THEMATIC PROGRAMME

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

-1-
UNEXPLORED TERRITORY

NO ONE’S LAND

Discrimination Stigma Ignorance

Prejudice
-2-
DRUG USERS AND DRUG DEPENDENT PERSONS
-3-
DRUG USERS
AND DRUG DEPENDENT PERSONS -4-
PERSONS WHO HAVE COMMITTED AN OFFENSE
IN PRISON SETTING
-5-
PERSONS WHO
HAVE
COMMITTED
AN OFFENSE
IN PRISON
SETTING

-6-
PERSONS VULNERABLE TO HUMAN TRAFFICKING

-7-
PERSONS VULNERABLE TO HUMAN TRAFFICKING

-8-
 UNODC has
the unique position
to ameliorate
the condition of…

Victims of crime:
- Drug users Perpetuators of crime:
- Vulnerable to HIV - Offenders
- Vulnerable to - Convicted offenders
human trafficking
and violence

UNCONDITIONED RIGHT TO HEALTH

-9-
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

- 10 -
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
- 11 -
 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
- 12 -
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
- 13 -
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

- 14 -
Ministry of Health Ministry of Interior Ministry of Justice

UNODC
health and human development

WHO UNDP UNICEF

UNAIDS
ILO IOM

A MULTI-DISCIPLINARY APPROACH
- 15 -
 Do we have consolidated evidence
concerning the effectiveness of
prevention of drug use,
treatment of drug dependence
and prevention and treatment of HIV?

- 16 -
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

- 17 -
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
- 18 -
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

- 19 -
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

- 20 -
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

- 21 -
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

- 22 -
WHAT IS WORKING IN HIV PREVENTION

- 23 -
 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 - 24 -

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

- 25 -
 strengthening
social support family educational activities
to families program alternative jobs

life skills sustainable livelihood

programs
and vocational
training
A continuum health and social
care in prison
of care
high-threshold recovery-oriented health and social
treatment care for vulnerable
centres to human trafficking

HIV/AIDS health care and

low-threshold Hepatitis TBC mental health
treatment outreach prevention treatment
centres interventions and treatment
- 26 -
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

- 27 -
Life Skills Training during Junior High School
Up to 56% reduction in drug use by 12th grade

45
40
35
30
25 Marijuana
20 Hallucinogens
15 Narcotics
10
5
0
Control Life
Skills

Botvin et al., 2000

- 28 -
NTORS,
Gossop et al.,
2003

- 29 -
NTORS,
Gossop et al.,
2003

- 30 -
Woody et al.,
2008
- 31 -
Comer et al., 2006
- 32 -
Combination of Olanzapine With Opioid-Agonists in the Treatment
of Heroin-Addicted Patients Affected by Comorbid Schizophrenia
Spectrum Disorders

Gerra et al.,
2007
- 33 -
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.

- 34 -
Countries Worldwide with Treatment UNODC Activities

Treatnet II
CAM-H90
EU-UNODC, Focus on Treatment
EU-UNODC
- 35 -
 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
- 36 -
 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 - 37 -
 INTEGRATION IN REGIONAL PROGRAMS?

Anti-trafficking
action

Alternative development Anti-corruption

action action
25% of police
positive for drugs
Building Anti-money laundering
criminal justice system action

Anti-terrorism
action
- 38 -
(1997)

- 39 -
Universal access to treatment of drug dependence

- 40 -
Sustainable Livelihoods:
A broader vision

Social Support and Integration

enabling Prevention
of Illicit Drug Use, HIV Epidemic and Crime

- 41 -
 Funding
Area of work Activity requirements
(million US dollars)

Establishment and validation of family skills 10.0

Prevention of drug use training programmes

Prevention of drug use 3.0

Adapting and mainstreaming evidence-based
drug education curriculum in schools

Prevention of drug use 3.0

Developing and establishing workplace
prevention programmes in public and private
companies

Drug dependence 31.0

treatment and UNODC-WHO Joint Action Programme on Drug
rehabilitation Dependence Treatment

Prevention of HIV and 70.0

AIDS among drug users, in
prison settings and as it UNODC obligations towards UNAIDS UBW 2008-
relates to the trafficking in 2009 and 2010-2011, Universal access by 2010,
persons MDG 6 by 2015

2009-2011 - 42 -