The non-medical use of prescription drugs, policy direction issues

The non-medical use of prescription drugs controlled under the Conventions is an increasing problem in many countries. In some countries, this is second only to cannabis. This is most notably in North America, but there are reports of significant treatment demand also in Europe, Africa, South Asia and Latin America. Prescription drugs controlled under the Conventions include a wide range of substances: tranquilizers (e.g. benzodiazepines such as diazepam), analgesics/ pain killers (e.g. opioids such as oxycodone), sedatives (e.g. flunitrazepam), antidepressants (e.g. fluoxetine), stimulants (e.g. methylphenidate). Depending on the country and the kind of substance, some groups (such as youth, women, older adults, health care professionals, but also street children and civilians and armed forces in post conflict situations) appear to be particularly at risk. Moreover, the health and social consequences can be as serious as for the use of illicit drugs. In the USA, at least 23% of drug-related emergency department admissions and 20.4% of all single drug-related emergency department deaths are due to the non-medical use of prescription drugs, and the non-medical use of prescription drugs can lead to dependence, including all its health and social consequences, especially when starting at a very young age.

Addressing the non-medical use of prescription drugs needs to carefully take into consideration the need to ensure the availability of these substances (that do have a recognised and much needed medical use), while preventing diversion and misuse. UNODC is developing a discussion paper to assist Member States in addressing the issue of the nonmedical use of prescription drugs, focusing on recommendations on policy and practice. The purpose is to provide the same kind of advice that exists with regard to prevention of the use and the treatment and care of the dependence of illicit drugs. The sources of prescription drugs is different, but the need for prevention and treatment with a view to promoting health is the same. Government authorities, parents, medical doctors, pharmacists, pharmaceutical companies have all important roles to play.

To this purpose, UNODC, together with WHO, convened a technical consultation in Vienna from 22 to 24 June 2010, inviting a wide range of researchers, policy makers and practitioners. Many Member States chose to participate as well. All in all more than 30 people participated in the consultation, representing 20 countries from all continents. Participants discussed the current situation and identified possible recommendations to improve policy and practice in the following areas: epidemiology and factors contributing to an increased prescription drugs use, effects on health and society, requirements of the Conventions, policy, role of the health sector and pharmaceutical companies, advocacy and prevention, and, treatment and care. Please see below the list of participants, agenda and presentations made at the meeting.

 

 

Tuesday, 22 June 2010

 

9.00

Welcome

Mr. Gilberto Gerra, Chief, UNODC Drug Prevention and Helath Branch

Official Opening of the Consultation

Mr. Antonio Maria Costa

Executive Director, UNODC

 

9.15

Introduction of Participants

Ms. Giovanna Campello, Programme Management Officer, UNODC Prevention, Treatment and Rehabilitation Section

9.30

Goals and Scope of the Experts Meeting

Opening presentation: Ms. Katri Tala, Programme Officer, UNODC Prevention, Treatment and Rehabilitation Section

10.30

Coffee Break

11.00

Epidemiology/Alarm

Facilitation: Mr. Gilberto Gerra

Presentation 1 (10min): Mr. Kamran Niaz, UNODC

Presentation 2 (10min): Mr. Wilson Compton, USA (NIDA)

Objectives for his session:

  • Statistics
  • Nonmedical use of prescription drugs around the world (Asia, Europe, Latin America, US, Australia)
  • Nonmedical use of prescription drugs compared to illicit drugs
  • Is the nonmedical use of prescription drugs being properly monitored? (Only few countries have monitoring systems, data from other countries come from studies)

Discussion (1h)

Wrapping up the session (10min)

 

12.45

Lunch

14.15

Factors contributing to increased nonmedical prescription drugs use

Facilitation: Ms. Katri Tala

Presentation 1 (10min): Mr. Tim Pfeiffer-Gerschel, Germany (EMCDDA)

Objectives for this session:

  • Which are the social factors contributing to an increased nonmedical prescription drugs use? (Short-cuts?)
  • Which factors make women and young and elderly people risk populations?
  • Are health care professionals also a risk population?
  • Does the mentality/education of physicians have influence in the increase of nonmedical prescription drugs use?
  • What is the role of online pharmacies?
  • Are new populations using prescription drugs for nonmedical purposes or are they switching from the use of illicit drugs?
  • What are the risk and protective factors?

Discussion (1h15)

Wrapping up the session (15min)

16.00

Coffee Break

16.30

Damages and consequences

Facilitation: Ms. Elizabeth Saenz, Expert, UNODC Prevention, Treatment and Rehabilitation Section

Objectives for this session:

  • What are the health consequences of the nonmedical use of prescription drugs?
  • What are the behavioural consequences?
  • What are the social and economic consequences?

Discussion (1h)

Wrapping up the session (15min)

18.00

End of Day

Wednesday 23 June 2010

9.00

Agenda for the day, visiting yesterday's conclusions

9.15

Conventions

Facilitation: Mr. Gilberto Gerra and Mr. Nicolas Clark

Presentation 1 (15min): Hanifa Rebbani and Gisela Wieser- Herbeck, (INCB)

Discussion (1h)

Wrapping up the session (10min)

10.45

Coffee Break

11.15

Policy

Facilitation: Mr. Nicolas Clark

Presentation 1 (10min): Mr. Ziggie Malyniwsky (CICAD)

Presentation 2 (10min): Mr. Malcolm Dobbin, Australia (Mental Health and Drug Division of the Victorian Department of Human Services)

Objectives for this session:

  • How can a right balance be achieved in order to guarantee availability and avoid the risk of diversion at the same time?

Discussion (1h)

Wrapping up the session (15min)

12.45

Lunch

14.15

Medical and pharmaceutical role

Facilitation: Mr. Gilberto Gerra and Mr. Nicolas Clark

Presentation 1 (10min): Mr. Sidney Schnoll, US (Pharmaceutical Risk Management Services Pinney Associates)

Presentation 2 (10min): Mr. Nicolas Clark, Management of Substance Abuse WHO

Objectives for this session:

  • What is the role of physicians in the nonmedical prescription drugs use?
  • Role of Pharmaceutical companies
  • How is the correct clinical approach in drug prescribing?
  • How should be physicians trained to prescribe?
  • How are the procedures for a supervised administration?

Discussion (50min)

Wrapping up the session (10min)

15.45

Coffee Break

16.15

Advocacy/Awareness/Prevention

Facilitation: Ms. Giovanna Campello

Presentation 1 (10min): Mr. Mohamed D. Abed (United Arab Emirates)

Presentation 2 (10min): Mr. Michael Soyka, Switzerland (Private Hospital Meiringen )

Presentation 3 (10min): Mr. Volodymyr Beznogykh, Ukraine (Ukranian Medical and Monitoring Centre for alcohol and Drugs)

Objectives for this session:

  • Should prevention programmes be adapted to the use of prescription drugs or should this issue be included in existing programmes?
  • Should prescription drug advertising be regulated and how?
  • Adequate dissemination of information
  • Apart form policy responses already discussed in previous sessions, what are the most appropriate preventive responses to the nonmedical use of prescription drugs?
  • In particular, are there any examples of interventions specific to nonmedical use of prescription drugs in different settings?

Discussion (1h)

Wrapping up the session (15min)

17.45

End of Day

Thursday 24 June 2010

09.00

Policy on treatment

Facilitation: Ms. Anja Busse, Expert, UNODC Prevention, Treatment and rehabilitation Section

Presentation 1: Mr. Fayzal Sulliman, Mauritius (Methadone Programme, Ministry of Health)

Presentation 2: Mr. Adam Bisaga, US (Columbia University)

Objectives for this session:

  • How can nonmedical use of prescription drugs be assessed?
  • What are the most appropriate preventive responses to the nonmedical use of prescription drugs?
  • Is there clinical guidance to address this issue?

Discussion (50min)

Wrapping up the session (15min)

10.30

Coffee Break

11.00

Recommendations and conclusions

Facilitation: Ms. Giovanna Campello, Programme Management Officer, UNODC Prevention, Treatment and Rehabilitation Section

12.30

Lunch

14.00

Summarising the meeting

Facilitation: Ms. Katri Tala, UNODC

Closing address: Mr. Gilberto Gerra, UNODC

15.30

End of Day

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List of particiants

Al Ansari, Aisha Ibrahim

Pharmacy & Drug Control Department

Supreme Council of Health

Qatar

Alfaro, Emilia Ramirez

Instituto Costarricense Sobre Drogas: Jefe Unidad de Control y Fiscalización de Precursores y coordinadora del Ámbito de Control y Fiscalización del Plan Nacional Sobre Drogas

Costa Rica

Al-Smail, Talal Saleh

Ministry of Interior

Kuwait

Astrauskienė, Audronė

Drug Control Department under the Government of the Republic of Lithuania

Lithuania

Bertolote, Jose Manoel

National Secretariat on Drug Policies

Brazil

Beznogykh, Volodymyr

Ukrainian Medical and Monitoring Centre for Alcohol and Drugs,

Ministry of Health

Ukraine

Bisaga, Adam

Department of Psychiatry at the College of Physicians and Surgeons of Columbia University

New York State Psychiatric Institute

United States of America

Busse, Anja

Prevention, Treatment and Rehabilitation Section

UNODC

Campello, Giovanna

Prevention, Treatment and Rehabilitation Section

UNODC

Clark, Nicolas

Management of Substance Abuse

WHO

Compton, Wilson

Division of Epidemiology, Services and Prevention Research at the National Institute on Drug Abuse (NIDA)

United States of America

Dobbin, Malcolm

Alcohol and Drugs to the Mental Health and Drugs Division of the Victorian Department of Human Services

Australia

Espejo-Reyes, Helen Maita

Philippine Drug Enforcement Agency

Philippines

Evranosoglu , Öznur Sevim

General Directorate of Pharmaceuticals, Ministry of Health

Turkey

Gerra, Gilberto

Drug Prevention and Health Branch

UNODC

Gonzalez, Ariel Walter

Embassy of Argentina

Argentina

Gonzalez, Luz

Unidad de Control de Quimicos de la Comision Nacional de Drogas de Panama

Panama

Groff, Alberto

Permanent Mission of Switzerland to the United Nations and International Organizations in Vienna

Switzerland

Hammond, Beate

Laboratory and Scientific Section

UNODC

Kahlesz, Timea

Ministry of National Resources (former Ministry of Health), Department for Pharmaceuticals and Medical Devices

Hungary

Li, Weihua

Department of Drug Safety and Inspection, China State Food and Drug Administration

China

Malungu, Mikal Ayiro

Ministry of Medical Services, Pharmacy and Poisons Board

Kenya

Malyniwsky, Ziggie

Supply Reduction and Control, Executive Secretariat

CICAD

Mendoza, Erasmo

Nacional de Comision Nacional de Drogas de Panama

Panama

Molnár, Balázs

Permanent Mission of Hungary

Okruhlica, Lubomir

Centre for Drugs Abuse Treatment

Slovak Republic

Pfeiffer-Gerschel, Tim

German National Focal Point of the EMCDDA & National Drug Treatment Statistics IFT Institute für Therapieforschung München

Germany

Qabazerd, Mohammad Mustapha

Ministry of Interior

Kuwait

Ray, Rajat

Department of Psychiatry, All India Institute of Medical Sciences (AIIMS)

India

Rebbani, Hanifa

Psychotropics Control Section

INCB

Saenz, Elizabeth

Prevention, Treatment and Rehabilitation Section

UNODC

Schnoll, Sidney

Pharmaceutical Risk Management Services, Pinney Associates.

United States of America

Shan, Xiaojing

International Cooperation Division, Office of China National Narcotics Control Commission

China

Soyka, Michael

Private Hospital Meiringen

Switzerland

Sulliman, Fayzal

Ministry of Health

Mauritius

Tala, Katri

Prevention, Treatment and Rehabilitation Section

UNODC

Viglione, Ariadna M.

Prevención de la Drogadicción y la Lucha contra el Narcotráfico

Argentina

Wang, Qianrong

China National Narcotics Control Commission

China

Wang, Xiangdong

Precursor Chemicals Control Division, Office of China National Narcotics Control Commission

China

Wieser-Herbeck, Gisela

Narcotics Control and Estimates Section

INCB

Zajzon-Boruzs, Hedvig

Department of the Office for Health Authorization and Administrative Procedures

Hungary

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