The United Nations Commission on Narcotic Drugs organizes a thematic meeting to review how to strengthen the scope of the treatment
By Lucía Goberna –“Health and drug treatment services continue to fall short of needs and drug-related deaths have increased“. The Ministerial Declaration is definitive, it was approved in March 2019 by senior representatives in the field of drugs/health at the United Nations.
Faced with this discouraging statement and with sight set on being able to meet the objectives committed to on an international level, it would imply, among other things, to significantly reinforce the scope of treatment (as established in UNGASS 2016). The Commission on Narcotic Drugs has planned to organize a series of thematic sessions annually from 2020-2024 planned for September-October to evaluate how to improve the difficulties described. In these meetings it is expected that information and good practices will be disseminated and that the lessons learned will be shared.
In 2020, the thematic session of the Commission on Narcotic Drugs (3rd intersessional meeting of the 63 session of the Commission on Narcotic Drugs) addressed the areas of treatment, harm reduction services, new psychoactive substances and the accessibility and availability of controlled substances for medical and scientific purposes.
A very worrying situation regarding the scope of treatment
The United Nations Office on Drugs and Crime (UNODC) estimates that around 35.6 million people suffer from a substance use disorder, meaning that drug use is problematic and requires treatment. However, only 1 in 8 people with a substance use disorder has availability and access to treatment services. In the case of women the situation is even worse: although women account for 1 in 3 drug users, only 1 in 5 people in treatment is female. The access and availability of services in prisons is even lower, especially considering that people deprived of liberty have a higher prevalence. The situation in other vulnerable populations such as asylum seekers or people in humanitarian settings is certainly worrying.
It is not just that availability and access are reduced. The quality of services entails a great problem. On many occasions, treatments do not follow evidence-based programs and there are even situations in which the addiction services themselves subject people in treatment to inhuman and degrading conditions, violating their human rights.
Another issue that is rarely discussed is the affordability of services. According to preliminary data from a 2020 study by the World Health Organization, although most countries offer specialized services for substance use disorders (specifically 85% of the 123 countries studied), a large percentage of these (35%) are not available without a financial contribution from those benefiting from the service. This indicates clear affordability problems, especially considering the low socio-economic profile and vulnerability of many of the people who require this type of services.
If to all this we add the global pandemic, which has affected people who use drugs in a very particular way, given that these people present additional infection risks and more pre-existing pathologies, which make them more vulnerable to COVID. In addition, as stated by the United Nations Special Rapporteur for the right to health, people who use drugs must be recognized as a high-risk population.
Moreover, COVID has been a real challenge for the continuity of services. Unfortunately, many services have had to close due to the pandemic as they do not have the support and the sufficient means to continue operating in accordance with the relevant security protocols. However, COVID has also led to great innovation in treatment services that have operated, in some cases, with a greater degree of flexibility in prescribing substitution treatment and have made greater use of telemedicine.
Numerous challenges for the future
Among many others, the session covered topics such as:
- Ensure the continuity of treatment services in the framework of COVID
- Increase the resources available for treatment services
- Have a greater offer of treatment centre vacancies
- Increase the coverage of treatment services and ensure that they comply with scientific evidence and respect for human rights.
- In line with the logic of the continuation of services, improve quality and integration with prevention, harm reduction and reintegration services
- Put a greater focus on the needs of vulnerable populations
- Ensure treatment services for opiate substitution
- Promotion of alternative measures to incarceration that involve the offer of voluntary admission to treatment services
- Ensure the availability of treatment services and pharmacological support in prison facilities and the continuation of services after release
- Significantly strengthen reintegration services
- Affordability of specialized services
- Continuous training needs for professionals
- Promotion of overdose prevention programmes
Update of International Standards for the Treatment of Drug Use Disorders
It should be noted that in 2020 the World Health Organization and the United Nations Office on Drugs and Crime have updated the guide to the International Standards for the Treatment of Drug Use Disorders. The publication aims to support countries in the implementation of effective services, based on evidence and with ethical treatment perspectives, especially focused on settings with few resources.
The guide provides key information for the organisation of treatment services, it describes the main components of treatment systems, and includes considerations for populations with special needs.
This updated edition has incorporated the results of field tests in nine countries. You can access the publication by clicking here.
Civil society voices
Civil society has a guaranteed position in these thematic meetings that is channelled through the platform of the Vienna NGO Committee on Drugs. For this session it was able to select 18 representatives among whom were:
- Phaedon Kaloterakis, representing the World Federation of Therapeutic Communities. You can access his written speech here.
- Laurène Collard, representing the EU Civil Society Drug Forum. You can access the video of the speech here.
Dianova is a member of both platforms and has actively participated in the development of the recommendations of the EU Civil Society Forum on Drugs for this session for the European institutions.
If possible: more and better treatments
Unfortunately, the need for treatment for substance use disorders and other addictive behaviours does not appear to be going away anytime soon. Treatment services, as well as all drug services (prevention, harm reduction, and reintegration) are continually improving and adapting to the needs of the people who require them. Complicated times are approaching with COVID, but it must not be forgotten that, if there is political will, there is much room for improvement in the design, implementation and improvement of programs. Thus, that the Commission on Narcotic Drugs will have dedicated a thematic session among others, to the subject of treatment, seems to be a step in the right direction to give it greater recognition and visibility.
Other links of interest
- Informative document of the session prepared by the United Nations Office on Drugs and Crime (only available in English) that describes the objectives agreed by subject in the different international agreements and includes a context of the current situation providing data from World Drug Reports
- List of speakers of the session with links to the presentations made in the session of 19th October 2020