Essential elements

for regulation

Bylaw on drug demand reduction

Working methode for drafting the bylaw

Identify the essential elements for regulation of demand reduction

Which elements are already regulated in Serbian legislation?

Model regulations in Europe Need for regulation through the bylaw

Topics which need to be regulatedI. General ProvisionsII. PreventionIII. Treatment of addictionIV. Harm reductionV. Rehabilitation and social reintegrationVI. Justice system (prosecution, courts,

prisons..)VII. Sanctions / penalties

General Provisions 1. Scope of the bylaw:

The aim of the regulation should be:– to prevent and counteract drug addiction, – to establish a legal framework for dealing with

consumers of psychoactive substances, – to establish tasks and prerogatives of relevant

institutions/organisations/entities involved in preventing and counteracting drug addiction,

– to establish sanctions for violating the provisions

General Provisions 2. Areas to be regulated: Prevention of drug abuse, reduction of the number

of drug users as well as the amount of drugs consumed,

Treatment of drug users and addicts, Reduction of the health and social harm associated

with drug use, Rehabilitation, reintegration of addicted persons

into society.

General Provisions 3. Guiding principles (I):

Programmes and measures in the field of Demand Reduction should– ensure health and security of individuals and

society,– acknowledge that addiction is a disease which

can and should be treated,– respect Human Rights, in particular guarantee the

right to be treated

General Provisions 3. Guiding principles (II):

Programmes/measures in the field of demand reduction should– provide help to drug users (treatment,

counselling, rehabilitation, reintegration) in principle on a voluntary basis, notwithstanding other legal regulation,

– constitute a comprehensive, integrated and coherent system of Demand Reduction,

– be easily accessible to all those who need them

General Provisions 3. Guiding principles (III):

Programmes and measures in the field of Demand Reduction should– comply with the International Drug Control

Conventions of the UN,– be complementary to Supply Reduction

programmes ("Balanced Approach")– be based on (scientific) evidence and on the

relevant standards of conduct,– be systematically monitored.

General Provisions 4. Relevant institutions/ entities / organisations (I)– Government administration, – Regions, Local Communities, Special drug related

institutions– Educational institutions (Kindergartens, Schools,

Universities, Training institutions) – Health care system– Judicial system (Police, Courts, Prisons)

General Provisions 4. Relevant institutions/ entities / organisations (II)– Welfare organisations– NGO’s – Civil Society – Media

Responsibilities and competences should be clearly defined within the legal framework

General Provisions 5. Coordination– All the relevant stakeholders should participate in

planning, organisation and implementation of programmes and measures

– All relevant activities should be coordinated on the local, regional, national level by respective coordinating bodies

– Demand Reduction policy should be matched with Supply Reduction policy ("balanced approach”)

General Provisions

6. Strategy and Action PlanStrategy and Action Plan should form the basis for measures for counteracting drug addiction

General Provisions 7. Research– Research in all the sectors of demand reduction is

necessary and must be funded by the State and other institutions

– International cooperation in drug research is essential. Results of research performed in other countries should be taken into account.

General Provisions

8. Monitoring– National Monitoring Centre is to be established– Records on: consumption, drug related diseases,

treatment, drug related deaths

Prevention of drug use 1. Forms of prevention

a) Universal prevention (Programmes and measures to avoid that population take drugs)

b) Selective and indicated prevention (Programmes and measures targeting at-risk groups and individuals)

Prevention of drug use 2. Means of prevention

a) Universal prevention:• educational activities, • health promotion programmes, • informational and awareness raising activities

b) Selective and indicated prevention:• counselling • early intervention• support/assistance

Prevention of drug use 3. Institutions/organisations responsible for /

dealing with prevention

4. Financing of PreventionFinancing of prevention is needed to ensure the sustainability of prevention activities

Treatment of addiction Treatment of addiction disease

= scope of the bylaw Treatment of other diseases with narcotics

(e.g. pain) – symptomatic treatment= to be regulated elsewhere

Drug addiction treatment must be integral part of the health and social care system

Treatment of addiction Range of treatment methods– Detoxification– Medically assisted treatment (substitution

treatment)– Abstinence-oriented treatment – Psycho-social assistance

Any method must comply with the agreed professional standards (state of the art)

Treatment of addiction

Settings for treatment:– Outpatient – Inpatient (residential) – Outreach work

Treatment of addiction

Aim of the treatment:– (Gradual) reduction of drug consumption with

the ultimate goal of abstinence – Improvement of the health status and the

quality of life of the addict – Treatment of (psychiatric) co-morbidities

Treatment of addiction Institutions / organisations / persons providing treatment– Medical doctors / nurses / psychologist / social

workers– Healthcare centres, hospitals, reference centres,

prisons– Social services, offices for youth← Qualification or certification required for institutions and/or professionals

Treatment of addiction Special provisions for substitution treatment (I)– Special licence for ST required for medical doctors – List of psychoactive substances that are expressively

admitted for ST – Registration • of all medical doctors with substitution licence • and of all cases of substitution treatment (in

anonymised form) in order to avoid double treatment

Treatment of addiction Special provisions for substitution treatment (II)– Titration of dose and quantities of substitution

substances to be administered– Indications, contraindications and refusal of treatment– Medical treatment should be combined with psycho-

social assistance wherever needed by the patient,– Administrative requirements / control measures

Treatment of addiction

Financing of Treatment

Financing of treatment is needed to ensure the sustainability of treatment activities

Harm reduction Definition – Programmes and measures aiming primarily at

reducing the adverse health and social consequences associated with the use of psychoactive substances

– “Aid for survival” (GER)– Must be an integral part of a comprehensive and

coherent continuum of demand reduction measures– Must be complementary to prevention, treatment and

rehabilitation, not replace them

Harm reduction Types of measures, interventions and services(I): – Low threshold facilities, drop-in centres, shelters,

contact and information units – Medication and emergency kits for management of

overdoses in appropriate places (e.g. naloxone distribution programmes),

– Vaccination programmes (against Hepatitis a.o.),– Voluntary HIV and HCV counselling and testing,– Needle/syringe exchange programmes– Measures to ensure safer use,

Harm reduction Types of measures, interventions, services (II):

– Services for the management of sexually transmitted infections, particularly to those involved in sex work,

– Diagnostic and treatment of HIV, HCV and TB in injecting drug users

– Well-equipped street-workers and peer outreach workers units,

– Medically supervised outreach facilities (so called “Drug consumption rooms”)

– Violence prevention programmes– Others....

Harm reduction Types of measures, interventions and services: – Services for the management of sexually transmitted

infections (particularly for sexworkers),– Diagnostic and treatment of HIV, HCV and TB in

injecting drug users – Street-workers and peer outreach workers units,– Medically supervised outreach facilities (so called

“Drug consumption rooms”) – Violence prevention programmes– Others….

Harm reduction

Integration of harm reduction into public health system and cooperation between e different stakeholders and actors is essential

Financing of harm reduction is needed to ensure the sustainability of harm reduction activities

Rehabilitation and Social Reintegration Measures aiming at assisting persons using drugs in participating in social interaction, particularly in work life.

Institutions/organisations providing Rehabilitation and Reintegration:• social care institutions and welfare system• unemployment offices• prisons• after-care programmes, therapeutic communities• NGOs• others...

Rehabilitation and Social Reintegration Cooperation between institutions is absolutely

essential All existing and appropriate programmes and

measures of Rehabilitation and Reintegration should be accessible for drug users

Special programmes and measures for the Rehabilitation and Reintegration of drug users should be established

Sustainable financing is needed

Justice system

Principle: Treatment instead of prison Rules for preventing and counteracting of drug

addiction within prisons Equal rights for addiction care in and out-side the

prison Reintegration into society after prison

Essential elements for regulation

Thank you for your attention!