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Background on CICAD'S Demand Reduction Program: 

 

CICAD’s Demand Reduction Program, now in its twentieth year, has developed hemispheric policies to prevent and treat drug use, and has conducted technical assistance, training and cooperation both nationally and multi-nationally to enhance the capacity of governments and NGOs to deliver substance abuse prevention and treatment programs.

 

Over the last ten years, CICAD has strongly encouraged its member governments and NGOs to set policy, and establish national regulations and standards for drug treatment centers. Most Latin American countries now have such standards, based on the standards recommended by the World Health Organization in 1993.  This regulatory framework needs to be implemented and complied with locally, where it is not widely known.  This Project will focus on:

  • Advocacy, at the municipal policy-making level, for the integration of drug treatment, rehabilitation and harm reduction* programs into the health care system, in order to facilitate referral of patients from one kind of treatment program to another, and to bring these efforts fully under the umbrella of the social security system
  • Improving access to drug treatment and rehabilitation at the local level, particularly for socially-excluded women, adolescents, HIV/AIDS patients, prisoners and youth in detention centers, and indigenous peoples.

Additionally, as CICAD’s member states are moving to improve their criminal justice systems and update their drug laws and strategies, a movement is developing to examine alternatives to incarceration for minor drug offenders.  CICAD strongly supports such initiatives, and anticipates that through the present Project, judges and public prosecutors in particular can be sensitized to the possibility of such alternatives and the rationale for them.

 

However, while these activities have conformed to best practices in the Western Hemisphere, there has been little cross-fertilization in the area of drug treatment,rehabilitation and harm reduction* with EU member states. 

 

CICAD’s ongoing program in LAC in drug treatment and rehabilitation

 

Standards of care in drug treatment: Since 1996, CICAD, in initial cooperation with the Pan American Health Organization (PAHO), has been fostering the adoption by OAS member states of standards of care in drug treatment, following the 1993 World Health Organization model.  In each country, the program brings together the main treatment providers (usually NGOs), the Ministry of Health and the National Drug Commission to agree on basic standards that a drug treatment program should meet, such as recommended number of staff, medical supervision, adequate infrastructure, patient confidentiality, etc.)  The standards are adopted by the Ministry of Health, which typically has (or ought to have) regulatory authority over treatment programs. Most countries of Central and South America now have such standards on the books, but compliance is often haphazard. In the Caribbean region, Barbados, Belize and Suriname are embarked on the development of quality standards of care; Bermuda and Cayman Islands have in place a system for accreditation of drug counsellors, but the region as a whole is largely lacking in quality standards and regulatory authority.

 

CICAD’s next phase of this program is:  a) to provide Health Ministry planners and evaluators with the tools to monitor compliance with the standards and exercise their regulatory authority; b) move towards mandatory compliance, licensing of treatment programs, and enforcement, and c) expand the program to the English-speaking Caribbean.  The present Project will allow CICAD and the participating LAC cities to advance this goal by drawing on European experiences and expertise, while at the same time, sharing with European counterparts their obstacles and successes.

 

Integration of drug treatment into national health care services: CICAD’s goal over the next five years is to advocate for national policies to bring drug treatment into the national health care system or national social security system.  This will increase coverage; improve access by making care more affordable, and reduce stigmatization of problematic drug users by ensuring that they receive equitable care.  CICAD’s policy in this matter is based on guidelines developed by an expert task force and approved by the CICAD Commission.  To that effect, see CICAD’s web site at:

 

http://www.cicad.oas.org/Reduccion_Demanda/ENG/DRprojects/NatlTx/practical guide for the organization drug treatment system.pdf

 

Drug treatment in adult prison and juvenile corrections systems:  CICAD is embarked on four initiatives in this area:

  • Training for corrections officers and prison service central staff in the provision of rehabilitative services for drug-dependent prisoners (Caribbean);
  • Policy development (Central America), with cooperation from Spain and Canada;
  • Direct financial support and technical assistance for three projects to set up, for the first time, pilot programs of drug treatment in prisons (Guatemala, Peru, and Saint Vincent and the Grenadines), and
  • A new initiative in Central America, focused initially on El Salvador and Guatemala, to establish a long-term training program for drug treatment providers.

The present Project will provide another umbrella under which these various programs can come together.

 

Training in drug treatment in the Caribbean:

  • Since the EC-sponsored Barbados Plan of Action of 1996, CICAD has been providing short training courses for drug treatment counsellors in the Caribbean.  Many of the staff of leading treatment providers in the Caribbean have attended one or more of these courses, but the extent of the training has been limited because of the expense of face-to-face courses.  
  • Also in the 1990s, CICAD and UNODC jointly conducted a certificate program in addictions studies in the Continuing Education Department of the University of the West Indies.  The education program was solid, and favourably evaluated by an external evaluator; however, the effort faltered after six or seven years for lack of funding and budget cuts within the University.  Picking up on that program, CICAD and UWI will offer in September 2007 an on-line continuing education program in the addictions. http://addictionstudies.dec.uwi.edu/index.html
  • Prior to the Barbados Plan of Action, the EC commissioned a major study on the state of drug treatment in the Caribbean, upon which some European governments acted, notably the UK, with training events
  • CICAD is sponsoring the production of a manual on drug treatment for the Caribbean.  The contributions to the manual are by Caribbean authors; it is anticipated to be published by the autumn of 2006.

The present Project will allow links to be made with the previous training strands and previous cooperative relationships to be resumed.

 

CICAD’s Inter-American Observatory on Drugs, established in 1999 as CICAD’s statistics and research arm, has established a uniform system for the collection of epidemiological data on drug use.  This system, known as SIDUC, is in regular use in 29 of the 34 member states of the OAS, and is replicated in the Multilateral Evaluation Mechanism (MEM) questionnaire.  Two of the survey instruments are relevant to the present Project, (the questionnaires used in drug treatment centres, and in detention centres) and will be used as part of the needs assessment described above.

 

The Inter-American Observatory on Drugs is also conducting an ongoing program to examine the social and economic cost of drugs to society.  This study is currently being conducted in Argentina, Barbados, Costa Rica, Chile, Colombia, El Salvador, Mexico and Uruguay.  The findings of the studies are already being used in Costa Rica, for example, to advocate greater reliance on drug treatment than on incarceration for minor drug offences.

 

CICAD’s program to decentralize drug demand reduction policies and programs in the Andean region: CICAD has been operating this program with the support of the Government of Spain. The present Project will draw extensively on the lessons learned from this ongoing program, and will build on the networks that have been created.

 

Background on the European efforts against drugs: