South Asia: UNODC calls for a health-centric approach in drug control

Around 27 million persons in the world use drugs in a problematic way leading to severe health consequences.  Some 250,000 persons die annually due to drug abuse, half of them from overdose.

Across the world, drug use is mainly a youth problem: prevalence rates increase through teenage years and peak between 18 and 25. Most drug users seek treatment only in their late 20s and most drug related deaths occur in the mid 30s. More men than women use drugs, women being a more hidden population. Not even a third of those who require treatment have received it.

Global drug markets continue to change with new drugs emerging. Organized criminal groups respond to better law enforcement efforts and diversify their routes and modi operandi seeking to expand into new markets. Traditionally known drugs such as cocaine and heroin are now consumed in a variety of markets across the world. The production and use of synthetic drugs, including amphetamines and ecstasy is spreading likewise. In some regions, especially in South Asia, prescription drugs containing narcotic substances are easily available across the counter and constitute a main substance of abuse.

The devastating effects of drug trafficking across borders on public health, security,  governance and related consequences, such as money-laundering and corruption, led the world community to agree as early as 1988 on an international Convention that deals specifically with drug trafficking.  The United Nations Convention against Illicit Traffic in Narcotic Drugs and Psychotropic Substances, 1988 provides comprehensive measures against drug trafficking, including provisions on money laundering and the diversion of precursor chemicals used for the production of drugs.  It provides for international cooperation through, for example, extradition of drug traffickers, controlled deliveries and transfer of proceedings.  Two earlier Drug Conventions from 1961 and 1971 established internationally applicable control measures for narcotic drugs and psychotropic substances with the purpose to ensure their availability for medical and scientific purposes, such as opiates for palliative care and prevent their diversion into illegal channels.

The United Nations Office on Drugs and Crime was created in 1991 to support countries in the implementation of the three Conventions balancing supply and demand reduction efforts in a holistic and comprehensive way. In doing so, UNODC mainly addresses three areas of concern:  (i) to secure reliable information, data and analyses on the global, regional and national drug situation, (ii) to adopt legislation, policies and procedures in line with international commitments, standards and principles and (iii) provide capacity-building and training to public officials and practitioners applying evidence-based approaches, global knowledge products and good international practices.

Since 1997, UNODC has been producing the annual World Drug Report which analyzes global data with regard to drug production, drug trafficking and drug use. Data are based on information provided by Governments and experts. While tremendous progress has been made in assessing quantities and flows of different drugs, there are still major gaps with regard to proper data on drug use, both in terms of quantity and quality. Such data are not only important to assess the drug problem at a global level, but are essential at the country level also, as only proper evidence can inform policy decisions. In South Asia, UNODC has provided technical assistance to India (2001), Bhutan (2010) and more recently to Maldives and Pakistan in producing drug use data of national scale. However, surveys need to be conducted and updated regularly considering the changes in drug markets and in fast-changing South Asian societies. It is most urgent that national drug use surveys be conducted for Bangladesh, India and Nepal as well as in new emerging hotspots at the state or local level - out of concern for its large share of young and vulnerable population.  

While all countries in South Asia have ratified the three drug control conventions and translated provisions into domestic laws, especially with regard to the establishment of drug production, drug trafficking and money-laundering as punishable offences, there is still a great need to develop and implement comprehensive drug use prevention, treatment, rehabilitation and reintegration policies both at the country and state/local level. These need to be health-centred, embody human rights and address stigma and discrimination of people who use drugs and who live with HIV.  

To help develop these, UNODC has supported rapid assessments, operational research and strategic information studies on knowledge, attitudes, behaviours and practices (KABP) on drug use and HIV prevention for selected target groups, such as injecting drug users (IDU), female drug users and prison inmates. UNODC has developed together with Governments in South Asia national advocacy strategies focusing on removing barriers in programme implementation related to drug use and HIV/AIDS. In Bangladesh, India, Maldives and Nepal, UNODC piloted drug treatment for opioid users rolling out methadone substitution treatment in selected hospitals and other medical institutions and developing respective operational guidelines and standard operating procedures. In India, this treatment was also initiated in Tihar jail, South Asia's largest jail. UNODC also developed low-cost service delivery models, such as drop-in-centers and health camps for communities to reach out to people who require treatment using a peer-led approach.

While in all South Asian countries, treatment and health services for drug users do now exist to some extent, drug use prevention policies lag critically behind. Drug use prevention efforts in the region rely mostly on grants given to NGOs without comprehensive, evidence-based drug use prevention policies or strategies that are regularly monitored, reviewed and evaluated with regard to their effectiveness and impact.

Considering the breadth of the three drug control conventions and the evolving challenges in drug control, capacity-building for a great variety of officials and practitioners is a must, in which UNODC engages continuously at a global, regional and national level.

In drug law enforcement, this includes training on proper understanding of legal frameworks, international reporting requirements, detection, identification and profiling of drugs and precursors, forensics, special investigative techniques, countering money-laundering, environmentally safe destruction of drugs and precursors, new forms of crimes and the use of internet for crimes.  While training in the past was imparted through class room training to a limited number of officials, UNODC has now introduced the UNODC-developed global knowledge product, the Computer-Based Training (CBT) on drug law enforcement to customs and drug law enforcement agencies across South Asia allowing to reach out to a much larger number of officials who can organize their training according to their own timings and requirements.

In health-related training on drug use and HIV, UNODC training has targeted a wide range of service providers, such as peer educators, outreach workers, project managers, counsellors, clinical staff and prison officials. Over the years, UNODC has used the 'Train the Trainers' methodology to impart training to master trainers. The training focuses on improving the quality of services they provide for injecting drug users (IDU), both male and female. The training includes a wide array of topics such as (i) Basics of Drugs and Drug Use, (ii) Understanding the IDU Community and their Vulnerabilities, (iii) Harm Reduction and its strategies, (iv) Co-morbidity issues (iv) Outreach Principles and tools, (v) Outreach Planning and Management, Reporting and Monitoring (vi) Networking, Referrals and Motivating for Referral Services.

The above presents part of the universe that UNODC has been covering in the last years in support of ongoing national efforts. The evolving drug scenario in South Asia calls for much more. At the forefront is the political will to make a health-centred drug control approach a top priority, at the same time embracing regional and international cooperation to investigate, bring to justice and recover the illicit proceeds of international criminal groups which drive drug trafficking - a $32 billion business affecting communities globally.

Written by Ms Cristina Albertin, Representative, United Nations Office on Drugs and Crime, Regional Office for South Asia