Drug use in public health perspective: WHO’s contribution to UNGASS 2016 commitments

Organized by World Health Organization

Devora Kastel, Director Dept of Mental Health and Substance Use at WHO:

WHO Mission and Goals – promote health, keep the world safe and to serve the vulnerable. Triple billion goal – – must reach 3 billion more people in the next 5 years to meet SDG targets – want to emphasise a comment from our Director-General “health is a human right. No one should get sick and die just because they are poor, or because they cannot access the service they need” – Dr Tedros

Public health dimensions of the world drug problem: prevention of drug use and reduction of vulnerability and risks, treatment and care of people with drug use disorders, harm reduction, access to controlled medicines, monitoring surveillance and evaluation

Many WHO programs working on drug-related issues and WHO core functions:

  1. Mental Health and Substance Use
  2. Division on Access to Medicines
  3. HIV, hepatitis and STI programmes – working on harm reduction as a critical component

Figures: new WHO estimates – nearly half million deaths attributable to drug use – 64% to opioid use, others from drug use disorders, BBVs, accidents, suicides

7 million deaths attributable to tobacco, 3 million to alcohol, 42 million DALYs lost

WHO collaboration with UNODC on demand reduction – celebrated 10th anniversary of collaboration last year – collaborated on many reports

Prof Paul Dietze, Burnet Institute

The Stop Overdose Safely (SOS) Initiative

Thanks WHO and UNODC for this opportunity. Incredibly exciting time and project to be working on- long process that stems from 2009. Seminal moment – CND resolution on importance of responding to opioid overdose 55/7

Lead to further incorporation of opioid overdose and naloxone in UNGASS session, documents and resolutions. 2014 WHO guidelines on community management of opioid overdose – naloxone being made more available – outside of traditional medical facilities – in particular by peers

90-90-90 targets – cascade of care idea – 90% trained, 90% supplied and 90% carrying naloxone

This is linked to the actual SOS initiative – 4 basic phases – big collaboration by WHO and UNODC, funded by US State Dept. Incredible work to get to this point so far – now in stage of evaluation

Ultimate aim – train 15-16000 people in how to use naloxone

Compact, cheap, easy to produce and scalable naloxone product. Team has been amazing – really humbling to be here presenting

Presenting our amazing results tomorrow – come to side event at 2.10pm in C3.

Chair: WHO role in International Drug Conventions – 41st expert comm meeting – 12 substances are being considered at this CND – this afternoon. Use of cannabis and cannabis preparations is increasing. Member states must provide more evidence. Available and robust scientific information. Protect health and harms from cannabis use. This vote now may take place in December.

WHO Guidelines: Ensuring balanced national policies for access and safe use of controlled medicines. – we’re developing guidelines. Policy makers and program experts to ensure access to safe use. Expect the guidelines to be ready later this year.

HIV, hepatitis and STI programmes: Develop normative guidance for public health response to harmful drug use and diseases; guidance to be updated in 2020-2021 with population specific module on people who use drugs (PWUD)

Why focus on people who inject drugs (PWID)?

  • 257 million with Hep B infection
  • 71 million Hep C
  • 34 million with HIV

Much is attributable to injecting drug use

Continuous update based on review of evidence – original package from 2009 – added components such as naloxone and addressing structural barriers in accessing appropriate health services.

UN common position: health related messages

Nguyen Thi Minh Tam, Vietnam Ministry of Health

‘Harm reduction program in Vietnam: Achievements and lessons learnt’

  1. HIV epidemic and drug use situation in Vietnam – started in 2009 – People who inject drugs (PWID)s increasing by about 2% each year -about 230,000 PWID in Vietnam now – HIV about 30% of drug users – and 54% with Hep C
  2. Harm reduction program: policy response and program implementation –
    1. a lot of documents involved in policy response –
    2. Needle Syringe Programs (NSPs) established in 1994 with support from WHO, expanded to 53/63 provinces since 2016 – with support from WHO. Methadone program introduced in 2008 = strong support from WHO, for advocacy, service delivery and decriminalisation – our prime minister talked about effectiveness of methadone – program expansion now around 50000 people on methadone
    3. Improved screening processes for blood borne viruses (BBVs) and syphilis for key populations including PWID – now plan for elimination of Hep C
  3. Men who have sex with men (MSM), PWID and female sex workers (FSW) impacted by national response of harm reduction programme – HIV has now reduced among PWUD
  4. Lessons learned – greater and more meaningful participation of civil society in response, way forward: expand and sustain NSP and opiate substitute treatment (OST) programs, improved access to the diagnosis and treatment of Hep through integrations of services

Chair: Unfortunately, other panel member couldn’t join due to travel restrictions with coronavirus. We are aiming to increase access to services. I’d like to promote the WHO Forum on Alcohol, Drugs and Addictive Behaviours in Geneva in 2021.

Thank you for attending this side event – do we have any questions from the audience?

Q: Vietnam – have you encountered tensions between law enforcement and harm reduction sectors? And how have those tensions been resolved?

A (Vietnam MOH): our policies are very important – advocacy is very important – many meetings and trainings with them to introduce them to harm reduction. Built relationship with civil society and police. Because we have HIV Laws

Q: Involving peers in naloxone programs: how was this done in SOS program?

A (Dietze): Peer and harm reduction involvement was fundamental to this program – but will be elaborated on in side event tomorrow

Q: Availability of direct acting antivirals (DAAs): does WHO have a role in implementing DAAs? There are many parts of the world where they are unavailable

A (WHO): We are working on increasing the availability – there are an increasing number of countries with developed Hep C plans – about 100 new countries in last 3 years. Prices of DAAs has dramatically reduced – Hep C cure can now cost less that $100 = trying to use frameworks from HIV response to include Hep C in that – similar populations, procurement issues will hopefully be easier because of existing frameworks. Also working with Global Fund. Working towards elimination of Hep C through our global strategy on this.

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