Side Event: Establishing Quality Assurance Mechanism Towards Truly Effective and Efficient Treatment and Recovery Support for People with Drug Use Disorders in Community Settings

Organized by the UNODC Prevention Treatment and Rehabilitation Section with the support of Nigeria, Pakistan, Portugal, Spain, the United States, the World Health Organization, the Vienna NGO Committee on Narcotic Drugs, the New York NGO Committee on Narcotic Drugs and the Singapore Anti-Narcotics Association (SANA)

Anja Busse:

Welcome to event ‘Establishing Quality Assurance Mechanism Towards Truly Effective and Efficient Treatment and Recovery Support for People with Drug Use Disorders in Community Settings’. Its a mouthful but you can blame Member States for these long titles. All the speakers have different perspectives to present today and I’d like to start with our first speaker.

Giovanna Campello, Chief Prevention, Treatment and Rehabilitation Section, UNODC:

Welcome to the event today. One size does not fit all and all treatment elements need to be inline with public health. Unfortunately this is not reality. Human rights challenges are still major issues in drug treatments. 64/3 Resolution Promoting scientific evidence–based, quality, affordable and
comprehensive drug prevention, treatment, sustained recovery and related support services‘
was adopted in 2021. Since then a conference paper has been released: The relationship between quality of specialist treatment for substance use disorders and patient outcomes: A scoping review of the literature’. This suggests a way forward. Finally behind every treatment situation is a person and a family, and we must remember this. If I seek treatment for a family or friend and I hope treatment is in alignment with quality standards and is also in alignment with human rights standards and that no one is left behind.

Vladimir Poznyak, WHO:

Thanks for for organizing this side event. The World Health Organization is glad to cosponsor the event. These standards (International Standards for the Treatment of Drug Use Disorders – revised edition, incorporating results of field-testing WHO, UNDOC, 2020) were field tested in 10 or 11 years and it took us several years. The conversation is about quality assurance. The principals are that treatment should be available, accessible, attractive and appropriate. The development of quality of assurance tool for the Standards was a long process and there are other Standards, but the question was how to accommodate various organizations and how to consolidate these so they are harmonized. The quality of care is crucial for the success of health services. For individuals and populations to increase the likelihood of desired outcomes is dependent on the treatment being evidence-based professional knowledge. The need to be evidence-based and ethical as well as have long term validity.

Dr. Norna Volkow, National Institutes of Health (NIH):

Great to be here today and honored to be speaking after Vladimir. In the US, and many other countries, only a small section of people are getting care they need. We need not only to expand care, but the quality of care. Researchers have been looking into it. Addiction is a chronic disease. Need to address quality of care. The problem is care is segregated. We need an integrated model of care so people don’t relapse. What prevents mortality? We need to implement what ever prevents mortality. Interventions needs to be personalized and meet the needs of people. Important to address the social determinate of health; we need secure housing, food, transport. Without these there will be no access to quality treatment. Also we need alternatives for people not ready for treatment. Such as harm reduction. We need to provide reimbursement to entice people and need address issue of prevention: primary, secondary and tertiary. We need models of quality care that deliver care for all individuals regardless of income or demographics.

Joan R. Villabi, Spain

We support quality assurance across Latin America. There is path from abstinence to dependence, but we have prevention: universal, indications or risk reduction and treatment. Need to see this as continuum based on science. Both science and international principals that guide us, such as the 3 international drug treaties

Our services derived form the heroin disaster 40 years. Now it has developed into a network for care and treatment; OAT, Supervised consumption, therapy community, drop in centers. In the 1990s the major drug was heroin, but alcohol and cocaine are now the main treatment admissions in Spain. Harm reduction is crucial to keeping people alive in order so they can join treatment when they are ready. We have been searching for quality and promoting everywhere, we use bench marking as a tool and international certification.

Joao Goulao, National Drug Director, Ministry of Health, Portugal

This topic is of utmost relevance for Portugal at both the national and international level. In national level we have a commitment to improve treatment. Similar to Spain, we had an issue with heroin in the 1980s and 1990s. We established a national treatment services. Since a very early stage quality treatment has been of utmost importance. This was not a choice, but a necessity, particularly against the backdrop of heroin public health crisis.

In 2021 Portugal cosponsored resolution 64/3 ‘Promoting scientific evidence–based, quality, affordable and comprehensive drug prevention, treatment, sustained recovery and related support services‘

Thanks to supportive documents from various countries we now have a wealth of documents to effect the delivery of treatment to people who use drugs. We work in 15 countries and look forward to expanding this work and treatment is high quality for people who use drugs.

I’d like to highlight the conference paper (‘The relationship between quality of specialist treatment for substance use disorders and patient outcomes: A scoping review of the literature’.)  Unfortunately most of studies are from high income countries. UNODC are also in the process of developing another paper and we call on people here to submit research.

Jimoh Salaudeen, Head Drug Demand / Harm Reduction, Government, Nigeria

I’d like to speak about the drug use situation in Nigeria. Prior to 2013 treatment was largely spiritual and not evidence based. In 2013 UNODC provided training, assessment, standardized scoring and quality improvement. Review of the drug treatment situation in Nigeria found that all the centers that existed prior to 2013 were not specialized and there was widespread use of chains and stocks and sexual abuse was rampant.

We now have evidence-based treatment with 109 centers across the country. We are working with civil society to accredit them to deliver services. Furthermore we have now rolled out harm reduction services.

Sabino Sikandar, Ministry Narcotics Control Pakistan:

We reviewed the situation in Pakistan and identified the treatment gaps in the country. Lack of standardized evidence treatment, lack of certified drug treatment professionals. Lack of mechanisms for certifications, monitoring and mentoring of service providers. Lack of coordination between relevant drug treatment and associated comorbidities (Health/Narcotics/Law Enforcement/Prisons/Education/Social Welfare/Civil Society etc..) . The 2019 Narcotics Strategy aimed at evidence-based drug demand reduction services by; enhancing coverage of gender and age sensitive drug treatment services. Integrating drug treatment and related services into the national health service, enhance partnerships with relevant stakeholders to prevent to transmission of HIV, viral hepatitis and other blood-borne virus associated with drug use.

We have also developed surveys and research to provide reliable data.  A drug use survey, a national household survey, a high risk drug user study and more. We look to set up standardized treatment service that is a one-stop shop for drug users.

We are training people in UTC: a universal treatment curriculum, including master trainers. Once approved by consultation we expect the following results: treatments are registered in under regulatory body, standardized treatment, services monitored and mentored for scaling up.

Dr. Andrew Kolodny, Physicians for Responsible Opioid Prescribing: 

It’s an honor to be here as representative of the NYNGOC and the VNGOC. I want to start with a joke. There are two ladies at a resort and one says to the other “the food is so terrible here”, to which the other replies “and the servings are too small”. When we discuss quality we are talking both about inadequate access and poor service. The heroin crisis in the US that occurred in the 1970s was manly in urban, non-white areas and concentrated among men. In 1980s and early 1990s we had crack cocaine epidemic within a similar population group. The current opioid crisis is quite different, mainly white, suburban or rural and spread across genders.

When I started working in a treatment facility a number of years, despite it being nearly 15 years into the opioid epidemic and the service they were offering services that were not gender-sensitive, or not focused on injecting drug harms (HIV, HCV) and not offering naloxone. Quality services offer evidence-based services that address the issues of their clients. This effort will save lives

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