To successfully address the problems of abuse and misuse of psychoactive substances, public health systems need to take a comprehensive approach that includes interventions to promote healthy lifestyles, prevent initiation of drug use, mitigate harms from drug abuse, provide treatment and rehabilitation for dependency, and fully rehabilitate the affected people.
Washington, D.C., 26 June 2014 (PAHO/WHO) — To successfully address the problems of abuse and misuse of psychoactive substances, public health systems need to take a comprehensive approach that includes interventions to promote healthy lifestyles, prevent initiation of drug use, mitigate harms from drug abuse, provide treatment and rehabilitation for dependency, and fully rehabilitate the affected people.
These recommendations emerged from a panel discussion on progress and challenges in advancing a public health approach to drug policy in the Americas, organized by the Pan American Health Organization/World Health Organization (PAHO/WHO) in observance of the International Day against Drug Abuse and Illicit Trafficking, June 26.
"The use of psychoactive substances has been recognized as an important public health problem in the Americas, one that is associated with a significant burden of premature death and disabilities," said PAHO Assistant Director Francisco Becerra. "Problems such as multiple drug combinations, prescription drug abuse, increasing availability of new synthetic drugs, and risky methods of administration—such as injection--are all cause for concern by governments."
Equally important, said Becerra, is the "enormous gap" between substance users' health needs and their access to health services, particularly for the most socioeconomically vulnerable users.
According to estimates by the United Nations Office on Drugs and Crime, more than 40 million people in the Americas (6.9% of the population aged 15 to 64) had used cannabis as of 2006. Some 10 million had used cocaine, 5.7 million had used amphetamines, and 2.2 million had used heroin. In recent years, the tendency in the Americas has been toward greater use of amphetamine-type drugs, thanks to the availability of chemical precursors needed to synthesize methamphetamines. In South America, the use of both cannabis and cocaine is on the rise.
Public health approach to drug policy
A public health approach to drug policy includes analysis of the problem and its determinants, said Luis Alfonzo, PAHO/WHO Advisor on Substance Abuse. It also implies that the response to the problem is centered in health systems and services, and takes a collective approach. "The focus is not on the drugs but on the person," said Alfonzo.
"This person-centered approach includes not just users but everyone who might be affected, directly or indirectly, by use of psychoactive substances," he said, adding, "Addressing the health needs of drug users is independent of whether the substance is legal or not."
Although the response to drug abuse and misuse must be centered in health services, it must also involve other sectors, with active participation by civil society, experts said.
"The drug problem is complex, with major costs associated with harmful use and dependency but also collateral costs from injuries, violence, neglect of other health problems, and diminished productivity, all accompanied by barriers in access to services and major social repercussions," said Alfonzo.
A major challenge is integrating treatment for substance abuse into health networks, primary care, and community-based interventions, he added.
Paul Simons, Executive Secretary of the Inter-American Drug Abuse Control Commission (CICAD), said that the public health approach has gained ground in drug policy in the Americas in recent years, in large part due to collaboration between CICAD and PAHO.
"The problem of drugs affects every country in the Americas, but in different ways," said Simons. "It must be addressed from a public health perspective, not a legal perspective."
He added that addressing drug dependency requires a focus on social determinants, risk and protection factors, and establishing a continuum of services from protection and prevention to treatment and programs to reduce problematic substance use.
"Prevention efforts require much more effort and dedication on the part of countries," he said.
Simons also said that current treatment programs in countries of the region are fragmented and not based in the public sector, but rather in civil society providers, churches, and other private institutions.
"With PAHO, we are working to develop an accreditation system for centers that provide treatment, both residential and out-patient, and also offering training to those who provide treatment for the most vulnerable groups, especially women and youths," Simons noted.
As part of the incorporation of a public health approach into drug policy, there has been increasing participation in policymaking by different sectors, including ministries of health, drug commissions, and civil society. Simons noted that CICAD and PAHO are developing a guide to help countries formulate policies to reduce demand for drugs that are based on a public health perspective.
Breaking the cycle
Westley Clark, Director of the Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration (SAMHSA) of the U.S. Department of Health and Human Services, said it is important to "break the cycle of drug use and incarceration and eliminate stigma against those who abuse drugs or are in treatment."
Data from a survey of Hispanics in the United States show that 95.4% of people who use drugs and are eligible for public assistance say they do not need treatment. "This points to a difficulty in providing treatment because people do not realize they need it," said Clark. "Our society recognizes that diabetes is a disease that can be prevented and treated, and that it requires changes in behavior and lifestyle, and it can be treated with medication. The same is true for drug and alcohol abuse. Users with these problems should receive holistic, integrated care."
Clark also emphasized the importance of addressing the conditions that can lead people to abuse drugs. He said policies and programs should be based on good data, should take a comprehensive approach that improves care, and should protect the human rights of people suffering from mental health problems or drug abuse. Prevention, treatment, and rehabilitation are the three key areas of work, he said.
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