevention of overdose-related deaths.

While this language is a positive step, there remains a considerable gap between rhetoric and implementation of these lifesaving measures. One of the primary barriers to implementation is inadequate funding for harm reduction.

Harm Reduction International tracks funding for harm reduction in low- and middle-income countries and our latest research found that only US$188 million was allocated in 2016. This is just over one-tenth of the US$1.5 billion that UNAIDS estimates is required annually in LMICs by 2020 for an effective response to HIV among people who inject drugs.

The trend in harm reduction funding in LMICs is of serious concern. There has been no increase in funding since 2007. Moreover, harm reduction funding represented just 1% of the estimated US$19.1 billion spent by donors and governments on the HIV response in 2016 and available funds equate to just four cents per day per person injecting drugs in low and middle-income countries

International donors continue to be the most important sources of support – yet their funding for harm reduction has declined almost one-quarter over 10 years. Donor governments are withdrawing bilateral support that was once strong for harm reduction, and our research suggests that funding allocations from the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund)—the largest funder—were 18% lower in 2016 than in 2011.

In the face of donor withdrawal for harm reduction the responsibility is shifting to national governments. There are select bright spots where LMIC governments are working to protect people who use drugs through a scale-up in funding. Our research identified domestic investment of over US$1 million in 10 countries, including India, China, Vietnam, Georgia, Thailand and Myanmar. However, nearly all national governments, including those with higher rates of investment in harm reduction, continue to prioritise ineffective drug law enforcement, placing the health and rights of people who use drugs and their communities at risk.

In short – funding for harm reduction is in crisis. Even when funding is available, it is often not aligned with where there is a clear need. For example, upper middle-income countries have the largest share of people who inject drugs, but receive a fraction of harm reduction funding.

The consequences of donor retreat and the lack of domestic investment in harm reduction cannot be overstated. People who inject drugs are among the most vulnerable to contracting blood-borne viruses. New HIV infections among this population increased by one third from 2011-15, and HIV epidemics among people who inject drugs are commonplace in Asia and Eastern Europe. Harm reduction is integral to the world’s HIV response and cannot be ignored.

The benefits of harm reduction go far beyond the HIV response, too. As several countries play witness to overdose crises, we should be reminded of the importance of adequate naloxone provision and medication assisted therapy, both of which are highlighted in the 2016 outcome document yet remain scarce. And this says nothing of the range of other evidence-based health, social and economic interventions for people who use drugs, which many countries continue to ignore to the detriment of improving public health.

If the enormous shortfall for harm reduction funding in LMICs is not addressed, the commitments made at UNGASS will continue to ring hollow and several important global health targets will be missed.

The Commission on Narcotic Drugs (CND) recognises this dire situation and in resolution 60/8 urged member states and donors to continue to provide bilateral and other funding to addresses the growing HIV/AIDS epidemic among people who inject drugs.

HRI supports CND’s call for funding and recommends that:

  • International donors increase harm reduction funding in line with epidemiological need and do not withdraw or reduce funds without adequate transition plans in place.
  • National governments invest in their own harm reduction responses. They should track, and critically evaluate their drug policy spending and redirect resources from ineffective drug law enforcement to harm reduction.
  • International donors, including donor governments, invest in multilateral funding mechanisms such as the Global Fund and ensure that UNODC is sufficiently funded.
  • International donors ensure financial support for overdose prevention, including naloxone and opioid substitution therapy.

Thank you again Mme. Chair for the opportunity to speak.

China:  If harm reduction measures are so good and the approach so favourable, why is there so many people not providing funding? I saw that funding has fallen so drastically, so why do people withdraw money? Are these people foolish?

Olga Szubert, Harm Reduction International: Member states are changing the way they fund harm reduction. They don’t fund older governments’ initiatives and are relying on multilateral agencies to provide support. How money is being channelled is changing.

China:  Are these measures really so good? Are they universally accepted?

Olga Szubert, Harm Reduction International: I believe harm reduction is universally accepted. Harm reduction measures are mentioned in the 2016 outcome document and HIV/AIDS declarations. 90 MS have it in their national policy, so yes… majority of countries accept this.

China: I don’t think UNGASS adopted this word.

Olga Szubert, Harm Reduction International: It mentions harm reduction interventions.

Russia: We’d like to point out that as far as we know, funding of such practices are not reduced laterally but rely on international organizations. That’s why the 60th session adopted a resolution addressing these issues. Since we talk about the world drug report, we need to have a complex and balanced approach – we’d like to ask the UNODC how are donors funding combatting measures and how that compares to addiction measures that are central issues if we talk about demand reduction?

WHO(?): I don’t know if HRI agrees, but I think there is a perception that AIDS is defeated but that’s the point of view of people living in high income countries. An other issue that this morning the colleague from UNAIDS underlined that these measures should be a continuity of care and we need a segment for people who are not responding or don’t even go into treatment – they are not motivated to go to treatment, they live on the streets, etc. It’s a segment of care, a new perspective of funding should be an entire chain of interventions.

Russia: We are interested in what’s the correlation of funding HIV activities of UNODC with prevention. When we talk about comprehensive approaches, prevention and treatment are essential, if we talk about funding – what’s the correlation of different activities?

UNAIDS: There is a strong decrease in funding in the recent years.

Egypt: When it comes to harm reduction activities, we still see that this is a quite big term to use, it encompasses a different set of activities that range from providing a blanket to more drastic measures. It would be unfair to deal with all of them under one umbrella. Statistically, what exactly works? What consists as success?

Austria: We consider all the presentations valuable and important. We look forward to a productive discussion.

Norway: We are pleased CSOs are taking part in this session. Norway is in strong support for harm reduction politically and financially, I want to ask what would be your advice be to member states in prep for next CND?

Slovenia: We look at harm reduction incorrectly. There are much more activities, but to begin with, it’ll help to know many people won’t reach abstinence… many of them will stay on the street without any help and it’s the most expensive person for society, so we need to organize help for them. Have we talked about live-in centres? A place where they talk about the problem and get help to solve their problems or reach if they are lucky, abstinence. This will reduce not only HIV prevalence, but many other diseases are coming back, chronical diseases who need to be in hospitals, so harm reduction really is a budget issue.

Iran: I don’t want to talk about harm reduction because we use it in Iran and we had a lot of activities but it’s different from the views of persons who already work in harm reduction. We see it as some part of the huddle against supply and demand, so we do it under the three 3 conventions. We believe it is good for family and patients and society, but as a country that is a leading in getting people into treatment, we can say harm reduction never helped us. We have a balanced approach, but demand reduction is of priority. The China model is an example we can use. The results are good. We have a lot of treatment and this year nearly 1million people were treated under our policy although it is not a policy to have just treatment. We want to free society of drugs. We didn’t have scientific evidence that harm reduction helps reduce addiction, we didn’t find any result of that, but it helps reduce the harms for society.

Canada: I’ve been fascinated and encouraged by the fact that harm reduction is a theme for today. It’s a very important topic. Canada have embraced harm reduction as a pillar of our national drug strategy. We are late coming to this understanding, our government embraced this concept in the last few years, but not say it was not practised, local communities lead the way – we just made it a national policy now. I have to agree what Iran has said, in some way the terminology doesn’t really matter, it is a loaded term for some delegation, for us what matters is the measures and the impact they have. In Canada, our measures had noticeable impact they prevent death and transmission of diseases, drug related crime it gets drug users in the door of our health care system. Lot of PUD can’t or won’t access treatment, so lot of our harm reduction is aimed to serve as a gateway. One of the main insights we gained in 2016 is that terminology is not as important as the measures we take. Harm reduction means different things to different people and so it should. I guess I had more of a comment than a question, so thanks for the panel.

Olga Szubert, Harm Reduction International: Thanks for all the comments and questions, I’ll briefly answer Egypt first, I should have said from the beginning, our report looked at the 9 interventions of UNODC, UNAID and WHO guidelines – that’s how we define harm reduction for the purpose of this report and if you are looking at these measures you can see positive impact coming from these. So often today we heard from UN agencies that harm reduction works and is cost effective and has a hugely positive effect on public health, it has a potential for economic and social point of view.

Monica Bourke: I completely agree with Olga, yes it harm reduction comes in many forms, but we jointly reviewed accumulated evidence of the last 3 decades and came up with 9 interventions that have been proven over and over again to be effectively.

Chair: thanks for the panellists, it has been very insightful, we have some experts in the room who are ready to share their ideas and open an interactive debate.

(panel) Austria: I have a complex topic, but I will be quick. We need a policy frame for the philosophy of interventions, so here are some features of the conceptualizations – we follow the disease model and prefer treatment over punishment, but if treatment fails, there will be consequences… highly educated professionals lead these initiatives but use a low threshold for access. We integrate harm reduction services and outreach social work, we have regular quality control of treatment facilities and harm reduction providers. This is not by any means a normalization of drug abuse! It’s a disease that needs to be treated. Risk minimization in Austria: (1) party drugs – drug checking, on-spot and online counselling, info providing – part of the early warning system.  (2) actual drug users counselling, survival support, opioid substitution within the medical system – integrated model offered in prisons and hospitals, empowerment , group work , syringe exchange , safer use counselling (3) drug use related disease sufferers: medical intervention, new wave for hepatitis: several clinics all over the country cooperate with hospitals, observed treatments, available for people in opioid treatment (4) incarcerated individuals, prison population: counselling, new treatment for infections in cooperation with the Medical University. So, we integrate harm reduction with health care services, models and methods. Our data shows that in 2018 HIV attributed to injecting drug use dropped dramatically. All patients who participated in the program showed good compliance and are considered cured of the disease, even though they might still be using drugs. Use whatever label doesn’t matter, but harm reduction works.

(panel) Portugal: NGOs are critical partners and should remain to be leading up to 2019. We have a strong commitment to human rights and evidence based approaches. In preventing risks and reducing risks I have a presentation. Our experience shows, severe drug users 1986, 1998 we were invited by musicality of Lisbon to manage an outreach service, we believed that 60 thousand PUD lived there, 400 were in living in vacant lots and the population shared paraphernalia that caused the extreme rate of illnesses as people never sought treatment. So we started with a facility fixed in a problematic neighbourhood but we also had mobile outreach programmes. We have two units in Lisbon

Germany: Did you observe a drop in criminal activities?

Portugal: We have no data on that, only perception – based on conversation with our patients, it seems they feel less drawn to crime.

Dr. Gerra, UNODC: It is true that we don’t have data, but we see with methadone mobiles, studies show that mental health disorders and crime goes down in the area.

Russia: How many addicts come to your services? Maybe you can share some trends in terms of demand and categories of addicts? Do you mean distribution on the streets? Who deal with this what the clients? What is their background? What other NGOs do you work with that provide rehabilitation, etc.?

Portugal: Since the law changed, we can work with social services, judicial facilities and other organisations – everything works in a network. We have a psychiatrist director, social workers, and nurses. Prescriptions are based on psychiatrist’s recommendation and have strict guidelines and protocols. We work only with opioid users and they are very stable, we don’t have a huge fluctuation.

USA: Your work to remove barriers in accessing the health care system is something we should all be working for. The main goal of your treatment is safe use of drugs, as we know drugs have negative effects on the brain, so do you think you are amplifying or prolonging other harms?

Portugal: We try to educate the population and our aim is to work together with them and inform them. As we are a low threshold program, we accept people as they are at the time.

Dr. Gerra, UNODC: There are harms and consequences of drug use, but the to say we are exposing them to prolonged harm….

EU: We see where extra work is being put in, I want to thank HRI for their work, we work very closely with CSOs and they are a valuable participating stakeholder in our work. Without their assistance on the streets we wouldn’t be so effective, thanks for the statement ad their crucial continuous work.

Morocco: We have a policy that combating drug demand as a priority. We conducted methadone replacement therapy tests and here CSOs are really important as they get involved in a hands-on way with individuals. The source of funding for these NGOs in Portugal would be what? Is there policy to evaluate the activities?

Portugal: We are supported by the institute from the ministry of health 80% and 20% by the municipality of Lisbon and we report to them.

Slovakia: We’ve been watching your work in the last decade, so I have a particular question, what’s your experience with buprenorphine, so far we only mention methadone.

Portugal: Buprenorphine is not used in low threshold programs in Portugal, only in high threshold treatment centres.

(panel) Russia: In addiction treatment, if there is clinical evidence for being useful, we include it in our treatment centres. Along with pharmacological preparations, there is support work in place – social support, psychologists, groups, non-commercial organisations. In serious cases, treatment starts in-patient care. That is the 1st phase, if there is any psychological stimulus that results in serious personality disorders, when it’s a destruction to the integration to society, one is put through testing for illnesses. Without any discriminations, any addict is able to take part, the in-patient phase can be 3 years, then they can turn to a psychiatrist Special organisation w addiction specialised doctors that are helped by NGOs. All of this is available for free, paid by national budget. Special attention paid on special needs communities: teens children, women, migrants, homeless, people in detention. Since 2012 the legislation underwent amendments that allowed addicts that committed minor offences to have their punishment converged to treatment and if they are treated successfully, they might be released. if they commit serios crimes, they go to detention centres where they are medically treated. the objective of this system is to rehabilitate these people and there has been a drop-in demand recently because our preventive approaches. we have a v complex and balanced approach in alliance with 2009 and we also have work going on in special needs communities. I point out that provisions of 2009 have been taken into account in our national drug strategy. It was adopted by presidential decree in 2010 for 10 years, we are starting to have preliminary conclusions and we see indicators for success, drop in the number of people who use drugs, intravenous users and addicts. in the case of opioids, we
I’d like to announce that we will be sharing our experience on drug reduction and we will be active in the thematic sessions in March.

Iran: I had a report from my country, but it is too long at this point to go through. I just have one suggestion, for the information of my colleagues, in Iran there are more than 7 thousand clinics and many centres providing treatment services and thousand are under care. I was waiting to hear about the special needs of special communities like pregnant women and children and there was not much on that. I didn’t hear about prisoners or the people who relapse, while most of the mortality is about these people. Most importantly, why are we telling our experiences, to do what? It seems everybody is doing their best and there is no problem. We should scrutinise activities of each other. We should forget about politics to actually achieve something. I was negotiating here in 2009 and the drugs in my neighbourhood multiplied since…because we didn’t help each other, we insist on national interests, this way we achieve nothing. I’ve been sitting here for 5 hours, I hope we will reach some result and colleagues are willing to cooperate. Each session should have tangible outcomes. I have problem, my country has a problem. We need help and we are ready to help.

Chair: As you will recall the working plan, our exact goal is to see how we can move forward together and tackle the world drug problem. It is affecting all of our countries, that is why we are here.

Russia: Russia would be pleased to demonstrate you the prospect in treating people with drug dependency disorders.

(panel) Dr. Monica Beg,  Chief, HIV/AIDS Section and Global Coordinator for HIV/AIDS, UNODC: As you know, since 2005 UNODC is a cosponsor of UNAIDS and we’ve been assigned to be the lead agency on the issue. We promote public health focused, human rights-based approaches. We have been also contributing directly to the realisation of SDGs. In 2016,we welcomed the reiteration of the goal to end the AIDS epidemic and ensuring access to treatment and care programmes. Some important figures: 11 million injecting drug users, 50% living with HIV, 1million with HIV and HCV. PUD are 22times more likely to get infections that the general population. According to the latest UNAIDS report, 47% of new HIV patients are key population, including injecting drug users – they account for 1/3 of infected people. UNODC, WHO, UNAIDS have a harm reduction package with 3 concrete interventions plus some more to care for these people. In spite of the effective tools we have we still see low availability of the most effective programs. 93 countries have needle syringes and substitution therapy is only available in 86 territories. We were also talking about prisons, so let’s take a look at that: globally 10 million people live behind bars, 50% of them are using drugs with a prevalence of tuberculosis, hiv and hepatitis. 3.8% of prisoners live with HIV suggests that they are 5times more likely to live with HIV and there is a high prevalence of hepatitis. Services are very limited or even not existing in prisons, definitely not universally accessible. UNODC has developed normative tools and guidelines and we’ve been promoting human rights and voiced our stance against stigma. We’ve been strengthening cooperation with civil society and support governments with effective legislation – in 2017, we scaled up opioid substitution in Kenya, in prisons in Vietnam as examples, but we also tried gender responsive programs. We produced an e-learning module to train supportive law enforcement officers and trained thousand. In conclusion, I remind the room that we missed the 2015 HIV target and if we keep going like this, we will most likely miss the SDGs. To avoid that, we have recommendation: harmonization, consideration for alternatives to incarceration, focusing on priority population, engaging communities of PUD, invest in the recommended interventions and scale up.

US: We’re aware and appreciative of the 2009 technical guide and we support it, specifically regarding people who inject drugs. Keeping in mind todays theme, I’m interested in hearing more practical lessons and propose to open a discussion on that.

Secretary: We don’t have sufficient time so here is the proposed course of action. Tomorrow morning, we expect the meeting will take less time, so as soon as we are done with that, we return to the topic of demand reduction.

Pakistan: I’d like to note that the presentations used an incorrect map, it is not the map used by the UN so please correct that before circulating it electronically.

Chair: noted.

Zaved Mahmood, on behalf of the OHCHR:  The Office of the High Commissioner for human rights thanks the Commission on Narcotic Drugs for inviting the Office to participate at today’s intersessional meeting on demand reduction and related measures. First, I draw your attention to the most recent report of the High Commissioner for Human Rights on the Implementation of the joint commitment to effectively addressing and countering the world drug problem with regard to human rights (A/HRC/39/39). The Office submitted this report to the current session of the Human Rights Council in Geneva, pursuant to the Council’s resolution 37/42, adopted in March 2018. Among other topics, the report addresses human rights aspects of both the prevention of drug abuse and treatment for drug use disorder.

Prevention of ‘drug abuse’ On several occasions, UN human rights mechanisms, including human rights treaty bodies and special procedure mandate holders of the Human Rights Council, have recommended that prevention measures, in addressing the drug problem, should be pursued through evidence-based interventions as well as accurate and objective educational programmes and information campaigns. The primary message of prevention has been one of complete abstinence from drug use. Research shows that there is not only little evidence of the effectiveness of such a message, it may in fact be counterproductive. Our office support the recommendation of the Global Commission on Drug Policy that if there are to be public awareness campaigns on youth and drug use, a possible way forward would be to give honest information, encouraging moderation in youthful experimentation and prioritising safety through knowledge. Furthermore, in line with the spirit of  resolution 61/11 of this Commission on Promoting non-stigmatising attitudes to ensure the availability, access and delivery of health, care and social services for drug users,  any prevention measures that include educational programmes should promote non-stigmatising attitudes and reduce any possible discrimination, exclusion or prejudice which people who use drugs may encounter. Mandatory drug testing in educational setting is used as a preventive measure in several countries.  The mandatory testing of children for drug use raises human rights concerns. Taking a child’s bodily fluids without their consent may violate the right to bodily integrity and constitute arbitrary interference with their privacy and dignity. Furthermore, such measure may amount to violation of the principle of the best interests of the child.  Depending on how such testing occurs, it could also constitute degrading treatment.

Treatment for ‘drug use disorders’ In accordance with  the international human rights law, all services, goods and facilities for treatment must be available, accessible, acceptable and of good quality. They must be accessible physically as well as financially and be based on the principle of non-discrimination. On several occasions, the UN human rights treaty bodies have addressed issues related to the treatment of people who use drugs. They consistently recommended States to incorporate public health, harm reduction and gender sensitive approach into national drug strategies; and ensure availability of treatment services that are evidence-based and respectful of the rights of people who use drugs. A major obstacle to accessibility of treatment is the criminalisation of personal use and possession of drugs.

Criminal sanctions are ineffective and counter-productive and do not address drug use consequences. Evidence shows that decriminalisation of drug use and possession, along with the provision of a variety of support, prevention and treatment measures, resulted in a decrease in overall drug use and drug-induced mortality rate. In June 2017, twelve UN agencies, including WHO, UNODC and our Office- OHCHR, issued a joint statement recommending reviewing and repealing punitive laws, including that criminalize or otherwise prohibit drug use or possession of drugs for personal use. In the recent report, the High Commissioner further recommended that people who use drugs should be treated with dignity and humanity in treatment centres. States should also undertake rigorous and independent monitoring of treatment centres to ensure treatment takes place on a voluntary basis with informed consent and individuals are not confined against their will.  The High Commissioner further recommended that any allegation of torture or other ill treatment in treatment centres should be investigated. Centres that do not meet human rights standards should be closed.

Excellencies, The cross-cutting approach of the outcome document of UNGASS 2016 constitutes a new and better linkage of the objective of drug control – protection of the health and welfare of humanity- with the key priorities of the United Nations system, including human rights and the Sustainable Development Goals. Our Office- OHCHR- encourages the continuation of this structure for future UN drug policy debates. Our Office will continue to work with States and other partners to consolidate and expand human rights based approach to the drug control efforts, including those related to prevention and treatment so that we leave no one behind, leave no one out.

Egypt: As valuable as this contribution is, it is distant from the topic of our meeting today. You have said evidence tells us that decriminalization, combined with prevention methods, is the most effective way to respond to the drug issue – it would be helpful to know what this evidence is where it comes from?

OHCHR: In my presentation I referred to the report of the High Commissioner, who detailed the evidence in that report in length. For your information, I will give you the reference number of that report: A/HRC/39/39

Civil Society Speaker: Boi-Jeneh Jalloh from Foundation for Rural and Urban Transformation: Demand reduction and related measures (Prevention of drug abuse) Children are agents of change, and not only as targets for drug control. 1. The Problem/Challenge The Outcome Document of the 30th United Nations General Assembly Special Session (UNGASS) on the World Drug Problem (2016) spells out operational recommendations on demand reduction and related measures, including prevention and treatment, as well as other health-related issues. Implementing recommendations for the prevention of drug abuse, particularly those that place children and young people at the heart of addressing the drug problem are critical to achieving lasting results and protecting the future. Experiences from this project will contribute to building effective mechanisms that give greater voice to children as change agents of change. The Sierra Leone National Drug Policy (2008) spells out measures to deal with drug abuse and drug trafficking. Illicit drugs are easily available. They are sold and Leone is known as one of the transit points for the trans-Atlantic illicit drug trade. Common drugs used in Sierra Leone are marijuana, tramadol and to some extent cocaine. Some of their sale points are easily identifiable in neighbourhoods. While police continue to crack down on illicit drug sale, local drug control is generally unimpressive. Children and young people are vulnerable to alcohol and substance abuse. Alcohol prevention also benefits drug prevention and vice versa. An integrated approach to dealing with harm from drugs and alcohol therefore helps deal with both problems. The project therefore focuses on both drugs and alcohol. Sierra Leone does not have a national alcohol policy that restricts the sale of alcohol to children. The archaic Liquor Act of 1920 does not respond to current development and human rights challenges of alcohol availability and consumption in the country. There is a proliferation of cheap alcoholic drinks that are available almost everywhere in the country including school environment. The sale of alcoholic drinks is unrestricted with weak consumer protection strategy. The Child Rights Act (2007) gives children the right to express their views and have a say in the decisions that affect their lives and communities. Child participation is still quite low irrespective of the legal and policy frameworks that guarantee the voice of children in matters that affect them. Keeping the school environment alcohol and drug free should not only target school children as beneficiaries, but also as instruments to prevent and mitigate substance abuse. The Response FoRUT, with support from FORUT Norway, has implemented a four-year project on alcohol and drug prevention that targets children and at the same time, puts them at the centre of drug prevention and mitigation.

Project Objective: The project objective is to prevent and mitigate alcohol and drug abuse among school children. b. Target: The intervention directly targets over 38,000 children and young people who attend 54 schools supported by FoRUT in the five year project period. Many more children and young people in other schools, and out of school in targeted communities are reached. In addition, the project indirectly also reaches parents and family members of school children, and other members of the school communities. c. Strategy: The project implements a child-led advocacy approach that equips and supports 1,578 Children and 54 Young People’s Clubs (CYP) in FoRUT supported schools to lead prevention and mitigation actions that reduce alcohol and drug use among children and young people.

Support to Children and Young People: FoRUT undertakes the following activities as strategic actions that enable the CYP clubs to take the lead in preventing alcohol and drug abuse in their school environment: a. Capacity Building: FoRUT facilitates trains CYP club members to understand the dangers of harm form alcohol, and equips them with skills for advocacy, leadership and group management. It also support the orientation of new CYP Club members who join the club every year.Trainings are also conducted for teachers who serve as Focal Persons /Counsellors of the CYP Clubs, the school authorities, and the police so that each of these groups of leaders are able to confront alcohol and drug related issues at their respective levels for an alcohol and drug free environment in schools. b. Material and Financial Support to CYP Club Activities: FoRUT provides technical and material and financial support to CYP clubs to enable them develop their annual activity plans, organize awareness raising activities, and participate in national and international celebrations, such as International Day Against Drug Abuse and Illicit Trafficking and the Day of the African Child. FoRUT provides assorted indoor and outdoor recreational materials and support mini projects for competitions among schools. FoRUT also constructs multipurpose centres (MPCs) in some of the schools, which are used as safe spaces for hosting guidance and counselling sessions, peer group education sessions, indoor games, CYP club meetings and other child-led activities in the target schools. A total of 12 MPCs have been constructed in 12 schools in the Western Area. Recreational and sport materials are also provided to the targeted schools to keep the children from harm’s way regarding alcohol and drugs. FoRUT also liaises with the Focal Persons /Counsellors for quality supervision of the clubs under their guidance, and with the school authorities for implementation of Teachers Code of Conduct and implementation of the child rights principles. FoRUT also conducts periodic supportive supervision to the leadership of CYPs and Focal Persons to enhance their performance and sustain CYP club activities.

Child-Led Advocacy Campaign: CYP clubs have reached over 38,000 of their peers with messages on the dangers of alcohol and drug abuse. They have carried out awareness raising sessions in their respective schools through peer education, drama and quiz competitions in schools and outreach to other schools and communities. CYP clubs have used recreation and sports to educate their peers about the harmful use of alcohol and drugs. Awareness raising among CYPs club members and focal persons in schools on alcohol and drugs prevention for children has increased through peers education, skits and drama etc. They seek financial support for inter schools quiz and debate competitions among CYP club members and other out of school activities like friendly football matches. They use these events to share messages on the dangers of alcohol and drug abuse. The clubs also undertook sensitisation in the school environment to discourage alcohol and drugs related businesses from operating around their schools. Some of the CYP clubs have engaged pupils in other schools around them and their parents to discourage them from taking alcohol and drugs. Over the life of project, Focal Persons /Counsellors have held over 650 sessions of counselling and discussions sessions on harm from alcohol and drugs were offered to CYPs members vulnerable to alcohol and drug use in their schools. More discussion than counselling sessions have been held for CYPs because of their low involvement in drug abuse.

Results The child-led campaign has resulted in the reporting of minimal number of alcohol and drug related cases in target schools every year. Some schools, particularly those in the rural areas, hardly report drug related cases because of little or no exposure to drugs in their environment. CYPs monitor and report on alcohol and drug cases in and around their schools. The counselling and discussions facilitated by Focal Persons/ Guidance Counsellors and peer education by CYP Club members has also helped children and young people to stay away from drugs and alcohol. Children and young people are growing into dynamic child rights advocates for alcohol and drug control policies and implementation of child rights policies in schools and communities. They analyse the actions or inactions of leaders in their schools and communities and have conducted radio talk shows to voice their concerns for protection of their rights. Schools rules stipulate that children who are on alcohol and drugs risk expulsion. CYP clubs recognize that the situation of children who are expelled from school because of drugs get worse. They have therefore advocate for policy reform in their schools that demands that school children on drugs are rehabilitated, instead of expelled. This also encourages Focal Persons /Counsellors to support children that are on alcohol and drugs to withdraw from abuse, instead of reporting them to the school authorities. They also lobby and advocate for increased commitment and action from the Sierra Leone Police to ensure that unlicensed sales points for both alcohol and drugs are closed. Project activities have also increased police commitment to fighting illicit drug trade and substance abuse, and violence among youth in schools and communities. Police have arrested a number of petty traders who continue to sell alcohol and drugs around school environments which to a large extent has contributed to alcohol and drug free environment around targeted schools. There is reduction in incidents and reported cases of violence among young people in schools and communities especially during sport meets and other social events. CYP sensitization on nonviolent, and drug and alcohol free sports activities, complemented by joint monitoring of sports activities with the police are actions that are placing restrictions on alcohol and drug use and their consequences in events.

Egypt: While we value the presentations of today, my delegation is worried, that according to the work plan we adopted, there are plenty of points that were not properly discussed today. We encourage the regional groups to make sure that in our discussions in the coming meetings, we cover the topic we set out.

Meeting adjourned for the first day – continued on 25 September.

Belgium: We align ourselves with the statement delivered by the distinguished delegate from Austria on behalf of the EU and its MS, and we take this opportunity to highlight three practices regarding demand reduction policies in Belgium. Since many years, the implementation of drug policies based on evidence and best practices is an important guiding principle in our country. An earmarked programme for policy-oriented research on drug related issues was put in place in 2002. Since then several projects are financed every year and are followed by guidance committees in which public authorities as well as members of civil society and the scientific community take part. This way of working is helping us closing the gap between policy and practice on one side and research on the other. Secondly, in the area of prevention activities the key message Belgium focuses on are health promotion and determinants that have a positive influence on health. This positive approach has shown its efficiency, given its non stigmatizing character.

Thirdly, we started to promote more actively the implementation of demand reduction policies and measures in prison settings. Indeed an analysis in Belgian prisons has shown that despite countermeasures a significant amount of people in prisons still use drugs. Although a small and often local treatment offer is available in several prisons, these services do not always cover the main needs such as thorough screening on drug use, medical or psychosocial expertise, meaningful use of time, and so on. We believe a more coordinated and strengthened approach is needed in order to support the development of services with regards to screening, early intervention, treatment, aftercare, social integration, recovery, and so on. Last year, therefore, Belgium launched a pilot in three prisons and the final goal of the project is to offer a more tailor-made demand reduction model for PWUD in prison. The project will also be evaluated by an independent research team and the results are expected by June 2020 and we are willing to share these results with all interested partners.

Canada: This statement was originally meant for Monday. I am not complaining, -it is just that the discussions we were having are excellent and I really do not mind that the schedule has slipped over a bit. It has been well-worth the time we have put into it. So, I wish to update the Commission on how Canada has domestically implemented demand reduction and related measures from the 2016 UNGASS document and the 2009 Political Declaration and Plan of Action. As many have seen or are aware, Canada is currently experiencing a public health emergency stemming from the proliferation of highly potent synthetic opioids that have dramatically increased the numbers of opioid related overdoses and deaths.

The government of Canada has responded with a comprehensive, collaborative, compassionate and evidence-based approach to address the opioid crisis, guided by the Canadian drugs and substances strategy. First and foremost, our priority has been to save lives by reducing the harms of problematic drug use. We have expanded the number of supervised consumption sites across the country to keep people alive and facilitate their entry into drug treatment services. This is because Canadian and international evidence shows clearly these measures help to save lives and to improve health. We have also focused on expanding access to voluntary treatment programmes through the provision of a new emergency treatment fund. This one-time emergency fund of 150 million dollars is directed to Canadian provinces and territories to help people who suffer from problematic substance use to have access to evidence-based treatment services. In addition our government is working to provide better access for first nations and Inuit communities to access treatment through new funding, including for culturally-specific treatment programmes.

Mme Chair, part of our efforts to increase access to treatment also include efforts to reduce barriers to access to treatment. The 2009 Plan of Action speaks to the need to reduce discrimination associated with substance use and promote the concept of problematic substance use as a complex, multifactorial health disorder. Similarly, the 2016 UNGASS document speaks to the need to encourage voluntary participation in drug treatment programmes and to prevent social marginalisation, and to promote non-stigmatising attitudes to PWUD. Canada’s experience has shown that for people that have suffered from problematic substance use stigma and discriminatory attitudes can act as a barrier in their seeking or accessing healthcare or other social services. Reducing stigma is therefore key to effectively addressing problematic substance use and is a critical step in recognising the fundamental rights and dignity of all people including PWUD. It is for this reason that Canada was pleased to champion a resolution on stigma last year on CND and we will continue to prioritise on addressing stigma both domestically and internationally.

Finally, we know that to effectively address this crisis we also need to focus on prevention. The government of Canada is therefore implementing a number of awareness and prevention activities to reduce demand for opioids. Are efforts include aggressive restriction on opioid marketing activities, new opioids prescribing guidelines and awareness campaigns to inform canadians -especially youth- about the risk of opioids use. These are just some of the activities Canada is implementing to reduce the demand for illicit drugs and increase treatment options for those who suffer from problematic substance use disorder.

Italy: We align ourselves with the statement of the EU and we wish to add a few comments in our national capacity. In Italy treatment, rehabilitation, recovery and social reintegration for people with a drug use disorder are based on multivisionary public health oriented scientific-based approach. The cornerstone of the system is represented by the public services for addictions the so called SERD which is a part of our national healthcare system and they are spread throughout the entire national territory. There are 581 centres, which is equal to an average of one centre for every 100.000 citizens. They operate in collaboration and synergy with the therapeutic communities, schools and volunteering programmes. The services include observation and diagnosis, prevention, treatment of addiction, the inclusion in residential accreditation and instruction for rehabilitation, risk and harm reduction interventions, activities in prison settings, integration into school and employment system, social assistance and legal protection. In particular, the public services for addictions rely on teams composed by doctors, psychologists, social workers, educators and nurses that are well-trained and they assure medical visits, detoxification, treatment, psychological and psychiatric support, as well as social and educational assistance. Particular attention is paid to prevention and treatment for infection disease, chronic disease and psychiatric pathologies related to the abuse of psychotropic substances.

Treatment carried out in prison settings by the public services for addictions deserve a special focus. Activities are based on multivisionary approach and aim at strengthening the relationship between prison settings and local communities so as to facilitate the reintegration of inmates who abuse drugs and prevent the reitration of antisocial behaviours: sharing information about drug addiction targeting both inmates and rehabilitation stuff, increasing educational activities in cooperation with universities, institutions and private associations, spreading and applying about good practice in relation to prevention and care of diseases related to drug addiction, gathering data concerning the phenomenon of drug addiction. Monitoring the quality and the performance of the services offered by the public services for addiction is extremely important. To conclude, I wish to stress that in implementing harm reduction and related measures Italy attaches great importance to the relevant 2016 UNGASS recommendations. Such measures are carried out in line with the objectives of the 3 international drug Conventions to which we are committed.

Argentina: With regards to the subject we covered on the first day I have a very long list of activities that my country has implemented in a comprehensive and balanced way with regards to balancing supply and demand reduction. I wish not to monopolise the floor so I will only reference a few new ones: activities in different municipalities, to prevent drug abuse in school and in the workplace using arts and sports, to treat drug related pathologies and significantly reducing demand.

Algeria: Within our national strategy which is comprehensive and balanced, we attach more importance to reducing demand for psychotropic substances -this is a growing threat to mental and physical health- especially in young people. We have adopted preventive measures through the national office to combat drug addiction and we have introduced many forms of treatment. With regards to awareness campaigns -as part of our prevention strategy- we have worked with the ministry of Justice, ministry of Health and the Interior as well as other institutions. I would also like to recall the important role of the civil society. We have used awareness campaigns in schools. A survey regarding drug use among universities in under way. Young people are often targeted but awareness campaigns have to target the rest of the population too. We use law enforcement agencies, who are also focused on prevention just as much as the health and education sector, and they work with schools and universities. We are very focused on the enrichment of young people and we wanna keep them away from drugs.

Care for drug addicts is essential. We have a law from 2004 covering from illicit drug trafficking to treatment. We have a large network of centres and we have detoxification and treatment centres. We want to make sure that physicians have the necessary tools and we have a higher diploma in drug addiction which can be studied at three of our universities. Allow me to repeat our commitment to fulfill our obligation to the international Conventions, the Political Declaration and the UNGASS document to eliminate or reduce the demand for illicit drugs and psychoactive substances and the associated health risks.

Australia: Demand reduction is key to adjusting the world drug problem as agreed on 2009 and reaffirmed through 2016 UNGASS. Effective measures to minimise the harmful health and social consequences of drug abuse is a vital element in reducing demand for illicit drugs and substances. AU continues to focus on promoting an integrated and balanced health and law enforcement approach in our response to illicit drugs; an approach clearly reflected in AU’s 10 year national strategy, which was finalised in 2017 and committed to by governments at a national state and territory levels.

The first pillar of the strategy is dedicated to demand reduction where our priority is to prevent uptake and delay first use, to reduce harmful use and support people to recover through evidence-informed treatment. In Australia’s experience, demand reduction requires a comprehensive approach involving a mixture of regulations, government initiatives, community services and treatment services. By reducing demand for illicit drugs and substances we aim to protect public health and minimise harmful health and social consequences of drug abuse. We seek to address the health and the social consequences of drug use through a range of comprehensive and pragmatic measures and strategies that affect demand by providing access to information and education, early intervention, psychosocial therapies and care services for individuals and communities at risk. Treatments include relapse prevention, rehabilitation and social integration, and comprehensive harm reduction interventions. AU’s demand reduction approach is inclusive. We believe that resilient families and communities, and effective engagement with young people and broader with the civil society contribute to reducing the demand for illicit drugs. Our approach brings together communities, civil society, and a broad range of government agencies on health, education, law enforcement and social services to have a role in treating drug problems. Children, youth and other vulnerable groups are the focus of the Australian government prevention activities.

Australia’s harm reduction initiatives incorporate and are driven by evidence-based best practice, including HIV/AIDS prevention, opioid overdose treatment, opioid replacement therapies, diversion of non-violent drug offenders to treatment services, and safer injecting practices. The benefits of harm reduction extend beyond the individual to family, workplaces and the wider community. A strong evidence-based approach is necessary for the implementation of the comprehensive demand reduction strategies. Australia supports strengthening the evidence-based for reliable and comparable data on drug use, and epidemiology at the international level. At national and subnational level, Australia has a comprehensive array of specialist illicit drugs policies and clinical guidelines that are consistent with UNODC and WHO treatment standards. Australia supports regional and international cooperation on the development of treatment related resources and sharing the information on existing resources. We offer non-discriminatory access to all treatment interventions while providing targeted services and increase access opportunities to those populations that are at risk or vulnerable. We look forward to working with MS throughout the intersessional period to share best practices and experience as we work towards the 2019 Ministerial meeting.

Morocco: Drug policy in Morocco is priority. We have an awareness campaigns, a media campaigns and preventions campaigns, usually targeting young people. We provide treatment and care for drug abusers and addicts including social reintegration. We have a lot of experience in this field. Notably, using methadone as substitute. We have very well targeted campaigns in schools. We have joined police brigates to combat drug traffickers. We work with different stakeholders and we try to make sure our awareness campaigns reach out to the most vulnerable sectors of the society. The role of families and parents is also extremely important. We now make sure that more children are in school, -we have fewer child-workers and we have a lot of investments in local sports facilities. We attach a great deal of importance to the role of civil society in that field and we monitor and access those programmes to introduce any necessary improvements.

In regards to decriminalisation, that still contradicts the UN Conventions. It may be OK for some countries for risk reduction but it penalises what other countries are doing to reduce supply and we are hoping that CND can help us reach consensus in the future within the whole UN system and the global and comprehensive approach. Regarding this morning’s talk, in Morocco the extent of criminal law explained in terms of human rights and new forms of criminality as defined by international legal instruments. In Morocco people who are detained are ensured of them being informed of the reason for their arrest and their offences and of course of their right to a lawyer and to family visits. Another measure is also the removal of documents at the borders, measure for social reintegration and treatment in specialised clinics, and we have specific attention to minors. We hope to strengthen the legal protection of individual rights, -this draft bill plans to reduce prison sentences and also the use of alternative penalties. We have made significant progress in strengthening the independence of the judiciary and with regards to prisons we now are taking into account social reintegration and training programmes.

Chair: We will now hear the last thematic presentation for this afternoon.

UNODC Prevention, Treatment and Rehabilitation Unit, Giovanna Campello: In our work we try to summarise the science and putting it at your disposal. Where we can we pilot evidence-based initiatives, in particularly in low and middle income countries to really show that it is possible, it’s feasible and it’s effective. On prevention and in regards to the standards we published together with WHO, we have moved from a simplistic understanding of prevention that basically focuses only on increasing perception of risk factors. We know there are a lot of vulnerability factors that influence the development of children and expose them to risks, -starting drugs and developing disorders. The issue of these vulnerabilities is that are out of the individual’s control, they are active since an early age and they are found in many settings. In marginalised communities we provide education to strengthen the cognitive and emotional being and we support the families.

In regards to prioritising among prevention interventions, I would start with services for pregnant women especially with drug use disorders, support families and parents at all ages, promote schooling and when in school provide the children with personal and social skills, and education. Within the context of health oriented drug control system, access to treatment should be ensured but also strong tobacco and alcohol regulations should be imposed and also mental health services should be provided , including of course the treating of drug use disorders. Through parenting skills intervention we are being able to protect these children and make them feel better. We also know that family skills is effective against youth violence and child maltreatment and support the development. We know that these programmes benefit girls and boys more consistently than school and community based prevention. Our new family programmes are light and tailored to low-resource settings and they are available in the public domain.

In regards to school prevention, and with our programmes “Unplugged” and “Lion’s quest” in collaboration with UNODC “line up/live up” we work in the development of personal and social skills in sport settings.

In regards to treatment, our main question is about quality. We work our best to end the human right violations that often go under the name of drug dependence treatment. That is the reason we have developed the standards. We promote the variety in treatment options that are evidence-based and available in different settings. Any treatment option is much less costly than anything else: incarceration, probation or no action. The least invasive of the interventions is the most effective for the majority of the patients: the outpatient treatment. Also, we wish to build systems where there is no wrong door, no punishment of relapse -relapse should not be seen as a failure or treatment or the individual but as something that can happen but needs to be managed and people need to be supported on their road to recovery.

My last plea would be on the development of pharmacological treatments for stimulants. As it has been mentioned already there are only few if any options in this field. We have ideas. If you are interested, if you know any research institute you should let us partner, let us launch a serious trial to fill this incredible gap.

CHAIR: Distinguished delegates with this last presentation we have come to the end of our first round of our thematic segments. A big thank to all of you.

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