Evidence-based prevention, treatment and care needed for drug users

June 26, 2021 - 08:38
Julien Garsany, Deputy Regional Representative at the United Nations Office on Drugs and Crime (UNODC) Regional office for Southeast Asia and the Pacific talked to Việt Nam News as Việt Nam and the world is observing the World Drug Day on June 26.


Julien Garsany, Deputy Regional Representative, the United Nations Office on Drugs and Crime (UNODC) Regional office for Southeast Asia and the Pacific. — Photo Courtesy of UNODC

Julien Garsany, Deputy Regional Representative at the United Nations Office on Drugs and Crime (UNODC) Regional office for Southeast Asia and the Pacific talked to Việt Nam News as Việt Nam and the world is observing the World Drug Day on June 26.

The International Day Against Drug Abuse and Illicit Trafficking (June 26) known as World Drug Day this year is themed “Share Facts on Drugs. Save Lives.” Why was this theme selected? 

It stresses the importance of good awareness of actual facts on drugs and their dangers rather than perceptions, and the importance of evidence-based prevention, treatment and care.

On World Drug Day, we share the World Drug Report to disseminate factual and analytical findings. The theme ties in with the UN “Verified” campaign against COVID-19 misinformation.

COVID-19 has brought unprecedented public awareness of health considerations, of protective measures to stay healthy, and of the responsibility to protect each other.

The importance of community and solidarity became more evident than ever, as did the need for healthcare for all. At the same time, we witnessed unprecedented scientific innovation and progress within a compressed timeframe (vaccines).

We saw how much the world relied on science. The need to promote scientific information and to counter the “misinformation pandemic” became instrumental to our ability to win against the virus.

The purpose of selecting this theme is to tackle misinformation on drugs and to issue a call to everyone to only share facts about drugs, verify information that you come across, and share information only from trusted sources.

With this purpose, we would like to emphasise the importance of strengthening the evidence base and to raise public awareness, so the international community, civil society, families and youth can make informed decisions, better target efforts to prevent and treat drug use, and tackle the world drug problem.

Methamphetamine seizures increased substantially despite COVID-19 and the number of methamphetamine users in Việt Nam increased by nine times from 2016 to 2020. In China, Thailand and Việt Nam, the number of reported methamphetamine users and the seizures of the drug increased significantly between 2017 and 2019, which indicates that supply is driving the methamphetamine market. Can you suggest some measures to stop this?

Effective drug chemical precursors control is key to curb the supply of methamphetamine. It is not an overstatement to say that “supply reduction” measures in Southeast Asia have been primarily related to seizures of finished products (i.e. methamphetamine).

As a result, we see a stark difference in seizure trends between methamphetamine and its key precursor chemicals, for which there are barely any seizures.

Authorities often announce “record seizures of methamphetamine” but we rarely observe successful disruption of trafficking attempts for chemical precursors.

In addition, it is important for the authorities in the region to be informed of changes in the chemicals used for the illicit manufacturing of methamphetamine and other synthetic drugs. Some of the chemicals recently seized at methamphetamine manufacturing sites or en route to those sites clearly demonstrate that organized crime groups have diversified the types of chemicals and synthesis methods they use to manufacture methamphetamine.

I would highlight that UNODC and Việt Nam have a very strong relationship to counter drug and transnational organized crime through Border Liaison Offices, as an effort to stop illicit trafficking right at the borders of the country.

We are working with the police and other law enforcement agencies on capacity-building and with their training academies.

We are also working with prosecutors and other justice officials on reforms and how to effectively dismantle organised crime groups rather than focusing on low-level criminal operatives.

In addition, we believe that strong cooperation within the Mekong and the larger ASEAN region is a must.

This includes sharing intelligence and joint operations, but all this needs to have as overall aim the dismantling of criminal groups.

One cannot address the drug problem by simply focusing on supply. Making seizures is good. Dismantling organised crime groups is better. Adopting an evidence-based policy to address the demand for drugs and effectively prevent, treat and rehabilitate drug users is even better, and will have a visible impact.

In Việt Nam, the average MDMA content in ecstasy tablets analysed as of November 2020 was 37.5 per cent, compared with 35 per cent in 2019. What does the increased MDMA content mean? 

The increased concentration of potent substances in drugs is a global phenomenon, and it is related to precursor chemicals. The wide availability of chemicals for ecstasy has enabled organised criminals to produce ecstasy tablets with higher concentrations of MDMA than in the past.

Not more than a decade ago, real ecstasy tablets (with MDMA) disappeared from the market, as there was a global shortage of the chemical (i.e. safrole) needed to manufacture ecstasy. However, organised crime groups now use different chemicals (e.g. PMK glycidic acid) to circumvent the shortage of traditional ecstasy precursor chemicals.

Countries need to keep themselves up to date on the chemicals used to manufacture drugs, otherwise they will always be one or more steps behind.

Việt Nam chose June as the action month for drug prevention and control with this year’s theme “ For people’s health and families’ happiness – Keep away from drug”. During the month, localities across the country have been carrying out activities, focusing on improving the effectiveness of communications work on and education of laws and regulations on drug prevention and control. Besides increasing public understanding about the consequences of using, trading and trafficking the narcotic drug, activities will also equip students and young people with knowledge and skills to stay away from the drug. Why do you think such activities are needed and effective?

These activities are indeed in line with the Global theme for World Drug Day: “Share facts on Drugs. Save Lives.” And this is very good start!

The international standards on prevention of drug use explain that for an effective prevention policy, one needs to go beyond information-sharing.

There are many factors that may lead a person to use drugs and to the development of a drug use disorder.

This means that there are various reasons a person starts using drugs, and even more different reasons a person develops a dependence.

Most children and adolescents will never use drugs, and those who do are often affected by vulnerabilities beyond their control, e.g. poverty and exposure to violence; not benefiting from warm and supporting parenting; engaging with peers who are themselves at risk; etc.

These vulnerabilities do not just disappear with a public understanding of the dangers of drugs.

It takes meaningful and lasting interventions to shift behaviours and policies towards health and social development as an effective response to drug use.

Offering parenting skills programmes to families and teaching social skills at school to elementary school children can prevent two out of three cases of non-medical use of prescription drugs at the age of 21.

This is why UNODC has developed a family-skills programme called “Strong Families”, to help families cope with stress and support children building resilience against drug use.

Việt Nam’s revised Law on Drug Prevention and Control was adopted in March this year and would take effect next year. The revised law regulates more forbidden behaviours, supplements regulations on the control of drug precursors and specific cases that require drug tests. 

It contains specific regulations on the compilation of dossiers to send drug addicts aged from full 12 to under 18 to compulsory detoxification establishments and is more flexible for drug addicts to choose treatment. What do you think about those changes?

The UN has been and remains opposed to any form of compulsory treatment for people who use drugs. These measures violate the rights of individuals, as patients, to choose what medical interventions they wish to undergo. It should also be underlined that people between the age of 12 are 18 are children. They should never be placed in compulsory detoxification establishments.

Secondly, the international standards on the treatment of drug use disorders outline available scientifically-sound measures for the treatment of dependence.

It is imperative that drug dependence treatment complies with international norms to ensure the health and safety of those undergoing treatment.

Detoxification alone does not guarantee compliance with a treatment. It merely ensures that the person, while undergoing detoxification, does not use any substance. This needs to be supervised and, depending on the level of dependence and the types of drugs used, supervision of detoxification can be done in an outpatient setting.

It is very important that people with a drug use disorder have access to treatment that  has been scientifically-qualified by the medical fraternity. In this regard it is unclear what “treatment with alternative drugs” might be in the law.

Drug treatment should always be offered on a voluntary basis and comprise a range of options to address the physical and psychological symptoms of dependence, if the patient is dependent to drugs.

Very specialised diagnostics tools are needed to determine whether a person might be dependent to drugs or not. For people who are not dependent to drugs, there is no need for specialised interventions inside a facility.

A previous World Drug Report stated that one in 10 people who use drugs might benefit from treatment inside a facility. For the rest, they should benefit from harm reduction measures instead.

They may also benefit from outpatient interventions, such as voluntary services including general health screening, psychosocial counselling, and social welfare support.

There is no simple fix to the world drug problem.

There is a need to focus on supply, by dismantling the criminal groups generating billions of US dollars every year. It takes time to conduct in-depth investigations to uncover all the links between various actors, up to the very top of a group, but it must be done. In parallel, there is a need to focus on demand by understanding the various factors that lead to drug use and dependence and how best address those factors. Drug users are not criminals, they are people in need of help. Once we realise that, and policies reflect that fact too, we can effectively address the demand side of the drug problem. — VNS