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Addressing health and human development vulnerabilities

in the context of drugs and crime

THEMATIC PROGRAMME

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UNEXPLORED TERRITORY

NO ONE’S LAND

Discrimination Ignorance

Prejudice

Stigma

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DRUG USERS AND DRUG DEPENDENT PERSONS

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DRUG USERS AND DRUG DEPENDENT PERSONS

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PERSONS WHO HAVE COMMITTED AN OFFENSE IN PRISON SETTING

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PERSONS WHO HAVE COMMITTED AN OFFENSE IN PRISON SETTING

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PERSONS VULNERABLE TO HUMAN TRAFFICKING

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PERSONS VULNERABLE TO HUMAN TRAFFICKING

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UNODC hasthe unique positionto amelioratethe condition of…

Victims of crime:- Drug users- Vulnerable to HIV- Vulnerable tohuman traffickingand violence

Perpetuators of crime:- Offenders- Convicted offenders

UNCONDITIONED RIGHT TO HEALTH

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Vulnerabilities relating to drug use and dependence

Political Declaration 2009Paragraphs 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

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Health at the center stage of the drug control system (A.M. Costa, 2009)

To protect the health of people,particularly the most vulnerable, from the dangerous effects of drug useand from drug use disorders

To reduce drug-related diseasesand social consequences

Supply reduction Demand reduction

Harm reduction

HEALTH CARE

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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

Vulnerabilities in prison setting

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Vulnerabilities in prison setting

Commission on Crime Prevention and Criminal Justice2009

Thematic debate: Penal reform and reduction of prison overcrowding

Improving health conditions in prisonReducing overcrowding

Stopping of reducing the use of alcohol and drugsImproving sanitation

Providing foodPromoting exercise

Preventing TB – HIV infections Preventing mental health disorders

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Vulnerabilities in the context of human trafficking

United Nations Convention AgainstTransnational 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

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UNODChealth and human development

WHO UNDP UNICEF

IOMILO

Ministry of Health Ministry of Interior Ministry of Justice

A MULTI-DISCIPLINARY APPROACH

UNAIDS

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Do we have consolidated evidence concerning the effectiveness of

prevention of drug use,treatment of drug dependence

and prevention and treatment of HIV?

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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

WHAT IS NOT WORKING IN PREVENTION

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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

WHAT IS WORKING IN PREVENTION

Faggiano et al., Cochrane 2005

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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

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PrisonPunishmentPure re-educationWorking aloneSpirituality aloneIndividual psychotherapy aloneDetoxification without after-careShort-term therapySymptoms therapyTreatment without assessment

WHAT IS NOT WORKING IN TREATMENT

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WHAT IS WORKING IN TREATMENT

Brief interventionMotivational interviewingCognitive-behavioural therapyContingency therapyFamily therapyVocational trainingSelf help 12 stepTherapeutic community method

Long term opioid-agonistsSlow release opioid-antagonistsMedications for psychiatric comorbidity

Integrated pharmacological and psychosocial therapy

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WHAT IS NOT WORKING IN HIV PREVENTION AND HEALTH CARE

Information aloneCounselling aloneDemonizationPanic disseminationStigma and marginalizationDenialViolation of privacyLack of medical carePunishment for drug dependent individuals

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WHAT IS WORKING IN HIV PREVENTION

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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

WHAT IS WORKING IN DRUG USERS HEALTH CARE

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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

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A continuum of care

recovery-orientedhigh-thresholdtreatment

centres

social supportto families

life skills programs

and vocational training

strengtheningfamily

program

HIV/AIDSHepatitis TBC

preventionand treatment

outreachinterventions

health care andmental health

treatment

health and social care in prison

health and socialcare for vulnerable

to human trafficking

educational activitiesalternative jobs

low-thresholdtreatmentcentres

sustainable livelihood

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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

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Botvin et al., 2000

Life Skills Training during Junior High School

05

10152025

30354045

Control LifeSkills

MarijuanaHallucinogensNarcotics

Up to 56% reduction in drug use by 12th grade

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NTORS,Gossop et al.,2003

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NTORS,Gossop et al.,2003

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Woody et al., 2008

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Comer et al., 2006

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Combination of Olanzapine With Opioid-Agonists in the Treatmentof Heroin-Addicted Patients Affected by Comorbid Schizophrenia Spectrum Disorders

Gerra et al., 2007

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Amato et al., 2004, Cochrane Database Syst Rev.

Results suggest that adding any psychosocial support to maintenance treatments improve the number of participants abstinent at follow up (20% increase at 48 weeks)

associated treatment Abstinent subjects

48 weeks

3,000

single treatment

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Treatnet II

EU-UNODC

EU-UNODC, Focus on Treatment

CAM-H90

Countries Worldwide with Treatment UNODC Activities

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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

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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

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Anti-traffickingaction

Anti-corruptionaction

Anti-money laundering action

Anti-terrorism action

Alternative developmentaction

Buildingcriminal justice system

25% of police positive for drugs

INTEGRATION IN REGIONAL PROGRAMS?

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(1997)

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Universal access to treatment of drug dependence

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Sustainable Livelihoods:A broader vision

Social Support and Integration enabling Prevention of Illicit Drug Use, HIV Epidemic and Crime

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Area of work ActivityFunding requirements(million US dollars)

Prevention of drug useEstablishment and validation of family skills training programmes

10.0

Prevention of drug useAdapting and mainstreaming evidence-based drug education curriculum in schools

3.0

Prevention of drug useDeveloping and establishing workplace prevention programmes in public and private companies

3.0

Drug dependence treatment and rehabilitation

UNODC-WHO Joint Action Programme on Drug Dependence Treatment

31.0

Prevention of HIV and AIDS among drug users, in prison settings and as it relates to the trafficking in persons

UNODC obligations towards UNAIDS UBW 2008-2009 and 2010-2011, Universal access by 2010, MDG 6 by 2015

70.0

2009-2011