CND Thematic Discussions on Strengthening Public Health Responses to Drug Use
Session 2: Drug Treatment and Health Services Falling Short of Meeting Needs; Increase in Deaths Related to Drug Use
Chair: We begin the afternoon session with a discussion on the topic of Treatment and health services – falling short of meeting needs, increase in deaths related to drug use. We’re happy to have with us Ms. Giovanna Campello, Chief of UNODC Prevention, Treatment and Rehabilitation Section, who will provide us an introduction to the topic and also moderate the panel discussion. Ms. Campello, you have the floor.
Giovanna Campello, UNODC Prevention, Treatment and Rehabilitation Section: Thank you so much, Mr. Chair. Excellencies, ladies and gentlemen, dear co-panelists, both here and online. We have many co-panelists online. It’s a great honor for me to introduce this session, especially accompanied by such distinguished co-panelists. I’d like to begin by defining the scope of our discussion today, because it’s very broad. We say “treatment and health services,” and as per the international standards for the treatment of drug use disorders—published together with WHO, who are also online with us—we are referring to a broad understanding of services. Today we’ll be keeping in mind the whole recovery-oriented community continuum of care needed to protect and promote the health and recovery of people who use drugs and those with drug use disorders. This means a broad spectrum, from low-threshold services and harm reduction to pharmacological and psychosocial interventions, and recovery support. Now, if you think about the data Angela presented this morning—it’s very easy to feel despair and sadness. After all, all indicators—drug use, drug use disorders, drug-related deaths, burden of disease—have been increasing in recent years. We discussed a bit this morning why that may be. And I think this is our first challenge and opportunity. It’s inevitable in a context where less than 10% of people with drug use disorders are in treatment. A challenge, because the treatment gap seems overwhelming, but also an opportunity, because we know it’s possible to reverse this by investing in evidence-based services. I’ll take one example, very relevant to our session: opioid overdose. Opioids account for most fatalities, and new synthetics like nitazenes and fentanyl are making the crisis worse. Opioid agonist maintenance treatment, supported by psychosocial intervention, is effective in preventing overdoses and reducing drug use disorders. In suspected overdose, training and equipping people likely to witness with naloxone—a WHO essential medicine that is safe and effective—saves lives. Together with WHO, we’ve shown this is true not only in high-income countries but also in middle-income countries through our SOS “Stop Overdose Safely” initiative. Yes, new opioids complicate things and may need process review—we were discussing this just yesterday with WHO colleagues—but applying existing tools, we could already prevent the majority of overdoses and save lives. With the panel here and online, we’ll cover many dimensions and opportunities to improve treatment and health services—looking at specific groups, integration, and addressing stigmatizing attitudes. What I’d like to highlight: services for people who use drugs and people with drug use disorders. The data from last year—not 2025, but the 2021–24 cycle—shows the proportion of people in treatment has actually increased between 2019 and 2022, even with COVID in that period. However, we’ve also seen clear decreases in funding, including internationally and for UNODC. This risks reversing progress achieved together. I mentioned one success. There are many others—improving quality, treatment for women, pregnant women, adolescents with drug use disorders. There was a beautiful picture on the slide that disappeared, but keep it in mind. Let us not forget: providing services is not only about honoring the right to health—it’s also an issue of public safety. Evidence-based treatment decreases violence, crime, recidivism, and prison overcrowding. Organized crime networks—according to the World Drug Report—derive the majority of their revenue from this: behind every number is a person, a family, dreams. If it was me, or you, or a loved one, we’d want access to services. Let us use this opportunity to make that reality. Thank you very much. It’s my great pleasure to introduce my colleague. She’s a psychiatrist and head of the National Center for Treatment of Drug Addiction in Ljubljana, Slovenia. When I say a minority of people with drug use disorders are in treatment, I mean access—we know little about the quality of treatment they’re accessing. So I’d like to ask Mariana to comment on the dimensions of quality in improving outcomes of drug addiction treatment. Are there priorities, ideas, or recommendations? The floor is yours.
Head of National Center for Treatment of Drug Addiction, Ljubljana, Slovenia: In response to the core question—dimensions of quality in Slovenia—we’d highlight several key points: accessibility and equity, integrated person-centered and age-responsive care, evidence-based treatment, outcome measurement, stigma reduction and involvement of people with lived experience, social reintegration and employment support, responsible cannabis policy, and treatment in prisons. In conclusion, improving quality means making treatment accessible, person-centered, evidence-based, and respectful. It requires reducing stigma, ensuring reintegration, and providing care also in prisons. These must guide our collective work. Thank you very much.
Giovanna Campello, UNODC: Thank you so much, Mariana, and especially for underlining person-centered care. Our review found that dimension most closely linked to better outcomes. Now I’d like to dive into comorbidities with other mental health disorders. We’re fortunate to have online Dr. Marta Torrens, head of addiction at the Institute of Neuropsychiatry and Addictions, Hospital del Mar, Barcelona, and member of the scientific committee of the European Union Drugs Agency (EUDA). Marta, if you’re online, could you speak about addressing comorbidities with mental health disorders?
Dr. Marta Torrens, Hospital del Mar, Barcelona; Scientific Committee, European Union Drugs Agency (EUDA): Yes, thank you. It’s important to address mental health conditions in people with substance use disorders. They have greater psychopathology—for instance, suicide. We say many overdoses, but about 25% are not accidental, they are suicide. They also have medical conditions—hepatitis C, infections—and social problems like unemployment, homelessness, violent behavior. They are not a small number—very prevalent. Depending on factors, 40–70% of people seeking treatment also have mental health disorders. Recommendations: systematic detection of mental health conditions in people with substance use disorders, treat both conditions together in an integrated model, and avoid “wrong door syndrome,” where patients are bounced between substance and mental health services. The most severe patients end up excluded. Take them together. Integration is essential. Thank you.
Giovanna Campello, UNODC: Thank you, “No Wrong Door” is a very good way to put it. Too often services are fragmented—if someone doesn’t present to the right place, they fall through cracks. This is particularly true between mental health and drug treatment services, but also between treatment and harm reduction services. That’s why I’m glad to give the floor to Catherine Cook from Harm Reduction International, to tell us about opportunities for integrating treatment and harm reduction services, and their value. Catherine, the floor is yours.
Catherine Cook, Harm Reduction International: Before discussing opportunities for integration, we must face the evidence: health services are falling short of meeting the needs of people who use drugs. The cost is measured in preventable infections and deaths. Harm reduction is not optional—it is a public health and human rights obligation, endorsed across the UN. Interventions include needle-syringe programs, opioid agonist therapy, and take-home naloxone. These reduce HIV, hepatitis C, overdoses, and link people to wider health services. Since 2008, HRI has monitored progress. Governments have signed up, but implementation lags. Only 93 countries operate NSPs, 94 provide OAT, 34 have take-home naloxone. Services are concentrated in urban areas; in prisons, only 11 provide NSP, 60 provide OAT, 11 provide naloxone on release. Punitive laws undermine uptake. People who use drugs cite fear of arrest, police violence, stigma, breaches of confidentiality. Certain populations face inequities: women encounter gender-based violence, lack of reproductive health services; LGBTQI+ people report discrimination; young people face age restrictions; Indigenous communities rarely have culturally appropriate models. Most services focus on opioids, while responses to stimulants and new psychoactive substances lag. Underlying this is a funding crisis. Harm reduction faces a 94% shortfall in low- and middle-income countries. Services depend on a few donors, mostly the Global Fund. This reliance is dangerous, especially with USAID cuts and threats to UNAIDS. Governments must reassess spending: vast amounts go to punitive approaches that do not reduce drug use but create harm. Shifting funds to evidence-based, rights-based health responses is essential. Integration may optimize resources, but it cannot succeed if people risk arrest or discrimination when accessing mainstream services. Governments must decriminalize drug use, protect confidentiality, remove age restrictions, address stigma, and fund community-led organizations. Harm reduction must be sustainably embedded in health systems, with meaningful involvement of people who use drugs. Without this, we’ll continue to see rising deaths and infections. Governments should make practical, evidence-based choices: shift funding from punitive systems to health and community approaches, embed harm reduction in national health systems, and adopt supportive laws. This is the only way to protect harm reduction from funding shocks and achieve global health goals.
Giovanna Campello, UNODC: Thank you so much, Catherine, for eloquently describing how systems influence access to services. Thank you for raising stigma as a barrier. You also mentioned women. Angela’s data this morning showed how wide the treatment gap is for women who use drugs. In this context, I’m privileged to call on Dr. María Elena Medina Mora, academic at UNAM in Mexico.
Dr. María Elena Medina Mora, National Autonomous University of Mexico, UNAM: I’ll start with the story of a 25-year-old woman whose life ended in the streets. “When my sons were killed—so violently—I didn’t know how to deal with the pain. Heroin—nothing hurts. I forgot what happened when I was a girl, only dreams. I remember how the police showed me the corpses—pieces of meat and bones. Then I started taking pills. At first prescribed, later clandestine. Then heroin. I walked the streets like a crazy girl. ” Women are more vulnerable to opioids, as shown here. Factors included lack of control over illicit markets, lack of strategies for social determinants of poor health, lack of community mental health facilities. What was needed: management of emotional pain, appropriate pharmacological and psychotherapeutic treatment, doctors trained to manage opioids, supervision, and care for depression. We need tailored approaches for women: addressing stigma, fear of losing custody, lack of childcare, lack of resources. Consider trauma, hormonal conditions, cultural context, unpaid care burdens. Treatment models should be integrated and flexible—reducing frequency and quantity lowers risks and may help women keep jobs and make healthy decisions. Relapse prevention must involve women and aim to make relapses less frequent and prolonged. Consider structural barriers: economic resources, children, discrimination, domestic violence. Special care for vulnerable women should be improved: voluntary, dignified treatment; psychosocial care; work training; housing; good food. Our actions should not further stigmatize but instead prioritize funding and support for them and their families. Thank you very much.
Giovanna Campello, UNODC: Thank you so much for describing so eloquently the dimensions of services that actually meet women’s needs. Just last week, I visited a service for women and asked what message I should bring to policymakers. They said: Please. We have a safe space here. We don’t want to exclude anyone, but this supportive space allows us to work through our needs, and it is invaluable. So I promised to share that with you. We need stronger investment in treatment services for all people, but let us not forget the wide treatment gap for women, and invest there as a priority. There are many gaps in the science. One of the gaps that we have is with regard to people with stimulant use disorder. For opioid use disorders, we have some very powerful pharmacological and psychosocial treatment options. In the case of stimulant use disorder, we do not have such pharmacological options, and there are evidence-based psychosocial options that are not very well implemented all around the world. The Commission took notice of this in its last session, and therefore it’s my very great pleasure to introduce to you Apinun Rattana. You will excuse my unashamedly Italian pronunciation of your surname. He’s Assistant Professor at the Faculty of Medicine at Chiang Mai University, Thailand. He is online, it’s very late for him, and it’s my great pleasure to give him the floor because he will tell us his reflections on how to make Resolution 68/2—which is the resolution with which the Commission took notice of this important issue just a few months ago—something we can bring forward. Dr. Apinun, you have the floor.
Dr. Apinun Rattana, Chiang Mai University, Thailand: So I am happy to share my thoughts on CND Resolution 68/2 implementation. The resolution, tabled by Thailand and Norway at this year’s CND meeting, was a continuing joint effort from the UNODC–WHO scale-up initiative on stimulant use disorder treatment research launched at CND 67 last year. The resolution carefully reviewed the global gap in treatment of stimulant use disorder—no medication has yet been approved—and clearly addressed the need for promoting research on evidence-based interventions for both pharmacological and non-pharmacological approaches. At CND 68, the Norwegian delegation also hosted a side event to highlight progress and challenges of the scale-up initiative. Experts, policymakers, and individuals with lived experience highlighted the importance of tailoring interventions to diverse contexts, especially in low- and middle-income countries. They stressed the need for multi-country studies to evaluate feasibility, safety, and effectiveness of interventions to meet global demand. Next steps should build upon existing scale-up initiative commitments. In my view, the initiative should be strengthened and regionalized. Strategies could include regular meetings and conferences on global and regional scales to share and exchange research, forming networks among experts, policymakers, and others. For example, in July this year a regional workshop on treatment and care for people with stimulant use disorder was organized by UNODC’s Regional Office for Southeast Asia and the Pacific in Bangkok, serving as a good opportunity for exchange. Later in August, Thailand hosted an international conference on methamphetamine and synthetic drugs in Bangkok, bringing experts, policymakers, and civil society from Asia to share experiences and discuss the way forward. The annual CND meeting can be further utilized for this purpose. Regional conferences or meetings in between can keep collaboration active, and strategic partners are already organizing international conferences, such as ISAM, ISUB, or Lisbon Addictions, which could also serve as platforms for collaboration. The most crucial issue, clearly, is funding for research and collaboration initiatives. This could be challenging, but some financing may come through bilateral or multi-country cooperation targeting promising interventions. That is all from me. Thank you for your attention.
Goodman Sibeko, University of Cape Town, South Africa: The digital space is increasingly an important frontier for both exposure to risk and for extending services to people who use drugs and those with substance use disorders, particularly in low- and middle-income countries where health systems are under-resourced. We’re seeing a broad spectrum of digital interventions being piloted and scaled—telehealth and tele-counseling platforms, mobile health solutions such as SMS motivational messages or adherence reminders, internet-based self-help programs offering screening, psychoeducation, and modules like CBT. In some contexts, chatbots, digital peer support networks, and hybrid models are emerging. WHO has supported web-based self-help and screening tools in India, Mexico, Brazil, Belarus. Reviews show promising acceptability and feasibility, though most studies are small and concentrated outside Africa. Digital interventions using CBT and motivational strategies can reduce substance use frequency and improve outcomes. Opportunities: extending reach into rural areas, reducing stigma through anonymity, scalable and cost-efficient services, data systems for monitoring and adaptive care, entry points for people with mild to moderate use who might not present to clinics. Barriers: digital divide (smartphones, data cost, connectivity), literacy and digital literacy, privacy and data security (especially where drug use is criminalized), engagement and retention, sustainability beyond short-term pilots. Digital services should not yet be standalone solutions but part of stepped or hybrid care. Low-intensity digital interventions can serve as accessible first steps with escalation to in-person care. Interventions must be co-designed with users, aligned with local policy frameworks, and integrated into national health systems. In closing: the digital space offers powerful tools to reach excluded populations, but they must be designed for low-resource realities, co-created with users, and embedded within broader care systems including community-based and clinical support. The question is not whether digital services can play a role, but how to ensure they do so equitably, sustainably, and safely. Thank you.
Anja Busse, WHO: Greetings from the margins of the 6th Global Ministerial Mental Health Summit in Doha, which is why I cannot be with you in person. Drug use disorders are recognized as health conditions by the International Classification of Diseases, by science, and by the UN General Assembly. The international drug control conventions affirm the health and welfare of humankind as central. International standards for treatment of drug use disorders state they should be considered primarily health problems, and people with these disorders should be treated in healthcare systems. Yet in many countries, ministries of interior, justice, and drug control agencies lead not only drug policy responses but also treatment efforts. Recognizing drug use disorders as multifactorial health disorders, treatment must be centered in health systems. Ministries of Health must be empowered and funded to lead on guidance, implementation, and oversight, just as they do for other health conditions. This is needed to close the treatment gap and ensure quality services. Advantages: Ministries of Health bring expertise to integrate evidence-based psychosocial and pharmacological treatment into health services, enabling earlier interventions, wider reach, and better alignment with complex health needs—mental health, infectious diseases, NCDs. Streamlining allows better resource use, leveraging infrastructure, producing beneficial outcomes across domains. A health-led approach also reduces criminal justice contacts and savings can be reinvested into services. Challenges: Ministries of Health are often not involved in policy development, leading to imbalanced policies and funding gaps. Global health spending declined in 2022, and national budgets allocate less than 1% to substance use disorder treatment. In 80% of countries, people with these disorders are not eligible for government support (disability, housing, education, food), creating barriers to treatment adherence and recovery. Criminalization of drug use limits effective care. Stigma persists even in health services. In some contexts, other government entities historically lead treatment efforts, but long-term the goal must be to strengthen Ministries of Health. What needs to change? Business as usual will not reduce the treatment gap. Ministries of Health must be central actors with clear authority and funding. Drug treatment and harm reduction must be integrated into health systems and UHC schemes. National action plans are critical. Dialogue between drug and health policymakers via CND or World Health Assembly can embed health-centered responses. Encouragingly, this thematic session focuses on public health, and the Global Mental Health Summit is considering substance use in parallel. Perhaps we can all reflect on the role of Ministries of Health and how they can be empowered to lead integrated, evidence-based responses benefiting individuals and communities alike. Thank you.
Chair: I would like to open the floor for questions to our distinguished panel. We’ve heard many insights on drug treatment, its evolution, technologies, targeted interventions, and useful points on quality and quantity of care. We also heard about women’s vulnerability to treatment gaps. There’s a lot to unpack.
Colombia: This morning you invited us to be clear on what works. We want to thank the parties for showing that a public health approach to drug use and harm reduction services works. We have some questions. First: how can harm reduction interventions be better integrated into treatment and health services? Second: how can UN agencies support this integration to help states achieve their goals? Third: regarding women and girls—harm reduction sometimes lacks a gender perspective. The Special Rapporteur on the Right to Health documented this year that women who use drugs face violence rates up to 42 times higher than women who don’t. How can this need be integrated into harm reduction measures? We would like to know from the panelists how best to address this challenge.
Oman: My question: the main problem we face is how to address drug overdoses statistically. Most are not reported to treatment centers—they go to general hospitals or are found in the street. How do we address that problem?
International Federation of Red Cross and Red Crescent Societies, IFRC: I would like to link to Colombia’s question and underline again the importance of harm reduction as an essential component of public health. Despite decades of discussion, harm reduction is still misunderstood and misrepresented. Some suggest it encourages drug use—this is a dangerous misconception. The scientific community must clarify its meaning and eliminate political instrumentalization. Harm reduction is the first step of a comprehensive person-centered health response. It is not an alternative to treatment, but the entry point. Recently, some speak of recovery-oriented harm reduction—we welcome this, as it reflects the truth that all effective harm reduction activities are oriented towards therapy, dignity, and health. Harm reduction includes treatment measures such as methadone. The goal is not to keep people in cycles of use but to accompany them towards better health. Ignoring this has dangerous consequences. In too many places, coercive measures are promoted as “treatment,” undermining human rights and public health. We call on international organizations, member states, and the scientific community to strengthen common understanding and shared language on harm reduction and treatment. Only by aligning approaches can we ensure equitable access. Harm reduction must be seen as the beginning of treatment, leading to comprehensive recovery.
Brazil: Thank you, Mr. Chair, Brazilian experts have realized that there are persistent barriers to continue to impede equitable access to health for certain population groups, specifically women, people of African descent, indigenous peoples and people in marginalized communities. Do the panelists have special considerations on policies oriented for specific segments of the population? Thank you.
France: Thank you very much. I just have a simple question regarding the platforms, the tool, the digital platforms, which was mentioned by the colleague from South Africa, which is very interesting, just in order to make people be able to to contact a hospital through digital devices, which is very useful, and not to be ashamed and to be able to do this, did you develop some procedures, some proceedings, and is there at the EU level some kind of guidelines regarding this possibility to have access to hospitals through digital platforms?
UNODC: If you look at international standards for drug use disorder, for the treatment of drug use disorder, the title is treatment, but inside you will find all of the services, including harm reduction services that are needed to protect the health and the recovery of people who use drugs and people with drug use disorder. So I think that for one first step might be to go beyond the terminology and really start looking at that continuum of care in a similar vein to also what the delegate from the Federation of Red Cross and Red Crescent societies was mentioning. Of course, this will mean also that because drug treatment needs to be a health response and harm reduction is also health response, that we need to be some institution to take the lead. The most natural institution is the Ministry of Health, and we have heard reflection from our colleagues at WHO and how Ministry of Health can do it, but need our support to do it. And in that respect, I think that we need to start sitting down together and really break down the barriers and bring together all of these services and make sure that these services are collected, that there is not the wrong door syndrome that Marta introduced in the case of the people with dual diagnosis of drug use disorder and mental health disorders. But that happens with all of the services that if you don’t report the right service right from the point of view of the service, not of the patient, not of the person that needs the service, right? We will not go very far. And of course this also means that in the design of the service, and this is something that the commission has taken notice of, we need the involvement of affected populations so that the services are really designed responding to the needs of those that need to use them. And this brings me to a very last comment with regard to the question from the distinguished delegate from Brazil. There are people who use drugs and people with drug use disorder that are part of groups that are particularly marginalized for different reasons. These groups often suffer from higher not only levels of deprivation, but also victimization and violence. It would not be enough to have nicely designed services. It would be need. There will be a need for the services to go to this to these groups, possibly through peers. So that that first contact between the person who needs a service, and the service is really meets the person where they need it, when he or she needs it most. And this is you might think this is very generic. But of course, this will need to be tailored to the different situations, and we will see different kind of organizations of services, depending on the community, depending on the country. But this is the successful services. This is all they share the fact that they make an effort to reach out in in a very respectful way, and possibly using peers so that people feel safe in coming forward and in accepting our support, I think that is all I would like to I think that maybe Maria Elena and Martha might want to comment on women who use drugs and women with drug use disorder. Then maybe there might be comments from here as well, of course, and Woodman is online for the question on digital space.
Mexico: I think that Brazil has done a wonderful job in people that are in very unsafe conditions, and that also happens in Mexico and in other countries in the region, when females live in streets, there are these they do not have access to care. They usually go to services that former drug addicts promote, and they are like jails, because when they get in these services, if we can call services, they don’t have, they don’t they’re not sure to go to get out of these, these systems. So there is a very big need of policy making to be sure that the services that are enhanced of this civil society, which some are very, very good, are really well performed. And this happens because people with severe disorders are not included in the services that are usually provided for people that take drugs, especially females, their bodies are used to test new mixes of drugs in the streets, and we have more proportionally more females in jail for drug issues because they are news and they are not benefited for policies that when drug is not when the jail is not provided for those that use drugs for personal use, and also in the in this, they are new problems, because the people that like females, that have a husband that is in the drug market, and he disappears or dies, they take they sell the drugs to feed their children. And then this is something that is happens in some areas in Mexico, so we really need to have policy to address these populations that are very vulnerable. Thank you very much for the question.
Spain: Well, I would like to say that I am absolutely with Maria Elena, but I would like to say that psychiatric comorbidity is more frequent in females this second point, also they are very big differences in gender. Females have much more depression than an anxiety and post traumatic stress disorder than males that are using drugs, and, of course, three, four times more than females that are not using drugs. Then this is a key problem. This is the first then services, in respect to the services, services have to adapt the portfolio, the portfolio, including this, the dual disorders, of course, that they say, but also harm reduction, because it’s possible to improve harm reduction in the services and also doing a gender perspective to facilitate the accessibility for for women. They say women are more depressed, and then they don’t came to the centers. And also that many times they have a partner that is also drug addict and also with substance use disorder, and they are the person, the females that are more suffering violence for the partner, then we have to increase the accessibility for women that are that use, that are using drugs. And then just a key point for me, very important, that when one woman arrive to the to the center, is for the women to arrive to the center to seek treatment, then we have to put red carpet, because for them, it’s much more difficult for a man, a man who arrives to treatment, they are always a woman pushing him. The mother is the wife. Always there is a woman pushing the man. But for a woman, this is the more stigmatized person. The woman who takes drugs is the more stigmatized condition in the health overall. Then, if she arrives, red carpet…the most important is that she comes. This is the more relevant, because we have to work for long with her, but only she’s alive, we can work then this is our responsibility, a center for treatment to make accessible for the women also, and this is all Thank you.
Colombia: In monitoring drug use and treatment services. We have registry of health service providers and a national producer prevention systems that access to treatment. According to our registry, there are 147 institutions with inpatient care for adults, 63 for minors, and 165 outpatient centers, however, access three months, far below the need in 2022: 350000 people showed patterns of abuse or dependence. Only 70000 received treatment + our participatory process to design the natural drug policy with 20 with 27 dialogs in 150 regions confirm that most treatment centers are provide and concentrate in capital cities, leaving rural communities, woman, youth and indigenous people without sufficient coverage. Additional careers include weak coordination, lack of covers like under unregulated centers that often violate rights and persistent stigma. In response, Colombia, together with civil society and local governments, has expanded community based harm reduction services programs such as with mobile teams and peers, bring health care and cycle support people in the streets and place of use. In recent years, we founded 22 projects in nine territories, triplets, investment, distribute more than 38 thousand kits, enrolled more than 100 people in methadone maintenance and reach more than 52k people. None of this will be health, social and justice sectors. The government has over 10 thousand basic health teams across all regions, reaching 5.5 million with home based health services, including intervention, early detection, chronic conditions and mental mental health through international cooperation, over 660 professionals has been trained in International treatment as standard. Our policy now integrates six levels of care, promotion, prevention, early detection, treatment, harm reduction and social inclusion. Align with the international guidelines on human rights and reports close with this. These initiatives coordinate emergency measures. They are points to the health system of health in patient disease, treatment and other social services, our reduction access and continue to avoid trust United Nations agencies such as UNODC, and support to this evidence based.
Catherine Cook, Harm Reduction International: Thank you, my colleague from Colombia, your question on gender services for people who use drugs, it’s a it’s a huge gap in the harm reduction response in terms of tailored responses for women who use drugs, and it’s a huge need. And I think that a lot of the discussion today has been about access and for women who use drugs, there’s a particular extra set of values in terms of being access services, greater need for services to be tailored. We do have best practice examples from several countries, including Lebanon and Spain and others on gender tailored responses for harm reduction, which we need to scale up. We need to share those experiences and hear more about the success of those and scale up those approaches. And I think similarly, my colleague from Brazil, the question that you gave on in digital, tailored responses there, I think it’s the same answer we need the people, the people in mind to receive those services. They need to involve those communities in the design of those services. And there are networks developing, particularly around harm reduction for indigenous peoples that you know, those experiences need to be amplified. And I’d just finally like to say that, you know, with harm action and integration, I think that the most important point is that harm reduction is an entry point of lots of services, including all that, all of the variety of treatment services that we talked about today, voluntary, evidence based treatment. And I think that the peer outreach element that harm reduction, that is at the core of harm reduction is essential in meeting people where they’re at and, you know, going out and stigma free kind of access to services and that that is the crucial role that harm reduction integration can play.
South Africa: We appreciate the question digital platforms are indeed transforming how people access hospitals and health care, importantly, reducing barriers like stigma and distance. And I think an important element is that of driving self efficacy and enhancing opportunities for non judgmental access to care at the global and EU levels, there are guidelines such as the WHO digital health recommendations and EU e health frameworks, which provide some standards for safe, confidential and effective use. The key priorities to be mindful of are ensuring accessibility, user friendliness and equity, and especially for vulnerable groups. And continued collaboration, as we’ve been talking about across regions, will be essential to strengthen the procedures and scale up innovation responsibly. And finally, it’s essential to make sure that these interventions that we pursue are evidence based prior to being scaled forward. So thank you very much for the question.
WHO: Thank you so much, I hope last, not least, to us. And really, thanks everybody for the questions raised. I think we are trying to bring it in this session, and obviously from a WHO perspective, together in a public health framework, right? So I think in a public health framework, it’s got to be relatively easy to integrate drug treatment and harm reduction responses, but also seeking, really to integrate with response to health overall. So I mean, harm reduction obviously comes also from preventing HIV, preventing hepatitis, but in a public health framework, at the same time, we can also address other health issues, right? So that might be dental health or that might be non communicable diseases that are associated with drug and substance use. So I just wanted to also respond to the question from the delegate from Oman, which maybe was not responded before, on overdose prevention and management and aid, to also inform the commission that we’re currently updating, WHO guidelines on psychosocially assisted pharmacological treatment of opioid use disorders, and the WHO guidelines on community key management of opioid overdose. So those guidelines are already available for you, but an update and an integration of these guidelines will soon be available, and also for those who are looking obviously at emerging evidence. But as I think I said before in one of the presentations, or when Joanna said that, obviously for cases of suspected opioid overdose, at the moment, as emergency management, we have effective medication, Naloxone, right, which can when given in time, reverse and overdose. But that emergency management, of course, is not the only response. This is again, kind of where the continuum of care needs to come in, and we need to offer low threshold, attractive, evidence based, person centered services so that people that have experienced an overdose or at risk of actually find another entry door into the health system where there will be supported. So I think maybe the last thing in this, and also, as we were discussing right, how to make services effective, is really to again highlight. I think other speakers have done that, also the importance of the role of civil society in many ways, as a partner, and also people with lived and living experience in the design of services. I think that can help us with a lot of the discussions we had, also around increasing accessibility for different types of marginalized groups. So maybe that’s my my other take home and over to you again.
Chair: Contributions to the pledge for action initiative are next.
Israel: To strengthen our public health responses and address the global drug challenges, we recognize the serious challenges highlighted in the 2019 ministerial declaration, drug treatment and health services too often fall short of meeting the needs of individuals, while drug related deaths are on the rise, families, communities, women, children and youth must remain at the center of our efforts to safeguard health ensure access to treatment. In this period, Israel has launched a major structural reform to enhance and develop its national addiction treatment system. Responsibility for addiction treatment services, including insurance coverage is being transferred to our four to one of our four national health maintenance organizations, HMOs. The aim is to improve accessibility, continuity and quality of care for all individuals with substance use disorders or behavioral addictions by integrating these services into the mainstream health system Israel seeks to ensure comprehensive and person centered care. The reform will expand services nationwide, addressing the full spectrum of addictions, including alcohol, cannabis, illicit drugs, prescription medications and behavioral addictions. The program provides a full continuum of care, from prevention and early intervention to outpatient treatment, alternatives to hospitalization and dual diagnosis services, rehabilitation and occupational programs will be strengthened through the Ministry of Welfare, while the HMOs focus on treatment delivery. The reform is anchored in government resolution 1415, of 2022. Implementation began at the end of the that year, and is proceeding in a modular manner, with the Ministry of Health continuing to provide services during the first three year phase, where community services are developed in parallel. blablabla 🍉
Uruguay: The ability and quality of care, treatment and integration interventions adapted to people’s needs and characteristics from centers is complex and dynamic, rooted in social, economic, political and cultural factors, and that it affects the fundamental rights of individuals in order to achieve the objectives set out in the high-level declaration of the Commission as a follow-up to the 2019 ministerial declaration. Uruguay pledges to develop lines of action for articulation of treatment and care services under a balanced, integrated, comprehensive, multidisciplinary and evidence-based approach, grounded in the principle of common and shared responsibility. This pledge recognizes the importance of incorporating gender and age perspectives in drug-related programs and policies, with particular attention to individuals, families, communities and society as a whole, focusing especially on women, children and youth with a view to promoting and protecting health, ensuring access to treatment, safety and well-being. Accordingly, Uruguay has developed the guide “Women and Gender Diversity and Drug Policy from Community Treatment” within the framework of technical cooperation with the COPOLAD III program. This document provides a territorialized care model that responds to the specific needs of cis women as well as trans, non-binary and gender fluid persons who use drugs, and constitutes a concrete tool for developing drug treatment policies from an integral, inclusive, diverse and community-based perspective, based on human rights, with an intersectional approach. Building on this framework, Uruguay will open a new community women’s center for women and gender diverse persons in the city of Las Piedras in Canelones Department, in partnership between the National Drug Board and the local government. Mr. Chair, through this pledge Uruguay reaffirms its commitment to protecting health, advancing equality, equity and human rights at the center of drug policy. Thank you very much.
Argentina :Within the framework of the pledge, Argentina undertook the commitments to strengthen accessibility to treatment, to consolidate articulation between care facilities as a mitigation system, and to guarantee continuity of care for all people. To implement those commitments, treatment was strengthened through the expansion of the care network, which currently has more than 800 community prevention and treatment facilities. A comprehensive network of first-level ambulatory, residential and prevention centers was consolidated in coordination with organizations and municipal governance, strategically located with high resolution. The aim was to bring services closer to the people, guaranteeing compliance with international standards of equality and equity of access. In 2025, Argentina committed to the continuous training of the teams that are part of the social and healthcare network. Within this framework, 17 groups of training and 11 face-to-face meetings were developed. These activities included participation from across the federal system. As part of the capacity-building activities, five support tools were prepared to improve quality of care and operational management for comprehensive drug policies. Argentina is also working on a guide for addressing public rights situations, aimed at providing territorial teams with tools to intervene in critical and complex contexts. These actions reaffirm Argentina’s commitment to strengthening the technical capacities of the federal care network, promoting evidence-based, articulated and people-centered interventions. Argentina has made progress in consolidating prevention and treatment policies, holding federal meetings with the country’s 24 jurisdictions within the Federal Council on Drugs, strengthening coordination across government levels. The federalization of public policies has been key to promoting co-responsibility and participation of all actors involved. Work was carried out with provinces to articulate between territorial mechanisms, the health system and local areas, consolidating a comprehensive approach adapted to each territory. This system relies on the participation of civil society organizations, municipalities, unions, churches, clubs and other community actors. Provincial meetings were promoted in educational, labor, cultural, religious and sports environments, strengthening a broad community network. Argentina’s particular territorial realities, with contexts of high social vulnerability, require a tiered care network as part of a cohesive, efficient system aligned with international standards. Argentina has made steady progress in strengthening prevention, treatment and continuing care services since the 67th CND and reiterates its commitment to expanding access.
Belgium: Ladies and gentlemen, during the 67th session Belgium pledged to invest in improving treatment for drugs in prisons. This was done through pilot projects in 10 prisons, training of healthcare professionals, data collection and research. At the beginning of this year, investing in drug treatment and recovery programs for people in detention remains a priority. The Belgian government has the ambition to extend these programs to all Belgian prisons by 2029. The objective is to improve not only quick identification of people who use drugs in prisons but also referral to tailored treatment. This is done through evidence-based screening tools, training and awareness raising of prison staff, development of tailored care pathways including motivational support and referral to outside services, and promoting continuity of care after imprisonment. Thank you.
Japan : Japan is firmly committed to the international fight against the world drug problem, as a country that regards the rule of law as a central pillar of its foreign policy. Japan shares the same fundamental values as the United Nations Office on Drugs and Crime and takes pride in being its longstanding partner. Japan has contributed over 21 million US dollars to UNODC projects focusing on three areas: first, strengthening border management and law enforcement in regions vulnerable to trafficking, including Central Asia and borders surrounding Afghanistan and Ukraine; second, enhancing maritime security and the rule of law at sea, particularly in support of a free and open Indo-Pacific, with projects in Africa and Southeast Asia; and third, responses in areas affected by displacement and instability, notably in the Mekong region. These efforts reflect Japan’s emphasis on practical, field-based cooperation, rooted in long-term institutional building and respect for sovereignty. Looking ahead, Japan is exploring cooperation in Latin America, a region where we have not yet implemented UNODC projects. To this end, I visited Uruguay and Argentina in April, accompanied by Mr. Mathias, Director of Operations of UNODC, to conduct field consultations. These missions assessed potential cooperation in disrupting illicit drug flows, particularly synthetic drugs, and supporting national efforts to prevent illicit use and build domestic law enforcement capacity. This initiative marks a new chapter in Japan’s engagement with UNODC, building on collaboration in Southeast Asia and Africa. Mr. Chair, Japan stands ready to continue working closely with UNODC and member states, driven by shared responsibility and belief that real-world impacts must remain at the heart of our efforts. Thank you very much.
Chair: May I again impress on everyone the need to look at the clock, because we are short on time.
EU and its member states + Albania, Bosnia and Herzegovina, Georgia, Iceland, Montenegro, North Macedonia, Norway, Republic of Moldova, Serbia, Ukraine and Azerbaijan. Achieving universal health coverage and access to quality essential healthcare services is part of the SDGs and of universally accepted human rights standards, as pointed out by WHO. Strengthening health and social responses and ensuring gender- and culturally-sensitive access remain a priority of the current EU drug strategy. According to the European Drug Report 2025, around half a million people receive some form of opioid agonist treatment in the EU, though disparities remain. Harm reduction interventions remain important, including access to antiviral treatment for HIV and HCV. In some EU member states, HIV prevalence among people who inject drugs is about 15% and HCV around 50%. Needle and syringe programs and opioid agonist treatment reduce these risks. Greater efforts are needed to prevent outbreaks and reduce transmission, including investment in harm reduction services, testing and treatment. The EU has supported harm reduction for nearly two decades, including 20 million euros since 2023 for community-based health interventions. Evolving drug markets, especially stimulant use, require further research and service development. We support the UNODC scale-up initiative for stimulant treatment. Overdose deaths in the EU were at least 7k in 2023, an increase from 2022. Beyond overdose, people who use drugs face higher risks of cardiovascular disease, cancer, infections and suicides. The EU supports overdose prevention through forensic and toxicological lab networks, early warning systems, take-home naloxone, peer distribution and drug consumption rooms. Effective, equitable responses must take into account the needs of people who use drugs, including gender-specific experiences, families and communities. In light of evolving markets, we are keen to develop new forms of treatment with scientific and civil society partners, with the overall goal of reducing harms. Thank you.
Armenia:For the sake of time, I will address treatment and prevention together. Adoption of evidence-based approaches in line with UNODC/WHO international standards, incorporating gender responses and human rights, is key. Equal access for vulnerable groups, including prisons, must be ensured. Armenia’s programs include addiction treatment, detoxification, substitution therapy, mental health and psychosocial support. Prevention is a core strategic goal in Armenia’s national drug strategy, developed with UNODC support. We focus on public awareness campaigns, carefully identifying target groups; expansion of school and community programs focusing on life skills, mental health promotion and resilience; curricula for healthy lifestyles; teacher and staff training; and national capacity for early identification and intervention, especially for vulnerable groups. Efforts include care for people with drug use and mental health disorders in prisons and socialization programs. Prevention must be long-term, resourced and culturally adapted, rooted in evidence and human dignity. Armenia reiterates its commitment to a balanced, integrated approach where prevention is a proactive and central element. Thank you.
Peru: Peru recognizes the major challenge posed by the gap between the need for care and the capacity of specialized health services. The emergence of new and dangerous substances requires urgent responses. The Ministry of Health has been expanding specialized coverage with more than 2000 community mental health centers nationwide, each with an addiction unit. Through the budget program for prevention and treatment of drug use, led by the National Commission for Development and Life without Drugs (DEVIDA), 116 specialized ambulatory treatment services have been developed at the primary care level. This program promotes ongoing training, differentiated intervention guidelines for vulnerable groups, epidemiological studies, expansion of coverage, and strengthening of referral networks. With these actions, Peru reiterates its commitment to strengthening its response capacity, preventing drug-related deaths and guaranteeing timely access to inclusive, effective, rights-based health services. Thank you.
Australia: Access to quality, evidence-informed and affordable treatment is a core principle under Australia’s long-standing commitment to harm minimisation. The government funds treatment and support services across Australia, available across a wide spectrum, including peer-based community support, brief interventions, hospital services and specialist treatment. Integrative care remains a principle, addressing associated risks such as physical and mental health, socioeconomic, legal and housing needs. Despite efforts, unmet needs remain in some regions and populations. Priority populations include Indigenous peoples, culturally and linguistically diverse groups, LGBTIQA persons, people in rural and remote areas, and those referred from the criminal justice system. Globally, only one in seven men and one in 18 women are in treatment. This gap highlights the importance of gender-responsive approaches. Stigma and discrimination remain barriers. Peer-led awareness, diversion from criminal justice, and reforms can help, but must be coupled with increased service availability. Australia’s national strategy recognizes drug use occurs on a continuum and not all requires treatment, underscoring the need for harm reduction services. These include take-home naloxone, needle and syringe programs, opioid substitution therapy, drug alert systems and supervised consumption rooms. We acknowledge the powerful role of the peer workforce in reducing stigma, improving health literacy and linking to services. Australia reaffirms its commitment to working with partners, civil society and affected communities to improve access to voluntary, evidence-based services to reduce harm. Thank you.
Canada: Canada continues to observe substantially elevated opioid toxicity deaths. On average, 18 lives are lost each day. While there are encouraging signs with a 21% year-over-year decrease, overall numbers remain high. Highest overdose risks are among men, especially young and middle-aged workers, and elevated risks among people in corrections, facing housing insecurity and Indigenous populations. Substance use disorder is a global condition that can be managed with the right services. People deserve timely access to evidence-based care. There is no one-size-fits-all approach. A continuum of care remains essential, including prevention, harm reduction, treatment and recovery. Opioid agonist therapies are evidence-based tools for moderate to severe disorders. Canada works with provinces and territories to strengthen services through targeted investments and funding transfers to improve access to mental health, substance use and addiction services. Substance use is multifaceted. Canada will continue working with governments, Indigenous peoples, providers, people with lived experience, civil society and the international community to expand access to effective, responsive treatment.
Zimbabwe: Zimbabwe acknowledges the challenges posed by substance use and recognizes the need for a comprehensive, evidence-based approach to prevention, treatment, and rehabilitation. We continue to strengthen community-based programs and enhance the capacity of health and social services to respond to the needs of people who use drugs.
Mexico: Mexico recognizes that substance use disorders are a significant public health concern. We continue to expand access to prevention, treatment, and harm reduction services, with a focus on vulnerable populations, including youth, women, and marginalized communities. Efforts include capacity building of healthcare professionals, development of evidence-based guidelines, and strengthening community engagement to ensure continuity of care.
South Africa:South Africa emphasizes the importance of integrating drug treatment and prevention within broader public health strategies. We are expanding access to community-based interventions, including mental health support, psychosocial services, and vocational training for people in recovery. Special attention is given to addressing the needs of women, children, and youth, while also promoting awareness campaigns to reduce stigma associated with substance use.
Brazil: Brazil continues to implement a network of psychosocial care centers and community-based treatment programs for people with substance use disorders. These services are integrated into the public health system, ensuring accessibility and continuity of care. Brazil prioritizes evidence-based interventions, harm reduction strategies, and collaboration with civil society organizations to strengthen community support and reintegration.
India: India acknowledges the need for a multi-sectoral approach to drug use prevention and treatment. Our efforts focus on scaling up community-based services, capacity building for health professionals, and expanding access to opioid substitution therapy. Special programs are implemented for vulnerable groups, including women, children, and marginalized populations, while emphasizing evidence-based interventions and harm reduction measures.
Kenya: Kenya continues to enhance its treatment and prevention programs through community engagement, strengthening health services, and expanding access to rehabilitation facilities. We recognize the importance of data collection, monitoring, and interagency collaboration to ensure continuity of care, as well as addressing stigma and discrimination toward people who use drugs.
Peru: Peru reiterates its commitment to improving access to inclusive, human rights-based treatment services. We have expanded coverage through community mental health centers, integrated addiction units, and specialized ambulatory services at the primary care level. Training of healthcare professionals and evidence generation remain central to our strategy, alongside strengthening referral networks and promoting ongoing monitoring of patients.
Australia: Chair. Guided by our national drug strategy, Australia takes a harm minimisation approach, built on the three pillars of demand, supply, and harm reduction. Prevention interventions focus on delaying initiation of drug use, increasing drug literacy, promoting protective factors, and engaging communities in multi-sectoral approaches. Community-driven initiatives, such as the Local Drug Action Team (LDAT) program, develop tailored strategies informed by local data and community feedback.
Morocco: Morocco emphasizes prevention, particularly among youth, as a priority under the National Strategic Plan for Addictive Disorders. Programs are implemented in schools, universities, and community spaces, offering guidance, social support, and risk reduction education. The Ministry continues to strengthen the skills of professionals in early detection and intervention, ensuring culturally appropriate programs and active involvement of civil society.
Zimbabwe Despite dedicated efforts, including treatments, we still fall short of the growing need. Drug-related deaths have risen, an indication of the urgency and a clear call for an effective public health response that places prevention at the center. Zimbabwe has adopted a multi-sectoral government-society approach, involving government, law enforcement, health, education, social services, civil society, faith-based organizations, traditional leaders, churches, and the private sector. The plan encompasses interconnected pillars, each with a prevention function: Demand reduction: Evidence-based interventions in schools and communities, family life skills programs, youth life skills, sports and arts initiatives, and early identification and interventions in primary care and workplaces. Supply reduction: Targeted policing, market surveillance, and water management to disrupt availability of illicit substances. Treatment and rehabilitation: Continuum of care pathways to prevent relapse and transmission of infectious diseases, especially among high-risk populations. Psychosocial support and community reintegration: Counseling, mentorship, life skills, and community resilience to enable safe reintegration of survivors of drug use. Media and communication: Strategic campaigns to counter myths, delay onset among adolescents, and promote help-seeking. Legal and policy: Review and development of legal frameworks to prevent systemic gaps. Resource mobilization: Predictable financing, workforce development, and robust data systems to prevent service interruptions and expand reach. Zimbabwe’s multi-sectoral experience shows that prevention is overarching: every pillar contributes to saving lives, protecting our people, and ensuring public health.
United Kingdom: Effective prevention is central to improving the lives of people in the UK. We aim to reduce drug misuse and harms through prevention, treatment, and timely action against those supplying harmful substances. The most sustainable approach is preventing use among children and young people, building long-term resilience, and providing early support to prevent involvement in crime or risky behaviors. Every local authority offers targeted interventions delivered by children and young people’s drug and alcohol services. These interventions help young people make positive choices, reduce harm, and link to additional support services. Drug education is compulsory in state-funded schools, with specialist teams supporting youth at risk of involvement in crime. Civil society, including charities, plays a critical role in delivering these prevention initiatives.
Angola: Prevention is the central pillar of Angola’s anti-drug policy. Programs are coordinated across three modalities: Universal: School populations aged 12–14. Selective: Groups and communities with heightened vulnerability. Indicated: Individuals at high risk. Programs are implemented in collaboration with the Ministries of Education, Interior, Labor, Communication, community, religion, and NGOs. Public campaigns aim to reduce consumption and strengthen resilience and self-control. Treatment and rehabilitation are integrated into the national health system, with ongoing training of doctors, psychologists, and specialists, and partnerships with community support centers. Challenges include a shortage of specialists, segmented drug use, and insufficient funding. International cooperation is vital to address these challenges.
Lithuania: Align with the EU statement. Prevention is a fundamental public health strategy requiring long-term investment, community ownership, and intersectoral cooperation. Efforts focus on building a system-wide approach to prevention, with a strong role for the education sector, municipal leadership, and evidence-based practices. Key initiatives include: Mandatory life skills curriculum in schools, teaching social-emotional competencies, decision-making, and substance use prevention. National Early Intervention Program for adolescents. Piloting community-based care models in selected municipalities. Safer recreational environments in partnership with civil society and event organizers. National monitoring system improvements and contributions to international data collection. Lithuania remains committed to building a comprehensive, ethical, and effective prevention system that empowers communities and protects public health.
Iran: Iran emphasizes primary prevention through initiatives including: Promoting healthy child-rearing and family life skills. National addiction counseling hotline. Integrating prevention content into school textbooks. Student associations “Helpers of Life” to raise awareness of addiction harms. Training specialized human resources in prevention. Community-based projects and educational exhibitions. Iran implements a balanced strategy addressing demand reduction, harm reduction, and supply control, with strong regional and international cooperation. As of 2024, over 2k active NGOs are engaged in drug control efforts, ca. 1800 focused specifically on prevention and cultural activities.
Brazil: Prevention is a cornerstone of a humane, effective, evidence-based response to drug use (?) Our 2024 initiatives include the Prevention and Citizen Program, reaching people where they live and learn: public schools and community social assistance centers. Evaluations show reduced alcohol onset among adolescents. Brazil implements territorial drug prevention approaches such as CHAMPS and Communities That Care, focusing on families living in poverty and communities affected by structural racism and gender-based violence. Actions are tailored for children, adolescents, women, Black populations, and Indigenous peoples. Effective prevention is smart public policy and a core element of all drug initiatives.
World Federation Against Drugs (VNGOC) : Representing 480 organizational members and the Child Protection Working Group, the federation welcomes the focus on prevention as a core public health response. Continuous investment is essential, starting prevention early and embedding a prevention culture. Programs must integrate child protection, youth participation, family support, and mental health, especially for conflict-affected communities. Collaboration with civil society and youth is essential to fulfill rights under Article 33 of the Convention on the Rights of the Child.
BGoC / David Patton: Prevention should not narrowly focus on substances. Research shows recovery communities promote well-being, human flourishing, solidarity, self-care, authenticity, creativity, and purpose. Embedding a culture of recovery in communities creates alternative spaces that positively impact not just those in recovery but also their families, neighbors, and colleagues. Prevention, like recovery, is about starting something generative, not only stopping harm.
UNODC: Concluding Observations: Discussions highlighted: Public health perspectives integrating services for more effective treatment. Recovery-oriented continuum of care, and integration with mental health services. Innovative approaches, including digital tools and research on stimulant use disorders. The importance of prevention systems targeting children from early age through adulthood, with evidence-based, long-term interventions. Delegations are encouraged to exchange experiences and continue expanding evidence-based services.
Chair: Thank you to all panelists, delegations, and participants. Today’s discussion concludes. Tomorrow morning we will discuss HIV, hepatitis C, and blood-borne diseases associated with drug use, and tomorrow afternoon, adverse health consequences and risks of new psychoactive substances. Adjourned.