Contribution on the Challenges Identified in the 2019 Ministerial Declaration

The following contribution appears in the documentation of the 67th session of the Commission on Narcotic Drugs (CND), on the website of UNODC

Contribution to the challenge:

Positive developments in recent years

• Greater visibility of the need to provide treatment services grounded in a public health and human rights approach. Significant importance of the recognition of the “the lack of and unequal access to treatment and harm reduction” as a Human Right challenge, as mentioned in the report by the Office of the High Commissioner for Human Rights entitled “Human rights challenges in addressing and countering all aspects of the world drug problem” presented at the 54th session of the Human Rights Council – read article
• Understanding of treatment as being necessarily person-centred, with the objective of responding to different needs and paces with different programs and modalities within a continuum of care, as well as a greater acknowledgment of the importance of harm reduction services.
• Greater acknowledgment of the need to mainstream the gender perspective in drug policies and services (which should translate into concrete actions on the ground).
• Innovations stemming from the COVID responses: greater flexibility of methadone prescription and recognition of community-based support.

Negative developments in recent years that require further attention

• As latest data of the World Drug Report 2023 show, there are not enough drug treatment programmes available to meet the demand. Many services have been seriously affected by the budgetary constraints of the post-COVID era. Despite the fact that drug demand services are increasingly viewed from a public health perspective, the same services are still not considered as essential in many countries, possibly undermining their functioning, sustainability, and stability. Drug treatment services are typically underfunded, which results in a lack of resources, specialized personnel, and programs adequately adapted to the current situation.
• Treatment options are not only scarce and not readily available, but many places present long waiting lists in primary attention services, including detoxification and early admission in drug treatment, while specialized programs are notoriously difficult to access.
• Dianova has witnessed the lower support granted to inpatient services by public authorities. While there are more outpatient services offered nowadays which is a very positive step, it is important to stay vigilant to the fact that residential services are crucial for a segment of the population that does not respond effectively to outpatient services, and thus those services need to be guaranteed. Economic logic should not be the only guiding principle for allocating funds to the various treatment methodologies.
• There is a huge gap when it comes to the provision of reintegration services. This gap puts the effectiveness of treatment services at risk. All in all, there should be a greater coordination between services, including those dedicated to mental health, gender-based violence, homelessness, among others.
• Prevention as a proven, essential field of drug demand reduction deserves increased consideration and investment. This field of work has a direct impact on the health-related issues and should be reinforced, considering the dire reality and the future projections on drug use.
• Stigma associated with drug use – particularly targeting women – still persists at all levels. It has been shown that addiction stigma prevents many people from seeking treatment or requesting support. It is critical to address this issue, with special efforts dedicated to eliminating stigma among healthcare professionals.

Recommendations from Dianova

• More needs to be done to improve and expand drug treatment provision worldwide, in particular by promoting sustainable funding models for demand reduction services.
• Promote the implementation of a gender perspective in services on the ground and encourage the development of women-only services.
• Improve accessibility in treatment services for population in vulnerable situations, especially women,  refugees, undocumented migrants, homeless people, etc.
• Invest in the training of professionals in all fields related to drug demand reduction, including mental health, primary attention, services for women experiencing physical and sexual violence, support services for the homeless, etc.
• Dianova believes that prevention should stand out as an additional challenge looking to the future of CND’s work.
• Take steps at the international level to promote the decriminalization of drug consumption for personal use as this would result in a positive outcome from a public health and human rights perspective.
• Greater attention should be paid to non-substance addictive behaviours and addictions, particularly among the youth.
• It is critical to strengthen the response to the opioid crisis worldwide through a holistic perspective that includes all aspects drug demand reduction, including drug treatment and prevention, drug offer reduction, judicial responses, etc.