CND Thematic Discussions / Session 7 – Increase in drug-related deaths – unmet need for drug treatment and health services

Chair: Good morning, everyone. Welcome to the second part of the 2023 Thematic Discussion of the Commission on Narcotic Drugs on the implementation of all international drug policy commitments following the 2019 ministerial declaration (…) Agenda is adopted. Thank you very much.

Secretariat: (organizational announcements)

Director of the Division of Policy Analysis and Public Affairs (?) on behalf of UNODC Executive Director: It is a pleasure to address you today . As we conclude this year’s discussions, I am confident that your contributions will set a strong foundation for the 2024 midterm review of international policy commitments. During our meeting last October, we delved into challenges related to organized crime, criminal misuse of ICTs, and the supply side of illicit drug markets. Today, the focus shifts to issues more closely related to the demand side of the world. Despite the complexity of technical aspects, we must recognize that, at the core, these are fundamentally human issues that directly impact the health and well-being of individuals, families, and communities affected by drug misuse. Globally, drug use is escalating, causing significant suffering. According to the latest report, close to 3 million people used drugs in 2023, marking a 21.23% increase from over a decade ago. Tragically, almost half a million people lost their lives to drug use in 2019, representing a 17.5% increase since 2009. Synthetic drugs, particularly opioids, remain a leading cause of fatal overdoses, accounting for nearly 70% of deaths in the United States alone, where the opioid crisis claimed over 100,000 lives. Methamphetamine use has expanded in Southeast Asia, and the non-medical use of Tramadol continues to cause harm in Africa, with more than 16 million individuals estimated to be using non-medical opioids globally. The sharing of needles contributes to global epidemics of HIV/AIDS and viral hepatitis, affecting millions. Despite progress in harm reduction efforts, persistent barriers hinder the accessibility of treatment services. Only one in five individuals suffering from disorders can access treatment, disproportionately affecting marginalized and vulnerable segments of society. Young people are particularly vulnerable to initiating drug use, emphasizing the importance of early intervention. A recent session allowed us to hear directly from young people, providing new ideas on promoting healthier lifestyles and shaping international policy for the future. The new early prevention initiative, Children Amplified Prevention Services (CHAMPS), aims to prevent drug use and promote the healthy and safe development of children and youth. To address these challenges, our commitment is to put people first in responses, prioritize public health, ensure equitable access to essential medicines, and eliminate the stigma associated with substance use disorders. The Commission on Aquatic Works is dedicated to supporting member states in saving lives and protecting people’s health through treatments, care, and rehabilitation initiatives. Our efforts have trained policymakers, reached service providers, and contributed to opioid agonist therapy initiation in several countries. Our synthetic drug strategy provides a balanced and comprehensive framework for informed health responses. We’ve also launched our first report on cocaine use and continue to collect data on new psychoactive substances, working with the World Health Organization to bridge the global pain divide and ensure essential medicines reach everyone. As we approach the 2024 midterm review, let us uphold the commitments of international drug control conventions and prioritize compassion, putting people, their health, and well-being first. Thank you very much.

WHO: Thank you. Good Morning. The illicit use of psychoactive drugs claims an estimated 600,000 lives annually, and drug users often encounter barriers to essential care. Stigma, inequality, and criminalization of drug use disorders exacerbate the challenges in accessing effective treatment. WHO is dedicated to supporting countries in implementing cost-effective and evidence-based services for prevention, treatment, and harm reduction. This includes the establishment of needle and syringe programs and community-based Naloxone initiatives, proven to be effective in preventing the transmission of blood-borne viruses like HIV and hepatitis C. Simultaneously, the harms associated with the illicit use of psychoactive drugs contribute to restrictions that hinder access for millions who require them for legitimate medical purposes. In collaboration with the UN Office on Drugs and Crime and the International Narcotics Control Board, WHO is fully committed to addressing this intricate challenge. Our focus is on minimizing the harms of illicit drug use, delivering high-quality prevention, treatment, and harm reduction services for drug users, and ensuring safe and timely access to controlled medicines for those in need. (…)

INCB: Ladies and gentlemen, I am honored to be part of the second set of thematic discussions as we approach the mid-term review scheduled for March 2024. The issues at hand are vital for the health and well-being, and the INCB has dedicated significant time to these matters during its 138th session held two weeks ago. Many of these discussions will be reflected in our 2023 annual report, set to be released on March 5, 2024, under the leadership of the INCB President. Throughout the intersessional period, the INCB has remained committed to supporting member states in implementing the three drug control conventions and fulfilling their commitments under international drug policy. It is crucial that our collective efforts center around safeguarding the health and welfare of humankind. As a healthcare professional from Africa, I am acutely aware of the disparities existing not only between regions and countries but also within nations, particularly between rural and urban communities. The mid-term review of the 2019 ministerial declaration, coinciding with the midpoint of the implementation of the 2030 agenda, provides an opportunity for a crucial assessment of our progress. This evaluation is necessary to transform these documents into tangible realities and positively impact the lives of many. Additionally, this session aligns with World AIDS Day, observed last Friday, and I anticipate participating in the afternoon’s side event themed “Let Communities.” I encourage those who can attend this significant event. In the upcoming days, I will share INCB’s perspectives on health and regulatory challenges stemming from synthetic opioids, non-medical use of synthetic drugs, and the limited availability of internationally controlled substances for medical and scientific purposes. We previously briefed member states on these issues on November 8, outlining operational responses to address the public health threat posed by synthetic opioids. During tomorrow’s session, I will delve into the threat arising from the exploitation of legitimate sectors by traffickers, aiming to undermine regulatory mechanisms, with a focus on the role of the internet and drug trafficking entities. On Wednesday, I will provide insights into the low availability of controlled substances and the challenges faced by countries in procuring necessary medications, including opiates. This issue was extensively examined in collaboration with the previous Chair of CMD, emphasizing the theme of “No Patient Left Behind.” In conclusion, I look forward to our discussions this week and assure you of the INCB’s ongoing support during the midterm review and beyond. Thank you.

Chair: We will commence our thematic session addressing the challenges related to the shortage of drug treatment services and the rising deaths associated with drug use. A warm welcome to Kamran Mears from the Euro DC Drug Section and Chief of the Drugs Laboratory Scientific Services Branch of UN OPC, who will be assisting in today’s proceedings. 

UNODC: My brief presentation will address the challenges of reducing drug-related deaths and the services designed to tackle these issues. The graphic presented here illustrates a familiar yet critical point: nearly one in eight individuals who use drugs suffer from drug use disorders, with less than a quarter receiving treatment in a given year. Women, though fewer in number as drug users, are underrepresented in treatment due to various structural and social challenges they face. Young people, those under 25 years of age, constitute a significant portion of individuals in treatment for drug use disorders, ranging from one-third to almost half in many regions. In 2019, there were nearly 30 million healthy years of life lost due to disability and premature deaths related to drug use, marking a 14% increase since 2010. Opioid use disorders, along with Hepatitis C, contribute significantly to these losses. Over the past decade, drug-related deaths have risen by almost 18%, reaching half a million in 2019. Opioids are the primary contributors to drug overdose deaths, which have surged by nearly 45% during this period. It’s crucial to note that behind fatal overdoses, there are numerous non-fatal cases with their own health implications. Surveying responses from fewer than 60 member states, we find that prevention policies are widespread, but evidence-based interventions and accreditation standards for prevention programs are often lacking. Similarly, while treatment remains a key element in national drug policies, the coverage of evidence-based interventions and the availability of standards for treatment programs remain low. Opioids continue to dominate the global burden of drug-related diseases, with cannabis being reported as the primary concern for drug use disorders by many countries. Naloxone availability varies across countries, with limited access in some to reverse opioid overdoses, even in medical settings. Treatment for hepatitis C among drug users is severely limited, contributing significantly to drug-related deaths. In summary, prevention and treatment interventions, while common in country responses, are not always evidence-based. The availability, accessibility, and coverage of evidence-based treatment interventions, along with quality standards, remain areas of concern. I appreciate your attention and welcome any questions. Thank you very much.

China: Distinguished Excellencies, Ladies and Gentlemen, The Chinese delegation is pleased to participate in this thematic discussion. As this marks our first contribution, I wish to extend our gratitude to Mr. Chair and UNODC for organizing this event. The Chinese government has consistently strengthened efforts in drug prevention, eradication, and treatment to reduce drug demand and address health issues arising from drug use. Below are some of our experiences and achievements. Prevention and Education: Utilizing various levels and types of social and specialized drug media to raise awareness and knowledge. Employing innovative approaches like Internet-based publicity campaigns, targeting groups such as adolescents. Conducting the National Youth Anti-Drug Knowledge Competition annually, involving students from around 20,000 to 30,000 schools nationwide through the national digital platform for adolescent drug prevention education. Implementing continuous anti-drug prevention education, resulting in the discovery of 71,000 new drug users in 2000, representing a year-on-year decrease of 41.7%. The number of adolescents among existing drug users has dropped below 5,000 for the first time.
Treatment Measures: Implementing various treatment measures, including voluntary treatment, community-based treatment, and methadone maintenance treatment. Providing comprehensive services, such as medical intervention, psychological counseling, social assistance, and employment support. Promoting the construction of treatment institutions and encouraging users to undergo treatment. Assigning 100,000 full-time drug control social workers and 145,000 part-time staff, ensuring one full-time staff member for every 15 existing users. These personnel offer services to aid users in overcoming drug use disorders, restoring health, resilience, and reintegrating into society.

South Africa:  Esteemed colleagues, This moment offers an opportunity to assess progress ahead of the 2024 midterm review of the 2019 ministerial declaration to accelerate our joint commitments to address and counter the world drug problem. As we delve into the challenges presented this morning, South Africa is guided by UNODC and WHO’s international standards on Drug Abuse Prevention and the international standards for the treatment of drug use disorders. I am pleased to share the following developments in my country:
Treatment Centers: South Africa currently has more than 307 private treatment centers and 13 public treatment centers nationwide. All treatment centers are equipped with programs to address the harms posed by substance and/or drug use disorders, providing both inpatient and outpatient treatment. Public treatment centers, managed by the government, offer services at no cost to those accessing them. Private treatment centers, run by NGOs and private companies in collaboration with the government, offer services at a minimal cost. The universal treatment curriculum, an internationally recognized and validated program, has trained over 400 practitioners countrywide.
Prevention Strategy: The South African government conducts continuous awareness campaigns at schools, higher learning institutions, and social gatherings to educate the youth and society about the negative impacts of drug use disorders and substance abuse. Over 75,000 students have been reached through prevention and early intervention measures. The government will implement the Alcohol, Smoking, and Substance Involvement Screening with an App in 2023, aiming to identify substance use-related health risks and disorders in primary healthcare and medical settings.
Reintegration services ensure that individuals completing therapeutic programs safely return to their families and communities. Aftercare services are provided to ensure ongoing support, minimizing the risk of relapse for program graduates. South Africa remains optimistic that these treatment services, combined with prevention efforts, will effectively reduce the negative health and social consequences associated with drug use disorders. Thank you.

Czechia: First of all, I would like to thank the Secretariat of the UNODC for organizing the second intersessional meetings this year. We welcome this opportunity to discuss the international challenges related to global drug policy and its impact on public health, as well as to support our shared responsibility in minimizing the harm caused by problem drug use. We greatly appreciate the hybrid format of these meetings, which allows for the inclusive involvement of all member states and parties, including civil society. The Czech Republic extends its deepest condolences to all victims of terrorist attacks and wars around the world. Populations grappling with socioeconomic disadvantages, ongoing conflicts, and limited opportunities are particularly susceptible to mental health issues and addiction disorders. Ensuring access to healthcare for everyone, including individuals with addiction disorders, in regions impacted by humanitarian crises is of paramount importance. Data indicates that less than 20 percent of people with substance use disorders involving illegal drugs are receiving treatment, with access being highly unequal. Women who use drugs continue to face significant stigma and encounter multiple barriers to long-term treatment. Only one in five people with substance use disorders are estimated to have access to treatment, and merely one percent of people who inject drugs have access to the level of harm reduction services recommended by the UN. In its latest report, the OHCHR identified this lack of health responses as a major obstacle to the enjoyment of human rights. Many communities, often marginalized and stigmatized continue to suffer. Despite of, or perhaps because of our current drug policy regulation settings, the harm caused by drug use remains high and is increasing annually. Clearly, there is a fundamental issue in our approach and a lack of will to challenge an often extremely negative situation. Globally, we are witnessing serious human rights violations, including death penalties for drug offenses, extrajudicial killings, disproportionate sentencing, arbitrary arrests and detentions, compulsory detention under the pretext of treatment, incarceration of people who rather need health and social care and a lack of alternatives to punishment and imprisonment. Additionally, there is a notable absence of access to prevention, treatment, recovery and harm reduction services. Today, more than ever, it is imperative that human rights, dignity and freedom form the cornerstone of drug policies. We must persist in our efforts to protect vulnerable groups, irrespective of their age, colour, gender or nationality. Everyone is entitled to the highest attainable standard of physical and mental health. In this context, we reiterate our strong commitment to the comprehensive 2016 UNGASS outcome document and all obligations under international human rights law. A truly evidence-based approach, grounded in harm reduction philosophy, must be promoted. Consequently, the decriminalization of drug use and possession for personal use is essential. Ladies and gentlemen, in conclusion, it is imperative that all policies, programmes and interventions consider human rights and strive to mitigate the harm and impact of drug use on individuals and society. We must work towards reducing stigma and enhancing the capacity for treatment and other services for people who use drugs and those with drug use disorders. This encompasses offering a range from low-threshold to more sophisticated forms of care, and ensuring the provision of appropriate funding. Services should be voluntary, without discrimination, and accessible to everyone without barriers. It is crucial that people should not feel afraid to seek help. Thank you ladies and gentleman for your attention.

Switzerland: Switzerland welcomes this international meeting focused on the health-related aspects of drug policy. This is an opportune moment to discuss the shortcomings in the availability of health services for people suffering from dependence on illegal drugs. The World Drug Report published last May, along with the civil society report launched today, provides important information about the increasing problem of drug users and rising mortality. Hepatitis C is responsible for half of all drug-related deaths globally, and HIV transmission remains a significant threat for people who inject drugs. Despite the proven effectiveness and cost-effectiveness of harm reduction services in preventing transmission, these services are still limited on a global scale. In Switzerland, studies have demonstrated that without easy and low-threshold access to harm reduction services, we would still face a major HIV and hepatitis C crisis among people who inject drugs. It is imperative to extend and offer these services globally, as agreed in several resolutions and called upon by UN health-mandated entities. The lack of access to treatment services is another crucial issue that demands attention. A regrettable fact is that only a limited number of people with problematic drug use have access to evidence-based treatment options. Providing treatment, care, and support is integral to a rights-based approach to reducing drug-related harm. Urgently, women and girls, who have lower rates of access to tailored treatment services and prevention services, as well as essential medicines for pain relief and palliative care, require attention. Low- and middle-income countries need our support and expertise to improve the full chain of supply and beverage control. To achieve the ambitious goal of protecting public health through effective control of medicines, we must collaborate with all partners, including civil society and UN entities such as WHO and INCB. Implementing our commitments in this regard requires enhancing and protecting the role of civil society in delivering services and sharing data collection.

Thailand: The Royal Thai Government has prioritized addressing drug-related issues on our national agenda, aligning with the 2016 UNGASS outcome document. The 2021 Narcotic Act has marked a paradigm shift towards a health-centered approach, emphasizing human rights and focusing on providing treatment services rather than punitive measures. People who use drugs are viewed as patients, not criminals, and they should be treated with care and reintegrated into their communities. In Thailand, efforts have been made to enhance the accessibility, affordability, and availability of treatment and care services for people who use drugs at both local and national levels. Currently, the country has a network of treatment and health services, including 9,700 screening and primary care centers, 1,218 hospitals, and treatment and rehabilitation centers, as well as 2,838 socio-reintegration centers. The Ministry of Public Health plays a leading role in providing treatment services, adhering to qualified treatment standards and collaborating with relevant agencies to offer rehabilitation and reintegration interventions. These interventions cover educational opportunities, vocational training, and grants to ensure the quality and safety of services, empowering individuals to lead fulfilling lives. Despite these efforts, there is a continued need to enhance accessibility to treatment services with seamless care. The Ministry of Public Health has recently initiated the Quantum project, designed to offer acute, intermediate, and long-term care for patients in treatment, aiming to prepare recovering individuals for reentry into society and support their transition to independent living. Under the Quantum project, residents are supported by staff and peers to develop life and social skills, fostering their successful reintegration into society and promoting sustained recovery. Thailand believes in the importance of placing people at the center of our approach to addressing drug-related problems, and we are committed to continuing these efforts.

UK: Thank you to the panel of experts for their interesting and insightful presentations at the start of this session. Now, I would like to share some insights from the UK on improving drug treatment and recovery services. In 2019, the UK government commissioned an independent expert, to conduct a two-part independent review of drugs. The review sets out the scale of the challenge for the treatment and recovery system, delivering stark findings, including: Disinvestment in adult treatment, with an even greater reduction in funding for young people. Lack of oversight and accountability at local and national levels. Loss of skills, expertise, and capacity within the sector. Lack of specialist services, including inpatient detoxification and Residential Rehabilitation. High rates of reoffending and crimes relating to drug use among people in prison.
The UK government is committed to transforming the lives of those affected by drug addiction and reducing drug-related deaths. The long-term drug strategy, “From Harm to Healing,” published in December 2021, allocates an additional £780 million for the first three years of an ambitious decade-long transformation of drug treatments and wider recovery support in England. This marks the largest-ever increase in treatment and recovery funding, bringing the total to more than £2.8 billion.  Key components of the strategy include: Ambition to prevent nearly 1,000 drug-related deaths. Investment in expanding treatment capacity. Rebuilding the workforce and increasing the mix of professionals. Empowering local leaders to deliver on commitments while ensuring accountability. Establishing strong partnerships at the local level among education providers, local authorities, the National Health Service, and criminal justice agencies. Since April 2022, progress has been made on the commitment to deliver 54,500 more treatment places by 2025. This includes recruiting 1,224 new drug and alcohol workers, exceeding the target of 950 new staff by 2024. Continuity of treatment has improved by 10 percentage points over the past 12 months, reaching a record high of 48%. The individual placement and support program for employment support service has expanded from 46 to 66 areas, with a target of reaching 90 areas by the end of March 2024. Additionally, the number of incentivized substance-free living units in prisons has more than doubled, from 25 to over 60. Thank you for the floor, and we look forward to working with and hearing from other member states on these important issues.

Oman:

Russia: Over the decades, the Russian Federation has witnessed a significant decrease in alcohol use and a corresponding reduction in alcohol-related health indicators, thanks to its effective alcohol policy. A similar, though not as impressive, trend has been observed for indicators reflecting the medical consequences of illicit drug use in the population. The total registered drug prevalence has effectively halved, and registered incidents have dropped by more than two times. The latter, registered incidence, is considered a dynamic indicator reflecting changes more accurately. This decrease was primarily driven by a significant reduction in opioids, with a substantial drop in first treatment demands from 90% to 28%. A plateau in primary opioid-related incidents is now observed, especially noticeable among younger groups. However, in the last four to five years, there has been a gradual increase in mortality due to opioid poisonings despite an increasing proportion of auto-correlated treatment demands. Opioid-related mortality, which historically stayed at about 50% among all drug-related deaths, has been increasing, reaching two-thirds of all federal poisonings in 2022, accounting for more than 1,000 cases out of a total of over 10,000 drug-related deaths in a nation of 146 million. Currently, the Russian Federation is implementing the strategy for state anti-drug policy until 2030. The fundamental goals include reducing illicit drug trafficking and drug availability, shaping a negative attitude towards illicit drug use and participation in drug trafficking, and reducing the severity of health consequences associated with illicit drug use. The strategy aims to achieve these goals through various measures, including the comprehensive development of the state addiction treatment service, known as the narcological service in the country. This involves enhancing material and technical capacity in specialized medical organizations and units within the general medical service. Additionally, methods for preventing drug use and addiction, along with treatment and medical rehabilitation for patients with dependency, are being improved. There is a focus on collaboration between medical services and organizations involved in social rehabilitation and reintegration for former drug users. Notably, these services are provided free of charge in the Russian Federation. In conclusion, the speaker emphasizes the crucial role played by UNODC, WHO, and INCB in preparing the most effective and comprehensive approach to addressing the global drug problem. Thank you.

Korea: Thank you to all the panelists for their informative presentations. I would also like to express deep appreciation for the well-prepared and valuable session, along with all the materials provided for this opportunity. Based on the panelist presentations, we acknowledge the severity of drug use, and it is evident that the Republic of Korea is actively working to suppress the overuse of opioids and other drugs. Prioritizing the health and well-being of our population is crucial, and precise strategies must be implemented. In light of this, Korea would like to raise a specific issue related to solving the problem of opioid overuse and discuss the way forward. The primary focus of our concern is how to strike a balance between controlling the substance and providing treatment for opioid use. This issue involves coordination between the state government, regulatory agencies controlling substances, and entities responsible for treatment. Organizing these aspects can be challenging, and we would appreciate hearing from our fellow member countries about their perspectives and experiences in this regard. We encourage open discussions and the sharing of diverse views to arrive at a comprehensive conclusion. Let’s actively participate in this ongoing campaign and work together to find effective solutions for addressing the opioid overuse issue. Thank you.

Singapore: I would like to highlight two key aspects of Singapore’s efforts in this presentation. Numerous delegations in 2023 have reported an estimated 3% increase in drug use over the previous decade and a 45% increase in people suffering from use disorders during the same period. Young people, particularly in certain regions, have been identified as the most vulnerable to drug use and are severely affected by substance disorders. These trends and statistics are concerning, especially considering the potential impact on our youth and future generations if not addressed promptly. Singapore advocates for a comprehensive and proactive approach to prevent the harms of drugs from becoming entrenched. We believe that every individual has the right to live in an environment free from the negative effects of drugs. To address this, Singapore has adopted a comprehensive harm prevention strategy that focuses on reducing both supply and demand. Significant investments have been made in preventive drug education, a critical component in raising awareness and educating the community, particularly young people, about the harmful effects of drugs and minimizing the downstream consequences of drug abuse. There is a recognition of changing risk perceptions globally, especially among Singapore’s teenagers and young people who may be less aware or have mistaken impressions about the harmful nature of drugs. Consequently, awareness-raising efforts include initiatives by Singapore central non-profits, such as CFB, conducting public education through social media using infographics. They have even utilized platforms like TikTok to engage with the youth, creating the Cannabis Club in 2019 to educate them about the effects of cannabis consumption. Beyond prevention, Singapore is actively involved in treatment efforts. There is a significant focus on rehabilitation and supporting the reintegration of drug users into the community and society. The belief is that every drug user should be given the opportunity to overcome addiction, recognizing it as a result of complex interactions with biological, psychological, social, and environmental factors—not solely as a mental health condition. Singapore’s Euro Project, initiated in 2004, symbolizes how ex-offenders, including drug abusers, can be given a second chance. The Yellow Ribbon project collaborates with employers to ensure job availability for offenders reentering the community, helping them secure employment. A key rehabilitation program under this initiative is the App Program, focused on training and developing skills for drug abusers to pursue a positive future, especially in the field of art, after rehabilitation. In conclusion, these efforts in Singapore aim to minimize the downstream effects of drug abuse and maximize the benefits of rehabilitation and reintegration for individuals seeking a second chance

US: Thank you for the opportunity to speak today, and I extend my appreciation to you and UN ODC for organizing this crucial session. Our focus is on the projects and programs implemented by the United States over the past several years. While acknowledging that there is much work ahead, we are proud of the significant strides made, emphasizing the priority placed on addressing addiction and the overdose epidemic. Our president has declared a major surge to combat fentanyl, aiming to expand access to evidence-based prevention, harm reduction treatment, and recovery support services. This includes efforts to disrupt the trafficking and sale of illicitly manufactured fentanyl. The President’s National Drug Control Strategy advocates for a harm-bridge approach, meeting people where they are and engaging them in care and services. There is a call for action to expand access to evidence-based prevention and treatment, emphasizing the need for robust data collection and analysis to enhance public health interventions. A “recovery ready workplace” strategy has been adopted, reaching out to voters to ensure a safer environment for individuals in recovery returning to employment. The United States overdose prevention strategy, released in 2021, expands the continuum of care and services for those using substances that cause overdose. Significant investments have been made to address opioid use disorders, stimulant use disorders, and other substance use disorders. Civil society support is crucial for implementing and developing these strategies. Over the past year, the administration has invested in mental health and substance use support, including the expansion of community behavioral health clinics and resources for the suicide prevention hotline. Results indicate positive outcomes, such as reduced homelessness, decreased time spent in correctional facilities, lower inpatient hospitalization for mental health treatment, and a decline in illegal substance use. The US Food and Drug Administration’s approval of a second over-the-counter Naloxone product enhances options for consumers and increases competition in the market, ultimately improving access to life-saving medication. Healthcare providers play a critical role in identifying substance use and co-occurring mental health challenges, engaging in prevention, treatment services, and recovery support. Key investments are being made to support healthcare providers globally, with a focus on training in substance use and mental health. The United States partners with UN ODC to advance the treatment and prevention workforce, supporting quality assurance mechanisms for drug treatment centers. A global network is promoted to connect stakeholders, share best practices, and we encourage fellow members to consider funding initiatives addressing gaps in treatment and health services. We have a question for the panels regarding the CHAMPS program, seeking recommendations on further promoting it within the Commission on Narcotic Drugs.

Iran: (…) Urgent attention is required to address the needs of former farmers and workers related to opium poppy cultivation through alternative development projects and financial educational training. Otherwise, the absence of alternative livelihoods may lead to challenges more than ever before, replacing illicit profitable jobs related to methamphetamine manufacturing. The Republic of Iran has implemented a comprehensive strategy in drug control, focusing on demand and harm reduction plans while countering drug supply. Over the past two decades, Iran has invested significantly in treatment, rehabilitation, and harm reduction plans.Coverage for individuals suffering from drug use disorder, the number of authorized treatments and Harm Reduction Centers, including centers for curing dependence, agonist drugs, Harm Reduction Centers, etc.. As of October 2023, approximately 24,000 HIV/AIDS cases were registered in Iran, with preventive interventions and harm reduction activities leading to an 11% decrease in the virus’s spread among young individuals.  llegal and unjustifiable, unilateral, coercive measures by certain state has led to denial of service, medicine and medical equipment for treatment of drug related patients in Iran and exacerbated the health conditions treatment and food rehabilitation. The total HIV AIDS cases registered as of October 2023 approximated to 24,000 infected persons who were made between 25 to 40 years old, and 76.6% of whom are under state medical treatment.  Efforts also involved providing medical insurance for drug use disorder services, expanding coverage for addiction treatment, and designing non-pharmaceutical interventions for the 18-year-old age group. Training courses on pharmaceutical treatment, methadone, and buprenorphine were organized for psychologists and social workers. Virtual training workshops on the Family Treatment Network and treatment elements for youth with drug use disorders were conducted in collaboration with UN ODC. Translation of six books and virtual training on drug use disorder among children and teenagers in collaboration with UNICEF were also implemented. Online maintenance treatment for opioid use disorder and case management projects for inmates with drug use disorders were initiated, along with harm reduction measures like retroviral IP tests, counseling, tuberculosis prevention, and needle and syringe programs. Additionally, free training was offered for those who inject drugs and their partners. Methadone maintenance treatment continues to be a crucial aspect of Iran’s harm reduction efforts.

Japan: The commitment to universal access to treatment is a cornerstone of our approach to reduce HIV rates and enhance the quality of life for individuals within our healthcare system. The implementation of antiretroviral therapy, irrespective of socioeconomic status, ensures not only access to life-saving medications but also contributes to treating the associated diseases. In addition to delivering treatment and prevention services, our HIV/AIDS programs underscore the significance of community involvement. Mentor organizations, civil society groups, and people living with HIV have played pivotal roles in shaping and implementing policies. This inclusive approach aids in tailoring interventions to the specific needs of affected communities and has been instrumental in diminishing the stigma associated with these environments. To combat new HIV infections, extensive public health campaigns have been executed, targeting key populations like men who have sex with men, sex workers, and people who inject drugs. Support for harm reduction initiatives, such as needle exchange programs, further contributes to multifaceted strategies that have led to a decline in the rate of new HIV infections. While challenges persist, we are committed to sharing our best practices with other countries in their endeavors to effectively combat HIV/AIDS

Canada: Canada is grappling with an unrelenting surge in overdose deaths. Between January 16 and March 23, a staggering 8,514 individuals lost their lives to opioid overdoses. This crisis is exacerbated by a volatile and increasingly potent illegal drug supply, resulting in an alarming average of 21 overdose deaths per day during this period. The opioid overdoses represent a profound public health crisis in Canada, further exacerbated since the onset of the COVID-19 pandemic in March 2020, impacting individuals and communities tragically. Canada adopts a gender-based approach to understand how diverse individuals and groups are affected differently by policies. Data reveals that the two groups experiencing the highest rates of opioid overdoses are men, particularly young and middle-aged men, and men working in trades, along with Indigenous peoples. Canada’s public health strategy recognizes substance use as a medical condition and acknowledges that not everyone using substances has a multifocal substance use disorder. Acknowledging the absence of a one-size-fits-all treatment approach, Canada combats stigma and fear of criminalization, common barriers to treatment access. The country emphasizes harm reduction through supervised consumption sites, vital for preventing accidental overdoses and providing access to critical health and social services, including treatment. Canada maintains the “Good Health with Substance Use” website, offering resources and information, facilitating access to evidence-based substance use services, support, treatment, recovery, and harm reduction nationwide. Opioid agonist therapy, viewed as the primary treatment for moderate to severe opioid use disorder, is complemented by injectable hydromorphone and diacetylmorphine for severe cases. Recent initiatives have removed barriers to accessing drugs for treating opioid use disorder, fostering cooperation between practitioners, pharmacists, and regulatory bodies. National guidelines for the atypical approach of opioid use disorders have been established, informed by evidence and engagement with diverse stakeholders. Canada has committed over $1 billion for evidence-based prevention, treatment, and reduction measures, expanding access to services that mitigate overdose harms. Naloxone distribution and training efforts are widespread across provinces and territories. Canada emphasizes regional, national, and international cooperation to address overdose and substance use-related harms, demonstrating a steadfast commitment to evidence-based solutions, health, safety, and human rights. This commitment includes collaboration with civil society organizations, people with lived and living experience, and marginalized populations. Thank you.

Lithuania: Fully aligned with the EU statement. The Ministry of Health has committed 24 million euros to evidence-based substance use prevention initiatives in alignment with the EMCDDA European drug prevention quality standards. Initiatives encompass drug use prevention and the European prevention curriculum. Acknowledging the complexity of addictions, the statement recognizes the increased demands for treatment, requiring greater efforts and resources. Specialized dependence treatment services adhere to international standards for the treatment of drug use, emphasizing a national agenda that considers diverse individual needs. The significance of opioid agonist treatment has been developed in collaboration with the European UNBC project for Baltic States in 2011, stimulated by the evolving landscape of active substances. Highlighting the importance of athlete engagement, the statement notes that encouraging people to seek help is vital, countering condemnation or marginalization. The evolving landscape of new substances and changes in drug use pose ongoing challenges to health systems, necessitating updates in diagnostic and treatment methodologies. Health professionals are investing in research and expanding overdose prevention efforts. Addressing services for individuals who use drugs in prisons, the statement emphasizes the integral role of such provisions in ensuring well-being and promoting public health. The involvement of all stakeholders is encouraged to establish national programs and protocols for drug users in prison. The statement underscores the imperative that individuals in prison receive equivalent care as those in the community. In conclusion, the European Union is committed to an effective system for treatment, rehabilitation, integration, and diseases, advocating for high-quality, approved, and cost-effective services. The overarching goal is to reduce discrimination and stigma, recognizing the importance of this effort. Thank you.

Brazil:  The decision to prioritize national drug prevention efforts is rooted in their ease of implementation within various environments and among children. Recognizing the positive impact of prevention efforts on the health of children, we have initiated a comprehensive prevention eco-program. This program integrates drug prevention education into the national curriculum, ensuring teachers are equipped with the knowledge to conduct prevention classes. As per the latest data, these classes are conducted in approximately 70% of elementary schools and about 80% of junior high schools and high schools across the country. Additionally, to address the surge in cannabis use among young people, we have launched awareness campaigns, including product listing advertisements on search engines and social networking sites. The results have been significant, with educational materials being displayed 52 million times and viewed by 260,000 people within a month and a half. In the realm of treatment and rehabilitation, medical institutions specializing in drug addiction treatment, with government support, provide access to adequate treatment and rehabilitation services nationwide. Key players in these efforts include earlier videos, consulting services for drug addicts, and support contact points. Our commitment to strengthening drug prevention and treatment measures involves collaboration with relevant stakeholders, including private sectors and NGOs.

Pakistan: The concern regarding disparities between the number of people using drugs and the insufficient availability of treatment services underscores the urgency of adopting a multidimensional approach to address the problem. It is disconcerting to note that only one in five persons with drug use disorders has access to proper treatment and rehabilitation services. However, this ratio could be much higher in developing countries. These statistics not only underscore the urgent need for collaborative and innovative strategies to bridge this gap but also emphasize the imperative for support and assistance, particularly to developing countries. Pakistan has undertaken significant initiatives, including the recently launched National Drug Use Survey 2020 to 24 in collaboration with Euro DC. This comprehensive survey aims to provide reliable evidence of the extent to which the population is using drugs and suffering from drug use disorders. The survey is intended to contribute to the development of effective prevention, treatment, and rehabilitation programs. Pakistan recognizes the significance of evidence-based treatment and supports the principles outlined in the UN ODC WHO International Standard for the Treatment. Pakistan is also actively collaborating with our partners to develop means of ensuring quality drug treatment services, contributing to scaling up the capacity to deliver services in line with international standards. These efforts are crucial in bridging the gap between the increasing demand for treatment services and their availability, as highlighted in the ministerial declaration. In conclusion, Pakistan reiterates its commitment to working collaboratively with the international community to develop and implement a comprehensive approach to overcome the challenges outlined in the 2019 ministerial declaration. Through a collective and inclusive approach, we can make significant strides towards ensuring better treatment and health services for all. Thank you.

Morocco: (tech issues)

Australia: We look forward to taking this important opportunity to learn from others in the coming days. Australia maintains a long-standing commitment to harm minimization through our national drug trials. Recognizing that drug use occurs across a continuum with associated harms, we advocate for a multifaceted, multi-sectoral approach. Prioritizing access to evidence-informed, effective, and affordable treatment is central to our strategy, supported by significant funding to ensure community members have the necessary support. Services span various models and settings, catering to diverse needs, including specific population groups such as young people, parents, indigenous peoples, and those referred from the criminal justice systems. Integrated care is critical, connecting services to address associated issues like physical health, social, economic, legal, or accommodation considerations. Collaboration and coordination between services are crucial to providing the most appropriate support. Despite available and accessible human services, there remains a significant unmet demand, particularly in areas like rural and remote regions and for those in contact with the criminal justice system. Stigma associated with drug use is a known barrier, and raising awareness and understanding of substances is vital to reduce stigma and promote health-seeking behavior. Australia has made strides in harm reduction initiatives, with a decrease in drug-related overdose deaths through programs like the National Take Home Naloxone Program, Early Warning Systems, drug checking facilities, and medical safe injecting centers. However, challenges persist, and Australia continues to invest in national and targeted prevention programs, including the Local Drug Action Team program. In summary, Australia remains committed to supporting recovery from dependence through evidence-informed treatment, integrated care, and collaborative efforts with civil society and affected communities to reduce drug-related deaths and overdoses.

France:  We would like to address the scale of the consequences of drug abuse on public health and emphasize the need for better access to treatment and more effective prevention. Opioids are a major contributor to global deaths, with only a minority of the 39.5 million people suffering from drug-related disorders receiving treatment. There are significant inequalities in access to treatment between genders and regions. Our delegation highlights a new inter-ministerial strategy against addictive behavior, focusing on prevention and education to combat drugs and addictive behavior. This strategy targets various levels, including families, schools, workplaces, social and medical establishments, and higher education and training institutions. Internationally, we support UN policies on prevention, contributing up to 220,000 euros, including 150,000 euros for the implementation of the Strong Families program in Senegal, Cote d’Ivoire, Ukraine, and (…).

Chile: Our drug prevent ion and treatment efforts reflect our commitment to evidence-based approaches and reintegration. We emphasize comprehensive strategies targeting individuals, families, and communities. School-based surveys regularly monitor substance use prevalence, informing evidence-based prevention interventions. We offer a comprehensive range of treatment, protection, and rehabilitation services, addressing the growing trend of substance consumption. Challenges include the normalization of drugs, increased availability through e-commerce, stigma barriers to seeking treatment, and difficulties in reintegrating individuals into society post-treatment. We address these challenges through a multi-pronged approach, strengthening prevention and enhancing treatment.

Colombia: We express our gratitude for your leadership, Mr. Chair. Since the 1961 United Nations Single Convention on Narcotic Drugs introduced a worldwide ban on drugs to combat the serious issue of drug addiction, the costs of this provision have been significant. This approach has resulted in misspent millions and billions of dollars, leading to negative social and health consequences. Furthermore, it has led to criminalization and stigmatization, discouraging individuals from seeking medical treatment for drug addiction. Our country firmly believes that drug users should not be treated as criminals; instead, they need state intervention to ensure the enjoyment of fundamental rights. As outlined in October, we have shifted our national drug policy from a war on drugs to a human rights approach, prioritizing public health. The overarching themes of this new policy include promoting universal health, focusing on risk and vulnerable groups, humanizing individuals who use drugs, reducing associated stigma, and addressing multiple vulnerabilities leading to drug consumption. Our policy emphasizes risk and harm reduction principles, offering various treatment services, including residential, ambulatory, mobile, and fixed facilities, with a specific focus on community-based devices and safe consumption spaces. Seizing assets from drug trafficking for home bases, such as supervised consumption rooms, is highlighted as a strategic approach. This strategy extends to the creation of safe consumption spaces and bases that incorporate community-based strategies, emphasizing the street-dwelling population and vulnerable youth. Our approach, with a gender perspective and adherence to human rights standards, aligns with the right to the highest attainable standard of health, as outlined in the international guidelines on human rights and our draft policy.

Argentina: The presenters underscored the intricate nature of the global drug issue, shaped by interconnected social, economic, and political factors. This complex context, exploited by criminal networks, necessitates a transformative shift in perception. University hospitals contribute significantly to the understanding of this global challenge, particularly in addressing the rise of potent substances and the resulting increase in addiction-related deaths. To counter these trends, there is a call for enhanced services, personnel training, and intensified prevention efforts. The commitment of civil society and public authorities is vital to making drug-related concerns a national public health priority. The presenter encourages open dialogue among members to collaboratively address this pressing issue.

Ecuador:  We are actively addressing the challenges posed by the increasing drug use, aligning with the global mapping initiative by the CND. However, understanding the root causes behind consumption remains a question. It is crucial to explore social and cultural factors contributing to consumption, especially in Greece, seeking scientific insights. Acknowledging the health issues related to addiction, we recognize the need for therapies to reduce associated costs. Our substantial investment aims to combat drug-related problems caused by trafficking, organized crime, and societal violence. We believe a reduction in consumption is linked to a shared responsibility approach, emphasizing the importance of common efforts globally. This principle remains a key aspect in our negotiations, considering the interplay between consumption, production, and their impact on the data we observe.

Oman: We have witnessed a significant surge in drug abuse issues in recent years, especially poly-drug-use. To address this, we are intensifying our efforts through various initiatives, emphasizing prevention, treatment, and rehabilitation. Our future focus is on enhancing accessibility to services by integrating addiction services into primary care. Additionally, we aim to strengthen prevention programs through collaboration with social organizations and industries. Thank you.

Chair: Now I turn to Mr. Tettey to answer questions.

UNODC: Mr. Chair. We have questions from the distinguished delegate from Mexico and one from the United States. I’ll begin with Mexico. Your first question pertains to airports. To comprehensively address the issue, quality data is crucial. We need disaggregated gender-specific data for a nuanced understanding. Currently, data on prevention is limited, available for less than 60 countries. Research and data are imperative in mainstreaming gender concerns into our work. Gender remains a key focus, aligning with international sentiments and expert presentations this week. Regarding the link between drugs and other crimes, the session’s summary has covered this extensively. If there are specific concerns or questions, the secretariat is open to providing detailed responses.Concerning the harm reduction strategy collaboration between UNODC and WHO, we prefer the term “minimization measures” to denote actions aimed at reducing the potential social consequences of drug use. We view the response as a continuum of care, aligning with the commitment outlined in Article 38 of the 1961 Single Convention. Our approach encompasses prevention, early identification, treatment, rehabilitation, and social reintegration. It’s important to follow international standards set by WHO and UNODC, focusing on evidence-based practices and a multidisciplinary approach. Finally, addressing the query from the distinguished delegate from the United States about the UNODC prevention framework, especially for countries with a young demographic, there’s a collective commitment to protecting children during their crucial developmental years. The UNODC is encouraging countries to invest in their prevention systems over a five-year period, aligning with the next five years of ministerial deliberations. Countries are urged to offer their cities as model cities, working towards building resilient societies. The goal is to demonstrate positive change and progress before the 2030 deadline for the Sustainable Development Goals. Colleagues are invited to pledge and invest in prevention as an integral part of a broader strategy to address this global issue.

Secretariat: Additionally, Mexico raised the issue of cooperation between the CFT and the Statistical Commission. I have duly noted this concern. During Hungary’s chairmanship, there were instances of the Statistical Commission chair’s participation in CME and CCP CG sessions, making coordination more straightforward. Currently, in collaboration with the ECOSOC president and colleagues in UNDC, we are actively exploring ways to enhance and fortify relationships among the council’s various subsidiary bodies. We anticipate putting forth different proposals to address these concerns effectively.

VNGOC // NGO:

VNGOC // International Network of People who Use Drugs (INPUD):  Thank you Chair for this opportunity to speak. My name is Judy Chang and I am the Executive Director of the International Network of People who Use Drugs. We are the global peak body representing the voices of people who use drugs. We are well aware that people who use drugs are disproportionately affected by HIV, Hepatitis C and other BBVs. This is a global health inequity that we all must address. To do so, we have to acknowledge the drivers – not drug use in and of itself but – structural, social and funding barriers that stand between us and the tools we need to protect ourselves. As we saw during COVID-19, the most sustainable way to counter pandemics is not social control, but to ensure wide-scale access to PPE and medical countermeasures. For people who use drugs the tools we need are harm reduction. And yet only 5 countries provide high coverage of harm reduction.  Posing long term recovery as the primary solution to HIV, Hepatitis C and other BBV’s, as discussed during the 2020 intersessionals is a fallacy, ignoring the complexity of our lives. I have been very fortunate to have access to needles and syringes, opiate agonist treatment and naloxone. They have saved my life and I believe that no one should be denied harm reduction simply based on where they live or who they are.  Youth and women face specific barriers and challenges, including non-tailored services and intersectional stigma and discrimination. This was emphasized in a recent multi-stakeholder consultation organized by UNODC, UNICEF, WHO, INPUD and YouthRise.  Lack of funding and criminalisation underpin health and social inequities. Currently, there is a 95% funding gap for harm reduction in LMIC’s. How can we expect to make a dent in HIV, Hepatitis C and BBV’s infections without urgently funding more services? How can we address high transmission rates when people are arrested for simply possessing needles and syringes, or when hotspots and harm reduction services are raided and monitored by police?  Decisions made in Vienna directly impact our lives, but remain disconnected from them. Hundreds of thousands of lives are lost or destroyed each year due to the drug control treaties. Currently, there is no ‘balanced approach’ when it comes to drug control and health and human rights. We only have to look at the funding data; 100 billion is spent annually on the war on drugs versus 131 million on harm reduction.  As we come to the Mid-Term Review we request member states to be bolder and more honest in admitting the failures of the current prohibitionist paradigm, that include driving HIV, Hep C and BBVs.  We need decriminalisation, and we need inclusion in decision-making. People who use drugs know what works and what ‘good practice’ entails, because we are the end-users. Many of the policy and service innovations that emerged during COVID-19 came from our long-standing advocacy asks. Working for and with the most marginalised, that requires removing legal and funding barriers to participation, will create systems and models that work for fighting current and future pandemics.

Morocco: Apoligies for the technical delay. Mr. Chair, in full compliance with national conventions and resolutions related to drug culture, Morocco strives within the framework of its national strategy to prevent and combat illicit trafficking. This involves aligning its legal system with international standards and addressing the root causes of drug-related issues. Given Morocco’s proximity to Europe and its strategic location in the global drug trade, the country faces challenges with the spread of narcotics, including cocaine, and the diversification of trafficking methods. To counteract this situation, Morocco has implemented a comprehensive approach that emphasizes public health. Addiction treatment and rehabilitation have been systematically integrated into national plans, including the 2008-2012 and 2012-2016 initiatives. In 2010, Morocco launched a substitution treatments program, becoming one of the first African countries to do so. This program includes needle exchange to prevent infections and addresses psychosocial aspects of substance use disorders. The Ministry of Health and Social Protection has established an integrated national strategic plan (2018-2023) focused on mental health prevention, early detection of substance use disorders, and strengthening the skills of health professionals. The plan emphasizes partnerships and aims to combat stigmatization. Morocco has expanded addiction services, including the establishment of addiction units in prisons. The national plan for the prevention and treatment of addictive disorders encompasses various aspects, such as the provision of care, the development of addiction centers, and the creation of an information system. Future actions include the development of a new strategic plan (2024-2030), the introduction of new opioid substitution, and the enhancement of health professionals’ expertise. In conclusion, Morocco is committed to actively and constructively participating in the negotiation of documents related to the global drug problem. The country looks forward to addressing root causes and manifestations of this issue during the 2024 ministerial review, seeking to give new impetus to its ongoing efforts.

Chair: Thank you. We break for lunch now.

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