WE MUST RAISE QUALITY OF CARE
A recent announcement by the United Nations articulated what many of us know and advocate for: “most people with drug-use disorders do not receive effective treatment and care”. Jeff Wilbee urges us to “raise the bar”.
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The United Nations announcement about lack of effective care, made on International Day Against Drug Abuse and Illicit Trafficking last June, was in connection with a new information system launched by the World Health Organisation, designed to assist people with access to prevention and treatment services. The United Nations Office on Drugs and Crime – UNODC – is also working on this project.
We should all applaud the WHO and UN for raising the profile of the plight of the estimated 5% of the world’s population with a substance abuse disorder. But we also have an obligation to ensure that, though this is obviously a good place to start, there must be effective prevention and treatment services available staffed by competent addiction professionals in every jurisdiction.
It is one matter to set up an information system – but it will be to little avail if prevention and treatment programmes do not exist or are not competent.
The WHO recognises that many countries do not consider drug dependency as a health issue. This needs to change. Lacking is the recognition that benefits of treatment go far beyond the individual user. Treatment can enhance society and even the local economy. We must change attitudes, as well as promoting tangible services, if we are to see success.
One group getting international attention is the WHO’s Global Advisory Group on Drugs. This group summarises its principles and recommendations as: “End the criminalisation, marginalisation and stigmatisation of people who use drugs but who do no harm to others. Challenge rather than reinforce common misconceptions about drug markets, drug use and drug dependence”. We need to constantly challenge and assess new approaches, including this one.
If decriminalisation is considered, we must ensure that there are significant enhancements to current prevention and treatment resources, which are clearly inadequate. There will always be a need for enforcement; the supply side of drugs is a global affair. So we also need to view and approach the demand side in a similar fashion. What is needed is a balance of focus between supply and demand. Both need to be reduced.
The two organisations, UNODC and WHO, are aware that only 20% of people needing assistance worldwide actually access the services which are available. The coordinator of WHO’s Management of Substance Use team, Dr Vladimir Poznyak, has said that “only 45% of the assessed countries are able to provide essential medicines to treat the dependence on heroin and other opiates”. This also needs to change.
We must raise the bar. We need to come to some agreement on minimum standards for treatment programmes and for the workforce who keep them running.
Even sophisticated G8 nations, including my native Canada, which can acknowledge substance dependency as a health issue, have no government standards to regulate the profession. The European Commission planned to introduce standards for counsellors some years ago, then quietly dropped the move.
Even in north America, there are no national standards for substance abuse treatment professionals. This is a bit of misdirection, since in reality there are no “national standards” for doctors, nurses or a plethora of other health professionals. There might be uniform standards across some US states for several health professions but that is a far cry from a national regulatory standard. The Canadian Centre on Substance Abuse developed technical and behavioural competencies for addiction counsellors which could be used across the land, but they are not yet part of national regulations.
One international organisation, the IC&RC or International Certification and Reciprocity Consortium, has long endeavoured to meet global challenges. It is affiliated with 24 international certification boards, certifying over 45,000 addiction professionals. IC&RC receives many enquiries from around the globe on setting up counsellor certification boards in their respective jurisdictions. The major barriers are twofold: policy and funding.
We have a responsibility to assist the other 230million people who suffer around the world, by being part of the effort to raise the bar. To begin, we can share our experience and expertise and encourage not only governments but motivated individuals to take up the cause. Nothing could be more effective than to see organisations involved with training and certification join in an effort to develop and implement a strategy that will make an indent into the global problem. By engaging the UN and WHO, we can do more than offer empty rhetoric. We can stop saying “this needs to change” and at least offer a baseline to start.
JEFF WILBEE is past president of IC&RC.