Initiatives for Sub-Working Group 3.2 - Engaging People with Substance Use and Substance Use Disorders

UNODC/WHO S-O-S (Stop-Overdose Safely) Initiative for effective management of opioid overdose

The Stop Overdose Safely (S-O-S) initiative—developed in compliance with WHO guidelines on Community management of opioid overdose—aims to prevent opioid overdose deaths by promoting access to naloxone and the training of potential first responders in overdose management. It aims to prevent opioid overdose deaths in line with the recommendations of the WHO guidelines on Community Management of Opioid Overdose (WHO, 2014). The goal is to contribute towards reducing deaths due to preventable opioid overdoses.

The S-O-S initiative supports people likely to witness an overdose in the community, with a focus on people who use drugs, their peers, as well as family members with THN programs including training, provision of naloxone, and linking with treatment services. Moreover, it encourages broad partnerships between national governments, municipalities, regional organizations, research institutes, civil society, interested funding agencies, and other entities to work towards the 90-90-90 targets. The targets are 90 percent of the relevant target population will have received training in overdose risk emergency management; 90 percent of those trained will be given a supply of emergency naloxone; and 90 percent of those who have been given a naloxone supply will be carrying the naloxone on them or have it close at hand.

Within the framework of the UNODC/WHO S-O-S initiative, a “S-O-S Multisite project on community management of opioid overdose including the use of naloxone” was designed to demonstrate the feasibility and public health impact of the implementation of an opioid overdose intervention in low- and middle-income countries, specifically in Kazakhstan, Kyrgyzstan, Tajikistan and Ukraine. The study showed that the implementation of a WHO–UNODC S-O-S training project resulted in the successful use of take-home naloxone at around 90% of witnessed opioid overdoses in low- to middle income countries and many lives saved.

UNODC and WHO stand ready to expand the initiative to other countries affected by opioid use disorders and opioid overdose related mortality, availing ready-to-use resources, including Training Manual, Take-Home-Naloxone-Kit specification, framework for planning, implementation, monitoring and evaluation from the initial phase of SOS implementation

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#NothingLess: UNODC Quality Assurance Initiative for Drug Use Disorder Treatment and Care and its impact on treatment outcomes

UNODC was mandated by the Commission on Narcotic Drugs (CND) resolution 59/4 on the “Development and dissemination of international standards for the treatment of drug use disorders” and the most recent CND resolution 64/3 that calls for “Promoting scientific evidence-based, quality, affordable and comprehensive drug prevention, treatment, sustained recovery and related support services” to support UN Member States in their efforts to enhance the quality of drug use disorder treatment services and systems. In line with these mandates and the UNODC-WHO International Standards for the Treatment of Drug Use Disorders (2020), the UNODC Quality Assurance (QA) Systems and Services toolkit was developed. Moreover, to align quality assurance efforts across different organizations, the “Quality assurance in treatment for drug use disorders: Key Quality Standards for service appraisal” were launched in 2021.

UNODC is supporting national decision makers in their efforts to review and improve local drug use disorder treatment and care systems and services, in line with the Standards. By fostering a culture of continuous drug use disorder treatment system/service assessment and enhancement, quality assurance contributes towards sustainable and ethical healthcare delivery for people in need, including for those using synthetic drug for non-medical purposes. To better understand the impact of quality assurance on drug use disorder treatment outcomes, UNODC has commissioned a scoping review and is suggesting further evaluation to identify which quality elements contribute in which way to desired outcomes of drug use disorder treatment.

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Care in Crises: Addressing substance use disorders in humanitarian emergencies and among displaced populations

The numbers of people in need of humanitarian assistance and the numbers of displaced populations have reached a new record high in 2023. Considering the limited availability of information on substance use in humanitarian emergencies and the limited access to substance use disorder (SUD) treatment and care services in humanitarian contexts, UNODC is promoting the provision of treatment and care to people with SUDs in humanitarian emergencies as an essential component humanitarian assistance. For that purpose, UNODC is building partnerships with humanitarian actors, conducting rapid assessments, working on the development and piloting of practical technical tools including training materials on addressing SUDs in humanitarian settings. With a view to enhance information on substance use disorder treatment needs as well as the development of feasible and effective strategies to provide live-saving care in acute and protracted humanitarian emergencies, UNODC supports humanitarian actors, host countries and vulnerable communities through technical guidance and services for affected populations. 

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Implementation of the UNODC/WHO International Standards for the Treatment of Drug Use Disorders

Implementation of the WHO/UNODC International Standards for the Treatment of Drug Use Disorders at national level in all regions to promote evidence-based and ethical treatment and care for people with drug use disorders and help develop treatment systems that meet populations’ needs. 

The “International Standards for the Treatment of Drug Use Disorders” is a joint product of the World Health Organization (WHO) and the United Nations Office on Drugs and Crime (UNODC) aimed to promote evidence-based and ethical treatment and care for people with drug use disorders and help develop treatment systems that meet populations’ needs. The Standards provide key principles for organizing treatment services for drug use disorders. They describe the main components of treatment systems, including treatment settings, modalities and interventions. Additionally, they include considerations for populations with special treatment and care needs. 

UNODC and WHO developed the initial elements of the Standards in 2014 and released it as a draft for field-testing during the 2016 Commission on Narcotic Drugs (CND). The 2016 United Nations General Assembly Special Session on Drugs (UNGASS) Outcome Document, as well as 2016 CND Resolution 59/4 on the “Development and dissemination of international standards for the treatment of drug use disorders” and CND Resolution 64/3 on “Promoting scientific evidence-based, quality, affordable and comprehensive drug prevention, treatment, sustained recovery and related support services“  reiterated the importance of disseminating the Standards, which have become an internationally agreed reference point for quality drug use disorder treatment, to further promote a balanced approach to drug policy and a health-centred approach to drug use disorders in a continuum of care.  

WHO, working in collaboration with UNODC, field-tested the Standards to assess their comprehensiveness, appropriateness, utility, feasibility, and evaluation capability and identify areas for improvement. The field-testing was carried out in nine countries with different health systems. Over 1200 health professionals participated in the field-testing survey, while 43 experts from countries participating in the field-testing provided detailed feedback on the draft Standards. Additionally, 43 focus groups comprising over 300 participants discussed the Standards, which were also presented and discussed at multiple international forums. The revised edition incorporating results of the field-testing was launched during the Commission on Narcotic Drugs in March 2020. 
One of the salient themes raised during the field testing of the Standards was related to the feasibility of their implementation in countries: about 40% of participants rated the Standards as “somewhat or not feasible” for the implementation. Extensive amount of information was collected on barriers for the implementation across different regions. Participating countries requested agencies to provide additional support to assure the feasibility of changes in services and system to be compliant with the Standards.  

In response to requests from Member States, organizations, institutions and individuals for technical guidance, WHO and UNODC have developed a quality assurance toolkit to assist countries with the implementation of the Standards. 
The quality assurance toolkit, together with the UNODC/WHO facility survey for substance use disorder treatment facilities and the upcoming full dissemination toolkit for the Standards (to be finalized in 2024), form a recommended package for countries interested in implementing the Standards. 

Additional technical assistance is required for countries to fully implement the International Standards for the Treatment of Drug Use Disorders at national and sub-national level and to evaluate the impact of such implementation on the treatment outcomes of people with drug use disorders.

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#ScaleUp: Scalable interventions for the treatment and care of stimulant use disorders

#ScaleUp is an initiative of UNODC to identify scalable and effective interventions for the treatment and care of stimulant use disorders. In 2021, stimulants were the second most commonly used internationally controlled substance worldwide, with the cannabis being the first. The total number of people using drugs was approximately 296 million that year, marking a 23% increase over the past decade. Of these, an estimated 78 million people used stimulants annually, and notably nearly as many women have used synthetic stimulants than men. Stimulant use has led to a high demand for treatment, with notable variations across subregions: stimulants being a primary drug for 11% seeking treatment in Africa, 14% in Europe, 36% in the Americas, 42% in Oceania and 48% in Asia. 

Despite the rising need for efficacious interventions, no medication has yet been approved for the treatment of stimulant use disorder to date. Additionally, the implementation of evidence-based psychosocial treatment such as contingency management, remains very limited for a variety of reasons.  

There is an urgent need to bridge the global treatment gap for stimulant use disorders by rapidly disseminating and implementing scalable interventions. While some countries are advancing research on pharmacological treatments, a consensus on uniform treatment intervention and key outcome measures that align with regulatory requirements and the needs of affected populations is essential. UNODC is suggesting a multi-country study on combined psychosocial and pharmacological treatment of stimulant use disorder with a focus on feasibility, safety and effectiveness in different contexts, to strengthen the evidence base for scalable interventions benefitting different population groups and regions in an equitable way. 

International Organization

  • UNODC Prevention, Treatment and Rehabilitation Section 
  • UNODC Informal Research Collaboration on Treatment of Stimulant Use Disorders

Possible partners: Member States and national research institutes, professional organizations in the field of addiction medicine, Partner UN agencies 

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Addressing the health needs of people with synthetic drug use disorders through voluntary community-based services in Southeast Asia

The program focuses on advancing voluntary community-based services over compulsory treatment for individuals with synthetic drug use disorders. The initiative aims to enhance capacities, improve availability, ensure access, and elevate the quality of community-based services for people dealing with substance use issues. UNODC, together with the Ministries of Health, Drug Control Agencies and Civil Society will leverage the guidance documents and training toolkits for community-based treatment and care services to engage stakeholders constructively, through training, workshops, and dialogues to facilitate discussions on system strengthening, encompassing coverage, delivery, and service quality. 

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Strengthening Substance Use Disorder Treatment and Care through WHO’s Special Initiative for Mental Health

WHO Special Initiative for Mental Health is underway in nine countries across all WHO regions. The initiative focuses on two key strategies; advancing mental health policies, advocacy and human rights; and scaling up quality interventions and services for individuals with mental health conditions, including substance use disorders. This proposal aims to assist WHOs Special Initiative for Mental Health countries to increase coverage and improve the quality of treatment and care for people with substance use disorders. 

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Implementation of clinical guidelines to manage polysubstance use and comorbidity cases in primary care and specialized facilities

Stemming from the recommendations of CICAD's Demand Reduction Experts Group, this initiative aims to develop practical resources to identify and characterize polysubstance use to address the needs of people who consume either concurrent or sequential substance combinations. Additionally, the scope includes the management of cases that concurrently present drug use disorders and other mental health and organic conditions. 

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Enhancing Treatment Services for People who Use Substances [ENTRUST]

Considering that providing care for people facing drug use disorders imposes a heavy burden on public health systems and that there is a significant treatment gap worldwide, a specialized consultancy team will help countries design and implement a plan to carry out specific actions toward addressing the drug problem within the local dimension, based on the needs and opportunity areas identified through drug policy evaluation tools and resources like the Multilateral Evaluation Mechanism (MEM) that countries in the Americas utilize. 

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Tele-mentoring program for clinical teams that provide treatment services.

A multidisciplinary specialized team of highly skilled tutors with clinical experience will conduct online mentoring sessions for the health workforce that deliver therapeutic interventions to people with substance use disorders. The tutors will also organize clinical case discussions using a teaching methodology based on the ECHO (Extension for Community Healthcare Outcomes) model. 

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Internship for healthcare professionals in treatment programs that deliver evidence-based clinical and psychosocial services.

To reinforce the clinical training of health professionals who provide treatment and recovery services to people with substance use disorders (SUD) and other health problems, a short active stay in the facilities of treatment programs that meet international quality standards will be organized. 

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Emergency Response Training for cases of acute intoxication with New Psychoactive Substances

This initiative targets health workers in emergency settings, focusing on the management of cases involving acute intoxication, with a special focus on New Psychoactive Substances (NPS). Primary objectives include enhancing the capacity of healthcare professionals to rapidly and effectively respond to emergencies related to the non-medical use of psychoactive substances, including potential NPS use. It seeks to fill critical gaps in emergency healthcare by providing specialized training on the identification, assessment, and immediate intervention for cases involving intoxication with emerging psychoactive substances. It furthermore provides guidance on how to provide ongoing care and link people that have experienced an acute intoxication with continuing services. 

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Closing the gap – Increasing access for treatment of drug use disorders for women and girls and ensuring management of substance use disorders during pregnancy

This initiative aims to enhance the capacity of health and social workers, including in maternity services, to address substance use among pregnant women. Its main objectives include improving early identification, intervention, and support for pregnant women who use substances through capacity building of health care professionals, especially primary health care, emergency medicine professionals, obstetricians, gynecologists, neonatal care specialists, as well as specialists in substance use disorders treatment and social workers. The initiative seeks to fill gaps in current maternal healthcare by offering specialized training that focuses on evidence-based practices and a comprehensive understanding of the intersection between maternity care and substance use, including drug use disorders. 

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Want to Improve Women’s Substance Use Disorder Treatment in Your Country? Tailored Evidence-Based Technical Assistance through the Global Women’s Network

Scientific evidence shows that women respond best to a women-centered approach to treatment, onsite childcare, co-occurring disorder treatment, and trauma or sexual abuse counseling. Treatment programs should also provide women with skills, knowledge, and support to enable them to maintain their change in substance use behavior when they return to their homes and communities. This practical and evidence-based Technical Assistance program will help any program or country review its women's substance use disorder treatment access, programming, workforce and treatment outcomes. It will also provide tailored training, mentoring, and support to improve treatment access, treatment quality, and resulting treatment outcomes for women with substance use disorders. 

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Strengthening Quality in Substance Use Disorders Treatment through Technical Support 

The provision of technical support to interested countries to assist in their efforts to improve the quality of substance use disorder (SUD) systems and treatment, as well as their Quality Assurance (QA) and evaluation efforts of their SUD treatment services. 

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Strengthening Drug Use Treatment and Recovery Services

This initiative aims to enhance countries capacity for implementing evidence-based drug use treatment and recovery services. The overall objectives are to build expertise in drug use treatment and recovery and to ensure the effective deployment of evidence-based interventions. The initiative will help address these existing gaps by providing targeted training in the Universal Treatment Curriculum (UTC) Basic and Advanced Series, the Universal Recovery Curriculum (URC), the Women’s Intervention for Substance Exposure (WISE) Curriculum. In addition, this initiative will also develop networks and regional conferences for sharing best practices in treatment and recovery services.

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Baseline study on the offer of academic programs in demand reduction in universities

This proposal aims to develop an analysis of the current situation on the offer of academic programs in drug demand reduction in universities and other educational service providers, which can provide a starting point for the establishment of cooperation programs and projects between universities and national and international organizations working on the issue of demand reduction. 

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Enhancing National and Global Capacities to Address Substance Use Disorders Among Adolescents

This initiative will provide capacity building and training for professionals working with adolescents with substance use disorders.  Also, will work with regional and global experts to develop and implement guidelines and best practices for providing treatment for adolescents with SUDs at the national and local levels. Substance Use Disorders (SUDs) among adolescents poses unique challenges for nations and for the service providers tasked with overseeing SUD treatment and recovery programs.  The Curriculum for Treating Adolescents with Substance Use Disorders was developed by CICAD by OAS/CICAD to build the capacities of drug prevention and treatment professionals who work with adolescents made vulnerable to substance use. This evidence-based curriculum introduces an approach to the treatment of adolescent substance use and presents the main factors that put youth at higher risk and vulnerability than other age groups.  
Due to variations in developmental and emotional growth between adolescents and adults, the intricate needs of this demographic significantly differ from those of the conventional adult treatment population. Addressing these unique challenges requires specialized expertise and tailored guidance to optimize the effectiveness of SUD treatment and recovery programs specifically designed for adolescents. 

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Strengthening capacity of the workforce in services for substance use disorders on identification and management of mental health conditions using updated WHO mhGAP Intervention Guide

Strengthening capacity of the workforce in services for substance use disorders on identification and management of mental health conditions using updated WHO mhGAP Intervention Guide and related materials (such as mhGAP Training Manual, mhGAP Community Toolkit, mhGAP Operations Manual, e-mhGAP Digital Tool) 

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Building capacity of health and social services to deliver screening, brief interventions and referrals using WHO ASSIST technical package

Building capacity of health and social services to deliver screening, brief interventions and referrals using WHO ASSIST technical package, consisting of 

  1. The Alcohol, Smoking and Substance involvement Screening Test (ASSIST); 
  2. The ASSIST-linked brief intervention for hazardous and harmful substance use; and 
  3. Guide for self-help strategies for cutting down or stopping substance use. 
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SACENDU plus SQM

The strengthening of the South African Community Epidemiology Network and Drug Use (SACENDU) surveillance system, which includes Service Quality Measures (SQM). The SACENDU surveillance system enables the continued identification of changes in the nature and extent of AOD (alcohol and drug use) use, including the emergence of new drug threats which include synthetic drugs. The SQM project which falls under the SACENDU umbrella is a performance measurement system which is aimed at improving the quality of South African substance misuse treatment services through the routine use of service quality measures (SQMs).  

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Science-policy-practice - UNODC Policymakers Training on the Nature, Prevention, Treatment and Rehabilitation of Drug Use Disorders

The UNODC Policymakers Training on the Nature, Prevention, Treatment and Rehabilitation of Drug Use Disorders (DUDs) aims to support decisionmakers in developing policies and interventions targeted at preventing drug use and increasing access to comprehensive systems of care for people affected by DUDs, including synthetic DUDs. With the active participation of governmental institutions, universities, treatment centers, civil society organizations and professionals in the development of an action plan and respective follow-up, UNODC promotes an intersectoral and multidisciplinary response to towards the healthy and safe development of children and towards improving the lives of those affected by drug use disorders, in line with international standards. 

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Strengthening rehabilitation, reintegration and recovery as part of UNODC’s global programmes on treatment and care of drug use disorders

Especially for people with substance use disorders associated with the use of often stronger synthetic drugs, long-term recovery can be a challenge and specific support needs to be availed. Sustained recovery management for people with drug use disorders is a core component of the UNODC/WHO International standards for the treatment of drug use disorders, describing it as “…a long-term process of increasing patients’ health and wellness, as well as supporting them in recovery from DUDs”. Elements of sustained recovery management can be access to housing, healthcare, social services, recovery peer networks, legal support, transportation, education and employment, empowerment for increased community participation and contribution, connection with faith-based and spiritual support, connection or reconnection with cultural practices, among other aspects of individual, local or cultural relevance. 
The aim is to support people with drug use disorders with or without concomitating mental health disorders to manage their health condition, attain their highest standard of health, manage negative health and social consequences of drug use disorders and increase recovery capital in areas such as health, social connectedness, work and income, family and overall community participation, while reclaiming full, meaningful lives in their community. 
To support Member States in their efforts to enhance access to rehabilitation, reintegration and sustained recovery management, UNODC PTRS aims at collecting of good practices, updating evidence available, sharing information between Member States, experts, civil society and people with lived experience and offer and offer capacity building for different audiences, including, policy makers, people with lived and living experience, family and community as well as different health and social professionals involved in the provision of recovery support.  

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Brief Intervention Program for Adolescents who Use Alcohol and Other Drugs, PIBA [only available in Spanish]

PIBA is for adolescents between 12 and 18 years old who are presently studying, have experienced adverse consequences of substance use within the last six months, and do not have dependence symptoms. This evidence-based intervention, available in online and face-to-face formats and only in Spanish, comprises five serialized phases that rely on validated tools such as the POSIT questionnaire and techniques and approaches like motivational interviewing. At its core, the program focuses on six treatment sessions to address critical topics such as the adolescents' communication with those around them, the decision-making process with an emphasis on reflecting on the pros and cons, discussing substance use risk situations taking into consideration individualized risk factors, implementation of action plans and how to set life goals. The final part of the program includes follow-up with at least one session six months after finishing the intervention to evaluate long-term change. 

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