Side Event: Five years of UNGASS implementation – promoting public health and well-being

Organized by Sweden with the support of Denmark, Finland and Norway, and the UNODC Prevention, Treatment and Rehabilitation Section and the World Health Organization

Opening remarks • H.E. Ambassador Kjersti E. Andersen, Permanent Representative of Norway to the UN in Vienna: We are, in many ways, siblings – sharing more political similarities. There are some common characteristics that I find useful for you to have in mind as we go along but there are also differences among us, Nordic countries. Among the commonalities is the so called Nordic welfare model, which is similarly applied among all the Nordic countries. The model is built on the core universal principle that all citizens have the right to free and equal access to social and health services, where access is not based on the ability to pay for economic needs. The services are intended to allow individuals, accessing services, to maintain a relatively decent standard of living. The basic values underpinning the model are equality, compassion and tolerance. Furthermore, public health is at the core of the Nordic welfare model and drug policies as public health approaches offer effective, evidence based responses. The underlying mission here is to improve the conditions and behaviors that affect health through prevention and treatment of disease and other physical and mental health conditions, so that all people can attain good health. That fully corresponds with and mutually reinforces the overall goals of the drug conventions to increase health and well being. Also, the commitments of the Sustainable Development Goals, namely to leave no one behind, is a core message. Moreover, the preparations and adoption of the UNGASS outcome document confirmed a global interest to increase the focus on public health on prevention on ensuring treatment on care and on harm reduction, and thus to rebalance the implementation of the treaties – more emphasis on demand reduction and health without abandoning the other pillars. Consequently, the Nordic countries welcome the process leading up to the UNGASS outcome document. It is very promising and a potential catalyst for a shift in international policy, as this will be in line with the values and range of instruments that Nordic drug policy is based on. The document contains over 100 operational recommendations in seven thematic chapters, focus on demand and supply reduction, the availability of controlled substances for medical and scientific purposes, human rights challenges and new trends, international cooperation and development in both areas. We would claim that these recommendations were already included in the Nordic countries approaches. However, that does not imply that we have fully honored all recommendations, without a need to further improvements. We do also know that the world drug problem continues to create public health challenges, leading to overdose deaths, HIV and hepatitis C infections, and other chronic health conditions. At the same time, about a third of all deaths are classed as premature and could have been prevented by lifestyle changes at an earlier stage in life. For these reasons, it is useful to assess what we have learned and achieved in these past years after the adoption of the outcome document, and most importantly, what we need to improve. I look very much forward to the other interventions and to the panel discussion today. Thank you.

Moderator Elina Kotovirta, Ministerial Advisor, Ministry of Social Affairs and Health, Finland

Joakim Strandberg, Public Health Agency of Sweden: I will try to give a short overview of the work that we recently have done in Sweden, and a report that we have produced for the Swedish government. So the mission from this discovery was to provide an overview of the past and ongoing work on the national level, that relates to the recommendations in the UNGASS outcome document – we just recently finished this report so if you want to have more information we have an English summary. Swedish policies are in line with the majority of the declarations and recommendations. This comes from the national strategies and programs, where all areas correlate well to most of the recommendations. However, from our report, it was not possible to draw the conclusion on what extent in Sweden have the recommendations been comprehensive. So that is something to look into further if we feel the need to do that.  We firstly we looked at all the 103 recommendations and assessed them according to the Swedish relevance, and the conditions in Sweden were then reviewed with all the available data and reports. So we did not produce any new data for this, but compiled all the existing data. Then we identified and described examples of work that were in line with recommendations. I will give some examples of what we have found when it comes to the recommendations concerning demand reduction prevention and treatment: we see that we have a lot of activities and strategies that support this. For instance, we have activities that strengthen and empowering parents and creating a safe school environment for children. We also have targeted measures for groups and individuals that are in greater risk to start using drugs or develop problems. We also have strategies and laws that ensure access to drug related treatment and care and support, and this is mainly by voluntary participation. It could be both by psychosocial or medical interventions. And we’re also have in place activities to reduce drug related deaths – For instance, programs that deliver Naloxone to people at risk. When it comes to the recommendations concerning supply reduction, law enforcement and responses to drug related crime: We have seen that we have a National Crime Prevention Program, which is called ‘combating crime together’, which was taken forward in 2017. Here we have focused on creating the necessary conditions for structured and long term crime prevention work in all areas of society. We also have a 34 Point program to combat gang crime, the police have increased efforts to reduce the availability of illicit drugs. And we also have in place national strategies and actions plans to combat money laundering and financing terrorism. So, when it comes to recommendations of drugs and human rights, youth, children, women, and in community, we see that we have policies and strategies that support gender equality perspective, and that this gender equality perspective should run through all of Sweden’s policies, and it also has been emphasized in the Swedish strategy for alcohol narcotic drugs and doping tobacco and gambling. We also have made the UN Convention on the Rights of the Child as a natural law. We have in place, alternatives to imprisonment, and it can be intensive surveillance or conditional sentence with the community service.  In the last example that I was about to present. Of course we have a more detailed description in our report. So please contact me if you are interested in more information.
Thank you.

Gabriel Wikström, Swedish national 2030 Agenda coordinator, former minister with responsibility for public health and health care issues: I remember from UNGASS the spirit of understanding and trying to find a common ground among actors that came from different backgrounds and different perspectives on the issues. I mentioned this because this is, as we all know, very important for the continuing work but it was also a main aim for from Sweden, trying to build bridges with other countries, and stakeholders with a totally different perspectives. In that sense I think that we succeeded. I also mentioned this because, being the National Coordinator for the 2030 agenda, we need this kind of understanding and and collaboration and it’s the same with the outcome document from UNGASS 2016. I think to integrate drug prevention in a much broader public health, prevention and promotion is necessary –  this is much easier to say than to do, because we, we still treat the different aspects of public health in their respective silos, even though we know that drug use is of course related to mental health is of course related to what happens in childhood and so on. I think this should really be the focus from the Nordic countries’ perspective: to show how a history and a tradition of generous universality in a much broader public health perspective or public health, family – this is not a very easy journey, not at least from a Swedish perspective. But I really hope that this could be a project for the coming years and that we could, in many ways, integrate this with what we’re doing around 2030 agenda. So this is my two remarks, we have a ground collaboration we have a ground for understanding and that we now need to to broaden drug prevention and promotion in in public health perspective. Thank you very much.

Giovanna Campello, Chief, UNODC Prevention, Treatment & Rehabilitation Section: it’s a great honor to be here with you today to think together about the legacy of UNGASS in 2016.Let’s not think only about the challenges, let’s also think about the positives. The truly remarkable feature of the outcome document, was the fact that this is the document where the international community really took t at the core of the conventions’ basic concern, the health and the well being of people and the aspects of responses on the world drug problem should always be in the light of health, dignity and human rights. And you can really see it in the extensive commitments on prevention, treatment, harm reduction, improvement of access has led to progress. I have seen consistent promotion of evidence based prevention of drug use, based on the standards and increase even sometimes sustained action supporting families and schools – so much so that this led us to publish the standards on treatment. Now, let’s think about treatment and coverage of treatment: it is low, we know that only one in eight people with drug use disorders are in treatment. However, the few evidence based services that exist are effective, they do reduce drug use, drug use disorders they can reduce crime, and they are resilient. I have been to a scientific consultation last week on services in the context of COVID, and it has been impressive to see the degree to which services have adapted and pushed for continuity to be maintained to support people who use drugs and people who interact use disorders, really remarkable. And finally, I’ve seen at least some countries taking decisive action to promote access to control medicines for the management of pain and proving that it is possible to improve access while preventing diversion of abuse. So now what we need to do is take this progress and expand it. Yes, the pandemic is a challenge but there were challenges before, and the pandemic has shown that this work is more necessary than ever, particularly in the prevention, the pandemic is not an excuse. So I have two areas in my mind, where I think we need to do more. Two out of the many. I’m very grateful to Norway for sponsoring a pilot that will allow us to develop a tool to assess a national prevention system on the basis of the standard. It’s a great step forward for prevention. Sometimes we don’t even know how much prevention that is what the quality is, and of course also really need to improve the at least the data on treatment coverage that is at the core of the progress on SDG 3.5 on prevention and treatment. So this is about knowing more regarding responses. I would like to underline the need for building systems that are responsive to population that are also responsive to populations that are in difficult circumstances, and the circumstances make them particularly vulnerable – people in contact with the criminal justice system, including imprison settings, people whose humanitarian settings. These are the ones that come to my mind, that has been mentioning, we can expand in the discussion. There are many more, of course, but there needs to be more action there. And as a final point to conclude, I would like to mention that this calls for a quantum leap in the level of national action, international cooperation and interagency coordination. We agreed to this year work together with WHO for 10 years now. Really working together in a joint program and national international level we’ve seen how effective this can be, and we think that this cooperation should be expanded to become a new interagency mechanism that connect existing and new resources in a clear and poll so that we’re all working together to achieve the commitments.

Vladimir Poznyak, Head, WHO Alcohol, Drugs and Addictive Behaviours Unit, Department of Mental Health and Substance Use: The UNGASS outcome document is definitely an important milestone on the road towards public health approach to the worldwide problem. And today, we saw evidence by experiences from Nordic countries that tangible results can be achieved with the implementation of the recommendations, though, of course, not everywhere, and with different level of investment, and with different outcomes. We welcome the shift to a more balanced and comprehensive approach to drug policies that puts public health and development outcomes at the forefront. It is consistent with the goals and intentions of international drug conventions, and the agenda of sustainable development goals. It is remarkable that among SDG health targets, we have the target 3.5 with a commitment to strengthen prevention and treatment of substance abuse, covering both alcohol and drugs. Effective implementation of UNGASS commitments are necessary for advancing all these health targets and the rebalancing of policies requires implementation of a comprehensive package of public health measures that include preventionand treatment in care of people with drug use disorders and have legitimate access to control medicines and proper monitoring and evaluation, effective prevention of drug use, particularly among children and adolescents is one of the key pillars of public health approach. This approach requires comprehensive multi sectoral actions that target risk and protective factors, as well as broad social determinants of health, and this is a very challenging task. But at the same time the prevention efforts should not entrench discrimination propagate human rights violations, only to deny access to health interventions for people who use drugs. We produce the second edition of the International standards for the treatment of drug use disorder. Also last week, we released the final report from our collaborative implementation research project on prevention of opiate overdoses that project was implemented in four middle income countries, and demonstrated feasibility and public health benefits have access to Naloxone for potential weaknesses of overdose. Unfortunately, the reality is that for the vast majority of people with drug use disorders, effective treatment is not available, or when available, is often too expensive for individuals that drives them and their families into poverty. One of the major problems that we have now is sustainable funding of prevention and treatment systems strengthening health services, ensuring availability and quality of treatment for drug use disorders, addressing stigma and discrimination and inequities in treatment access are cornerstones of a health system response. We clearly see the progress with implementation of unbiased recommendations, but it is uneven in different parts of the world. And the theory of public health, we do not see yet, the same level of commitment, investment in global coordination and action, as in some other areas of public health. We need to accelerate action at all levels. We are convinced now after five years, that we need to engage more strongly with UN entities, intergovernmental organizations are the partners to accelerate action on prevention. We need an effective interagency coordination mechanism, focused on unveils recommendations on prevention and treatment of drug use and drug use disorders, and that will allow us in the UN system to support more effectively countries in implementation, Thank you

Jan Gunnar Skoftedalen, Leader of Fagrådet, the Norwegian Addiction Federation: Thank you for the opportunity to participate here. From our point of view, the outcome document was a step forward. I recognized that the it has been claimed that the implementation of the document has not been taken seriously in several countries. In Norway, I think it’s possible to see how the spirit has inspired our drug policy over the last five years, the Norwegian Addiction Federation is especially pleased that the human rights has gradually gained increased international attention in the drug policy, despite some setbacks. I mean each country must see how they comply with human rights at home. Also, we know, Norway, must improve. The only discussion in our country right now, whether the police has violated the human rights, and used research one
director of the public prosecution had to send a clarification to the police. It’s important, of course, and we have good access to treatment for addiction in Norway. Just, just as important is this the access to other kind of healthcare and medicine. We know that diseases like Hepatitis is a big problem among people who use drugs  – in Norway we believe that we’ll be able to eliminate hepatitis C already in 2023.  A good health care for drug users will increase the public health enormously. Harm reduction is necessary, as I said earlier, is the spirit of the Norwegian government. The government has proposed several important changes to decriminalize, and the parliament has proposed proposal for consideration this spring,  we will decide in June – it’s exciting but the outcome is uncertain. At this time, we will also start with a pilot project with seven assisted treatment and the guidelines for other opiate substitution treatment is revised. Most of these changes are brought forward by civil society, The UNGASS outcome document recognized that civil society play a crucial role in effective addressing the issue. So overall we mean that the civil society is important and often improved our work… though we don’t always get what we want. Thank you.

Moderator: One of the big progress of the UNGASS is indeed the larger space civil society is allowed to take up. I would like to hear the point of view of the UNODC and WHO is we can do more to encourage more involvement?

UNODC: In my experience organizing the youth forum, we invite the Member States to nominate youth. These are completely up to the Member States to organize as they want. Some organize competitions. We often askMember States to nominate experts – there is some work that we can do together. We can really start shifting perspectives and make sure CSOs are actually participating and have access to delegations. We need to do more there and increase representation of people working in treatment but also of people who use drugs and also people who are in recovery.

WHO: We involve civils in the normative work. Now, in every process of developing guidelines, we require to involve people with lived experiences.

SSDP International: Youth Forum transparency? Young people who are located in countries where there is not a tradition of CSO participation, can they access support?

UNODC: This has come up in the past and we have to move our frameworks where Member States are in the driving seat. We encourage transparency, we do a lot of connecting. If people reach out to us, we make sure they find their way – we published a handbook for Member States on youth participation including setting up selection processes that are more participatory.

Gabriel Wikstrom: Capacity around CSO and treatment. We have to strengthen capacity at national governments.

Moderator: Youth participation hasn’t been something we shared best practices about yet, but so this is a point to return to. Us, in the capitals, we work on CND-related issues only this week. In the public health perspective, law enforcement is key: police officers refer people to services, they are not just there to punish.

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