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Addressing health and human development vulnerabilities in the context of drugs and crime

THEMATIC PROGRAMME. Addressing health and human development vulnerabilities in the context of drugs and crime. UNEXPLORED TERRITORY NO ONE’S LAND. Discrimination. Stigma. Ignorance. Prejudice. DRUG USERS AND DRUG DEPENDENT PERSONS. DRUG USERS AND DRUG DEPENDENT PERSONS.

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Addressing health and human development vulnerabilities in the context of drugs and crime

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  1. THEMATIC PROGRAMME Addressing health and human development vulnerabilities in the context of drugs and crime

  2. UNEXPLORED TERRITORY NO ONE’S LAND Discrimination Stigma Ignorance Prejudice

  3. DRUG USERS AND DRUG DEPENDENT PERSONS

  4. DRUG USERS AND DRUG DEPENDENT PERSONS

  5. PERSONS WHO HAVE COMMITTED AN OFFENSE IN PRISON SETTING

  6. PERSONS WHO HAVE COMMITTED AN OFFENSE IN PRISON SETTING

  7. PERSONS VULNERABLE TO HUMAN TRAFFICKING

  8. PERSONS VULNERABLE TO HUMAN TRAFFICKING

  9. UNODC has the unique position to ameliorate the condition of… Victims of crime: - Drug users - Vulnerable to HIV - Vulnerable to human trafficking and violence Perpetuators of crime: - Offenders - Convicted offenders UNCONDITIONED RIGHT TO HEALTH

  10. Vulnerabilities relating to drug use and dependence Political Declaration 2009 Paragraphs 20, 21, 22, 23 Prevention of drug use, treatment of drug dependence, rehabilitation and reintegration Prevention of health and social consequences of drug use HIV prevention, treatment care and support

  11. Health at the center stage of the drug control system (A.M. Costa, 2009) Supply reduction Demand reduction To protect the health of people, particularly the most vulnerable, from the dangerous effects of drug use and from drug use disorders HEALTH CARE To reduce drug-related diseases and social consequences Harm reduction

  12. Vulnerabilities in prison setting United Nations Standard Minimum Rules for the Treatment of Prisoners (ECOSOC resolution 1984/47) Art. 12 : The right of everyone to the enjoyment of the highest attainable standard of physical and mental health. Those who are imprisoned retain this fundamental right Resolution 2004/28:United Nations standards and norms in crime prevention and criminal justice (E/RES/2004/28) Art. 9: Prisoners shall have access to the health services without discrimination on the grounds of their legal situation. The United Nations General Assembly Special Session 1998 prisoners as an important group for activities to reduce demand

  13. Vulnerabilities in prison setting Commission on Crime Prevention and Criminal Justice 2009 Thematic debate: Penal reform and reduction of prison overcrowding Improving health conditions in prison Reducing overcrowding Stopping of reducing the use of alcohol and drugs Improving sanitation Providing food Promoting exercise Preventing TB – HIV infections Preventing mental health disorders

  14. Vulnerabilities in the context of human trafficking United Nations Convention Against Transnational Organized Crime (Annex II, Article 6) Protection of victims of trafficking in persons Para 3 (c) medical, psychological and material assistance mental health promotion substance abuse prevention (a) housing (d) education-training opportunities employment

  15. Ministry of Health Ministry of Interior Ministry of Justice UNODC health and human development WHO UNDP UNICEF UNAIDS ILO IOM A MULTI-DISCIPLINARY APPROACH

  16. Do we have consolidated evidence concerning the effectiveness of prevention of drug use, treatment of drug dependence and prevention and treatment of HIV?

  17. WHAT IS NOT WORKING IN PREVENTION scare tactics and moralistic appeals curricula that rely solely on information about drugs and their dangers curricula that only work to promote self-esteem and emotional well-being single shot assemblies testimonials by former addicts counseling in peer-group context recreation and community service activities Levine et al. 1999

  18. WHAT IS WORKING IN PREVENTION training in resistance skills normative education life skills: communication life skills: decision making life skills: emotional communication life skills: impulse control life skills: self esteem trained teachers interactive methods / reliable information Faggiano et al., Cochrane 2005

  19. WHAT IS WORKING IN PREVENTION Supervising and monitoring skills Caring, trusting relationships between parents and children Warm child rearing style Communication of positive family values Setting age appropriate limits, rules and consequences Praising children appropriately for their behavior and accomplishments Structured family life including having meals together Parents involvement in the lives of their children

  20. WHAT IS NOT WORKING IN TREATMENT Prison Punishment Pure re-education Working alone Spirituality alone Individual psychotherapy alone Detoxification without after-care Short-term therapy Symptoms therapy Treatment without assessment

  21. WHAT IS WORKING IN TREATMENT Brief intervention Motivational interviewing Cognitive-behavioural therapy Contingency therapy Family therapy Vocational training Self help 12 step Therapeutic community method Long term opioid-agonists Slow release opioid-antagonists Medications for psychiatric comorbidity Integrated pharmacological and psychosocial therapy

  22. WHAT IS NOT WORKING IN HIV PREVENTION AND HEALTH CARE Information alone Counselling alone Demonization Panic dissemination Stigma and marginalization Denial Violation of privacy Lack of medical care Punishment for drug dependent individuals

  23. WHAT IS WORKING IN HIV PREVENTION

  24. WHAT IS WORKING IN DRUG USERS HEALTH CARE • reliable information and counseling • low-threshold pharmacological interventions • (example opioid-agonists and antagonist drugs) easily accessible • adequate social assistance for marginalized drug dependents • vaccination programs against Hepatitis to all drug abusers • medication and emergency kits for management of overdoses • in appropriate places • availability of measures to prevent acute consequences • of stimulants abuse (free water…) • appropriate interventions in emergency rooms • well-equipped street-workers and peer outreach workers units • measures to prevent car and workplace accidents • social assistance for children of drug dependent individuals

  25. help low and middle income countries to build a community-based continuum of care through the ‘normal’ health and social services system for the vulnerable populations at all the stages of their problematic conditions

  26. strengthening family program educational activities alternative jobs social support to families life skills programs and vocational training sustainable livelihood A continuum of care recovery-oriented health and social care in prison high-threshold treatment centres health and social care for vulnerable to human trafficking HIV/AIDS Hepatitis TBC prevention and treatment health care and mental health treatment low-threshold treatment centres outreach interventions

  27. 1) Advocacy/ethical approach 2) Training, science-based practice dissemination 3) Low cost treatment/health care centers/prevention 4) Data collection / evaluation and research 5) Adaptation to regional country needs /ownership 6) Guidelines and therapeutic tools

  28. Life Skills Training during Junior High School Up to 56% reduction in drug use by 12th grade Botvin et al., 2000

  29. NTORS, Gossop et al., 2003

  30. NTORS, Gossop et al., 2003

  31. Woody et al., 2008

  32. Comer et al., 2006

  33. Combination of Olanzapine With Opioid-Agonists in the Treatment of Heroin-Addicted Patients Affected by Comorbid Schizophrenia Spectrum Disorders Gerra et al., 2007

  34. Results suggest that adding any psychosocial support to maintenance treatments improve the number of participants abstinent at follow up (20% increase at 48 weeks) 3,000 Abstinent subjects associated treatment single treatment 48 weeks Amato et al., 2004, Cochrane Database Syst Rev.

  35. Countries Worldwide with Treatment UNODC Activities TreatnetII CAM-H90 EU-UNODC, Focus on Treatment EU-UNODC

  36. Countries Worldwide with IDU/HIV UNODC Activities Russia, Romania, Estonia, Latvia, Lithuania, Azerbaijan, Uzbekistan, Kyrgyzstan, Turkmenistan, Kazakhstan, Ukraine, Moldova, Egypt, Palestine, Lebanon, Pakistan, Afghanistan, Nepal, Iran, India, Sri Lanka, Bangladesh, Bhutan, Thailand, Laos, Myanmar, China, Cambodia, Vietnam, Indonesia, Kenya, Mauritius, Brazil, Argentina, Paraguay, Costa Rica, Maldives, UAE, Yemen, South Africa

  37. Countries Worldwide with HIV UNODC Activities in Prisons Algeria, Benin, Morocco, Namibia, Mozambique, Sudan, Swaziland, Togo, Zambia, Kenya, Latvia, Lithuania, Estonia, Russia, Romania, Egypt, Lebanon, Jordan, Palestine, Azerbaijan, Uzbekistan, Kyrgyzstan, Turkmenistan, Kazakhstan, Pakistan, Afghanistan, Bangladesh, Cambodia, Nepal, Iran, India, Malaysia, Maldives, Belize, Costa Rica, Dominican Republic, El Salvador, Guatemala, Honduras, Nicaragua, Panama, Bolivia, Ecuador, Peru

  38. INTEGRATION IN REGIONAL PROGRAMS? Anti-trafficking action Anti-corruption action Alternative development action 25% of police positive for drugs Anti-money laundering action Building criminal justice system Anti-terrorism action

  39. (1997)

  40. Universal access to treatment of drug dependence

  41. Sustainable Livelihoods: A broader vision Social Support and Integration enabling Prevention of Illicit Drug Use, HIV Epidemic and Crime

  42. 2009-2011

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