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

Implementing Organization
Organization of American States [OAS]

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. 


The non-medical use of fentanyl and other drugs is challenging due to the role such substances can have as adulterants in unintentional exposure and when people consume them intentionally to experience their psychoactive effects, with an added complexity in polysubstance use cases. Traditionally, research on substance use disorders has focused on individual substances, considering separate profiles and overlooking polysubstance use. Clinical studies often exclude individuals with multiple drug use backgrounds, and guidelines usually address substance use disorders separately. With these elements in mind, and as Chair of CICAD's Demand Reduction Experts Group, Panama hosted in March 2023 a side event within the sixty-sixth session of the Commission on Narcotic Drugs (CND) to highlight the relevance of developing initiatives, measures, and practical resources to minimize polysubstance use's adverse public health effects. Given that such cases usually are of prominent complexity and can involve highly toxic drugs, countries agreed on the need to develop and update clinical guidelines for the management of polysubstance use and comorbidity conditions. 

Accomplishments to Date

As Chair of CICAD's Demand Reduction Experts Group, Panama prioritized this proposal in the conclusions of their work so countries can continue striving to tackle the world drug problem. 

Project Activities
  1. Establish a working group that will develop the resources like clinical guidelines to address substance use disorders and comorbidities. 
  2. Identify effective teaching strategies to train the health workforce that delivers care and services to people with drug use disorders and comorbidities. 
  3. Conduct an evaluation of the workforce trained in using the clinical guidelines. 
  4. Provide technical assistance and manage a network of working groups dedicated to improving care delivery and services to people with substance use disorders, their families, and communities. 
Global Level Outcomes
  1. An expanded global health workforce's capacity to deliver accessible, timely, and non-discriminatory services to people facing the health threats and consequences of drug use disorders. 
  2. Updated programs, materials, and other resources, like clinical guidelines to tackle consequences to health and other areas in people who use substances. 
National Level Outcomes
  1. Enhanced services to address drug use disorders. 
  2. A structured network of information on the delivery of drug use disorder treatments. 
  3. Updated documents containing general guidelines on the management of polysubstance use and comorbidity cases. 

Current State Participation

This initiative is not currently being implemented. 


JoseLuis Vazquez-Martínez Senior Program Officer Demand Reduction Unit Executive Secretariat of the Inter-American Drug Abuse Control Commission (CICAD) Organization of American States (OAS) E-mail: JVazquez [at] oas [dot] org (JVazquez[at]oas[dot]org)