International Standards of Treatment of Substance Use Disorders

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1 International Standards of Treatment of Substance Use Disorders Igor Koutsenok, MD Professor of Psychiatry University of California San Diego, Department of Psychiatry Director, UCSD Addiction Training Center Director, International Addiction Technology Transfer Center - Ukraine

2 What are the UN entities with the conventionbased mandates to work on drug issues? Commission on Narcotic Drugs (CND) a UN organ with 53 Member States - governing body for UNODC. UN Office on Drugs and Crime (UNODC) mandated to assist Member States on issues related to illicit drugs and crime WHO treaty body mandated under the conventions to assess medical and scientific properties of psychoactive substances and make recommendations on whether they should be placed under international control or not. International Narcotics Control Board (INCB) the quasi-judicial monitoring body for the international drug control conventions.

3 Framework In 2013 the UNODC and WHO launched a joint Program on Drug Dependence Treatment and Care Program goal is to promote and support evidencebased and ethical policies, strategies, and interventions to reduce the health and social burden of drug use and addictions UN Member States have repeatedly called for development of healthcare standards for the treatment of substance use disorders as there are no standards applicable to all member states

4 Why International Treatment Standards? Globally, addiction treatments is available to less than 10% of people who need the treatment Even with that, most people do not get the evidence-based treatment, rather they receive less effective, ineffective, or even harmful treatments Treatment providers are disconnected with no mechanisms for quality control A need for a major push to promote evidence-based treatments to narrow the gap between science and practice To promote practices that respect human rights and suppress those that do not

5 International Treatment Standards: Objectives The objective of the International Standards is to provide UN Member States with a practical and comprehensive technical tool to: Guide policy development Plan, organize, and manage addiction treatment services Evaluate interventions Develop the workforce Use resources to fund treatment in the most efficient way This is a concrete document that can be used in all member states

6 Goals of the Standards To provide member states with a set of minimum standards that: Will achieve results Are cost effective Are applicable to countries in various social and economic situations Are practical for policy makers

7 Relationship to existing documents The Standards are based on the existing peerreviewed publications and the opinion of the expert panel with good reliability We have good evidence based guidelines, yet there is an alarming rate of ignorance and harmful actions The Standards: List minimum standards that can be applicable to all member states, as well as optimal standards Useful to policy and decision makers

8 Source Documents

9 How the Standards are different from guidelines? The two documents answer different questions The guidelines answer the question How to deliver effective treatment? The Standards answer the question What must be in place to deliver effective treatment?

10 Process The first meeting of the Expert Panel took place in December 2014 in Vienna and included representatives from UNODC and WHO, as well as academic, clinical, and governmental organizations from 23 countries and 6 major international organizations Multiple meetings afterward: various approaches to the structure and scope of the Standards were discussed existing standards were reviewed work groups for sections of the document were formed During the following 2 years, workgroups generated several drafts of the document that were edited at each stage by the core group of experts

11 Structure of Standards Standards are defined for the setting where the treatment is delivered (treatment cycle) Workgroups were organized to match the sections of the document Principles of treatment Outreach Screening, assessment, and brief intervention Outpatient treatment Short-term inpatient and residential treatment Long-term residential treatment Continuing care and recovery management Rehabilitation and reintegration Prisons and law enforcement environments Special populations

12 Chapter Structure Brief definition and description of the setting Goals Types of clients the setting is suitable for Treatment models, methods used, dose of treatment in the setting (length and intensity) Specific requirements (activities, documentation, staffing) Criteria for program completion and indicators of effectiveness Rating of the strength of evidence Core references

13 Core definitions and Key Terms Substance Use Any use of any substance. Driven largely by market forces Misuse Use that can harm self or others. Driven by consequences Addiction Compulsive use and lost control over it. Driven by progressive brain changes

14 Core definitions We spent hours trying to define treatment. No consensus was reached Then we decided to changed the question from What is treatment? to What treatment should do? The consensus was reached very quickly In order for any activity to be considered as treatment it must be able to do 4 things: Reduce the symptom Prevent complications Improve functioning Respect human rights ALL 4 CRITERIA MUST BE SATISFIED

15 Process The Expert Panel took place in December 2015 and March 2016 in Vienna. During that second meeting: outstanding issues that need expert consensus were discussed strength of evidence to support Standards were rated steps towards finalizing standards Preparation of the final draft to be presented at the CND in March 2016 for approval

16 Result so far In March 2016 the document was presented at the CND for discussion and approval It was approved by the 198 Member States unanimously (Resolution ECN72016) for field testing CND_Sessions/CND_59/ECN72016_CRP4_VI60I463. pdf Field testing protocol has been developed

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18 Field testing protocol

19 International standards for the treatment of drug use disorders: Objectives of field testing Test the comprehensiveness, appropriateness and clinical and public health utility of the International standards for the treatment of drug use disorders, and finalize the standards based on the results of field testing. Develop, test and disseminate technical tools and procedures to support implementation of the international standards.

20 Main functions of testing the International standards for treatment of DUD Serve as a method for dissemination and implementation of the Standards Contribute to capacity building in field testing sites for assessment of existing treatment systems and services Test the suitability of the Standards for development of national clinical guidelines and quality standards in different settings Generate data and factual information to guide finalization process and procedures for effective dissemination and implementation of the Standards.

21 Key areas of testing Utility: Is a standard useful for improving coverage and quality of treatment for drug use disorders? Appropriateness: Is a standard appropriate for your cultural context and health/social care system? Feasibility: Is a standard feasible for implementation or, in other words, applicable for use in your treatment system for drug use disorders? Comprehensiveness: Is a set of standards sufficiently comprehensive to facilitate improvements in provision of treatment for drug use disorders?

22 Thank you!!!