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

Description

#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 

Background
Accomplishments to Date
  • Following an international expert group meeting, UNODC published a discussion paper on Stimulant use disorder treatment – current practices and promising perspectives (UNODC, 2019), summarizing available evidence on psychosocial and emerging evidence on pharmacological treatment options. The paper called for scale up of effective psychosocial treatment but also for increased research on pharmacological treatment options with a view to increase treatment engagement, treatment retention and effective treatment for stimulant dependence. 
  • An article has been published in the Canadian Journal of Psychiatry in 2022, to further disseminate this call for action in the scientific community, calling for further research on medical treatment of stimulant use disorders. Continuing Increase in Stimulant Dependence - Time to Implement Medical Treatment  
  • A UNODC training package on stimulant use disorder treatment has been developed to disseminate the discussion paper and provide practical support and capacity building to clinicians working with people who use stimulants for non-medical purposes. 
  • UNODC has facilitated an informal research collaborative, bringing together leading researchers in the field of stimulant use disorders, many involved also in advancing research on pharmacological treatment for stimulant use disorders, for regular exchange, including on the development of common, meaningful outcome measures that would also meet the requirement of regulatory agencies and could inform future multi-country trials. 
  • Briefings to Member States and civil society have started in 2023 to collect input and indications of interest in #ScaleUp and plans are underway to map medication availability, control status and price in different countries 
Project Activities

#ScaleUp is a new initiative of the United Nations Office on Drugs and Crime. It has been pre-launched during the thematic sessions of the Commission on Narcotic Drugs in December 2023 and presented at the Global Synthetics Coalition in December 2023. It builds on previous work and publications of UNODC, partner agencies and international researchers and will be formally launched at the Commission on Narcotic Drugs in March 2024. Interested Member States and other entities are invited to schedule a briefing on #ScaleUp, express their interest in participation and contribute to the implementation of #ScaleUp.  

#ScaleUp implementation is envisaged in four phases: 

  • PHASE 1: 
    • 1.1. Development of evidence-based treatment and research protocols (behavioral/pharmacological, for craving, withdrawal, dependence, relapse) for implementation of psychosocial/pharmacological treatment of stimulant use disorders in the specialized community-based substance use disorder treatment and care programs, adapted for local environments, including in lower- and middle-income countries  
    • 1.2. Assessment of availability of promising medications for the treatment of stimulant use disorder (e.g. extended release prescription amphetamines, mirtazapine, bupropion, naltrexone) in different countries or regions (usually for other indications such as treatment of ADHD, treatment of depression etc.), mapping of availability and capacity for the implementation of evidence-based psychosocial treatments (e.g. contingency management) and identification of interested countries to join or support #ScaleUp
  • PHASE 2: 
    • Design and local preparation for an implementation study to test feasibility, effectiveness and safety as well as implementation outcomes (pilot followed by a multi-country study including LMICs) of a combination of behavioral and pharmacological treatment and care for stimulant use disorder. This includes national level agreements and assessments, identification of study sites, capacity building, ensuring availability of medication, involvement of a variety of local stakeholders, local adaptation/translation of study protocols and ethics approval, identification of study participants and related implementation aspects. 
  • PHASE 3: 
    • Implementation of multi-country study on treatment and care of stimulant use disorders with a view to feasibility, safety, scalability and effectiveness in line with agreed upon study protocols and outcome measures: Initially a pilot in one or a few sites is envisaged followed by a multi-country study. 
  • PHASE 4: 
    • 4.1 Monitoring, evaluation and data analysis  
    • 4.2 Dissemination of study results and development of implementation package to facilitate country level follow-up and recommendations for further research towards scalability 
Global Level Outcomes

#ScaleUp will provide: 

  • Enhanced evidence, expertise and practical experience on scalable responses for stimulant use disorder treatment and care, in the light of increasing use of stimulants for non-medical purpose in all regions, including lower-and middle-income countries 
  • Co-development of innovative ways for the treatment of stimulant use disorders, considering the needs of population groups with special clinical needs  
  • Contribution to human-rights and health-centred response to stimulant use disorders 
  • A global network of countries, researchers, professional associations and international agencies to address challenges associated with stimulant use disorders and their negative health and social consequences 
National Level Outcomes

#ScaleUp will provide: 

  • Nationally adapted treatment and research protocols for the treatment and care of stimulant use disorders, including behavioral and pharmacological interventions  
  • Increased national capacity of professionals at national level to deliver state of the art treatment and care for people with stimulant use disorders 
  • Nationally relevant evaluation reports and recommendations on sustainability, scalability and future research as well as capacity building needs to ensure en effective response to stimulant use disorders and associated health and social consequences 
  • National networks of policy makers, researchers, clinicians, people with lived experience, communities/families united in addressing the challenges associated with non-medical stimulant use in a meaningful and effective way 
  • Participation in an international network of countries, researchers, practitioners and communities for exchange and mutual support to address stimulant use and stimulant use disorders effectively. 

Current State Participants 

A number of countries have already expressed interest in #ScaleUp and national level briefings are being organized in the lead up to CND. UNODC’s informal research collaborative includes researchers from North and South America, Europe, Asia, Australia and has reached out to researchers from Africa.  

Contact

Anja Busse Programme Officer, Prevention, Treatment and Rehabilitation Section (PTRS) Drug, Laboratory and Scientific Services Branch (DLSSB) United Nations Office on Drugs and Crime (UNODC) anja [dot] busse [at] un [dot] org (anja[dot]busse[at]un[dot]org)