Building an EU consensus for minimum quality standards 15-17 June 2011, Brussels | WHO: Normative guidance on and quality standards in drug demand reduction.

Building an EU consensus for minimum quality standards 15-17 June 2011, Brussels

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WHO: Normative guidance on and quality standards in drug

demand reduction Dr Vladimir Poznyak

Coordinator, Management of Substance AbuseDepartment of Mental Health and Substance Abuse

WHO: Normative guidance on and quality standards in drug

demand reduction Dr Vladimir Poznyak

Coordinator, Management of Substance AbuseDepartment of Mental Health and Substance Abuse


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OutlineOutline

WHO and its core functions

Examples of WHO guidelines/technical standards and requirements for their development

WHO guidelines and quality standards on drug demand reduction

Implementation and evaluation

Recent developments and future plans


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WHO: three levels of operationsWHO: three levels of operations


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WHO Core FunctionsWHO Core Functions

1. Providing leadership on matters critical to health and engaging in

partnerships where joint action is needed (Leadership & Partnerships)

2. Shaping the research agenda and stimulating the generation,

translation and dissemination of valuable knowledge (Research

agenda & Knowledge management)

3. Setting norms and standards, and promoting and monitoring

their implementation (Norms & Standards)

4. Articulating ethical and evidence-based policy options (Ethical

and evidence-based policy)

5. Providing technical support, catalyzing change, and building

sustainable institutional capacity (Technical support, Change &

Capacity)

6. Monitoring the health situation and assessing health trends

(Monitoring health)


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Examples of WHO standards in Public Health and Health Care Provision

Examples of WHO standards in Public Health and Health Care Provision


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Examples of WHO Normative Guidance and Technical Tools on Drug Demand and Harm Reduction

Examples of WHO Normative Guidance and Technical Tools on Drug Demand and Harm Reduction


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WHO Policy Frameworks for Norms and Standards related to Substance Use and Demand Reduction

WHO Policy Frameworks for Norms and Standards related to Substance Use and Demand Reduction


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WHO HIV/AIDS 2011-2015 strategy and technical guides on HIV prevention, treatment and care for IDUs

WHO HIV/AIDS 2011-2015 strategy and technical guides on HIV prevention, treatment and care for IDUs


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WHO Expert Committees on Drug Dependence (28th and 30th Reports, 1993,1998)

WHO Expert Committees on Drug Dependence (28th and 30th Reports, 1993,1998)

Addressing the concepts of primary, secondary and tertiary prevention as well as harm reduction

Definition and objectives of "treatment" in the context of drug demand reduction

Principles of interventions and the management of drug-related conditions

Quality assurance in treatment and monitoring of services


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Schedules for the assessment of standards of care in substance abuse treatment (WHO, 1993)

Schedules for the assessment of standards of care in substance abuse treatment (WHO, 1993)

A. Standards on access, availability and admission criteria

B. Standards on Assessment

C. Standards on Treatment Content, Provision, and Organization

D. Standards on Discharge, Aftercare and Referral

E. Standards on Outreach and Early Intervention

F. Standards on Patient's Rights

G. Standards on Physical Aspects of the Treatment Setting

H. Standards on Staffing


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Standards in substance abuse treatment and grading of meeting them (WHO, 1993)

Standards in substance abuse treatment and grading of meeting them (WHO, 1993)

Types of standards– Essential (E)– Advisable (ADV)– Not Indicated (NI)

Grading of meeting the standard requirements– Adequately met (AM)– Inadequately met (IM)– Not met at all (NM)

Invited suggestions on how to rectify the situation


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WHO regulations for guideline development (last update in 2010)

WHO regulations for guideline development (last update in 2010)


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Steps in developing WHO recommendations

Steps in developing WHO recommendations


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Quality of the EvidenceQuality of the Evidence

Five factors should be considered: limitations, inconsistency, indirectness, imprecision, reporting bias

Quality assessment

No of studiesDesignLimitationsInconsistencyIndirectnessImprecisionOther

Outcome 1

0


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Formulating WHO recommendationsFormulating WHO recommendations

WHO reference documents,

other sources including GDG input, WHO experience (explicitly stated and recorded)


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Categories of recommendationCategories of recommendation

Strong

Standard


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UN ECOSOC (Economic and Social Council) Resolution (2004)

UN ECOSOC (Economic and Social Council) Resolution (2004)

"Invites the World Health Organization, in collaboration with the United Nations Office on Drugs and Crime, …to develop and publish minimum requirements and international guidelines on psychosocially assisted pharmacological treatment of persons dependent on opioids, taking into account regional initiatives in this field, in order to assist the Member States concerned"

World Health Organization


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WHO Guidelines on pharmacotherapy of opioid dependence (WHO, 2009): selected system level

recommendations

WHO Guidelines on pharmacotherapy of opioid dependence (WHO, 2009): selected system level

recommendations Treatment of opioid dependence should be

provided in the health care system

There should be a treatment strategy / policy framework

Psychosocially assisted pharmacological treatment should not be compulsory

Treatment should be accessible to all those in need, including those in prison and other closed settings

Essential pharmacological treatment consists of opioid agonist maintenance treatment and services for the management of opioid withdrawal


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Minimal requirements/standards in WHO Guidelines on pharmacotherapy of opioid dependence:

Minimal requirements/standards in WHO Guidelines on pharmacotherapy of opioid dependence:

minimal recommendations are suggested for adoption in all settings as a minimum standard; these should be considered the minimal requirements for the provision of treatment of opioid dependence

best practice recommendations represent preferred strategies for achieving the optimal public health benefit in the provision of treatment for opioid dependence.


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Example of WHO recommendations for treatment programs for opioid dependence

Example of WHO recommendations for treatment programs for opioid dependence


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Example of WHO recommendations for pharmacotherapy options for opioid dependence

Example of WHO recommendations for pharmacotherapy options for opioid dependence


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WHO/UNODC Discussion Paper Principles of Drug Dependence Treatment (2008)

WHO/UNODC Discussion Paper Principles of Drug Dependence Treatment (2008)

Nine principles with:

Description and justification

Components

Actions to promote the principle

Components and actions to promote the principles are indicative of (minimal) requirements and standards for treatment


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Steps for implementation a WHO guidelineSteps for implementation a WHO guideline

Analyse local needs and priorities (look for additional data on actual practice)

Identify all potential barriers and facilitating factors

Determine available resources

Design a strategy to support the adoption of recommendations and the make the overall context favorable to the proposed changes


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Evaluation of a WHO guidelineEvaluation of a WHO guideline

The guideline should include parameters or outcome measures that can be monitored for the main recommendations.

Ideally there should be baseline measures against which to assess performance in relation to the targets of change of the recommendations.

Follow-up measurements can be taken once the guideline is implemented.


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ATLAS on Substance UseResources for prevention and treatment of substance use

disorders (WHO, 2010)

ATLAS on Substance UseResources for prevention and treatment of substance use

disorders (WHO, 2010)

Based on results of the questionnaire survey of focal points identified in WHO Member States

Information collected from 147 countries all over the world that represent 88% of the world population


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Availability of Guidelines on Pharmacological Treatment of Substance Use Disorders (WHO, 2010)

Availability of Guidelines on Pharmacological Treatment of Substance Use Disorders (WHO, 2010)


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mhGAP Guidelines

WHO mhGAPEvidence Resource Centre

by priority conditions

Intervention Guide Advocacy

/information documents

Policy/planning

documents

Adaptation/training material

Journal publications

Monitoring/Evaluation

tool

Presentation and Dissemination Plan for mhGAP Guidelines

Presentation and Dissemination Plan for mhGAP Guidelines


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Recent developments and future plansRecent developments and future plans

WHO training packages for:– mhGAP priority conditions, including Drug Use Disorders– Treatment of opioid dependence– Screening and brief interventions for substance use based on WHO ASSIST

package.

WHO guidelines on identification and management of substance use and Substance Use Disorders in pregnancy (including tobacco).

Continued implementation of the WHO/UNODC Joint Programme on Drug Dependence Treatment and Care in selected low and middle income countries

Further development of discussion papers produced in collaboration with UNODC

– Principles of drug dependence treatment Position papers

Development of international standards for primary prevention of drug use and drug use disorders (CICAD with involvement of WHO, EMCDDA, PAHO)


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Recent developments in normative guidance on demand reduction and future plans at global levelRecent developments in normative guidance on

demand reduction and future plans at global level WHO training packages for:

– mhGAP priority conditions, including Drug Use Disorders– Treatment of opioid dependence– Screening and brief interventions for substance use based on WHO ASSIST package.

Continued implementation of the WHO/UNODC Joint Programme on Drug Dependence Treatment and Care in selected low and middle income countries

Monitoring prevention and treatment resources for substance use disorders– Global Information System based on the ATLAS-SU data collection tools (ATLAS-SU report), in

collaboration with EMCDDA

WHO guidelines on identification and management of substance use and Substance Use Disorders in pregnancy (including tobacco)

Further development of discussion papers produced in collaboration with UNODC – Position papers with potential implications for standards/requirements

Assessment of treatment systems for SUD (WHO SAIMS project)

Development of international standards for primary prevention of drug use and drug use disorders (CICAD with involvement of WHO, EMCDDA, PAHO)


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Some challenges in addressing demand reduction international standards

Some challenges in addressing demand reduction international standards

Multisectoral scope of demand reduction systems often beyond the reach of governmental or professional regulations

Huge differences in resources available for demand reduction in the countries

Addressing different levels of health care– Primary health care as an important provider of demand reduction

interventions– Secondary and tertiary levels of health care

Differences in policy frameworks

Issue of effectiveness and cost-effectiveness of programs and interventions

Implementation, monitoring and evaluation


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WHO Department of Mental Health and Substance Abuse

Management of Substance Abuse

WHO Department of Mental Health and Substance Abuse

Management of Substance Abuse

http://www.who.int/substance_abuse/

Building an EU consensus for minimum quality standards 15-17 June 2011, Brussels | WHO: Normative guidance on and quality standards in drug demand reduction.

Documents

brussels standards

minimum quality standards

brussels quality

assessment of standards

guidelinestechnical

eu consensus

implementation norms

health slide