Side Event: The Humanitarian approach to drug policy: opportunities and challenges for an effective cooperation between public authorities and health-based organizations

Organized by Italy with the support of the Council of Europe – Pompidou Group, the International Federation of the Red Cross and Red Crescent Societies, the UNODC Prevention, Treatment, and Rehabilitation Section and the Vienna NGO Committee on Drugs

The event will provide concrete examples of cooperation, and a common ground of commitment between governments and health-based communities and professionals towards a humanitarian drug policy. The goal is to propose common strategies to avoid the suffering and death toll caused by drug abuse disorders, promoting a humanitarian drug policy approach in the international community. In the event, it will be taken into consideration the experience of the “Rome Consensus 2.0: towards a humanitarian drug policy”, as a valid document promoted by civil societies and NGOs, aimed at enhancing treatment accessibility, rehabilitation and mental health services, creating healthier and safer communities.

Moderator: Flavio Siniscalchi, Head of the Department for Antidrug Policies of the Presidency of the Council of Ministers of Italy

Panelists:

Fabiana Dadone, Minister for Youth Policies of Italy with the Mandate for Drug Policies and Addictions: Thank you – unfortunately there is an unjustifiable situation in Ukraine at the moment – this is completely unacceptable – I offer Italy’s solidarity with Ukrainian people. Today’s topic – this approach is essential and people centred services must always be implemented – the reduction of the supply and prevention, treatment, risk and harm reduction, also investment for research. You must not focus only on one side of the coin – there is too much stigmatisation of drug users. We should consider different approaches and consider psychological side – the risk of stigmatisation is not worth it and should be avoided at all costs. It leads to marginalisation and is not helpful. Distrust is created in relation to different systems and treatment services. We need treatment that considers the needs of the person. We as decision makers should always be open to requests from civil society. We should use these proposals as best practices with civil society, at the national and international level. This stems from civil society and the Rome Consensus 2.0. We can achieve the most ambitious objectives and provide effective responses. At the national level I have seen this myself – a bottom-up approach and together have built a path forward. We have finally agreed to a conference every 3 years. Symbolically – the consultations have also started in prisons with people who are not free. These people must be included too. This is the right forum to promote humanitarian approaches to effectively fight against drugs and drug addiction and balance supply and demand reduction.

Ghada Fathi Waly, Executive Director of the United Nations Office on Drugs and Crime (UNODC): I’m pleased to be here to highlight the need of communities in drug policies. Health wellbeing and dignity should come first in drug policies. 1 in 8 receive adequate treatment – policies need to enable provisions of such care. Others are denied access to pain relief. Joint call to action to facilitate access to essential medicines yesterday. This is more crucial than ever before with the humanitarian and climate crises around the world. This includes access to treatment and care for drug use disorders, HIV and other diseases. Civil society has a key role to play with other key agencies in implementing these policies and but the health, wellbeing and dignity at the centre. We are the bridge between law enforcement and health responses. We work with prevention, rehabilitation, overdose prevention, improving access to controlled meds. Since 2016 we have supported best practices been health and criminal justice services. At country level we are supporting the review and training of law enforcement and in prison settings. We have pledged to leave no one behind in our achievement of SDGs. We reaffirm this commitment in the CND. Welcome this event in providing concrete examples of this. UNODC will continue to work with all cosponsors to put people first and leave no one behind.

Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO): Your Excellency Minister Fabiana Dadone, Executive Director Waly, Dear colleagues and friends, Good afternoon, and thank you for the opportunity to join you to discuss this very important topic. The twin challenges of drug use services and access to controlled medicines are difficult even at the best of times. In humanitarian emergencies, they become infinitely more complex. The COVID-19 pandemic has severely disrupted services for people who use drugs, and hampered access to controlled medicines for epilepsy, pain management, palliative care and more. Likewise, the war in Ukraine puts at risk the lives, and the health, of thousands of people. Ukraine has one of the most well-developed programmes to address opioid dependence in Eastern Europe, with almost 17 thousand people at risk of disrupted services. Many people who use drugs also live with hepatitis, HIV, mental health disorders, and social deprivation, marginalization and stigmatization that makes them highly vulnerable. At the start of the conflict, people who use drugs were allowed to take home up to 30 days of opioid substitution therapy, or OST. The longer the war drags on, the higher the risk that people who rely on OST will lose access, putting them at elevated risk of many other harms. WHO and our partners are working with the governments of Ukraine and neighbouring countries to support continuity of access to essential health services and medications, especially for the most vulnerable. Of course, this is not just an issue in Ukraine. Recently, WHO and UNODC participated in a joint mission to Afghanistan, which included visits to treatment and criminal justice facilities, and meetings with key stakeholders, including the deputy minister of public health. Progress was made, including on the need for policy dialogue to integrate substance use services into primary and secondary care. Everywhere we work, in humanitarian emergencies or not, WHO’s commitment is to protect and promote the right to health for all people. And that means protecting and promoting the right to services and treatments that people need to manage life, or to manage the end of life. Too often, people who use drugs are not afforded the same dignity and care as those with other health needs. And too often, people who need controlled medicines are not afforded the same dignity and care as those who need other medicines. WHO remains committed to working with all countries to progress towards the goal of universal health coverage, based on resilient health systems that provide access to the services and products people need, when and where they need them, including for drug use disorders. And we’re also committed to working with all countries to develop drug policies that protect and promote health and human rights, in line with the Rome Consensus. A humanitarian approach to drug policy is the best way not only to protect health, but also to minimize the health and social harms associated with drug use. Thank you all for your continued partnership, and your continued advocacy on this issue. We look forward to working with you in the months and years ahead for a healthier, safer and fairer world for everyone, everywhere. I thank you.

Denis Huber, Executive Secretary of the Pompidou Group of the Council of Europe: We express full solidarity with Ukraine, our newest member of Pomp Group since Jan 2022. We are about to hold an EGM later this week that will likely result in the expulsion of the Russian Fed from the PG due to the war. I will highlight 3 main aspects: 50th anniversary of the Pompidou Group last year, we adopted a new statute with a strong focus on human rights, to promote human rights in all aspects of drug policies in our statutes. We have developed a self-assessment tool to evaluate their drug policies for human rights. There is also a focus on strong synergies with UN partners – we are working on a daily basis with them. Also partnerships with civil society – we must have civil society to uphold human rights. Strong points – harm reduction and fighting stigmatisation -we hope this will be addressed in one of the upcoming CND meetings. We support the implementation of drug consumption rooms and are working on setting up a network of drug consumption rooms including civil society orgs including Harm Reduction International and Correlation. Focus of people in detention and deprived of liberty – we are working to provide services in Eastern Europe for people in prison. OAT in prisons is very important – we share concerns with Tedros re Ukraine today.

Massimo Barra, International Federation of Red Cross and Red Crescent Societies: I have a lifetime of work with people who use drugs. Among those who suffer the most – drug use is the most discriminated. We have been calling for a very long time for a human approach to drugs. Rome Consensus campaign since 2015 – to explore solutions in health, criminal justice and community responses to addiction problems. The Rome Consensus supported all around the world to inspire international community on the effectiveness of humanitarian drug policies. Our dream – first responders, people who use drugs working together. The pathway is long, and should be considered a continuum of care – death must always be avoided by harm reduction initiatives. Our strategy is to reach, meet and treat all people in the world with drug disorders. Fruitful solution that should be in the interest of any government, those that want to be treated in a recovery centre. In this sense – treatment is the best prevention. Today many governments still consider drug users a criminals and they are being punished. They are forced to live in pathogenic environments. Resources are not distributed properly – resources should go to health responses over law enforcement in a balanced way. People should not be treated under a justice regime. I sit in first board of Global Fund – this changed the lives of 1 million people treated for HIV and malaria – this was very successful. A new Global Fund on drugs is needed, to address drugs in humanitarian matters. As the Red Cross and Red Crescent – we are ready to work together. Cooperation and partnership are needed.

Mercy Karanja, Ministry of Health of the Republic of Kenya: Kenya supports the Rome Consensus 2.0 towards ensuring humanitarian and rights based approaches to people with drug use disorders. Multi-stakeholder involvement has resulted in progress with health care services, civil society and government agencies – there is room to improve but we are moving in the right direction. Kenya has implemented the UN package on harm reduction – needle syringe programs, opiate substitute treatment, HIV care, hepatitis management, overdose management – Kenya has 10 public facilities for opioid users – comprehensive services in coastal areas. We have now extended this into prison settings, to serve incarcerated persons. We have implemented mobile services in COVID, and looking at alternatives to incarceration. Needle and syringe programs have been implemented very successfully by people who use drugs themselves as peer educators – this is a big shift and success. We have empowered community health providers. The Kenyan MOH has adopted rights based approaches for people with intellectual disabilities and reduction of stigma. We have also a multisectoral approach for implementing treatment standards. MOH adopted use of technologies. Stigma is still a big part – culture change is needed by policy makers, supported by civil society organisations – we need special programs for youth and adolescents. NACADA – increasing vulnerabilities for youth and children. Sustainability of programs – we remain committed to ensuring rights based approaches for people who use drugs.

Joan Mary Marston, Vienna NGO Committee on Drugs (VNGOC): I’m speaking on behalf of the palliative care community. I’m a paediatric palliative care nurse. The goal is the relief of serious health related suffering, whatever the cause, particularly in Ukraine. Half million Ukrainians needed access to controlled medicines and opioids in Ukraine BEFORE the war. Now we do not know what the numbers are. We ask that the barriers to medicines be brought down in Ukraine. We ask that controls to not restrict access to controlled medicines opioids. We really appreciate the joint statement, particularly in humanitarian settings. These medicines have been listed for 45 years now and are on the list. Every country needs to integrate these into their health systems and training – until then, we will not reach everyone. This is not just for palliative care – for people with mental health and neurological. Also, neonates and older people. Conflict increases the need for controlled medicines – we need to get medicines across the border. The value of death highlights the need to alleviate suffering – how we value humanity and dignity in the face of this present and future humanitarian crisis – we need to take urgent steps to plan for the future and work together for long term solutions.

Representative of Ecuador, the Commissioner for Anti-Drug Policies: All the efforts must be focused on the person, not the substance. Despite the limitations of the epidemic, we aim for the coordination of central government, academic and civil society in regards for public policy. Through the committee of drugs, policies are implemented.

Matters of research – we have advocated for study and learning of natural plants to guarantee therapeutic uses of plants and species whilst also providing a robust network of scientific achievement. In regard to health care, the interventions have been designed for human rights and health approaches. Strategies have been developed to encourage social and economic change and sustainable initiatives. We are committed with reinforcement and development to achieve inclusive rural communities. Our aim is to create resilient communities with peaceful experiences. Shared responsibility of public and private institutions at national level – the commitment is made in the communities for local efforts regarding prevention and treatment, and research. Cooperative links between public and private centres, particularly for women in stages of pregnancy. Treatment centres refer cases to public health hospitals. Developing and attaining a system between public and private sectors was no easy task. Nationwide multisectoral strategies are needed – it was unlearning the notions we had about drug users, and recognising stigma. Only then we could implement successful interventions. Articulation of health and security strategies is increasingly demanding. This nourishes with the participation of civil society, academic and therapeutic communities.

 

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