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

Implementing Organization
United Nations Office on Drugs and Crime [UNODC] World Health Organization [WHO]
Description

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.

Background
  1. UNODC/WHO International Standards for the Treatment of Drug Use Disorders   
  2. Drug Use Disorder Treatment Services Quality Assurance Toolkit 
    (This link is password protected; to obtain a link, kindly contact us at unodc-ptrs [at] un [dot] org (unodc-ptrs[at]un[dot]org))
  3. Drug Use Disorder Treatment Systems Quality Assurance Toolkit 
    (This link is password protected; to obtain a link, kindly contact us at unodc-ptrs [at] un [dot] org (unodc-ptrs[at]un[dot]org)) 
  4. UNODC brochure on Quality Assurance for Drug Use Disorder Treatment  
  5. WHO/UNODC Substance Use Disorder Treatment Facility Survey, Draft for Field Testing  
  6. Conference Room Paper on the relationship between quality of specialist treatment for substance use disorders and patient outcomes: A scoping review of the literature  
  7. Outcome Document of the 2016 United Nations General Assembly Special Session on the World Drug Problem Paragraph (p) on page 7 : (p) Promote and implement the standards on the treatment of drug use disorders developed by the United Nations Office on Drugs and Crime and the World Health Organization and other relevant international standards, as appropriate and in accordance with national legislation and the international drug control conventions, and provide guidance, assistance and training to health professionals on their appropriate use, and consider developing standards and accreditation for services at the domestic level to ensure qualified and scientific evidence-based responses 
  8. Commission on Narcotic Drugs Resolution 59/4: Development and dissemination of international standards for the treatment of drug use disorders 
  9. Commission on Narcotic Drugs Resolution 64/3: Promoting scientific evidence-based, quality, affordable and comprehensive drug prevention, treatment, sustained recovery and related support services  
Accomplishments to Date
  • The Standards have become an international reference point for quality drug use disorder treatment along a continuum of care since they were launched in 2020. 
  • Mandates given to UNODC and WHO to develop initiatives to support the dissemination of the international standards for the treatment of drug use disorders and to provide Member States, upon request, with technical and capacity-building assistance in support of their efforts to implement practices consistent with those international standards for the treatment of drug use disorders (CND resolution 59/4)  
  • The Standards have been translated in at least 12 languages and been widely disseminated in numerous national and international fora. 
  • Development of derivative tools for the standard implementation started in 2021 from “Quality assurance in treatment for drug use disorders: key quality standards for service appraisal” to improve quality of care and ultimately the life of people with drug use disorders through implementation and improvement of quality assurance processes. 
  • Broader framework for the Standard implementation is proposed in the upcoming “WHO/UNODC Toolkit for Implementation of the WHO/UNODC International Standards for the Treatment of Drug Use Disorders”, currently available as a draft for piloting.  
Project Activities
  • The upcoming “WHO/UNODC Toolkit for Implementation of the WHO/UNODC International Standards for the Treatment of Drug Use Disorders”, mirrors the structure of the standards (system, settings, modalities, and populations with special needs) and outlines four key steps:
    1. situational/landscape analysis
    2. action planning/programming
    3. implementation of the roadmap
    4. monitoring and evaluation. 
  • The toolkit has a modular structure allowing flexibility in its use, therefore scope of work needs to be coordinated with interested countries, and can focus on either all, or some of the implementation levels: system, settings, modalities, and populations with special needs. 
Global Level Outcomes

A complete implementation toolkit for the implementation of the International Standards for the Treatment of drug Use Disorders, with a variety of tools to reflect realities of its use across diverse countries, in response to Member State requests. 

National Level Outcomes

Better quality and coverage of treatment and care for people with drug use disorders that meet populations’ needs. 

Current State Participation

  • Field testing of the standards was implemented in 9 countries: Australia, Brazil, Chile, China, India, Indonesia, the Islamic Republic of Iran, Mexico and Thailand
  • Several regional and country level workshops were implemented during policy-makers trainings in all regions of the world 
  • Preliminary interest in implementation of the standards was expressed by many countries and UNODC has supported several countries with quality assurance workshops and technical assistance 
Contact

Anja Busse (anja [dot] busse [at] un [dot] org (anja[dot]busse[at]un[dot]org)) Dzmitry Krupchanka (krupchankad [at] who [dot] int (krupchankad[at]who[dot]int))