Statement of the Informal scientific network in managing psychiatric co-morbidities: Considering the majority of people with substance use disorders have other mental health conditions, known as dual diagnosis. Policymakers should devise strategies to address common biopsychosocial factors in the development of dual disorders. The high prevalence and related disability of dual disorders requires a double intervention and active advocacy from health professionals. Service providers should be trained in the management of dual disorders and sufficient support should be granted for this purpose. Systematic screening for other mental disorders, through validated (…) by trained providers, is an essential service for people with drug use disorders. Availability of and accessibility of adequate treatment should be provided regardless of entry to care system, in line with the principle of no wrong door. Sex and gender based knowledge and a stigma free approach are required in managing dual disorders. Age specific interventions are required across the lifespan, especially for minors and the elderly. Science informed prevention interventions addressing common risk factors, such as early life adversity, should be available to children living with parents and caregivers with drug use disorders and mental health conditions. Attention should be given to at risk and vulnerable populations. Access to services for comorbid metal health in the criminal justice system, youth detention, should be secured. The collection and analysis of data should be required. Effective and efficient interventions, in consideration of cultural and specificities should be considered. Informal scientific network encourages research on new and effective interventions in psychiatric co-morbidities.
Adeeba Kamarulzaman, Faculty of medicine of the University of Malaya: The numbers are staggering. According to the 2019 World Drug Report, an estimated 271 million people, or 5.5 per cent of the global population aged 15-64, had used drugs in 2016, 30 per cent higher than it was in 2009. Of those, 35 million people are estimated to suffer from drug use disorders and require treatment services. The Report also estimates the number of opioid users at 53 million. Opioid overdoses are responsible for two thirds of the 585,000 people who died as a result of drug use in 2017. Globally, 11 million people injected drugs in 2017, of whom 1.4 million live with HIV and 5.6 million with hepatitis C. Whilst the number of people who use drugs is high, the negative health and social consequences don’t need to be so, if only evidence informed policies are implemented. Take HIV and Hepatitis C for example. Despite compelling and comprehensive evidence that harm reduction—including medication assisted therapy and needle–syringe programmes prevents HIV infections among people who inject drugs, coverage of these programs continue to remain low in many low and middle income countries or are simply unavailable in many countries around the world. Furthermore criminal laws on drug use and possession for personal use” and the widespread stigma, discrimination faced by people who use drugs remain as potent barriers to access to health and harm reduction services. It therefore comes as no surprise that of the estimated 11 million people who inject drugs worldwide, over half live with hepatitis C, and approximately 1 in 8 live with HIV. And despite the impressive global scale up of life-saving antiretroviral therapy, people who inject drugs continue to be left behind. Not only are we not implementing evidence informed programs for opiate use to scale, we are also not prepared and not responding adequately to the shift in drug using trend to amphetamine type substances. With an estimated 35 million ATS users worldwide, programmes to address this are severely underdeveloped all across the world. Criminal laws against drug use and possession for personal use have meant that up to 90% of people who inject drugs may be incarcerated at some point in their lives. People in prisons are suffering from multiple layers of stigma and discrimination that doesn’t allow them to access HIV services, if at all, available. Furthermore. in the absence of harm reduction programs, prisons provide a high risk environment for the transmission of blood borne viruses such as HIV and HCV, and other infectious diseases such as tuberculosis. Ladies and Gentlemen Four years ago in April 2016 at the thirtieth special session of the General Assembly, Heads of State and Government, ministers and representatives of Member States jointly committed to effectively address and counter the world drug problem and acknowledged that drug dependence is a complex, multifactorial health disorder characterized by a chronic and relapsing nature with social causes and consequences that can be prevented and treated through effective scientific evidence-based drug treatment, care and rehabilitation programmes. Amongst other pledges, member states also reiterated their commitment to ending, by 2030, the epidemics of AIDS and tuberculosis, as well as to combating viral hepatitis with effective measures aimed at minimizing the adverse public health and social consequences of drug abuse. This include making available appropriate medication-assisted therapy programmes, injecting equipment programmes, as well as antiretroviral therapy and other relevant interventions that prevent the transmission of HIV, viral hepatitis and other blood-borne diseases associated with drug use, as well as consider ensuring access to such interventions, including in treatment and outreach services, prisons and other custodial settings. Importantly member states reiterated their commitment to respecting, protecting and promoting all human rights, fundamental freedoms and the inherent dignity of all individuals and the rule of law in the development and implementation of drug policies. Ladies and gentlemen. Let not these commitments pass us by another four more years and become mere words on Outcome Documents. Let these commitments carry meaning by implementing and adequately investing in a comprehensive package of harm reduction services and increasing access to health-care services in a people-centred and health-centred approach and support the community-led responses. And let not the commitment to protect human rights and dignity of people who use drugs be ignored by continuing to criminalise and incarcerate them and perpetuate the stigma and discrimination that these individuals and their families face on a daily basis.