Background Information Roundtable 1 on demand reduction (UNGASS)

Member States have recently recognised the powerful connection between substance use, drug use, health and development by adopting Sustainable Development Goal (SDG) 3.5, thus committing themselves to strengthening drug prevention and treatment. This development should be a call for joint action by the international community, national Governments, civil society and the private sector

A comprehensive package of nine evidence-based HIV prevention, treatment and care interventions, also known as ‘harm reduction’, has been outlined in a technical guide, issued jointly by WHO, UNODC and UNAIDS in 2009 and revised in 2012, and referred to by the Commission on Narcotic Drugs, UNAIDS Programme Coordinating Board, UN ECOSOC and the UN General Assembly. In countries with substantial epidemics among people who inject drugs, analyses have consistently shown that investment in an optimal mix of evidence based interventions for HIV among people who inject drugs minimizes new HIV infections and deaths. For example, by prioritizing needle and syringe programmes, opioid substitution therapy and anti-retroviral therapy, countries could improve coverage and achieve fewer new HIV infections and deaths among people who inject drugs. This will also reduce new HIV infections among sexual partners of people who inject drugs and the wider population. These programmes also serve as an entry point to other services and engage clients on a regular basis, providing opportunities to facilitate access to other health services

Treatment, care, rehabilitation and social reintegration services that are based on scientific evidence and on the respect of the rights and dignity of the individuals who use drugs and suffer from drug use disorders can protect health, by preventing overdose, HIV, Hepatitis C and other health co-morbidities (consequences) and can lead individuals to regain control over their lives and initiate full and productive lives in recovery. In both cases, services have proven to be effective and cost effective

From an infrastructure point of view, evidence-based interventions should be supported by the balanced allocation of adequate and sustained financing in the context of the national health system and in coordination with a number of other sectors, most notably, law enforcement and justice, education, social welfare and labour, as well as civil society, universities and the private sector

Further, a significant ramp up in international and domestic investments is required to scale up prioritized evidence-based interventions, which will substantially reduce future health care cost, recognizing that every new HIV infection implies future cost for life-long treatment of HIV and opportunistic infections. To maximize the return on investment, it is, therefore, important for countries to review spending to ensure that resources can be reallocated to evidence-based interventions

However, access to these essential evidence-based and cost effective services for HIV prevention and treatment for people who inject drugs is disproportionately low to have an impact at an individual level as well as at the public health level. Globally, fewer than 8 in 100 people who inject drugs have access to opioid substitution therapy, only 2 sterile needles are distributed per month per person who injects drugs and only 4 in every 100 eligible people who inject drugs are receiving antiretroviral therapy. HIV services are often not responsive to the specific needs of particularly vulnerable groups of people who use drugs such as women, young people, and those living in prisons and other closed settings. As a result, the global community failed to achieve the global target of halving the transmission of HIV among people who inject drugs by 2015.xiv UNAIDS estimates that between 2010 and 2014, there was a mere 10% reduction in new HIV infections among people who inject drugs. On the other hand, countries having implemented and facilitated the access for people who inject drugs to needle-syringe programmes and opioid substitution therapy, have reduced the number of new HIV infections among people who inject drugs to almost zero

Equally important, affected communities, civil society organizations and the scientific community must collaborate in policy and programme development and implementation, in order to make sure that interventions targeting HIV are effective

The need to ensure the availability of controlled drugs for medical and scientific purposes, along with the need to prevent their diversion and abuse, has been first established by the international drug control conventions and has been supported by numerous recommendations of the international drug control bodies (including both the International Narcotics Control Board (INCB) and the Commission on Narcotic Drugs), as well as other international law instruments related to health and human rights. Most recently, in the UN framework of the Sustainable Development Goals, target 3.8.b aiming to provide access to affordable essential medicines and vaccines and 3.8.c aiming to substantially increase health financing and strengthen the health workforce in developing countries are closely aligned to the efforts to increase access to controlled drugs for medical purposes

A number of controlled substances under the three conventions, including morphine along with several other opioids for pain control and palliative care as well as buprenorphine and methadone for the treatment of opioid dependence, are on WHO’s Model List of Essential Medicines. In spite of this, over 80% of the world’s population have low to non-existent access to controlled medicines with inadequate access to treatment for moderate to severe pain; including an estimated 1.5 million people dying of AIDS-related causes, including people who use drugs, without adequate pain control; while less than 8% of people who inject opioid drugs have access to opioid substitution therapy. Even where pain control and palliative care services are available, people who use drugs often face additional access barriers, including adequate pain management being withheld on account of regulations concerning people who have had opioid dependence syndrome

The international drug control conventions provide a framework upon which to build a system that ensures access to controlled drugs for medical purposes while simultaneously preventing diversion, misuse and abuse. Access to controlled drugs for medical purposes, including most notably for the treatment of pain, should be guaranteed as an essential component of the right to health in the context of a health-based drug control system. Member States should enhance international cooperation and share lessons learned and best practices to address identified barriers to availability of controlled substances for medical and scientific purposes such as, attitudes and knowledge of the provisions of the international drug conventions; capacity of health care workers; national legislation and regulatory frameworks; and economic and procurement related issues

Additionally, the International Agency for Research on Cancer, the specialized cancer research agency of WHO, report that the global burden of cancer has risen to 14.1 million new cases and 8.2 million cancer deaths in 2012, with a predicted increase in new cancer cases to be almost 20 million by 2025 due to an ageing global population. The implication being that with this level of medical demand for pain management and palliative care, it is critical to support a system of drug control that provides increased access to essential medicines for all patients, including in developing countries, while preventing diversion, misuse and abuse. This can be accomplished through a collaborative approach when regulatory impediments are reduced, attitude and knowledge barriers to procurement are addressed, advocacy efforts are made in communities, the capacity of healthcare professionals to implement a comprehensive approach is increased and policies are in place to ensure safe delivery, while preventing their abuse and diversion

Concurrently, the aim of the three international drug control conventions is to guarantee the availability and access to controlled drugs for medical use for the treatment of a variety of medical conditions, particularly pain and many psychiatric and neurological conditions. All of these have recently been re-affirmed in the new adopted framework of the Sustainable Development Goals and this background document provides an overview of the situation and proposes action to achieve the objectives mentioned