Organized by Sweden, and UNODC Prevention, Treatment and Rehabilitation Section, Vienna NGO Committee on Drugs and World Health Organization
Giberto Gerra, UNODC
Welcome. I’m very excited to present the final version of the International Standards for the Treatment of Drug Use Disorders. I would like to thank the government of Sweden and state that we are not acting in partnership in WHO, but under their directive. Why have Members States been so excited to embrace the creation of these standards? – because they wanted the various UN agencies to take the lead in defining human rights-based, evidence-based treatment – not people who where chained to the bed or the wall, and the pretext of treatment.
Ghada Waly, Executive Director, UNODC
Good afternoon. Like to express my gratitude to Sweden for sharing their experiences today, and acknowledge their role in gender mainstreaming. We launched these Standards in 2009 and brought together health and law enforcement to create policy guidelines, that are based on science, are inline with the treaties, and to ensure healthy lives, and ultimately to leave no one behind.
Mikaela Kumlin Granit, Sweden
Honored to be here today. The treatment of drug users is an important issue for Sweden. The standards have been filed tested in over 10 countries ,and in Sweden it resulted in new national guidelines for drug treatment.
Vladimir Poznyak, WHO
These standards are the result of several years of collaboration with WHO. I’d like to acknowledge all that contributed in their development. This Standards are focused on how to deliver standards, and ensure that treatment is grounded in human rights and scientific evidence. Today’s launch is a result of several years of testing across 9 countries. The ultimate goal is improve treatment and coverage for people who use drugs. We conducted 300 focus groups, 43 experts were consulted in the review, and 100s of comments were considered, including a number from civil society. There was a strong push for changes from civil society for changes in language that was stigmatizing. We took these comments very seriously, and revised problematic language that appeared in the first edition. The Standards were developed through process of expert consultations and consensus building, and included an extensive literature review, and developed in the framework of WHO-UNODC Program on Drug Dependence, Treatment and Care. We hope these standards will result in human rights-based and evidence-based treatment.
There was very positive results from field testing. We performed major revisions to Chapter 3 – ‘Treatment Systems for Drug Use Disorders’, and Chapter 4 – ‘Treatment Settings, Modalities and Interventions’. We also focused on populations that need special treatment and care needs; pregnant women, children and adolescents, and people in contact with the criminal justice system.
Future plans include the development of technical tools to facilitate implementation, dissemination and capacity building in context of overall technical assistance, and technical support to countries in implementing the Standards.
[In response to comments from the floor and Angela McBride] People who use drugs should be advising doctors to help implement drug treatment programs.
Linda Pastorek, National Board of Health and Welfare, Sweden
Thank you for coming for this important event on substance use disorders. Today I plan to focus on opioid substation treatment and comorbidity. We have developed a comprehensive approach in Sweden that includes both alcohol and drugs and starts from before birth and continues throughout ones life.
In Sweden we have many actors working on the national, regional and local levels. National guidelines exist to provide support and help decision makers to make sure their budgets are informed by best practice. National guidelines are developed for severe, chronic illnesses, areas that affect large numbers of the population, have high societal costs or high costs of care, or are ethical dilemmas. The national substance use disorder guidelines were developed because of ethical issues and various regional differences in drug use. The guidelines take about 4 years and cost 1.2 – 1.5 million Euros to develop. We start with defining the scope, the collecting scientific evidence and finally the priorities based on severity, effectiveness of interventions and the cost effectiveness. We have 25- 30 external experts per national guideline. Our recommendations are arranged in priorities from 1 – 10, along with ‘further research is needed’ and ‘avoid / don’t do’. Drugs in included in Swedish guidelines include both alcohol and drugs. The Swedish national guidelines include 153 recommendations, 24 indicators that help define our performance indicators, and next year we’ll have our first evaluation.
In Sweden there are 8000 people who inject drugs and 4000 people are receiving opioid substitution treatment (OST). Access to OST is good in 50% of the country, but there are regional differences. OST is considered treatment initiative in Sweden, rather than harm reduction. Originally the thresholds were quite high to access OST, but we have lowered them. I consider OST as both treatment and harm reduction. Naloxone and needle syringe programs (NSP) are relative new in Sweden and there are also various regional differences.
Challenges remain. Failure to include social support. Patients with poly drug use or frequent relapses are not being catered for. Still much to do. We have run out of time, so going to skip the discussion on comorbidity.
Marta Torrens, University of Barcelona, Spain
Want to talk about our national standards in Spain. People with substance use disorders (SUD) and mental health disorders have a high prevalence of suicide, more risk for relapse, have more emergency admissions, risk behaviors such as HIV and hepatitis C, and experience high rates of homelessness. This is a high cost for society. This is a challenge for us and we need to diagnose these comorbidity. Then we have to treat both together.
Barriers for treatment include the separation of mental health and drug treatment networks in most countries in the EU. Most treatment services lack sufficient combined expertise to treat both types of disorders, and finally there are regulations and financial limitations. There are 3 types of healthcare in Spain, drug abuse health, general healthcare and mental health. We now have a dual diagnosis units and the priority is to reach those who experience comorbidity. The adaption of the portfolio of services in all facilities, across the health networks, has resulted in training to address stigma and discrimination from health professionals.
In conclusion we have created a system where people experiencing comorbidity can receive assistance no matter what their contact point is with the health system,
Angela McBride, South African Network of People Who Use Drugs
It think it’s important to note that people who drugs, are not patients, drug users, or prisoners. We need humanize our the approach, not quantify individuals. People who use drugs often have 2 choices prison or treatment. Harm reduction is an afterthought and punitive ‘choices’ take away our freedom to choose. Because I put a substance into my body, doesn’t mean I should be treated as less than human. I am more than a survey, I am more than a patient. I am more than prisoner. By forcing people who use drugs to make a choice between treatment or prison, you are making prisoners patients, and patients prisoners. We need to be met where we’re at. Language can be incredibly stigmatizing. I am someones daughter, someones sister, just as everyone else in this room. The most important thing is it is my choice.
Giberto Gerra, UNODC
There can be very unpredictable results with drugs. You can take one line of cocaine once in your life and have very different outcomes for someone else who did the same. We are launch the tool today and we are ready to work civil society to implement. Lack of respect for patients and disregard for human rights is what the standards are trying to achieved.
Comments from the floor:
The community that is directed affected, are the experts, and we need to be included in treatment and designed by PWUD. The evaluation of drug treatment MUST be done by people in drug treatment.
I’m not a fan of ‘parking people’ on OST, but we need to accept that some people do better on opioids and they should not have a end date for termination of treatment. Also outrageous that heroin assisted treatment (HAT) is not listed as an option in the Standards.