11th March 2025
The global rise in stimulant use – ranging from cocaine and methamphetamine to prescription stimulants – has created an urgent need for effective treatment and care. According to the 2024 UNODC World Drug Report, psychostimulants were the second most used class of internationally controlled substances in 2022. Despite this growing demand, access to effective treatment remains limited, particularly in low- and middle-income countries.
In response, the #ScaleUp initiative was launched at the 67th Session of the Commission on Narcotic Drugs (CND) in 2024, aiming to strengthen the evidence base for scalable interventions for the treatment of stimulant use disorders that can benefit different populations. At the 68th Session of the Commission on Narcotic Drugs (CND), Norway supported the #ScaleUp initiative by hosting a side event to highlight the progress and challenges of this groundbreaking initiative, bringing together experts, policymakers, and individuals with lived experience to share insights and solutions.
The event emphasised the need for integrated approaches that combine pharmacological and psychosocial interventions, such as cognitive-behavioural therapy (CBT) and contingency management (CM), to address the complex needs of individuals with stimulant use disorders. Participants highlighted the importance of tailoring interventions to diverse contexts, particularly in low- and middle-income countries, where resources are often limited. They also stressed the need for multi-country studies to evaluate the feasibility, safety, and effectiveness of these interventions, ensuring that they can be scaled up to meet global demand.
Ellen Rønning-Arnesen, State Secretary in the Norwegian Ministry of Health and Care Services, moderated the event, emphasising the growing global challenge of stimulant use. She underscored the need for equitable access to health and social services, recognising the right to health.
Nadine Ezard, Clinical Director of the Alcohol and Drug Service at St Vincent’s Hospital, Sydney, opened the discussion by highlighting Australia’s promising pharmacological treatments, including bupropion-naltrexone and lisdexamfetamine. She called for multi-country studies with standardised protocols to identify scalable, cost-effective interventions. She also emphasised the need for global collaboration to address the growing demand for stimulant use disorder treatment.
Nicolas Prisse, Chair of the French Interministerial Mission for Combating Drugs and Addictive Behaviors (MILDECA), highlighted the growing concern around stimulant use in France. Cocaine is now the second most consumed drug after cannabis, with related deaths quadrupling in the past nine years and emergency calls tripling in the last 12 years. Nevertheless, the importance of psychosocial interventions, including contingency management and cognitive-behavioural therapy (CBT), was emphasised, alongside innovative approaches such as virtual reality exposure. Recognising the importance of scalable psychosocial and pharmacological interventions for stimulant use disorders, the French government is also the first donor to the #ScaleUp initiative.
Suwana Arunpongpaisal, a Professor of Psychiatry at Khon Kaen University in Thailand, discussed the country’s 55-fold increase in methamphetamine use from 2019 to 2022. She shared that Thailand’s clinical practice guideline classifies interventions for people with stimulant use disorders into four risk groups, offering tailored interventions, from community-based education to specialised hospital care. She emphasised the need for international collaboration through initiatives like #ScaleUp to address the global treatment gap for stimulant use disorders. In this regard, Thailand, together with Norway, have sponsored a resolution on “Promoting research on scientific evidence-based interventions for the treatment and care of stimulant use disorders”, which was adopted at the end of the 68th Session of the Commission on Narcotic Drugs.
Fatemeh Chalabianloo, Chief Medical Supervisor at Norway’s Research Center for Agonist Treatment, presented the Atlas for Dependence trial. This government-funded study investigates dextroamphetamine substitution for amphetamine dependence, with 226 participants receiving either medication or placebo over two 12-week periods. The trial, which began in October 2024, focuses on reducing the non-medical use of amphetamines and improving quality of life. Fatemeh Chalabianloo also emphasised the importance of reducing negative health and social consequences related to drug use and collaboration with peer organisations, as well as international researchers.
Giovanna Campello, Chief of UNODC Prevention, Treatment, and Rehabilitation Section (PTRS), highlighted the #ScaleUp initiative’s focus on equitable and scalable solutions. She emphasised the importance of multi-country studies to demonstrate the feasibility of psychosocial interventions and to build evidence for pharmacological treatments. UNODC’s successful take-home naloxone project was referenced as a model for collaborative, evidence-based action. She called for increased advocacy and training tools to close the global treatment gap.
Anja Busse, Head of Alcohol, Drugs, and Addictive Behaviours unit, shared findings from WHO’s evidence review, recommending psychosocial interventions for non-specialised settings. While pharmacological treatments like dexamphetamine are not yet recommended due to safety concerns, promising research on mirtazapine and naltrexone-bupropion offers hope for future advancements. She emphasised the need for more research in low- and middle-income countries and the importance of equitable, cost-effective solutions.
The side event underscored the importance of listening to those directly affected by stimulant use disorders. One powerful testimony came from Arild Knutsen, speaking on behalf of the International Network of People Who Use Drugs (INPUD), who shared his personal journey of recovery through dexamphetamine treatment:
“I was a problematic user, injecting drugs and experiencing psychosis. When I was prescribed dexamphetamine, I became functional again – I slept, I worked, and I was free from psychosis.”
This story highlighted the transformative potential of pharmacological treatments, which are still under research.
The #ScaleUp side event, organised by Norway and supported by Australia, France, Thailand, UNODC PTRS, WHO and INPUD, was well-attended with close to 100 participants. It was a powerful reminder of the urgent need to strengthen the treatment for stimulant use disorders. As UNODC continues to lead this effort, the message is clear: change is possible, but it requires collective action.
Further reading:
Brochure #ScaleUp – Scalable interventions for the treatment and care of stimulants use disorders
UNODC World Drug Report 2024: Special Points of Interest
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