Universal Curriculum on diversion of controlled medicines – Prevent, Detect, Respond

Implementing Organization
United Nations Office on Drugs and Crime
Description

This project initiative consists of development of a Universal Curriculum on diversion of controlled medicines. This curriculum will allow the development of the required strategies to prevent, detect and respond to this phenomenon, which is the underlying cause of non-medical use and misuse of these substances, and constitute a major public health issue in many countries around the world. 

Background

Diversion refers to the movement of controlled medicines from licit to illicit distribution channels or to illicit use. Diversion and subsequent non-medical use of controlled medicines is a significant public health concern, resulting in increased rates of dependence, overdose, and other associated complications. 
Diverted controlled drugs/medicines such as pain relievers (mostly opioids), tranquilizers, sedatives, and stimulants are mostly non-medically used by youth and young adults aged 12 to 25 and constitute a major public health issue in the United States and other parts of the world. 

According to UNODC’s world drug report, women are the second most affected group due to the higher prevalence of the non-medical of pharmaceutical stimulants as well as opioids and tranquillizers compared to men. 

Diversion of controlled medicines is also linked to the limited access to those medicines for people in need, which in return fuels phenomenon such as medicines theft, falsified medicines, and corruption in health systems and more. Additionally, doctors and prescribers become hesitant to prescribe controlled medicines, even when clinically indicated, due to fears of enabling diversion. Similarly, pharmacists are usually reluctant to stock controlled medicines due to fears of diversion and consequent non-medical use/misuse of these medications. 
Strict drug regulations which aim to prevent the diversion of controlled medicines can pose challenges to the legitimate access to those medicines for medical and scientific purposes (treatment of mental health and neurological diseases, cancer related pain and palliative care and, drug use disorders). 

Regrettably, the majority of efforts aimed at reducing the non-medical use/misuse of controlled medicines have predominantly concentrated on developing specialized prevention programs targeted at affected population groups. Only a limited number of countries have taken the initiative to formulate and execute comprehensive, multisectoral, and multidisciplinary mechanisms addressing diversion. Most countries rely on the International Drug control Conventions and the International Narcotics Control Board as the main sources to develop national drug control policies and often, lack a systematic and holistic approach. Consequently, there is a notable absence of a global strategy guiding countries in the development of comprehensive programmes to effectively tackle the issue of diversion of controlled medicines/substances. 

A Universal Curriculum on diversion of controlled medicines- Prevent Detect, Respond, will allow the establishment of critical and effective responses at national level with a health-centered approach, and provide countries with the necessary mechanisms to assess, measure, analyze and respond to the diversion phenomenon. 

To counter diversion and ensure equitable access, legislative and policy changes are necessary. Effective measures must be implemented to deter suppliers of illicit digital vendors and large-scale contributors to diverted controlled medicines in addition to training programs for healthcare professionals, administrators, leaders, and the public focused on detecting and preventing points of diversion and non-medical use. 

Additional key strategies include improving surveillance and monitoring mechanisms, enhancing regulation and oversight of controlled medicines, and promoting evidence-based prevention and treatment programs. International collaboration, uniform policies and legislation, and securitization of digital markets are vital in curbing diversion. Furthermore, comprehensive data tracking systems should be established to monitor the flow of controlled medicines, from manufacturing to expiration. 

Accomplishments to Date

The world Health Organization has created a methodology for evaluating drug policies and supply chains to ensure safety, effectiveness, and prevention of diversion. Nevertheless, these aspects, though crucial, are insufficient in addressing the comprehensive challenges posed by diversion. 
 
Utilizing the WHO tools, UNODC has conducted supply chain assessments in Indonesia with excellent results but unfortunately, there are no additional tools available to consolidate the benefits of this process. 

Project Activities

The curriculum will include novel methods of detection, prevention, and response to diversion through the strategic integration of sectors, disciplines and expertise on security, policy, and public health. 

Curriculum Outline: 
The curriculum will be structured in a way that all stakeholders that deal with controlled substances/medicines i.e. policy makers, drug control experts; drug regulators; health authorities; health systems representatives; health professionals (prescribers); pharmacists; communities; patients and their families benefit from the capacity building activities and therefore contribute to the establishment of sound, science based and effective programs to address diversion of controlled medicines. 

Governmental and non-governmental organizations will be targeted in a way that will allow the multi-stakeholders and multidisciplinary approach to address this complex problem. 

Some of the topics to be included in the curriculum are: 

  1. Detection and Prevention Measures 
    Development of detection and prevention frameworks to standardize policies and legislation for manufacturers, distributors, digital vendors, pharmacies, physicians, and other handlers of controlled medicines at the point of care. 
  2. Detection of Emerging Digital Markets 
    Training of public health professionals to detect the emergence of digital access to controlled medicines via online pharmacies, encrypted messengers, and social media platforms, especially among young persons. 
  3. Legal Responses to Diversion 
    Legislative changes for the equilateral consequence to diversion, especially for suppliers of illicit digital vendors and large-scale contributors to diverted controlled medicines. 
  4. Education 
    Publication and proliferation of inclusive health and outcome focused curricula teaching standards and appropriate training on detecting and preventing points of diversion and non-medical use. 
  5. Controlled Drop-Off & Disposal 
    Awareness campaigns on proper disposal of controlled medicines, the expansion of drop-off sites in urban and rural areas, partnerships with pharmacies, hospitals, law enforcement agencies, and community organizations to establish collection points, and implementing innovations like mobile disposal units or using existing infrastructure like mail-back programs. 
  6. Regional Diversion Experts 
    Sponsor consultancies to connect governmental and NGO actors to implement solutions addressing issues of supply chain, unmet demand of controlled medicines, and the detection, prevention, and response to diversion. 
  7. Data Collection 
    The implementation of a secure, comprehensive data tracking to follow dosages, distribution, prescribers and expiration. Additionally, data tracking the unmet demand for palliative care and trends in diversion across all member states. 
Global Level Outcomes

The availability for a Universal Curriculum on Diversion of controlled medicines that will allow the development of standardized, science based and effective strategies to prevent, detect and respond to this phenomenon will enable countries to reduce the supply of controlled substances that end in the illicit markets. 

National Level Outcomes

The drug control system, regulatory bodies, health systems, health professionals, pharmacists and patients will benefit from having the key tool necessary to enhance the knowledge, skills and methodology in various sectors to put together coordinated response to diversion of controlled drugs/medicines. 

Finally, non-medical use and misuse of controlled medicines will decrease due to reduced supply, with the benefit to youth, young adults, women, and the general population at large. 

Current State Participants

As such curriculum doesn’t exist, no government or stakeholders have so far participated, however, there is an increasing interest in this topic therefore, the UNODC team has been disseminating the need for such tool. 

Contact

Dr. Elizabeth SAENZ, Programme Officer at the United Nations Office on Drugs and Crime (elizabeth [dot] saenz [at] un [dot] org (elizabeth[dot]saenz[at]un[dot]org))