Regional Seminar on International Standards in the Area of Drug Prevention and Treatment Introduced into the National Systems of the South Eastern European Countries in Sofia, Bulgaria
2-4 November 2009
1. Seminar Objective
The UNODC RPOSEE organized a seminar within the framework of the Regional Programme in Sofia, Bulgaria from 2 - 4 November 2009. The aim of the meeting was to increase the knowledge, expertise and the institutional capacities of the South Eastern European countries to prevent and treat drug-related problems. This aim was to be fulfilled through the exchange of national experiences and best practices, as well as through the introduction to the newest and most advanced perspectives on Drug Demand reduction and developments in the field of drug dependence treatment and care. The purpose of the seminar was also to define more specific and concrete technical assistance activities to meet the regional needs that had already been identified.
During the course of the seminar, UNODC presented an overview of the UNODC Regional Programme, focusing primarily on the third Sub-programme, and presented the participants with steps that had already previously been undertaken.
2. Seminar Participants
Participants at the strategy session included representatives from Albania, Bosnia and Herzegovina, Croatia, Montenegro, FYR of Macedonia, Serbia, and Kosovo under UNSCR 1244.
3. Seminar Activities
a. Definition of Drug Addiction and Treatment
UNODC representatives and participations engaged in technical discussions on current approaches and challenges relating to dependencies. The approach presented during theses discussions is the fact that drug dependence is a multi-factorial health disorder and is recognized as a brain disease. In light of this fact, the participants commended the consistency in UNODC approaches towards drug prevention. The 1988 UN Convention against Illicit Traffic in Narcotic Drugs and Psychotropic Substances stated that "as an alternative to punishment, measures such as education, rehabilitation or social reintegration, as well as when the offender is a drug abuser, treatment and aftercare" should be undertaken. In light of this, participants then emphasized the importance of moving from a sanction-oriented approach in drug prevention to a health-oriented approach, placing health as the centre piece of the drug control system.
In addition to the latest research on genetic legacy, the foundation of this drug prevention approach is built on the social factors that contribute to an individual's vulnerability to drug disorders. Starting form this basis, the need to develop a broader vision on drug abuse prevention was discussed. Participants agreed that such a vision should include social support for victims and their integration into the larger society in order to enable the prevention of illicit drug use and HIV epidemic crimes. In addition this new approach should be incorporated into national approaches, allowing for enhanced coordination on a number of levels.
Since drug addiction is now recognized as a chronic disease, it should be treated as other chronic diseases are: with uniform medical and social standards; on a case by case approach; with respect for human rights and dignity; and with an increase in the number and variety treatment methods available.
Evidence based interventions were also discussed in detail, with each approach being analyzed according to their advantages and disadvantages. Both inefficient and efficient approaches were mentioned. Inefficient approaches included scare tactics, moralistic appeals and curricula that rely solely on information on drugs and their possible adverse effects, while the more efficient and effective approaches discussed ranged from training in resistance skills to normative education and courses on life skills that use interactive methods. In addition the development and living environment of victims were also discussed: the parent-child relationship, establishment of appropriate age limits, as well as effective rules and consequence.
b. Drug Prevention
The topic of drug prevention was touched upon in a similar manner. Scientifically proven methods of prevention, for instance integrated pharmacological a psychosocial therapy, were compared to inefficient methods such as punishment and detoxification without any after-care or simply individual psychotherapy by itself.
c. HIV Prevention
HIV prevention was presented as a separate part of a package of interventions. For instance, the importance of needle and syringe exchange services, drug dependence treatment - particularly opioid agonists, voluntary HIV counselling and testing, as well as social assistance and support were discussed as possible means of HIV prevention.
Participants agreed that the simple use of a needle exchange programme or methadone alone were inadequate, and that a holistic approach that combined various prevention measures was needed if the spread of HCV and HIV infections were to be countered. In addition, it was discussed how low-threshold MMT programmes can reduce the risk of HIV without the enforcement of abstinence-based policies. Moreover, programmes aimed at risk reduction should precede abstinence programs.
In order to effectively prevent drug use and HIV, it was emphasized that only a comprehensive package of harm reduction measures and the need to see the treatment as a continuation of care within the Public Health System would achieve an effective and humane treatment for every individual possessing drug disorders.
d. Country Presentations on Drug/HIV Prevention
During the course of the conference, each participant country conducted a presentation summarizing the existing situation in their country, as well as the mechanisms in place for achieving drug demand reduction, prevention and treatment. Characteristics shared by all countries are the following:
All countries began facing drug problems more intensively following 1990, creating the need to improve the existing national response;
Although every country has developed a National Anti-Drug Strategy and Action Plans, effective measures have neither been implemented on a large scale nor in every country;
Although a number of surveys targeted at collecting data on target populations were implemented in some countries; that is not the case for all countries. In addition, General Population Surveys have yet to be carried out in any country;
Even though every country is implementing a number of prevention activities, proper evaluation mechanisms are lacking;
Although the HIV infection rate is low, a high level of Hepatitis C infections could foreshadow a massive HIV epidemic;
Existing legislation does not comply with international human rights standards, and in many cases addicts are not treated as individuals with chronic diseases;
Existing treatment services are available, but only in cities and even then their availability is limited; and
A lack of cohesion exists between separate criminal justice treatments and those of addiction.
The countries of South Eastern Europe are partners in implementing a number of drug prevention and intervention programmes through different international organizations (GFATM, EMCDDA, etc.). As such, participant countries expressed a clear desire to avoid competition and overlap in their efforts and current initiatives, and they stated an intent to strive towards complementary regional responses that would contribute added value to current national responses.
e. Working Groups
Participants of the strategy session were also divided into two working groups and charged with identifying regional activities that could also contribute to enhancing national interventions in the areas of drug prevention, drug treatment and reintegration programmes.
4. Seminar Outcomes and Recommendations
The following recommendations were put forth on the part of the participants of the seminar in the area of drug prevention programmes and drug treatment and reintegration programmes:
Regarding drug prevention programmes, the following recommendations were made:
The regional initiative, South European Drug Coordination (SEEDC), needs to be implemented, with a focus on demand reduction policies and strategies that are in line with the needs of member states.
Regional activities should be better coordinated through an agency such as UNDOC that is involved throughout the region.
Evidence based drug prevention programmes need to be implemented, with a focus on incorporating methods that are culturally adapted to the region.
There is a need to raise awareness on effective methods of drug prevention through courses on life skills education, family skills and work place prevention training, as well as training for relevant prison personnel on how to properly handle prisoners suffering from drug addiction.
Coordination between the Ministries of Health, Interior and Education needs to be increased so that effective drug abuse prevention and treatment interventions are properly promoted.
Concerning drug treatment and reintegration programmes, the following recommendations were put forth:
The capacity of member states to design and deliver drug treatment programmes in line with international standards and best practices needs to be enhanced. Areas where assistance is needed is in the training of relevant institutions on the implementation of international standards in the area of drug treatment, specifically as it relates to the pharmacological treatment of opiate dependence, as well as psychosocial therapy and guidelines for treatment of non-opiate addicts.
A regional model of multi-disciplinary addiction services needs to be developed and implemented in prison settings. Currently, agencies other than the Ministry of Health are involved in the administration of health care in prisons.
Technical assistance for implementing guidelines, principles and international standards needs to be provided so that prisons are included when drafting a comprehensive package of drug treatment.
Participant countries also expressed the need to continue meeting and exchanging experience and best practices, especially considering the difficulty of planning on a national level, yet coordinating activities on a regional level. It was recognized that the national expertise of each country could possibly become an important contribution to the region, as each country has the opportunity to both contribute and receive technical assistance during meetings held on a regional level.