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THEMATIC PROGRAMME. Addressing health and human development vulnerabilities in the context of drugs and crime. UNEXPLORED TERRITORY NO ONE’S LAND. Discrimination. Stigma. Ignorance. Prejudice. DRUG USERS AND DRUG DEPENDENT PERSONS. DRUG USERS AND DRUG DEPENDENT PERSONS. - PowerPoint PPT Presentation
Citation preview
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Addressing health and human development vulnerabilities
in the context of drugs and crime
THEMATIC PROGRAMME
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UNEXPLORED TERRITORY
NO ONE’S LAND
Discrimination Ignorance
Prejudice
Stigma
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DRUG USERS AND DRUG DEPENDENT PERSONS
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DRUG USERS AND DRUG DEPENDENT PERSONS
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PERSONS WHO HAVE COMMITTED AN OFFENSE IN PRISON SETTING
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PERSONS WHO HAVE COMMITTED AN OFFENSE IN PRISON SETTING
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PERSONS VULNERABLE TO HUMAN TRAFFICKING
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PERSONS VULNERABLE TO HUMAN TRAFFICKING
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UNODC hasthe unique positionto amelioratethe condition of…
Victims of crime:- Drug users- Vulnerable to HIV- Vulnerable tohuman traffickingand violence
Perpetuators of crime:- Offenders- Convicted offenders
UNCONDITIONED RIGHT TO HEALTH
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Vulnerabilities relating to drug use and dependence
Political Declaration 2009Paragraphs 20, 21, 22, 23
Prevention of drug use, treatment of drug dependence, rehabilitation and reintegration
Prevention of health and social consequences of drug use
HIV prevention, treatment care and support
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Health at the center stage of the drug control system (A.M. Costa, 2009)
To protect the health of people,particularly the most vulnerable, from the dangerous effects of drug useand from drug use disorders
To reduce drug-related diseasesand social consequences
Supply reduction Demand reduction
Harm reduction
HEALTH CARE
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United Nations Standard Minimum Rules for the Treatment of Prisoners (ECOSOC resolution 1984/47)
Art. 12 : The right of everyone to the enjoyment of the highest attainable standard of physical and mental health. Those who are imprisoned retain this fundamental right
Resolution 2004/28: United Nations standards and norms in crime prevention and criminal justice (E/RES/2004/28)
Art. 9: Prisoners shall have access to the health services without discrimination on the grounds of their legal situation.
The United Nations General Assembly Special Session 1998 prisoners as an important group for activities to reduce demand
Vulnerabilities in prison setting
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Vulnerabilities in prison setting
Commission on Crime Prevention and Criminal Justice2009
Thematic debate: Penal reform and reduction of prison overcrowding
Improving health conditions in prisonReducing overcrowding
Stopping of reducing the use of alcohol and drugsImproving sanitation
Providing foodPromoting exercise
Preventing TB – HIV infections Preventing mental health disorders
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Vulnerabilities in the context of human trafficking
United Nations Convention AgainstTransnational Organized Crime (Annex II, Article 6)
Protection of victims of trafficking in persons
Para 3 (c) medical, psychological and material assistance mental health promotion substance abuse prevention(a) housing(d) education-training opportunities employment
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UNODChealth and human development
WHO UNDP UNICEF
IOMILO
Ministry of Health Ministry of Interior Ministry of Justice
A MULTI-DISCIPLINARY APPROACH
UNAIDS
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Do we have consolidated evidence concerning the effectiveness of
prevention of drug use,treatment of drug dependence
and prevention and treatment of HIV?
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scare tactics and moralistic appeals
curricula that rely solely on information about drugs and their dangers
curricula that only work to promote self-esteem and emotional well-being
single shot assemblies
testimonials by former addicts
counseling in peer-group context
recreation and community service activities
Levine et al. 1999
WHAT IS NOT WORKING IN PREVENTION
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training in resistance skills
normative education
life skills: communication
life skills: decision making
life skills: emotional communication
life skills: impulse control
life skills: self esteem
trained teachers
interactive methods / reliable information
WHAT IS WORKING IN PREVENTION
Faggiano et al., Cochrane 2005
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WHAT IS WORKING IN PREVENTION
Supervising and monitoring skills
Caring, trusting relationships between parents and children
Warm child rearing style
Communication of positive family values
Setting age appropriate limits, rules and consequences
Praising children appropriately for their behavior and accomplishments
Structured family life including having meals together
Parents involvement in the lives of their children
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PrisonPunishmentPure re-educationWorking aloneSpirituality aloneIndividual psychotherapy aloneDetoxification without after-careShort-term therapySymptoms therapyTreatment without assessment
WHAT IS NOT WORKING IN TREATMENT
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WHAT IS WORKING IN TREATMENT
Brief interventionMotivational interviewingCognitive-behavioural therapyContingency therapyFamily therapyVocational trainingSelf help 12 stepTherapeutic community method
Long term opioid-agonistsSlow release opioid-antagonistsMedications for psychiatric comorbidity
Integrated pharmacological and psychosocial therapy
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WHAT IS NOT WORKING IN HIV PREVENTION AND HEALTH CARE
Information aloneCounselling aloneDemonizationPanic disseminationStigma and marginalizationDenialViolation of privacyLack of medical carePunishment for drug dependent individuals
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WHAT IS WORKING IN HIV PREVENTION
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reliable information and counseling
low-threshold pharmacological interventions (example opioid-agonists and antagonist drugs) easily accessible
adequate social assistance for marginalized drug dependents
vaccination programs against Hepatitis to all drug abusers
medication and emergency kits for management of overdoses in appropriate places
availability of measures to prevent acute consequences of stimulants abuse (free water…)
appropriate interventions in emergency rooms well-equipped street-workers and peer outreach workers units
measures to prevent car and workplace accidents
social assistance for children of drug dependent individuals
WHAT IS WORKING IN DRUG USERS HEALTH CARE
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help low and middle income countries to build
a community-based continuum of care through the ‘normal’ health and social services system
for the vulnerable populations at all the stages
of their problematic conditions
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A continuum of care
recovery-orientedhigh-thresholdtreatment
centres
social supportto families
life skills programs
and vocational training
strengtheningfamily
program
HIV/AIDSHepatitis TBC
preventionand treatment
outreachinterventions
health care andmental health
treatment
health and social care in prison
health and socialcare for vulnerable
to human trafficking
educational activitiesalternative jobs
low-thresholdtreatmentcentres
sustainable livelihood
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1) Advocacy/ethical approach
2) Training, science-based practice dissemination
3) Low cost treatment/health care centers/prevention
4) Data collection / evaluation and research
5) Adaptation to regional country needs /ownership
6) Guidelines and therapeutic tools
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Botvin et al., 2000
Life Skills Training during Junior High School
05
10152025
30354045
Control LifeSkills
MarijuanaHallucinogensNarcotics
Up to 56% reduction in drug use by 12th grade
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NTORS,Gossop et al.,2003
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NTORS,Gossop et al.,2003
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Woody et al., 2008
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Comer et al., 2006
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Combination of Olanzapine With Opioid-Agonists in the Treatmentof Heroin-Addicted Patients Affected by Comorbid Schizophrenia Spectrum Disorders
Gerra et al., 2007
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Amato et al., 2004, Cochrane Database Syst Rev.
Results suggest that adding any psychosocial support to maintenance treatments improve the number of participants abstinent at follow up (20% increase at 48 weeks)
associated treatment Abstinent subjects
48 weeks
3,000
single treatment
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Treatnet II
EU-UNODC
EU-UNODC, Focus on Treatment
CAM-H90
Countries Worldwide with Treatment UNODC Activities
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Countries Worldwide with IDU/HIV UNODC Activities
Russia, Romania, Estonia, Latvia, Lithuania, Azerbaijan, Uzbekistan, Kyrgyzstan, Turkmenistan, Kazakhstan, Ukraine, Moldova, Egypt, Palestine, Lebanon, Pakistan, Afghanistan, Nepal, Iran, India, Sri Lanka, Bangladesh, Bhutan, Thailand, Laos, Myanmar, China, Cambodia, Vietnam, Indonesia, Kenya, Mauritius, Brazil, Argentina, Paraguay, Costa Rica, Maldives, UAE, Yemen, South Africa
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Countries Worldwide with HIV UNODC Activities in Prisons
Algeria, Benin, Morocco, Namibia, Mozambique, Sudan, Swaziland, Togo, Zambia, Kenya, Latvia, Lithuania, Estonia, Russia, Romania, Egypt, Lebanon, Jordan, Palestine, Azerbaijan, Uzbekistan, Kyrgyzstan, Turkmenistan, Kazakhstan, Pakistan, Afghanistan, Bangladesh, Cambodia, Nepal, Iran, India, Malaysia, Maldives, Belize, Costa Rica, Dominican Republic, El Salvador, Guatemala, Honduras, Nicaragua, Panama, Bolivia, Ecuador, Peru
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Anti-traffickingaction
Anti-corruptionaction
Anti-money laundering action
Anti-terrorism action
Alternative developmentaction
Buildingcriminal justice system
25% of police positive for drugs
INTEGRATION IN REGIONAL PROGRAMS?
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(1997)
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Universal access to treatment of drug dependence
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Sustainable Livelihoods:A broader vision
Social Support and Integration enabling Prevention of Illicit Drug Use, HIV Epidemic and Crime
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Area of work ActivityFunding requirements(million US dollars)
Prevention of drug useEstablishment and validation of family skills training programmes
10.0
Prevention of drug useAdapting and mainstreaming evidence-based drug education curriculum in schools
3.0
Prevention of drug useDeveloping and establishing workplace prevention programmes in public and private companies
3.0
Drug dependence treatment and rehabilitation
UNODC-WHO Joint Action Programme on Drug Dependence Treatment
31.0
Prevention of HIV and AIDS among drug users, in prison settings and as it relates to the trafficking in persons
UNODC obligations towards UNAIDS UBW 2008-2009 and 2010-2011, Universal access by 2010, MDG 6 by 2015
70.0
2009-2011