Director Botticelli’s Remarks: Demand Reduction Roundtable at the Commission on Narcotic Drugs

Introduction:

Good morning all; it is an honor to be here with my distinguished colleagues. My remarks today will highlight the scientific progress that has been made in understanding substance use disorders; what this knowledge means for our future work to reduce drug use and its consequences, as well as the importance of using the UNGASS in 2016 to promote urgent action to bring evidence-based public health services to citizens around the world

Scientific Progress:

Next year will be the first U.N. Special Session on Drugs in almost two decades.  Much has changed in these years, especially with regard to our growing knowledge of how to prevent and treat substance use disorders.  

Thanks to advances in scientific research, we now know that substance use disorders are a disease.  It is a medical condition —like heart disease or diabetes—that can be prevented, treated, and from which one can recover.  Research funded by the U.S. and other nations, is revealing more and more useful information about the disease of addiction.

Think about the potential that exists to bring the fruits of this scientific knowledge and evidence-based practice to more of our citizens. This reality is both exciting and challenging. Exciting because the tools we need to address substance use disorders are research tested and ready to be put to use. Challenging because we no longer have the excuse to say we don’t know what works. That knowledge is now available. Will we do what it takes to make life better for the millions of people affected by substance use disorders?

Prevention/Treatment:

The way to reduce the demand for drugs is through instituting science-based programs and policies.  Resources are always limited so funds should be focused on what is shown to work.

Fortunately UNODC has developed, with Member State support, International Standards on Drug Use Prevention.  UNODC is also working to assemble a panel of leading treatment experts and to develop International Standards for Substance Use Treatment.  These treatment standards will synthesize the 60+ years of scientific research in the field of addiction science and will reflect the latest research on effective practices. The standards will also identify what doesn’t work.

The finalized international standards will be released at the 2016 CND.  These standards should be discussed in detail in the UNGASS as part of a critical effort to implement these best practices worldwide and to promote the integration of substance use disorder treatment into mainstream health care services.  Additionally, the international community has begun work to develop a curriculum program for the international credentialing of treatment professionals. The curriculum will cover a broad spectrum of topics from physiology and pharmacology to counseling skills and ethics, among others.

Public Health Approach:

Many of us talk about the importance of a public health approach to drug policy.  However, implementing such a policy requires hard work and an investment in building treatment capacity, including training medical professionals on how to address substance use disorders.

Screening for substance use disorders and early intervention are critical to our efforts. A modest investment in screening can have a huge payoff. Once medical professionals, including doctors, nurses and physician assistants, are trained to screen patients for substance use they can identify and address drug use problems earlier.  Screening is valuable both for the general population and for those arrested for drug-related offenses.  Arrestees have high rates of substance use and require screening to assess their health needs.  This type of assessment can result in huge long-term savings in future criminal justice and public costs.

Another critical part of public health is the use of medications to treat addiction, and the implementation of medication-assisted treatment (MAT) protocols.  Clinical research has shown that opiate substitution therapy is a highly effective intervention for those dependent on heroin, reducing relapse rates and improving health outcomes significantly. MAT is also being integrated into AIDS treatment in the United States through the President’s Emergency Plan for AIDS Relief, the largest effort in history to treat a single disease. The correlation between drug use and other diseases manifests itself in those who suffer from Hepatitis-C and HIV, MAT not only reduces heroin use it also is a critical tool in reducing other potentially deadly diseases.  Although cultural and social stigmas regarding medications used to treat opioid addiction persist in some places, both the research and the responsibilities of countries to provide such evidence-based treatment to those that require them is clear.

Judicial Reform

As citizens of the most interconnected global community in human history, we know how important it is to support peace and stability across the world—which is why the U.S. Government is committed to international partnerships that reduce both the demand and the supply of illicit drugs.

Our knowledge of the disease of addiction has helped clarify that, punishment – including labor – does nothing to address substance use disorders. In fact, punitive approaches often make the problem worse, leading to worsening health and public safety consequences and greater costs to governments.  Only evidence-based treatment can provide a long-term solution. Thankfully, we are developing innovative alternatives to incarceration that can help end the vicious cycle of arrest, incarceration, release, and re-arrest of drug users, while protecting public safety.

By finding alternatives to incarceration, we are able to keep people out of jail and help them reach their full potential.  The U.S. will be offering a resolution at this CND encouraging public health and justice sector collaboration.  We invite comments and ask support for this resolution and would welcome the opportunity after the CND to increase information sharing and exchanging on this vital issue.

Overdose Prevention:

There also have been important breakthroughs in saving lives. Scientists have long known that the effective use of naloxone can reverse the immediate effects of opioid overdose.  But for too long this life saving medication has not been reaching those who desperately need it.  In the U.S. and elsewhere, a growing number of police officers, first responders, and even family members are now carrying naloxone and literally saving the lives of opioid users.  We have also seen, as we have expanded use of this tool by police, a very positive change in the community/police relationship when citizens know that police have a strong stake in saving the lives of drug users. This partnership has been aided by laws that protect citizens who may otherwise fear arrest on drug possession charges, when they try to save the lives of friends who are experiencing an overdose.

Destigmatization:

Eliminating stigma is a critical piece to reduce drug use and its consequences and to encourage people to seek treatment.  In the United States, we have much more work to do to reduce stigma and eliminate barriers to recovery. We are committed to ending policies and practices that may contribute to the marginalization of and discrimination against individuals with substance use disorders.  We should all prioritize eliminating stigma, shame, and judgment for those who are affected by substance use disorders. 

Data Collection:

There is no more important investment than the timely collection of critical drug data. There is no way to assess if policies are working, or even targeted to the right problem, without the collection of drug consumption trends, information on the health and safety consequences of drug use, and related program implementation information.

These surveillance systems are vital for all of us. Fortunately, with new technology and proven methodologies, the costs can be limited.  Let us commit to improve our data collection, as well as our exchange of information, and our use of evidence-based practices at the UNGASS in 2016.

Access to Medications:

Let me also highlight the critical importance of access to medications for medical purposes. Creating a balance between regulatory controls that prevent diversion while ensuring availability is a central issue as we move towards UNGASS 2016. 

According to the WHO, 150 countries in the world or roughly 80% of the world’s population, report severe under-treatment of pain.  Annually, approximately 10 million people lack access to controlled substance medications.  It is one of the central purposes of the conventions. In this regard, the conventions have given both the International Narcotics Control Board (INCB) with Members States the mandate to ensure availability.

The INCB has stepped up actions to expand efforts to assess and clarify the challenge, and we note with appreciation they will provide us an updated assessment on these issues to supplement the annual INCB report. 

Data is critical to this effort and the INCB collects information on the use of licit opiates from Member States to ensure that opiates stocks are at appropriate levels. The INCB has also worked with WHO to help develop the guidelines for ensuring availability. WHO has further also studied the issue including the feasibility of assisting countries with improving access to opioid analgesics. 

However, there are practical factors that preclude opiate use as pain medications in certain countries, including: concerns about addiction, insufficient healthcare training, laws or regulations that restrict opiate manufacture, distribution, prescribing or dispensing, reluctance to prescribe opiates due to concerns over legal sanctions, administrative burdens, concerns over diversion, cost of medicines, insufficient health-care resources, and absence of national policies and poor economic conditions.

As we move forward, it is critical that Member States WHO, and the INCB and take steps to promote medical and scientific use of opiates for pain medication through publishing of updated guidelines, strengthening of supply chain systems and capacity building for regulatory agencies and public health practitioners. To do so, however, it will be important to that the INCB, UNODC and WHO work together to identify the areas where assistance is needed.  

Conclusion:

This is a time to be optimistic. We know that demand reduction works, and we know we cannot rely solely on supply reduction and control measures to address the very serious consequences of drug production, trafficking and abuse.  It is now time for us to increase public health’s role in in drug policy. 

Please join me in ensuring that the UNGASS in 2016 sends a very clear message to all of our nations and the multilateral institutions that the time for talk has ended, and the time for action – supporting a public health approach to drugs – has finally arrived.