Home » CND Third Intersessional meeting: Thematic Session 1- 19th October 2020

CND Third Intersessional meeting: Thematic Session 1- 19th October 2020

Thematic session 1: Drug treatment and health services continue to fall short of meeting needs and deaths related to drug use have increased; and the rate of transmission of HIV, the hepatitis C virus and other blood-borne diseases associated with drug use, including injecting drug use in some countries, remains high;

Chair (Standing in) Agenda adopted.

Secretary: [covid measures]

Chair: We are discussing three topics during this intersessional: Drug treatment and health services continue to fall short of meeting needs and deaths related to drug use have increased; and the rate of transmission of HIV, the hepatitis C virus and other blood-borne diseases associated with drug use, including injecting drug use in some countries, remains high; The adverse health consequences of and risks associated with new psychoactive substances have reached alarming levels; The availability of internationally controlled substances for medical and scientific purposes, including for the relief of pain and palliative care, remains low to non-existent in many parts of the world. We will be joined by experts nominated by the VNGOC. We will have a bell to remind speakers when they are going overtime so we allow everyone to get a chance to intervene.

Research and Trend Analysis Branch: The global evidence can tell us in terms of challenges that there are two major issues: Prevention & the perception of low risk for certain drugs. The number of PWUD is increasing – there has been around a 30% increase since 2009. the durg market is expanding globally because of social economic dynamics. It is particularly large in developing countries. We have qualitative informatino that MS have been prividing to UNODC. The perception of drug use has increased there much faster. The young populationis particularly increasing in developing countries. 1 put of 8 people that need treatment have access to the services they need. There is an increasing need for treatment but not much is done to increase the accessability of treatment. SDG5 is relevant here. I want to pose this question: is there anyhting we learned recently, the innovative solutions that surfaced during covid – can they be applied here to respond to the needs? An other element here is the complexity of the drug-use-market in terms of increasing poly-drug-use and that often users are not even aware of what they are using. The increased complexity requires new approaches in terms of treatment. I want to show you two graphs from the USA as an illustative example as to how much the risk-perception has decreased and in context, the change in prevalence of use.

Drug Research Section: 11.3 million people inject drugs, 5.5 million lives with HepC and ca. 3 million lives with HIV and many with both. The prevalence of HIV among people who inject is very high in Asian sub-regions and Africa. Half of those who inject live with Hepatitis C with high prevalence in South-Eastern Asia and Western-Eastern Europe. We estimate that 1 million people who inject drugs live with Hepatitis B with high prevalence in the Middle-East. The burden of diseases is extremely high. Anually, we estimate 7.3 million healthy lives lost because of drug-use related Hepatitis C and 4.3 million because of HIV. Alltogether, more than 60% of drug related deaths result from these deseases. The last issue I want to address today is that contamination iis particulraly a challenge for women who use durgs. Although there are fewer women who inject drugs, it is about 20%, in terms of risk, they are much more vulnerable due to gender-power-imbalances. For example, they have less possibilities to negotiate safer sex and some are sex workers.

Prevention, Treatment and Rehabilitation Section: The issues are intertwined and have been presented very eloquently so I will talk about the impacts of COVID19 on people with opioid use disorders. The best practices that we learned have to be implemented outside of the crisis. More than 80% reported that core medical and psychiatric services continue but only half reported contingency plans and an other half reported shortages in methadone and co; outreach and direct services have been incredibly impacted, in particular immigrants and refugees suffer unproportionately. We are expecting a large increase in evidence based services being implemented and many argue for universal health coverage – it is often not enough, services often subject PWUD to cruel practices, WHO standards have to be followed and MS should encourage each other to implement scientific, evidence-based interventions. We will create a toolkit and we will urge to „build back better” implementing learnings from the pandemic. We published some suggestions in March already and we continue to inform how to take better care for vulnerable communities. Let me talk about people in prison settings or in contact with the cirminal justice systems: we need to increase health care, offer treatment as an alternative. We published a handbook with WHO that is packed with best practices. We will soon focus on mental health as well. I don’t have time to address all of the issues here right now but I am very hopeful to see how many people are connected on these issues to promote and protect people’s health – it is their right and our commitment.

HIV/AIDS Section: PWUD are particularly vulnerable to the pandemic due to a number of external factors including a lack of access to housing and health-care and we cant imagine the situation of people in prison settings who lack personal protection equipment and no chance to socially distance. We have to make sure they are not left behind as they usually are in national responses. Global commitments have been made to address PWUD who live with HIV. Currently one very important development is the new UNAIDS Strategy where harm reduction and promotion human rights, equal access will be in center stage. The data has been disseminated well. We know what works – WHO will talk about it more. In countries where interventions have been adapted from our comprehensive packet, some really good results have been shown – there just needs to be more political commitment and resources allocated properly. We are working on stimulant use and we are suporting human rights centered law enforcement responses. We have developed many guidelines with UNAIDS, WHO, CSO partners and many webinars have been conducted, we are proud of the innovative work that has been done since March.

Singapore: Our approach to drug rehabilitation – we have a comprehensive 3 pronged harm prevention approach: prevention, robust law enforcement and evidence based aftercare/rehabilitation. According to our studies, wholistic intervention environemnet leads to better results; there is no one-size-fits-all. We invest heavily in protecting the most vulnerable like young drug abusers. We amphasize family support and provide comprehensive rehabilitation programmes. Women have different initiation pathways to drug abuse so we are working on adapting a gender sensitive approach that prioritizes emotional and community health. Yellow Ribbon Project Initiatives. Continuous drug-free living alse reuires former abusers capacity to rebuild and reintegrate so supporting (re)employment is one of our main focuses. We invest in local community partnerships to invest in recovery programmes. Causes and symptoms are multi-dimensional and vary by country to country.

USA: Substance use and disorder prevalence is increasing with marijuana as the leading drug, cocaine and methapmphetimne following after. The USA experiences gaps in the needs of people and available care. We are seeing progress around medication treatment – we use 3 medications to treat opioid use disorders. We experienced large increases in overdose deaths in the past decade though we saw a 5% decrese in 2018. Fentanyl and analogues are often present in overdose deaths – the trajectory was increasing prior to COVID19. The challenges of the pandemic further increased the trends. We made historic investments in our drug control budget – 45% goes to treatment. A core focus of our national strategy is that we adopt evidence based steps and professionals are properly trained. As part of the ongoing overdose epidemic, we see an increase in infections: HIV has stabilzed in the recent years but we see clusters of outbreaks among PWUD.

Russia: Organization of narcological care: we have an independent branch that is included in the Russian health care system. A full cycle of rendering of specialized medical care to patients with drug addictions is developed and introduced in practice. We also treat associated comorbities such as psychological issues. There are many commonalities with the UNODC-WHO Standards for Treatment. Ensuring the availability of drug-abuse treatment during COVID19 has been a special focus for us. Medical care is provided at patients’ houses. The scheme of social pressure on narcological population – it is important to understand the narclogical diseases itselves. There is no only one reason for such desease, we are addressing many risk factors. The Ministry of Helath Care started a new initiative within labor collectives.

Dr. Tlaleng MOFOKENG, UN Special Rapporteur: We live in a world with a high risk of durg abuse. This results in a limited level of opportunities for vulnerable commuites and political instablity. In 2018 around 269 million used drugs and 11 million injected drugs – half of the 11 million live with hepatitis C. The death toll is increasing – these are not only statistics, this counts individuals who are our family members, colleagues, etc. All countries committed to implement recovery, rehabilitationa nd social integration. Regrettably, the war on drugs and repressive policies continuted, based on an inaccurate idea … this approach has failed. Criminalization fuels stigmatization and poses significant obstacles for the right to health. This steers people aways from the health care they need. Decriminalization contributes to a decrease in mortality. There is an ever growing evidence that harm reduction measures and substitutes have been effective in responding to diseases. We have seen progress in the provision of services but we still see gender gaps. Travel restriction has interrupted supply of medications including substitues and HIV medications. Home delivery and dosing at community pharmacies are commendable measures. Everyon has the right to helath, to be treated with respect and dignity regardless of legal status, gender, sexuality, etc. Intersectional vulnerablities must be taken into account. Leaving noone behind means reaching first to those most behind.

WHO: Drug treatment and health services. One of our objectives within the Un system is to reduce the burden caused by drug use and abuse. A report has just been published that shows that there is no progress in the reduction of drug use in the past 30 years. Age group 29-49 has drug use as a top 10 health risk. This is largely driven by a certain areas that has already been identified earlier today. Drug and tobacco use are key indiators of poor health world-wide. We have to speak about the increase in exposure to drugs, hepatitus C and road accidents as well as suicide. One of the major challenges here is the capacity of health systems. The WHO did a survey and through that it is clear rhat specialized treatment is only availble in 85% od MS. The availability is still very poor and usually only available out-of-pocket. Overdose is a major issue – SOS (Stop Overdose Safely) initiative hass ben implemented jointly with UNODC 2016-2020 and more than 15000 Naloxone kits have been distributed. Policies and trainings are the major issues that need to be addressed. Overdose prevention and critical harm reduction services are key. 10 October is mental health day, the slogan is „Let’s invest!” which should be our priority exactly.

WHO: Why focus on people who inject drugs? Hepatitis C has no vaccine but there is a cure. The percentage of people who are infected are 1 in 4 are PWUD. 1.7 million new infections last year, mostly attributable to injecting drug use. We have been endorsing harm reduction for long years and here is a guideline about HIV and drug use public health response: a comprehesive package of 9 interventions from 2009 – we keep updating it so for example we suggest Naloxone since 2014. Structural barriers are a key consideration, strategic legislation, addressing stigma – this is what we are focusing right nie in the next update. The UN common position is in-line with our guides. The better the coverage, the better the results. Hepatitis preventions are completely lacking behind due to the structural barriers. Regarding COVID19, essential health services are covered in our booklet.

[…]: Early detection, treatment, aftercare and social integration. Next year, we are marking 60 and 50 years since the conventions. Not all parties have delivered their commitments. Often there is a lack of funding, lack of scientific evidence and coaching. The scientific understanding has been much more improved than national respondses. Less than half of the countries globally have a dedicated budget. Drug treatment based on scientific evidence is the most successful response, this has been proven. In recent years, we are dramatically reminded of the health and care needs of PWUD. Law enforcement approaches have a limited effect. We must recognise this as a coplex health disorder and reduce the stigma. Treatment is included in the conventions, it is a critical target for SDG3 and is a key operational objective of the 30th special session of the General Assembly. In 2017, the INCB devoted a chapter in ther report to the very issue and WHO recommended to record data on the needs, accessibilty, evidence base and to allocate sufficient funds, share best-practices, build capacities and invest in research to discover new solutions. The priority of the convention are to protect human life and ensuring access of substances for scientific and medical purposes. When it comes to the transmission of blood-borne diseases, injection is a big factor. Roughly 1 in 8 people that inject durgs live with HIV. The prevalence of these diseases in prison populations remains a huge problem – the rate is 22 times higher as in the general population. The controlled substances that are used extensively in health settings, cost-effectiveness is an issue. INCB analysis has underlined the trend that opioid substitution treatments are too limited. Methadone and buprenorphine shortages are an issue during COVID19. The locdown also impacted accessiblity of services.

EMCDDA: Europe has a long history of providing drug treatment. We have over a million people in treatment right now, receiving substiution treatment with good results: heroin is in a long-term drop for example. Challenges remain, there is a variation in accessability of treatment and related services. We have standard for an integrated approach. Emerging challenges: cannabis, NPS and poly-drug use problems are on the increase. Drug related deaths are relative low and stable. A concern for us is the vulnerability of elderly opiate users who experience a higher mortality rate. Northern EU countries have a higher rate as well due to cultural reasons. A range of interventions are used in the EU – most important: opioid substitution treatment available in all EU countries & a take-home-Naloxone program & some countries have supervised consumption rooms. Evidence in increasing, we have guides and evidence databases. In terms of viral hepatitis and HIV, we are experiencing a long-time decline. We are scaling up testing and treatment but outbreaks are still happening around PWUD who inject. Regarding patterns of use: there is an increase use of licit substances and there are more emergencies related to mental health. Harm reduction services during lockdown have been affected badly but we have seen high adaptibility and creativity.

World Federation of Therapeutic Communities: Drugs are not the problem, addiction is. I believe that this small phrase encompasses all basic principles of treatment. It implies that we cannot demonize substances – there are only matter, after all – but at the same time, puts an emphasis on addiction as a human behavior. Embracing this statement also means that we understand addiction not simply as an illness but as a multifactorial health phenomenon that requires a complex and comprehensive approach. Accordingly, the United Nations General Assembly Special Session in 2016 recognized “drug dependence as a complex, multifactorial health disorder characterized by a chronic and relapsing nature with social causes and consequences that can be prevented and treated”. The therapeutic community (TC) is a well-established and evidence-based treatment modality that provides services either augmenting high quality medication-assisted treatment or as a monotherapy. Most contemporary TCs attract a population with mainly poor prognostic indicators for addiction treatment: polydrug use, psychiatric comorbidity, poor work history, significant criminality etc. Significant evidence from large-scale effectiveness studies, randomized-controlled trials and meta-analyses support TCs as effective, cost-saving interventions. The patient outcomes measured, usually include sustained abstinence, reduced drug use, employment and criminal behavior. Organizations like the therapeutic communities espouse a bio-psycho-social approach to the treatment of addiction. The biological aspect is apparent because we do know that addiction affects the brain and its functioning, whereas addiction as a coping mechanism for past traumas manifests the psychological dimension. Also, we should take into consideration that addiction became a massive social phenomenon after (and because of) the industrial revolution. That is why we, in the field of treatment, understand addiction as a health issue of mainly a bio-psycho-social nature. Today, we face a new reality. The coronavirus pandemic has brought an economic and social crisis of considerable magnitude. How we, in treatment, react to this, is of paramount importance. Ten years ago, when the recession hit Greece, we saw a serious increase in substance use. More men using alcohol as a refuge, more women taking benzodiazepines. At the same time, funding for health and social services was reduced dramatically. For all these reasons, I strongly believe that this is the time to emphasize the political aspect of the issue. Let me clarify this. Obviously, I am not talking about partisan politics but I am using the word in its Aristotelian sense. We, both decision makers and treatment professionals, are part of the polis-city, we are concerned citizens. We should face the future and the challenges that lie ahead by drawing from our rich experience, from our values and tradition, from our past. Along these lines, I would like to offer the five following observations concerning the place of treatment services and more specifically the TCs, in the health spectrum. (1) We must acquire a stronger voice as treatment organizations and TCs in particular. Our services, together with prevention and harm reduction, should be an integral part of the continuum of care in any national health system. In some countries the reality is that TCs are marginalized and undervalued. This needs to change. Decision makers need to be persuaded of the necessity for adequate services thus providing the required funding. (2) We need to advocate for services aimed towards the most vulnerable groups: women, children, the homeless, people with HIV, Hepatitis C, co-occurring disorders, offenders and others. Women, for example, make up globally one third of people who abuse drugs but just one fifth of those who are in treatment. Unfortunately, during a recession the first services to have serious cutbacks are the ones we have just mentioned. (3) Recession also brings unemployment. With higher unemployment, social reintegration becomes very difficult to achieve. Treatment organizations therefore, should diligently and methodically redesign their re-entry programs to adapt to this new reality. At the same time, we should seek  the passing of laws that make it easier for people who complete treatment to reintegrate. (4) Experts say that the coronavirus pandemic is closely related to the destruction of the environment. Environmental awareness should become an essential part of the treatment process. Clients and staff need to be educated and trained in related matters. (5) These are times that we need each other even more. The development of efficient networks on a national and an international level is a priority. Treatment programs and organizations reaching out to others and seeking a unified voice, is the way to go. In Greek the word “treatment” is “therapeia”. It derives from the word “therapon” (therapist), which is first recorded in Homer’s Iliad. It originally signified the servant who helps a warrior put on his armor before the battle. Health providers, and more specifically addiction professionals, are exactly this: therapists, servants who serve people in their need. They equip vulnerable individuals so that they can go fight their personal battles. Few months after UNGASS 2016, the World Federation of Therapeutic Communities (WFTC) produced the Declaration of Mallorca which concludes with the following words: “This declaration reaffirms the commitment of the Therapeutic Community movement to serve addicted populations and their social networks all over the world by restoring their hope, dignity and personal well-being.”

Harm Reduction International: It has been a year in which public health has dominated the agenda and many governments looked to lessons from the AIDS response. Unfortunately, health-based responses to drug use are not part of this successstory. Our global tracking shows that harm reduction implementation has worsened since our last report in 2018, having effectively stalled since 2014. The data presented today was collected for the seventh edition of the Global State of Harm Reduction. According to the latest report from the United Nations Office on Drugs and Crime (UNODC), an estimated 11.3 million people inject drugs globally, with HIV prevalence estimated to be 12.6% and hepatitis C prevalence 48.5% among this population. 179 countries report some injecting drug use, however, 110 countries have no data on its prevalence. Without accurate data, our work to invest in and programme for harm reduction is limited and we cannot hope to effectively progress CND Resolution 60/8 in relation to preventing HIV amongst people who use drugs and increasing financing for the global HIV/AIDS response. The World Health Organization (WHO) recommends a package of services for HIV prevention,  treatment and care for people who inject drugs, such as needle/syringe programs, opioid  agonist therapy, and the provision of naloxone and training on overdose prevention. Since 2018, the number of countries implementing needle and syringe programmes (NSPs)  remained level at 86 (with some countries ceasing implementation and 4 new countries  adopting NSPs). The number of countries where opioid agonist therapy (OAT) is available  decreased by two to 84. There are also large differences between the regionsin terms of harm reduction implementation: while NSPs and OAT are available in most countries in Eurasia, North America and Western Europe, these core harm reduction interventions are severely lacking in the majority of countries in other regions.

Significant geographical gaps and an uneven distribution ofservices exist even in countries where harm reduction has been available for decades. In addition to geographical gaps in coverage, there are sub-groups of people who use drugs that experience barriers in access because harm reduction services aren’t tailored to their unique needs. These groups include women who use drugs, people who use stimulants and/or non-injecting methods, people experiencing homelessness, and men who have sex with men. Women who use drugs are still frequently overlooked despite the complex harms,stigmatisation and structural violence they face. A substantial increase in gender-sensitive services is necessary to appropriately address their needs and progress the commitments under CND Resolutions 59/5, 55/5 and 61/4. Overarching structural problems also negatively affect access to services. Criminalisation, racism and discrimination against Indigenous, Black, and brown people results in people from these communities disengaging from or actively avoiding health services. The COVID-19 pandemic disrupted harm reduction service provision around the world and  highlighted the importance of community-led responses in ensuring substantive and  sustainable change and should be seen as an essential component of responses. Disruptions include reduced opening hours, reduced capacity in drug consumption rooms, incarceration for  breaking lockdowns, and disruptions to the supply of OAT. OAT is delivered as directly observed  therapy in most countries in sub-Saharan Africa, and travel restrictions seriously affected  delivery in the region. The pandemic brought some examples of important positive changes that serve as evidence for the feasibility of less restrictive service delivery. OAT regulations were eased, longer take-home periods were allowed, and easier initiation and provision in community settings were introduced – all without any increase in diversion or overdoses. These cases prove thatsuch initiatives, which the harm reduction community have long advocated for, are realistic, feasible goalsthat not only lead to a better quality of life for people who use drugs but result in better public health outcomes overall. Human Rights: Progress in harm reduction and evidence-based health responses to drug use is at-risk as  punitive drug policies proliferate in regions across the world.  25% of countries that implemented COVID-19 prison decongestion schemes explicitly excluded  people detained for certain drug offences, regardless of whether they met other eligibility  criteria; and there is little attention of governments shaping their schemes to reflect pre existing health conditions or vulnerabilities, such as HIV and TB. As acknowledged by CND Resolution 61/11 we must work together to counter the stigma and discrimination which create barriersto services. Harm reduction services are equipped to address these gaps, as non-judgmental, community-based service delivery is among the core principles of harm reduction.

Mexico: […]

Analysis branch: Thank you for reminding us about the importance of data collection. In terms of including the quality and coverage of data, we are still far from achieving the objective, partcularly in Africa and Asia though we have new surveys in India and Nigeria. Data are not political documents, but there is one SDG that directly relates to drugs and drug use. The filling of the treatment gap is an important step in progress. I want to alert the international community that all projections predict more challenges coming.

Mr. Jones (USA): Certainly, surveillance is critical. Overdose deaths are an outcome of people not being able to get treatment. Various indicators are very interconnected. We continue to monitor and engage in multilateral surveillance collaborations.

Research Section: This session is our inspiring call for action to take all these best practices and really start using them on the ground.

Chair: This is a time for questions.

Luxembourg: In relation to programs that involve Naloxone: we are looking at implementing a pilot program for take-home-Naloxone. What is an appropriate population for this? During the pandemic, would it be reasonable to consider a wider population? Is it possible to obtain data from countries who have best practices in this area? For chronic pain patience, is there data on Naloxone overdose treatments?

EMCDDA: 10 countries have this in Europe, likely more… We have conducted some studies so the evidence is increasing with positive results. Scotland is a good case-study for low-threshold services. Naloxone can come in the medical package and training for pain patients.

WHO: People recently released from prisons is a very appropriate population. To not just users of opioids, Naloxone has been suggested as a lifesaving equipment. With mortality after prison release is also a matter of other treatments and continuity, not just Naloxone. In terms of pain medications, for high dise perscriptions, it is at the discretion of practitioners.

Luxembourg: Are they prone to additional issues, knowing that there is this „safety kit”?

WHO: Yes, this question has been raised often by doctors. Currently there is no evidence that the distribution of Naloxone, even in community settings, carries a higher risk of use. Giving out Naloxone does not make a Naloxone programme – there are trainings and education included.

Nigeria: We thank the research sections and I would like to respond to Mexico – only a small percentage of treatments are met in USA and Europe. The developing countries that understand the impact of resource allocation, do you think that low resources can be a reason for Africa’s falling short regarding treatment gaps?

Research Section: If I understand correctly, there are no sufficient resources? On the issue of treatment gap, of course certain regions have it more difficult than others.

El Salvador: […]

Research Section: Many of our suggestions have been found effective for many countries.

Venezuela: […]

HIV/AIDS Section: we have developed technical guidances and published those on our website. We also conducted webinars specifically concerning prison populatoins that are available on the website.

WHO: I would also refer you to the online resources.

STAND: Good afternoon Ladies and gentleman, my names is Stacey Doorly-Jones, Chief Executive Officer  of a Non-Profit organisation called STAND, based in Cape Town, South Africa. Thank you for this  opportunity for me to present a collective Harm Reduction, Gender Based Violence & Trauma  CRISIS INTERVENTION both developed and provided to the high risk population group of homeless  during the National COVID-19 Hard Lockdown period. In brief, STAND provides Treatment and Support to High Risk individuals gripped in the cycle of  addiction, trauma and gender-based violence in the most impoverished and disadvantaged  communities in rural, urban and peri urban areas in the Western Cape, South Africa.  The nationwide hard lockdown that was implemented in South Africa in response to the COVID19  pandemic, resulted in a significant number of desperate calls for urgent SUD (substance use  disorder) services and more specifically withdrawal management for the homeless in addition to  gender based violence and trauma interventions. The urgent need to provide these services for  the homeless necessitated a Provincial call out to SUD Non Profits to step up and volunteer to help  during a peak risk time for contracting COVID-19. Five organizations/institutions stood up and  reported for duty to VOLUNTEER our services at the emergency City Safe Spaces and Homeless  Shelters which required a proactive and effective harm reduction approach to further speak to the  humane treatment of our homeless individuals and families beckoned within the lockdown. The  consortium of organizations/institutions immediately developed a Crisis Intervention plan which was  concurrently mobilized “at the speed of light” to provide immediate treatment to the homeless,  transgender and sex worker communities who often identify as street based and are vulnerable to  the spread of HIV and Hepatitis C who were locked down in the City Safe Space Camps and  Provincial Homeless Shelters. The intervention was also developed to reduce the spread of HIV, Hep C and other blood-born diseases associated with drug use. Key objectives of the Crisis Intervention Plan: (1) To reduce the physical pain and physiological impact of withdrawals from heroin and  alcohol use disorders (2) To provide medical, Opiate Substitution Therapy and psychosocial support for the street based dwellers (3) To ensure that the SUD clients at the camp sites and shelters are not further criminalized and  or discriminated against because they use alcohol and or other drugs (4) To improve the physical and psychological wellbeing of people who use substance &  survivors of GBV and address their high levels of trauma experienced during this period. The phenomenon of this Crisis Intervention is that it was not only developed with the extreme sense  of urgency it required, but that it was immediately implemented as a multi-disciplinary team, and  barriers were addressed as we came up against them. It was agreed by the consortium of organizations that: (1) STAND assumes the role of Project Management, co-ordination of services, provision of  clinical SUD intervention services, trauma counselling services as well as the clinical  supervision and management of graduate Social Work volunteers provided by the University  of Cape Town (2) TB HIV Care provides their specialist Harm Reduction services such as initiating clients onto  their OST program, provision of sponsored methadone and the mobilization of a mobile  needle exchange program (3) SANPUD provided psycho social support to clients initiated onto the OST program, guidance  to the consortium on harm reduction approaches, trauma counselling, GBV women’s group  support and Contemplation Group Training (4) University of Cape Town – Professor Leon Holtzhausen & Lecturer (Clinical Social Worker)  Cindee Bruyns provided immediate training capacitation to professional volunteers in the  Homeless sector on trauma informed approaches to working with the residents and  recognizing and assessing suicide risks – which were peaking during this time (5) Cape Town Drug Counselling Centre provided SUD intervention services and trauma  services (6) The Chair of the WCSAF: Ministry: Department of Social Development co-developed the  Crisis Intervention Plan and lobbied within her Ministry and other key role-players within the  Provincial Government to adopt the Crisis Intervention Plan as a Blueprint for roll out to  Shelters Provincially. The Crisis Intervention Plan has subsequently been expanded on and adapted into Standard  Operating Procedure (SOP) and Referral pathway to enable relevant sector role-players and SUD  practitioners / specialists involved delivering services to high-risk population groups to understand  the step by step process needed to deploy when treating clients with SUDs, GBV and Trauma, as  well as referring clients for psychiatric assessment and treatment where necessary. It is for use by  Multidisciplinary Clinical Teams consisting of SUD practitioners and Homeless Sector specialist Non-Profits. It is both a collective and proactive approach which we hope to see adopted not only  Provincially but also Nationally within our Country of South Africa. Thank you for your time and attention.

International Committee of the Red Cross: Preventing the spread of this virus requires nondiscriminatory access care. Health systems are now called to reach populations everywhere and this might be the right moment to test people professionally for diseases associated with drug use. I recall the rome consensus. Reaching people here they are, ensuring availability of substitution therapy are crucial. The international commitments made by MS provide an opportunity to modernize national drug laws and make them balanced: treatment and punishment can work together. The chance of success of therapy is always prportionate to the time spent in treatment. Our humanitarian organizations ask you to listen to us and the Rome Consensus.

Jamaica: We thank you for your insightful presentations and reports. The World Drug Report indicates that only one in 8 people who need treatment are actually getting it and only 1 in 5 of these people are women. The pandemic furthered global problems. The measures put in place by governments have severly disrupted critical supply chains and services. We

Fiji: Our mental health services have been established in 1984. The facility provides rehabilitation as well as community rehabilitation, occupation therapy, etc. We move towards decentralizing services to community based centers. Recently, the pandemic […] We are talking about a number of comorbidities. Drug use continued to rise so does the need for a proper infrastructure for treatment, specialists, social workers, nurses and psychologists. Stigma is a huge issue, so is the lack of testing possibilities and infrastructure. There was increase in our clients in Fiji. We need a more balanced approach and we call on our international partners to help us increase our capacities.


Nigeria:  We are looking at a global challenge and we have to change our approach. We think that the increase in use that is visible in the World Drug Report is a cause for concern. Our attitude towards risks is a critical point as the lowering of the perception of risk in Cannabis seems to result in higher prevalence of use. This bring the important element of funding – we have to assist countries who are coming from a more difficult situation. We have an obligation to provide treatment to PWUD and also plce focus on prevention.

UNAIDS: In keeping with the UN common position, we strongly support decrim. I would like to highlight the huge social cost of the prohibition of drugs. The 2020 global AIDS updates show, 20% of all HIV infections are among people who inject drugs. We have not been ble to reverse the number of people getting infected by HIV. I would like to highlight three issues regarding the high rates of transmission associated with drug use (1) criminalization and stigma perpetuate the problem – perpetuating current prohibitive policies is inf act chosing not to improve this situation (2) COVID19 revealed the gaps in our primary helathcare systems and the lack of social protection for vulnerable populations, (3) community-led responses: grassroots organizations and families should be at the center of response, should be supported in monitoring and providing survices, more funding is needed as they have been the most effective decision makers – for example, Humanitarian Action in Russia has provided rapid HIV testing and Nalaxone in St.Petersburg, the only city in the Russian Federation to report a decrease in the numbers of new infections.

Canada: We have seen some trends as a result of our national legislature change. We will continue to collect data and are ready to share and discuss. We intend to be fully open and transparent with the entire issue. We are deeply concerned with the ongoing opioid crisis and are advocating for our 4 pillar-based national strategy that handles the issue as a health issue. Harm reduction measures, including supervised consumption sites, are essential in preventing more unneccessary deaths. We have clear evidence that these practices prevent the furter spread of blood-borne diseases and infections. The current pandemic makes it more challeging to address drugs-related problems. We are supporting a number of programs that are in direct contact with people who use drugs, provide safe supplies and center health and dignity. No one single organization or insitution can solve this issue alone.

EU&friends: I have the honour to speak on behalf of the European Union and its Member States. The following countries align themselves with this statement: Turkey, the Republic of North Macedonia*, Montenegro*, Serbia*, Albania*, Bosnia and Herzegovina*, Ukraine, Iceland, Norway, the Republic of Moldova and Georgia.
Mr. Chair, Excellencies, Ladies and Gentlemen, the European Union and its Member States wish to thank you for organizing this intersessional meeting. We would also like to thank the Secretariat for the comprehensive and concise background material provided for this meeting. The discussions of the upcoming days should help us accelerate the implementation of our joint commitments to effectively address the world drug problem, in line with the 2016 UNGASS Outcome Document and the 2019 Ministerial Declaration. Effective drug demand reduction strategies including risk and harm reduction strategies are cornerstones when it comes to addressing the world drug situation in a comprehensive manner. We are of the opinion that all of us can do more and can do better in that regard. We therefore welcome the focus of this thematic debate on three important issues that need to be addressed: treatment, drug-related deaths and blood-borne diseases. Mr. Chair, with your permission, I now address the first challenge.  Non-discriminatory access to health care and social services is a human right. Nevertheless, treatment and health services continue to fall short of meeting needs – particularly those of vulnerable groups and people who use drugs. This topic is even more relevant when we look into prison settings. People in prison should be offered treatment and health services on a level equal to those available in the community and it is vital that those programmes can be accessed easily without fearing any negative consequences. Moreover, ensuring continuity of care after release is essential. When it comes to treatment, the International Standards for the Treatment of Drug Use Disorders by the WHO and UNODC are a good guidance on effective treatment options. But we should not stop there: it is in the hands of the clinical and scientific community to regularly adapt treatments to upcoming trends as well as to develop new effective forms of treatment. Mr. Chair, it goes without saying that offering treatment and health care services that meet the needs of people who use drugs is one of the most efficient ways to reduce the number of drug-related deaths. By saying this, I would like to shift our focus to the second aspect of the first challenge. We are saddened by the high number of people dying from drug use, particularly as we have solid knowledge of the measures that can reduce the number of deaths. Opioid substitution therapy is the gold standard in treating people with opioid dependence. But we are far away from reaching sufficient levels of availability and access. New pharmacotherapies are available on the market. They are safer and more effective for people in substitution therapy. Practitioners should make good use of them. In addition, we deem it necessary to provide measures that reduce the negative health and social consequences from drug use as laid down in the EU Action Plan on Drugs. Those have proved to offer a meaningful contribution towards saving lives. Thanks to such measures, including outreach and low-threshold services and an enabling and empowering environment for people who use drugs, we will make a major step forward towards effectively addressing the world drug situation, as we committed to in the 2016 and reiterated in the 2019 Ministerial Declaration. Mr. Chair another important concern is the continuing high rate of transmission of blood-borne infections among people who use drugs – which will be the second challenge on today’s agenda. The regular progress reports on achieving the 2030 Agenda Sustainable Development Goals (SDGs) demonstrate that that there is one transmission mode where we stay far behind the goals that we have set. It is the transmission of HIV and viral hepatitis due to unsafe drug use. According to UNAIDS, although they represent a small proportion of the general population, in 2019 injecting drug use accounted for 10% of new adult HIV infections globally. The situation may have deteriorated with COVID-19 – first research indicates that due to interrupted prevention and treatment programmes, the figures will rise even more. And again we have to state that we have solid knowledge of the measures that can reduce the transmission of blood-borne diseases due to drug use. I will give but one example of the tools that can help countries in adapting their policies: this is the currently updated guidance on Prevention and control of infectious diseases among people who inject drugs, published by two EU Agencies: the European Monitoring Centre for Drugs and Drugs Addiction (EMCDDA) and the European Centre for Disease Prevention and Control (ECDC). In order to be successful, we believe that countries need to implement a comprehensive package of services for persons who use drugs. This should include targeted HIV and hepatitis prevention, low-threshold access to diagnosis and anti-retroviral treatment as well as accompanying care and support programmes. Particularly during the ongoing COVID-19 pandemic, we should concentrate our efforts on this key population in order to make sure that their vulnerability is not increased further. Mr. Chair,
let me conclude. There is already good evidence for effective drug demand reduction and harm reduction strategies, many guides and tools exist to share that knowledge. The UNODC and many others are supporting states in implementing those measures. On that basis, we should aim at accelerating the implementation of our commitments. Thank you!

Sri Lanka: With the leadership of the treatment, rehabilitation and health authorities we have been succeeding in Sri Lanka. Promoting efficient medical services and programmes with drug prevention authorities, we have been able to assess the complexity of the problem. NPS are emerging at an unprecendented rate with more toxic effects. There is a need to reexamine the current policy framework with focus on children and youth, intensifying innovative approaches to the prevention of drugs use. Enhancing family support and through community empowerment […]

OHCHR: It is critical that this particular population continues to receive harm reduction and health attention during the COVID19 pandemic. Underlying issues such as economic and social vulnerability, etc enhanced the need for serving this community. Prisoners have been infected with COVID19 in a larger rate than the rest of the population – their conditions facilitate the high transmission and poor nutrition, health care are also concerning from a human rights perspective. We recommend that detention of people suspected of drug use be dealt with treatment. Evidence informed and voluntary services are key in facilitating a succesful response. In line with our mandate, we provide support and would like to highlight the guidelines that were launched during the High Level Ministerial Segment of CND in 2019.

NGO – Drug Free America: Since 1999, more than 450,000 people have died from drug overdoses in the United States. Yet despite being one of the wealthiest countries on the globe, the US suffers from one of the most pronounced substance use treatment disparities in the developed world. According to the National Survey on Drug Use and Health, approximately 21 million Americans needed treatment for a substance use disorder in 2018. Of those, only 11% received treatment in a specialized facility while only 17% received treatment of any kind. This disparity between the number of people who need treatment and the number who actually receive it, is known as the treatment gap, and it is one of the factors driving the high mortality from drug overdoses in the US. So the situation was already exceedingly grim before the pandemic.

Now, social and economic stressors arising from the pandemic, combined with the disruptions to health care, placed many at an even greater risk of overdose. Many residential treatment programs shut their doors leaving patients with no safety net. In person treatment and recovery programs were vastly curtailed in the wake of COVID — including visits with healthcare providers, group counseling sessions, inpatient stays, and 12 step meetings. So there was far less of the emotional support that is vital to addiction treatment and recovery. The isolation of quarantine and social distancing also brought many additional dangers for people with substance use disorders. Using drugs alone is much more dangerous because there is no one nearby to render aid if an overdose occurs. And border closures and travel restrictions enacted as a result of the pandemic caused major disruptions the illicit drug supply– forcing many users to seek out new, unknown sources that carry a higher risk of adulteration with lethal synthetic opioids. And with the pandemic disrupting treatment centers and other places that help people with drug addiction, there may have actually been less naloxone available to those most at risk. So the pandemic really could not have come at a worse time—the US was already grappling with record levels of opioid and stimulant use. And the situation became even more dire as the mortality rate from overdoses accelerated as a direct result of the COVID-19 pandemic–the data that have come in so far clearly demonstrate this. Nationwide, overdose deaths increased almost 20% from March to May of this year compared to the same time period last year. In some regions of the country overdose have increased by as much as 300% since COVID-19 hit. On the surface, it appears as if there is little to be optimistic about—but all is not yet lost. While COVID-19 has produced a number of challenges to accessing treatment; it has also resulted in changes that have made accessing care easier—especially for high-risk populations. These changes include, firstly, the reduction of financial-barriers-to-accessing-treatment-and-obtaining-naloxone; which was achieved through emergency expansion of Medicaid, the nation’s public health insurance program for the poor. Secondly, the Quarantine and shelter-in-place orders have resulted in the easing of restrictions on the dispensing of methadone. And finally, the role of telemedicine has been greatly expanded making it easier for patients with opioid use disorder, especially those living in rural areas, to access behavioral health services and physicians who are licensed to prescribed buprenorphine. If they are made permanent, these policy changes have the potential to not only mitigate the effect of the pandemic on overdoses, but also to address long-standing structural barriers to accessing effective, evidence-based, substance use treatment. Thank you.

Prevention, Treatment and Rehabiliation Section: UNODC has developed a lot of tools to expand prevention (WHO international standards available online) and what I would like to announce now is something we hope that contributes news to the field. National Systems – we wanted to build on the European experiences that Norway agreed recently to support. Supporting Parents – two of the most important protective factors in a young persons life is parental monitoring and warmth. Because of the pandemic, we have seen children experience more violence than ever, especially when schools are shut and the main source of income of their family is impacted by the crisis. We published tools in over 40 languages with focus on difficult situations such as refugee camps. There will be a new Listen First campaign with the support of France.

USA: We must ensure our approached prioritizes recovery and builds on the Ministerial Declaration from 2019. We recommend a 3 prong strategy: treatment and prevention implemented within the health system; criminal justice & alternatives to incarceration; …

On a range of programs, we collaborate with international organizations and are making efforts to connect individuals to the service providers that they need.

Mexico: The commitments we made have not been met, it’s clear. We have the commitments and action plans, measurement tools – in our view, these have also not been met. The international community should now really start working to revise the commitments and measurement of implemmentations. We are preparing for a review, it is time.

NGO – Karim Khan: The Karim Khan Afridi Welfare Foundation __ dedicated to fighting the war on drugs in  Pakistan__ is pleased to present its statement to the Commission on Narcotic Drugs, the topic of  Drug treatment and health services falling short of meeting the needs of fighting drug abuse and  the increase in drug related deaths. The worldwide drug crisis is worse than previously thought. With the onset of the Covid-19  pandemic, the global drug problem has become among the most urgent public health challenges  impacting individuals, families and communities. In 2018 – even before the pandemic- the UN’s World Drug Report said 269 million people used  drugs worldwide and over 35.6 million people suffered from drug use disorders that required  treatment. In 2017 drug abuse alone killed 585,000 people. It is clear the response to the drug problem is inadequate. Treatment efforts continue to fall short  – with only 1 in 8 persons globally having access to proper treatment and rehabilitation services.  It’s even worse in developing countries. In Pakistan, it is critical that drug addiction treatment  and rehabilitation services are increased and improved. There is limited availability and access to  drug treatment across Pakistan, particularly for vulnerable groups like women, prisoners,  minorities, and mentally ill, due to barriers related to discrimination, stigma and affordability. Pakistan is on one the world’s busiest drug trafficking routes. With a population of 220 million,  there are an estimated 9 million drug users and close to 5 million drug addicts yet only 30,000  have access to treatment each year. The increasing drug use in Pakistan is endangering the  country’s vulnerable youth. There are 130 million Pakistanis under 30 years old. They are the  country’s greatest asset, yet they are at the greatest risk of drug abuse. In Pakistan there is an epidemic of HIV and Hepatitis C, mostly among those injecting drugs.  Drug users currently account for about 38% of Pakistan’s registered HIV patients. As well as an insufficient number of treatment centers, there is an additional concern about the  quality and methodology of treatment services offered. Recent studies indicate the quality of  treatment and intervention is low, in large part because of an inadequate number of trained  professionals and ineffective referral systems. Most private centers focus on profit with no  reliable evidence of successful treatment of drug use. Women users are particularly  disadvantaged with few facilities available to them. Government-run centers are woefully  inadequate and unable to meet the demand. There is also no consensus on what constitutes the best treatment in Pakistan. There is no  national policy that clearly outlines a holistic approach and uniform protocols for rehabilitation  services among public and private centers. Current information-management systems are poor  and there is a scarcity of data on treatment effectiveness. In addition, treatment center locations  do not necessarily correspond to potential demand, nor is there a system of monitoring or  accountability for the practices employed at these centers. The lack of consistent government  data concerning these issues remains a key constraint.

Despite the Government’s commitments to the 2019 Ministerial Declaration adopted by CND  along with the Anti-Narcotics Policy, the implementation is lagging and there are serious gaps in  the enforcement of stated goals. This underscores the lack of effective treatment intervention  based on scientific evidence, in keeping with international human rights obligations. The  government needs to step up its treatment interventions in order to address this disparity. KKAWF views enhanced coverage of gender and age-sensitive standardized evidence-based  treatment as urgent, as well as rehabilitation and social reintegration policies, which are centered  on rights-based protocols for all drug treatment and health services. These approaches deliver  better public health outcomes. It is also imperative to integrate these into national health systems  and put in place a system to monitor these services, with an eye to controlling drug use-related  blood borne diseases. As a beginning, the government led by the Ministry of Narcotics Control  must develop a robust national policy for both public and private rehabilitation centers in  Pakistan, which also clearly monitors the operation of private rehabilitation centers. There is an immediate need in Pakistan to create legislation, specific for private rehabilitation  centers, to force them to comply with international quality standards in drug treatment. It is  necessary to mainstream evidence-based treatment of drug use disorders, as well as the delivery  of services aimed at reducing the associated harm in community settings. KKAWF hopes that this intersessional meeting will be a wake-up call to better meet the  treatment and health services needs for drug addiction sufferers and provide an opportunity to  regain the loss that drug addiction causes in Pakistan. Thank you

Netherlands: We align with the EU statement. Drugs policy approaches – supervised drug consumption rooms are an important intervention that have steadily decreased the number of fatalities. These services are funded by the cities and municipalities with the intention initially to get people who use drugs on the streets inside, to a safe place. Social systems have evolved, living conditions have improved, heroin use has declined, especially injecting drug use. The number of new HIV infections is now virtually 0. We are saving human lives which in the context of the pandemic is as important as ever. Despite a strong political commitment, life saving services have continued to … Only if we leave noone behind, invliding PWUD, will we be able to achieve the SDGs.

EU: The continuing high rate of infections of blood-borne diseases – there is one major issue that keeps the number high, unsafe drug use. Injecting drug use counts for 10%of new HIV infections. This might have deterioirated during COVID19. The tools that can help countries are included in the guidelines by the EMCDDA & ECDC. In order to be successful, MS need a comprehensive package for PWUD that targets HIV and hepatitis prevention, low-threshold testing. During the ongoing pandemic, we should focus our efforts on this key population to ensure their vulnerabilities are not increasing.

NGO É de Lei: We are a non-profit civil society organisation that, since 1998, has promoted harm reduction in relation to drug use. Our actions are aimed at affirming and defending the human rights and citizenship of people who use drugs, especially in situations of vulnerability. É de Lei is the first drop-in center for people who use drugs in Brazil. Our work consists of four pillars: Strategic and operational management; Teaching and research; Communications and advocacy; Harm reduction practice. When it comes to the latter, our drop-in center offers a space for exchanges and support, guidance and referrals to other key services for people who use drugs. Our outreach work engages people who use different drugs in a broad range of contexts to encourage notions of self-support as well as to develop harm reduction and prevention strategies that respond to their realities. In this sense, we work, for instance, with environments of leisure, with people who are homeless, and with women. In the context of the pandemic, we have observed a worsening of the situations of vulnerability experienced by homeless people and people who use drugs. Being one of the few civil society organisations that continued to carry out activities despite pandemic-related restrictions, we noticed a significant gap in access to information related to COVID-19 prevention. We also noticed that the strategies and restrictions implemented by public authorities did not take into account the situation of homeless people. How does one shelter at home when one doesn’t have a home? How to wash one’s hands with soap and water when one doesn’t even have access to drinkable water? To respond to these challenges, so far, we have produced and distributed information leaflets with specific strategies for homeless people. We have used novel technologies, like using large-scale projectors to showcase crucial and accessible health and safety information onto building walls in the city center. We have affixed posters on city walls, to help street-based people navigate where to find water and food. We have also distributed basic supplies to protect health and prevent coronavirus transmissions. The situation has been dire in my country. Brazil has the second largest number of deaths by COVID-19 in the world. It goes without saying that responses to the pandemic need to consider racial and economic disparities, that condition the capacity to abide by confinement rules. Our national political context also poses challenges in terms of civil society participation. Despite prior progress in that regard, the National Drug Policy Council no longer provides space for the participation of civil society. The voices of populations most affected by drug policies are side-lined in the development of the said policies. In addition, there have been changes in the direction of drug policies and harm reduction services are being stigmatized and have lost funding. As we have increased our outreach, more and more people have come to our harm reduction teams to seek support in taking care of themselves, and to procure hygiene products, as well as harm reduction. That said, there have also been opportunities for new encouraging partnerships: The #LoveExists (#ExisteAmor) campaign, developed by musicians Criolo and Milton Nascimento, have raised funds to support street-based people during the pandemic. Our partnership with the International Drug Policy Consortium and the Elton John AIDS Foundation, has allowed us to provide protective and harm reduction supplies to street-based people. And our participation in remote webinars have allowed us to reach new audiences to raise awareness of the positive impact of harm reduction and to inspire others with the lessons that we have learnt. Our work supporting communities in the street has, thus, been complemented by building new productive partnerships online. Despite it all, we will continue to fight for health, prevention and to guarantee the rights of all people. Thank you

Switzerland: While both challenges are interrelated, I am focusing on diseases. What we hear from affected people is alarming. Consumption rooms have been operating in Switzerland for more than 30 years. They reduce risks and save lives, are scientifically proven and have reduced the rates of new infections associated with drug-use. They also mitigate the rate of overdose deaths. This is also an important touch point for other social services.

Paraguay: The national drug policies and health policies work in alignment with the SDGs and center integratied services working towards the univeral health coverage. There is no one-size-fits-all solution, it is our goal to improve the standards of living and lower the number of new infections.

 Civil Society Forum on Drugs: The CSFD is an expert group to the European Commission gathering 45 civil society organisations across Europe and representing the diversity of fields and stances on the subject. We are here to provide a set of recommendations from the European perspective to strengtheni the field of treatment in the upcoming years. We thank the VNGOC for giving us the chance to participate today. Recommendation 1: Promote the public health perspective – Drug dependence and other addictive disorders are a matter of public health and drug dependence services should be considered essential public healthcare services. Ensuring the continuity of treatment services is particularly needed in times of COVID. Organizations that provide evidence-based treatment should be integrated into each country’s healthcare system to improve the quality of the services. Unfortunately, the reality is that certain treatment modalities, such as therapeutic communities are sometimes marginalized and undervalued. This needs to change. Additionally, this public health perspective on drugs will help eliminate stigma, which constitute one of the biggest obstacles for entering and adhering to treatment, particularly among women. Recommendation 2: Need to assess the magnitude of the problem and provide sufficient resources – Public authorities should not only take into account the most problematic profile of uses but they also should widen the scope of treatment programmes and include populations who are often forgotten. This should result in a higher funding at national level. Treatment programmes are scarcely funded and decision makers need to implement high-quality treatment services and to provide the funding required to operate them.  Recommendation 3: Need to strengthen the continuum of care logic –
The split between harm reduction services and drug treatment services stands in the way of offering effective care. Treatmen is a continuum of methods, and abstinence can occupy different positions on this continuum. While harm reduction services endeavour to mitigate the risks that arise from drug use, detoxification and rehabilitation objectives are typically left out, and since drug treatment programmes are often seen as only abstinence-oriented, they are not included in the World Health Organization’s Harm Reduction package. Regarding opioid substitution treatment, we would like to emphasize that the use of illegal drugs while in OST should never be a reason for excluding a client from the programme. The medication dosage must never be adjusted as a reward or a punishment. We recommend to include the recovery perspective in national healthcare system to ensure greater effectiveness of care. Recommendation  4: Need to take into account all profiles of people who use drugs – There is a clear need to advance in the research, design and implementation of programmes for profiles such as:

  • Young people and their families
  • Homeless people
  • Aging population
  • Women
  • LGBTQI+ community
  • People with disabilities
  • Migrants and refugees

Additionally, treatment programmes should include an intersectional perspective as well as a gender perspective. All of this would require the professional teams to be trained. Recommendation 5: Ensure treatment in prison settings – We support offering treatment as an appropriate alternative to imprisonment and even more so, in times of COVID where prison overcrowding poses a major problem. Based on the equivalence of care principle, countries should ensure that evidence-based treatments, including OST and other pharmacological treatments are provided in prison settings. Currently, only fifty-four countries across the world provide OST for people with drug dependence in prison. Additionally, the continuity of care between the community and the prison upon admission and after release is key to ensuring the effectiveness of prison-based drug treatment programmes. Recommendation 6: Support the lessons learned from COVID – The field of treatment has been very innovative during COVID with the introduction of more flexibility in OST prescription and greater use of e-health options. We recommend to evaluate and monitor the impact of such changes on services and their clients, and adapt the services according to the evidence. All in all, CSFD considers that treatment is not considered a priority in the international and national political agendas. And it should be. As noted by the Ministerial Declaration, treatment services are falling short of meeting expectations and needs. We know that research, innovation, funding and political will could prove decisive in improving and strengthening evidence-based treatment services. Our recommandations, as Civil Society, can allow to do that and meet our common objectives. Therefore, treatment should definitely be in the political agenda. Thank you.


Thailand: Universal health coverage, including the provision of treatment to people who inject drugs, Thailand supports. Globally, health promotion and prevention of desease – we have been investing heavily. During the pandemic, we have seen the need to strengthen our collaborations and investment in people and their security is majorly important.

UK: The number of drug-related deaths continue to rise, we have to think about the trends behind that. According to our new strategy, we will focus on prevention, treatment and rehabilitation. We work with experts in academia, civil societies. During the pandemic, it is important to maintain our support of individuals – maintain access to OST, have in place take-home protocols and …



Chair: Thank you. See you tomorrow.

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