ORGANIZATION OF AMERICAN STATES INTER-AMERICAN DRUG ABUSE CONTROL COMMISSION FIRST INTER-REGIONAL FORUM OF EU-LAC CITIES: PUBLIC POLICIES IN DRUG TREATMENT April 2 5, 2008 Santo Domingo, Dominican Republic OEA/Ser.L/XIV.4 CICAD/EULAC/doc.16/08 31 March 2008 Original: English EUROPEAN UNION REGIONAL STRATEGY ON TREATMENT Meni Malliori Ass. Proffesor of Psychiatry University of Athens-Greeece Vice-Chair of the European Center for Prevention and Diseases Control-ECDC Former Member of the Europeam Parliament GENERAL SECRETARIAT OF THE ORGANIZATION OF AMERICAN STATES, WASHINGTON, D.C. 20006
EU and LAC regional strategies on treatment. Complementary or different approaches? EuropeanUnionRegional Strategies ontreatment Meni Malliori Ass. Proffesorof Psychiatry University of Athens-Greeece Vice-Chairof the EuropeanCenterforPreventionand Diseases Control-ECDC FormerMemberof the EuropeamParliament
The drugs phenomenon constitutes one of the major concerns of the European citizens and a major threat to the security and health of European society. The use of drugs, particularly among young people is at historically high levels. The European Union has 2 million problematic drug users and the incidence of HIV/AIDS among them is causing increasing concern in many Member States. Given the global nature of the drugs problem, the European Union takes action by utilizing a number of political instruments, such as the dialogue on drugs with various regions of the world. In December 2004, the European Council endorsed the EU Drug Strategy (2005-2012) which sets the framework, objectives and priorities for two four-years Action Plans
This Strategy is based on the relevant United Nations conventions and on the conclusions of the United Nations General Assembly Special Session on Drugs of 1998. It confirms the importance of a balanced approach, in which supply and demand reduction are mutually reinforcing elements in drug policy.
The international community in general and the European Union in particular have applied the supply reduction policy for many decades. To the contrary, demand reduction policy was adopted as late as June 1998 (Special Session of the United Nations) which required the Member States to follow a balanced policy between demand and supply in the field of drugs and, therefore, to strike a balance between punishment and treatment.
The current drug situation in the European Union is described in the European Monitoring Centre for Drugs and Drug Addiction's (EMCDDA) and Europol's annual reports. Despite the fact that patterns of drug consumption have always varied between the 25 EU Member States, the incidence of drug related health damage and the number of drugrelated deaths have stabilized and even declined. Treatment provisions for drug users have increased and services diversified.
The EU Drug Strategy (2005-2012) concentrates in preventing and reducing: drug use, dependence drug-related harms to health and society It aims to: protect and improve the well-being of society and of the individual, protect public health, offer a high level of security for the general public and adopt a balanced, integrated approach with regard to the drugs problem.
It implies the following measures: preventing people from starting to use drugs preventing experimental use becoming regular use early intervention for risky consumption patterns providing treatment programs providing rehabilitation and social reintegration programs reducing drug-related health and social damage.
It also seeks to obtain the following results: Measurable reduction of drug use dependence drug-related health and social risks through the development and improvement of an effective and comprehensive knowledge-based system, including prevention, early intervention, treatment, harm reduction, rehabilitation and social reintegration measures. The measures must take into account the health-related and social problems caused by the use of illegal psychoactive substances and of poly-drug use in association with legal psychoactive substances such as tobacco, alcohol and medicines.
The European Union data show that more than 150.000 clients enter treatment because of heroin-related problems and that four out of ten clients entering the services receive treatment for the first time in their life. The percentage of those who come for cocaine or cannabis-related problems has been increasing over the past years.
However accessibility of treatment is not the same across Europe, reflected in extremely large variations in the overall ratio of persons entering treatment (4-111 cases per 100.000 adult population). Opioid substitution treatment is supported by research evidence which shows that it can be effective and reduce opiate use and risk behaviour. These programs are also effective in increasing treatment retention and help to stabilise and improve health and social conditions of chronic heroin users.
In 2005, more than 550.000 opioid users received drug substitution treatment in the EU countries the vast majority of cases reported from the old EU Member States. This represents about a quarter to one third of the total estimated number of problematic opiate users in the EU. The substance predominantly used was methadone (72% of all substitution treatment), but the use of buprenorphine has increased over the past few years, especially among clients treated by office-based medical doctors in the community.
The current coverage of opioid substitution treatment varies significantly between countries with rates from under 10% to about 50% of opiate users currently receiving such treatment. The combined use of several drugs (poly-drug use) is a reality across the European countries and research on effective treatment approaches to cocaine, crack and other stimulant use as well as to cannabis use is rare and incomplete. However, a number of special services targeting cannabis and cocaine users already exist, but not in all Member States.
Political attention and investment has risen in some Member States in order to make available to the clients social care and reintegration services. The socio-demographic profile of clients entering treatment shows their specific needs: they are characterised by disadvantaged social conditions, low level of education and often poor living situation. Unemployment is particularly high among those in inpatient treatment (76%) but affects nearly half of clients in outpatient treatment as well.
Alternatives to prison (ATPs) are therapeutic measures or treatment which take place outside prison. A wide variety of alternatives to prison are available in almost all countries across Europe, for different types of users and for different types of offences but with a particular emphasis on problematic drug use.
The most common aim in these strategies or laws was declared to be prevention of future use (17 countries), followed by reducing crime and prevention of infectious diseases (14 each) and reducing the harm caused by imprisonment (12). However, few countries acknowledged that these strategies also include the aims of reducing imprisonment (6), easing prison overcrowding (5) and reduction of public expenditure (5).
In conclusion, thechallenges for the ongoing EuropeanUnion Strategy ontreatment continueto be the: Lack of availability and accessibility of the various therapeutic and rehabilitation services Coverage of other possible health problems among drug users (HIV hepatitis B-C, tuberculosis) Comorbitity with other mental disorders Treatment instead of punishment
Lack of cocaine and cannabis treatment services Lack of evidence based data proving that treatment cost less than repressive measures Lack of decentralized community based services which would respect the specific local needs
I hope and even more I am convinced that the outcome of our 3 days discussions shall contribute in a substantial way to face effectively the above challenges. Thanks for your attention