Home » Side event: Mainstreaming a gender perspective in the treatment of drug use disorders

Side event: Mainstreaming a gender perspective in the treatment of drug use disorders

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

H.E. Annika Markovic, Ambassador and Permanent Representative of Sweden: Sweden is very pleased to organise this event. There are serious challenges and shortcomings in tackling women’s specific situations in drug care and also in relation to gender-based violence. Very pleased to be discussing this in further detail through this panel. In a national capacity, Sweden is very glad to have a feminist governemnet. We are committed to building a gender-equal society. Our drug policy seeks to reduce health inequalities and as members of CND one of our priorities is promoting gender equality and mainstreaming in international drug policy. It should not be a separate track but permeate all work with drugs. We support UNODC’s work on gender through our general purpose funding. We call on member states who want to see real change in these matters to join us.

H.E. Luis Javier Campuzano Piña, Ambassador and Permanent Representative of Mexico: Before we go to the presentations of experts, it is important to address a question notwithstanding how obvious it may be – why is it so important to mainstream a gender perspective in treatment of SUDs: Because some still question the need and urgency of this matter. Our panellists will provide solid arguments and evidence that even the most sceptical will think twice before questioning again the need and motivation to mainstream a gender perspective in all of our work. This event is also an opportunity for networking. If the organisers are not opposed to this idea, I encourage participants to share links and ideas on this topic.

Ms. Lena Ag. Director General, Swedish Gender Equality Agency: The main goal of Sweden’s gender equality policy is that women and men should have the same power to shape their lives. The Gender Equality Agency supports the government’s goal in this regard. Through analysis, responsive budgeting, supporting coordination and monitoring of national strategy against men’s violence against women, etc. Women and men must have the same opportunities and conditions for good health and be offered health and social care on equal terms. Work in Sweden seeks to improve access to care and support. No quick fix but the goal is clear, equal care with an intersectional approach. An important area which needs further attention is people with drug use disorders. Sweden’s situation on gender equality on this matter isn’t sufficient. More men than women are being care for for a drug related diagnosis, harmful use or drug use disorders. More than 33,000 received care – only ⅓ were women. When it comes to OAT, we see clear differences too – 4,000 people access it but only 30% are women. Dispensing of drugs for opioid dependence is twice as common for men than women. The gender gap has decreased somewhat over the past 4 years. There are clear differences in terms of access to health and support. Why? Possible reasons include: female drug users manage to hide their substance use longer than male drug users; and we haven’t fully developed a gender sensitive approach to access to healthcare. Another important issue: gender-based violence. One of the goals of our equality is that men’s violence against women must stop. Sweden is implementing a strategy in this regard, stretching from 2017-2026. Various measures have been taken to increased detection of this violence as well as strengthening victim support, including municipality services and civil society organisations. However, not all groups of women have sufficient access to this support. Women with harmful use of substances or SUDs are at higher risk to be subjected to violence. The perpetrator is often a current/former partner, but also acquaintances and professionals. Women who use drugs are also more vulnerable when it comes to receiving protection and support. ⅘ shelters for women don’t have the capacity to receive women with harmful use of drugs or SUDs. Few measures are focused on this and women are often trapped between interventions. Women shouldn’t be forced to choose between SUD treatment and support in relation to exposure to GBV.

Ms. Carmen Fernandez, Director of Centros de Integración Juvenil (CIJ): Gender is a conditioning factor for health. Women and men get sick in different ways. Women experience stigma when they use drugs. Women who use drugs are more likely to experience aggression and violence when the couple uses drugs. Many women do not have access to treatment. Among women and men there’s different types of consumption and reasons to abandon drug use. When it comes to cases of treatment, we notice increase of methamphetamine use in Mexico, and cocaine. Both have consequences of violent behaviour. The first drug that lead people to access treatment is methamphetamine, cannabis, then alcohol. In the sample of women who access treatment, the women who use drugs suffer more violence, use more alcohol, and use more medical use of substances. When women use drugs, life is more difficult and with violence. In terms of the specific services we have: mental health care, because most women have depression (different from men, usually related to them losing work or lacking money to provide for their families). In terms of the topics that are raised: sexuality, motherhood, body image and gender violence. We have many activities to support children. We have many treatments in rehabilitation programmes: consultation; group therapy; family therapy – we include couple therapy because of the cases of couple violence; hospitalisation, harm reduction. The units are comfortable, the rooms are clean, there’s a gym; it’s a comfortable space. We respond to 151 thousand people, including online as a result to the pandemic. Now 75% attends online. Big opportunity to respond people all over the country. I made a family model with many components and these are some narratives of women in treatment: ‘I want to improve myself because I’m failing as a mother’, ‘I started to like my body slimming down due to drug use’, ‘you feel the prettiest, the most sensual, the sexiest, it gives you value…’, ‘I no longer want to be dependent on drugs or my parents’… We have produced a multidimensional family therapy model with a gender perspective, which has a gender equality perspective and integrates a complex vision, with a therapeutic team that has women and men, integrates psychoeducational group and social support too.

Dr. Vladimir Poznyak. Head of Alcohol, Drugs and Addictive Behaviors Unit, World Health Organization, Geneva: Development of gender sensitive drug services is  a prerequisite of good quality healthcare and UHC objectives. Still a challenge in the treatment for many conditions, including drug use disorders. Women are 3x less likely to use cannabis, cocaine or amphetamines. 5x less likely to inject drugs. 1.6 less likely to use alcohol. Convergent trends in use of alcohol, nicotine/tobacco in parts of the world. Overall, the prevalence of drug use disorders is smaller among women. When it comes to the burden attributable to alcohol and other drug use, there’s a clear need to have an early identification of SUDs. When talking about a gender perspective, useful to discuss the impact of sex and gender. These factors have an important impact on the development of SUDs. For example, high levels of anxiety and depression on women. Sex and gender have an importance on cause, prevalence and manifestations of SUDs, such as rapidity of development, comorbidities, gender based violence. Sex and gender have a huge impact on treatment of drug use disorders. First on health-seeking behaviour and initiation of treatment – delayed due to stigma and fear of consequence of diagnosis. Specialised programmes do not exist in many jurisdictions. Gender differences in stigma and discrimination associated with diagnosis – not all of programmes promote family, community and social inclusion. When it comes to health priorities: addressing social determinants, ensuring access to gender tailored prevention and treatment services and interventions, updating and developing further gender specific guidelines, updating of education and training curricula, safeguarding against stigma and discrimination, research and data disaggregation.

Ms Giovanna Campello. Chief, UNODC Prevention, Treatment & Rehabilitation Section: In terms of the recommendations for the effective management of drug use disorders, as included in the standards on the matter. It should be noted that females are more likely to take drugs for stress coping, have comorbidity with depression, stress-related diseases, have a shorter onset to addiction, show more craving and propensity to relapse. But let’s also frame these recommendations against the backdrop of women who use drugs themselves – Quotes by South African colleagues including a needs-assessment in the country. We know stigma and limited availability of gender-sensitive treatment services deter women from accessing services. Need to make services welcoming and empathetic. When it comes to caregiving roles and socioeconomic hardship, another big barrier – Treatment services must support caregiving responsibilities of women and address socio economic difficulties; essential to ensure access and retention. When it comes to violence and trauma, this is a recurrent theme – Women long for safe spaces, women-only spaces where they will not be aggressed. WHO identities violence as a risk factor. SUDs are a prevalent consequence of domestic violence. In fact, the prevalence of history of GBV is 2-5x higher among women who use drugs. Need for women.focused, trauma-informed treatment in a safe single-sex setting to obtain the maximum benefit. Special work must be done with regard to pregnancy as SUDs during pregnancy are associated with health issues in babies. Great opportunity to offer VOLUNTARY and evidence-based treatment. Again, non judgemental services, with pharmacological interventions, breastfeeding to be evaluated on a case by case basis and other caring duties. I conclude with 2 messages of hope: 1) Providing voluntary and evidence-based treatment for men and women, we contribute to preventing violence against women. 2) Women who use drugs and with SUDs suffer more health issues and violence, but recovery is completely possible. We must act now.

Questions & answers – If you had to highlight one priority of action, what would it be?

Lena Ag: Increasing access to care and support is so important. I’d highlight the importance of taking action against GBV in relation to drugs. We see care and support for women victims of GBV needs to improve. Better coordination between interventions but also increased quality of interventions. The EU Action Plan on Drugs 2021-2025 has a strong focus on this issue – Like importance of outreach efforts to reach women who use drugs and raise awareness of availability of women-centred treatment.

Carmen Fernandez: The violence. In Latin America, the challenge is to attend the antisocial personality related to the use of amphetamines and cocaine. The consequences on violent behaviour is clear. The impact of gender and couples violence is big and has increased. During the pandemic, more than 1.2 million calls because of family and couple’s violence in Mexico. Big problem and violence.

Vladimir Poznyak: Two of them: 1) Services for the management of SUDs can be sufficiently developed to facilitate gender-specific treatment programmes, but the situation currently is very sub-par. The first priority is establishing a parity of treatment of SUDs with other health conditions. The impact is not less but more, so we need, in line with SDGs, to pay attention to this issue. 2) When it comes to WHO, we have an increasing demand for the normative role of WHO to update the Standards (with UNODC) on the treatment of SUDs in pregnancy, for instance – these were not updated for 6 years, so it’s a priority to maintain updated guidelines.

Anja Busse, UNODC: In line with the Informal Scientific Network, I’d highlight the importance of ending stigma. We need more research on what works in this regard. Also access to healthcare, because so few people have effective access. When it comes to prevention, interventions that benefit boys and girls. When it comes to SUDs, pregnancy and particularly for those in contact with the criminal justice system. Investing also in gender-sensitive research to have verifiable interventions that we know work for women and men. Lastly, the inclusion of women with lived experience in the development of strategies and policies to the extent possible.

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