Drugs and Public Health: Where Are We Headed?

Repressive politices have been ineffective in tackling the drug phenomenon this is why the importance of a public health approach should be reaffirmed

Public health

The effects of the harmful use of substances are cumulative, significantly contributing to costly social, physical and mental health problems. It is therefore essential to advance policies that promote a public health approach to substance use disorders, rather than persisting with repressive policies – image Shutterstock

By Lucía Goberna – On 18 May, Dianova and its partners organised a webinar to raise awareness of the public health dimension of the global drug problem and to highlight the important role of the World Health Organisation (WHO) in this field.

The webinar was part of a series of public policy dialogues held by the Geneva Global Health Hub (G2H2), during the week prior to the opening of the World Health Assembly – G2H2 is a forum of civil society organisations working in the field of global health policy. The event was organized by Dianova together with the International Association for Hospice and Palliative Care, Harm Reduction International and Movendi International; it was attended by more than fifty people (watch event’s video).

In 2016, the UN General Assembly Special Session on the world drug problem reaffirmed the public health dimension of the problem. Six years later however, the need to truly implement this perpective and promote evidence-based responses in this area is still dire. Moreover, repressive drug policies do not improve the situation, and in many cases, they make it worse.

Webinar participants

Participants at the webinar: Lucía Goberna, Thomas Schwarz, Gisela Hansen, Vladimir Poznyak, Kristina Sperkova, Smriti Rana and Colleen Daniels – image: screenshot from webinar

The role of the WHO

The WHO is the coordinating authority for health within the United Nations system; as such, the organization addresses all psychoactive substances, including alcohol, illicit drugs and other narcotics, in addition to addictive behaviours in general. Among its many endeavours, WHO develops and disseminates standards and guidelines, and provides technical assistance to help promote evidence-based policies and interventions with the aim of reducing the demand for substances and mitigating the adverse consequences of substance use.

Dianova’s event featured an intervention by Dr Vladimir Poznyak, Chief the Alcohol, Drugs and Addictive Behaviours Unit, who outlined the organization’s role before summarizing some of the information that will be presented at the 75th session of the World Health Assembly (WHA 75) from 22 to 28 May, 2022. The WHO  focuses onf the areas of drug use prevention, access to internationally controlled medicines, treatment of people with drug dependence, as well as harm reduction, and monitoring and evaluation services.

In addition, the public health dimension of the global drug phenomenon is one the key areas of WHO’s commitment in this field. Since 2016, the organization made regular public reports on this topic a the World Health Assembly as well as in dedicated publications. At the WHA75, it will be decided whether the organization should continue doing so, as recommended, in order to keep this issue high in the organization’s political agenda.

Access to controlled medicines

Smriti Rana of Pallium India, a charitable trust aimed at providing quality palliative care and effective pain relief for patients, underlined the need for balanced and equitable access to pain relief in palliative care. As Smriti pointed it out, the situation in Asia in this regard is alarming, particularly in India.

Controlled medicines play a critical role in several areas of medicine, including pain relief, treatment of opioid dependence, emergency obstetrics, neurology, and psychiatry. In most of the world however, immense disparities persist in accessing essential opioid medicines: 75% of the world remains without access to proper pain relief treatment and Asia’s morphine per capita consumption is 36 times less than the global average.

Access to medicines is widely recognized as a human right, yet the system appears to be built around control rather than controlled access. As a result, there is a huge gap in the consumption of controlled medicines, which translates directly into human suffering. This can be prevented through immediate and decisive action designed to ensure adequate access to pain relief medicine, in particular in those parts of the world where it is virtually non-existent, thus replacing a merely restrictive vision with a genuine public health perspective.

Grafico: tratamiento contra el dolor en el mundo

75% of the world remain without access to proper pain relief treatment. Asia’s morphine per capita consumption is 36 times less than the global average – source IDPC: 10 Years of Drug Policy in India, How Far Have We Come, 2019 – credit: Juan Fernandez Ochoa, IDPC

Prevention

Kristina Sperkova from Movendi International spoke on alcohol and substance abuse prevention. She stressed that not only prevention is a crucial element of the public health approach but it also contributes to improving the outcomes of other types of interventions. Yet, she said, prevention practices are dramatically underused.

In addition, Kristina  pointed out that ineffective and non-evidence-based practices persist, while we need more targeted funding for programmes that have proven to be effective.

Treatment, recovery and social reintegration

Gisela Hansen PhD, from Dianova Spain, outlined the elements that a public health approach require and described some of the major challenges in this area, including the limited availability of treatment programmes. As she said, it is critical to focus on quality, evidence-based programmes that form an integral part of the public health system and services, through an array of different instruments capable of responding to each people’s needs and expectations.

Faced with such complex phenomenon as drugs, with social and other determinants aplenty, it makes no sense to dedicate one’s efforts to resolving the substance use problem, as though it were the sole and exclusive therapeutic goal. All the components of this complex web should be addressed. When this issue is addressed at the policy level, there is a huge gap in terms of recovery and social reintegration services. Should the latter not be an integral part of the continuum of care, with appropriate dedication and funding, the risk is high that many people will only receive partial care. It would be a long way from the vaunted holistic care services, and as a result, these treatment programmes would not be effective, nor efficient.

Harm reduction

To round off the wide range of topics covered, Colleen Daniels of Harm Reduction International, presented the huge gaps in the provision of harm reduction services around the world, the barriers to access people face (with particular emphasis on the situation of women) and the huge underfunding of these services. To give some context: only 5% of the budget needed is invested in these services in low- and middle-income countries

Colleen pointed out the need for these services to be firmly established as a health response and that punitive laws not only contribute to further marginalize people who use drugs, but they also maintain them alienated from health care spaces.

Dianova would like to thank the speakers for sharing their knowledge and experiences in order to offer a broad perspective on what the implementation of a health approach to the drug phenomenon means. We would also like to thank G2H2 for the opportunity to organize this dialogue. Lastly, there is no doubt that in order to move forward in this field it is important to talk about drug policy not only in drug policy forums, but also in forums that deal with health, human rights and development issues.