Drug Prevention, Treatment and Care

Nature and Scope

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Substance abuse refers  to the harmful or hazardous use of psychoactive substances, including alcohol and illicit drugs. Psychoactive substance use can lead to dependence syndrome - a cluster of behavioural, cognitive, and physiological phenomena that develop after repeated substance use. Typically these include a strong desire to take the drug, difficulties in controlling its use, persisting in its use despite harmful consequences, a higher priority given to drug use than to other activities and obligations, increased tolerance, and sometimes a physical withdrawal state.

South Asia is situated in the neighbourhood of one of the major opium-cultivating regions in the world. According to the latest UNODC survey, Afghanistan is the world's largest illicit opium-producing country, accounting for more than 90 percent of global output. This has increased the availability and use of illicitly produced opiates in South Asia. Many inject drugs which add to the problem as blood transfer through the sharing of drug taking equipment, particularly infected needles, is an extremely effective way of transmitting HIV to the general population.

According to the World Drug Report 2009, there are 3,620,000 to 3,660,000 opiate users in South Asia. According to the injecting drug use (IDU) task force, in 2007 the estimated number of people who inject drugs were 569,500 (IDUs) and the estimated number of people who inject drugs and who are HIV positive were 74,500.

People who inject drugs often have multiple risks such as sex work and drug use, and according to existing legislation in some countries, they often face incarceration for possession of drugs, which increases their risk of contracting or transmitting HIV. In general, drug use continues to be stigmatized both within the community and among health care workers, further marginalizing people with drug dependence problems. This means that HIV interventions may not be available to them, or that they are unable or unwilling to access services for fear of discrimination.

UNODC's response to drug use in South Asia

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UNODC in collaboration with UNAIDS and WHO encourages an approach based on promoting, protecting and respecting  human rights of drug users, ensuring that the environment in which these measures are offered must be supportive. This means training of health providers and law enforcement personnel to be able to work with IDUs without coercive measures and creating a safe environment for them to seek information and referrals for care and support.

In response to this problem, UNODC with the Governments and non governmental organizations (NGOs) in the region supports policies which can significantly reduce the public health problems attributable to substance use, implements interventions at the health care system level and works towards the restoration of  the health of affected individuals.

Since 1998, UNODC has worked to develop comprehensive demand reduction strategies by promoting evidence-based, locally appropriate treatment and rehabilitation opportunities.

The four priority areas of UNODC's work on drug treatment and rehabilitation include:
• Community based treatment
• Drug dependence treatment and rehabilitation in prison settings
• Role of drug dependence treatment and rehabilitation on HIV and AIDS prevention and care
• Sustainable livelihoods for reintegration and rehabilitation

UNODC supports the Bhutan Narcotics Control Agency (BNCA) to implement programmes on drug demand reduction, prevention, care and treatment and rehabilitation of drug users. It also supported the BNCA in its first ever 'National Baseline Assessment of drugs and controlled substance use in Bhutan (2009)'. With the available data, the Bhutanese Government is reinforcing actions in the area of drug use prevention and drug treatment.  During the commemorations of World Drug Day (2010), the BNCA launched a set of new Information, Education and Communication (IEC) material using UNODC's key messages, which address drug and HIV issues. Also, the new BNCA website was launched along with the inauguration of the first drop-in-center in  Bumthang, located in the center of Bhutan.

UNODC with the Government of India supported the project on "Empowering communities for prevention of drugs and HIV in India'. Under this initiative it launched a community based prevention activity across 15 States and Union Territories of India.  This initiative was carried out for 6 months, covering more than sixty thousand school children (60,000) and more than fifteen thousand adults (15,000) across the 15 states. A comprehensive report on, 'Beliefs and practices on substance use-A perspective from different states in India' was prepared. Similarly, with the same ministry, UNODC conducted a study on the 'Extent, Patterns and Trends of Drug Abuse in India'. As a follow up, a write up on  'Empowering school children and the teacher community to say, 'I Decide- I will not take drugs', was prepared, that revealed interesting facts and trends on drug use among the youth in India.

sp On 19 January 2010, UNODC signed with the Government of Maldives the ever first country-specific technical cooperation project for the Maldives, called "Strengthening the national response to combat drug abuse in the Maldives', funded by the European Union. The project will provide technical assistance to strengthen the national response on drug use prevention and treatment through a series of capacity-building measures both with the Government and the civil society under the framework of the United Nations Development Assistance Framework. UNODC has in the past provided technical assistance to the Government of Maldives to develop and launch in 2008 the first national "Drug Control Master Plan 2008-2012"

UNODC with the Government of Nepal implements the comprehensive package of services for drug users and HIV positive drug users. As part of these services, it supports organisations that provide clean syringes, methadone maintenance treatment and oral substitution treatment. It is also part of the injecting drug users' network in Nepal.

In Sri Lanka UNODC collaborates with the National Dangerous Drugs Control Board (NDDCB) and provides technical assistance on HIV prevention and care among drug users and among vulnerable groups in prisons.

UNODC's work on drug treatment and rehabilitation is guided by the following:

1. Raise the awareness of policy makers with respect to the need and advantages of investing in drug abuse treatment
2. Support national authorities in developing legislation, policies, and standards of care which enable the implementation of contemporary treatment approaches
3. Strengthen the capacity of staff and care providers of treatment and rehabilitation centres
4. Diversify and expand services for drug users and make them more accessible to different population groups, taking into account different gender needs,
5. Facilitate sharing of best practices and dissemination of knowledge
6. Upscale drug treatment and rehabilitation services available

HIV transmission through injecting drug use is best prevented by providing a comprehensive package of services in outreach to injecting drug users and their partners. UNAIDS, UNODC and WHO recommend a comprehensive set of measures for people who use drugs that includes the following:

• needle and syringe programmes
• opioid substitution therapy
• voluntary HIV counselling and testing
• anti-retroviral therapy
• prevention and treatment of sexually transmitted infections
• condom programming
• targeted information, education and communication
• hepatitis diagnosis, treatment and vaccination
• tuberculosis prevention, diagnosis and treatment

Learn more about UNODC supported tools and publications on prevention, treatment and care for drug users

Intervention toolkit (set of 6 books) on "Prevention of transmission of HIV among drug users in SAARC countries"

Rapid Situation and Response Assessment of drugs and HIV in Bangladesh, Bhutan, India, Nepal and Sri Lanka -A Regional Report

Drug use situation and responses in schools and communities - A Rapid Assessment in Phuentsholing, Bhutan

Legal and policy - concerns related to injecting drug use (IDU) harm reduction in SAARC countries

Positive Living - for drug users and their partners

Women and drug use in India: Substance, women and high risk assessment study

National Baseline Assessment of drugs and controlled substance use in Bhutan (2009)

Opioid Substitution - Buprenorphine in India, a study report

Female Drug Users and Female Regular Sex Partners of Male Drug Users in Bangladesh - Report

UNODC Advocacy Strategy - Removing barriers to scale up of HIV/AIDS prevention and care programmes for injecting drug users and oral opioid users in South Asia

Counseling in Targeted Intervention for Injecting Drug Users (3 part module): a) A Counsellor's Handbook b) A Facilitator's Manual c) A Resource Guide

A Trainer's Manual on drug use prevention, treatment and care among street children

Profile, Drug use pattern, Risk Behavior and selected bio-markers of women drug users from seven sites in Nepal

Opioid Substitution Treatment (Buprenorphine) Toolkit

Methadone Maintenance Treatment Toolkit

"Capacity Building Needs Assessment" in the context of IDU interventions in India

Diagnostic study on "Factors Influencing the performance of targeted interventions among IDUs"

SOP on "Needle Syringe Exchange program" for injecting drug users

SOP on "Drop-In Centre" for injecting drug users

SOP on "Outreach" for injecting drug users

SOP on "Opioid Overdose Prevention and Management" for injecting drug users

SOP on "Abscess Prevention and Management" among injecting drug users

SOP on "Care and Support for Co-Morbid Conditions" among injecting drug users

Staying Safe - A Manual to Train Peer Educators in IDU interventions

Staying Safe - A Manual to Train Outreach Workers in IDU interventions

Staying Safe - A Manual to Train Project Managers in IDU interventions

Staying Safe - A Manual to Train Clinical Staff in IDU interventions

Access to comprehensive package of services for injecting drug users and their female sex partners