Special populations and settings

Rural settings

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Drug use has traditionally been viewed as an urban and inner-city problem. However, increases in the prevalence of drug use disorders and substance-related mortality in rural areas, particularly due to opioid overdose, have led to the international recognition that the problem of drug and other substance use has spread to rural settings across the globe. This is true for both developing and industrialized countries.
 
 
To support the planning, management and delivery of drug prevention and treatment services in rural settings, UNODC has developed a guidance document as part of the “Special Population” series Prevention of Drug Use and Treatment of Drug Use Disorders in Rural Settings.
 

Dual disorders

Drug use disorders can have devastating consequences on affected individuals as well as their families and communities. Such disorders are associated with lost productivity, security challenges, crime and myriad negative health and social consequences. The care and treatment of individuals with drug use disorders also exacts a heavy toll on public health networks. This situation is further exacerbated by the fact that 50-80% of people with drug use disorders are also affected by mental health conditions resulting in dual disorders, which are associated with increases in emergency department admissions and psychiatric hospitalizations, higher risk of relapse to drug use and increased likelihood of premature death, including from suicide.
 
Under the auspices of the United Nations Commission on Narcotic Drugs, in 2020 a meeting of the UNODC/WHO Informal Scientific Network was convened to discuss the management of dual disorders. The discussion focused on strategies linking science, policy and clinical practice to further enhance the management of psychiatric comorbidities in drug use disorders. The resulting publication, Managing dual disorders: a statement by the Informal Scientific Network, UN Commission on Narcotic Drugs, highlights fourteen key recommendations specifically underlining the importance of a non-discriminatory approach, the ‘no wrong door’ principle as well as the need for support from policymakers. UNODC and WHO are currently working on a joint publication on this topic.

Criminal justice system

Many people suffering from drug use disorders are in contact with the criminal justice system. At the same time, incarceration may have severe negative consequences for people with drug use disorders as it could worsen the underlying health and social conditions that are associated with drug use. 
 
For the latest information on substance use and the criminal justice system as well as a brief overview of the long-term consequences of imprisonment for women incarcerated for drug law offences, please see World Drug Report 2020 Booklet 6.  
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The international drug control conventions encourage the adoption of a health-oriented approach to both illicit drug use and drug use disorders rather than relying solely on a sanction-oriented approach.  A health-oriented approach targeting non-dependent drug users may involve providing education, reliable information and brief motivational and behavioural counselling, as well as measures to facilitate social reintegration and reduce isolation and social exclusion. In the case of drug dependent individuals, it may also involve more comprehensive social support, specific pharmacological and psychosocial treatment and aftercare. Evidence shows that the most effective response is the treatment of drug use disorders through evidence-based, voluntary treatment modalities.  
 
 

UNODC has published a discussion paper outlining a model for referral from the criminal justice system to the treatment system that is more effective than compulsory treatment and which results in less restriction of liberty, less stigma and better prospects for the future of the individual and society.

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From Coercion to Cohesion: treating drug dependence through heath care, not punishment

This UNODC/WHO document presents information for policymakers on a variety of treatment and care options for people with drug use disorders who come into contact with the criminal justice system.

 

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Alternatives to Conviction or Punishment: treatment and care for people with drug use disorders in contact with the criminal justice system