Vienna, 10 October 2023 - As noted by Ghada Waly, Executive Director of the United Nations Office on Drugs and Crime (UNODC) in the preface to the 2023 World Drug Report, drug use disorders can have dangerous impacts on individuals and societies.
“Drug use disorders are harming health, including mental health, safety and well-being. Stigma and discrimination make it less likely that people who use drugs will get the help they need,” she stated. As Ms. Waly has also urged elsewhere, “let us show those who need us that we care.”
Across the globe, fewer than 20 per cent of people with drug use disorders are in treatment, with access highly unequal. Developing quality assurance mechanisms for drug use disorder treatment at the local level can contribute to improved overall quality of life of people with drug use disorders, including those in recovery, and create resilient communities.
To help drug treatment professionals gain expertise in this area, UNODC organized a study tour for 16 high-level officials from Tajikistan, Uzbekistan, Kazakhstan, and Kyrgyzstan to the United Kingdom (UK) to exchange practical experiences with experts on clinical governance, quality assurance, and performance management of drug use disorder treatment and care services.
Gulmira Sadvakassova, the Head of the Information and Analytical Monitoring Center of the Republican Scientific and Practical Center for Mental Health under the Ministry of Healthcare of the Republic of Kazakhstan, shared her impressions of what can be applied from the tour to her country in more detail.
What issues exist in Kazakhstan when it comes to treatment and prevention of drug use?
Currently, in Kazakhstan and throughout the world, the problem of reaching young people and adolescents with drug use disorders is acute. Numerous efforts have been made to develop effective methods for diagnosing and preventing non-medical use of psychoactive substances.
But at the same time, there is also the importance of gaining the patients' trust in us. As a whole, we need to systematically reduce barriers, expand accessibility, and improve the quality of drug treatment services on a national level. With the knowledge we gained through the study tour, we will apply relevant information and practices when designing new policies.
What impact has the introduction of UNODC Quality Assurance (QA) tools had on your country’s treatment systems and services?
Despite the ongoing reforms in Kazakhstan's healthcare system aimed at patient orientation and reducing stigmatization over the past ten years, the need to introduce quality standards for drug treatment is still very much a reality. Drug dependence treatment and care availability remain low: outpatient and inpatient treatment coverage (of drug-dependent individuals) does not exceed 10-15 per cent.
Now, the quality of treatment has become even more important as the number of young people with drug use disorders keeps increasing, and there is a rise in the use of new synthetic drugs as confirmed by studies conducted in Kazakhstan.
The piloting of UNODC quality assurance tools in 2018-2021 in Kazakhstan showed us and our colleagues what organizational and structural components of our service work are in place and where we need to change to further enhance the system.
How have patients benefitted from UNODC’s technical assistance so far?
Training is always aimed at reducing the stigmatization of our patients, which is clearly reflected in increased patient satisfaction. Not only has patient satisfaction improved over the years, but there has also been a significant increase in contentment amongst specialists in the rehabilitation team while piloting UNODC quality assurance tools.
What role does data play in Kazakhstan to enhance access to evidence-based treatment and care?
In Kazakhstan, a comprehensive “Plan to Combat Drug Addiction and Drug Trafficking for 2023-2025” was developed and approved by the Government in 2022. This plan is a national document, which includes, but is not limited to, the issues of improving diagnosis, prevention, treatment, and rehabilitation.
However, it is crucial to have sufficient scientific and research data to determine the direction of policy on enhancing access to evidence-based treatment and care. In 2018, with the support of UNODC, we conducted a survey which also looked into the prevalence of new psychoactive substances (NPS) among adolescents and young people. The subsequent study on problematic substance use has now been launched. The UNODC data obtained became the baseline for the national plan.
What new ideas/best practices for your work are you taking from the study tour back home?
The study tour highlighted the importance of multidisciplinary interaction between treatment services, the police, the education system (if they are teenagers), and the social and penitentiary system when it comes to our accreditation system for compliance with treatment quality standards, which we are currently working on. The UK’s system for quality assessment was built on this integration and co-operation of services with different complex characteristics compared to the general medical organizations. We can apply the theoretical practices and the practical examples presented to us – a crucial lesson gained thanks to the study tour.
What information from the study tour can benefit professionals working with people with drug use disorders?
Even with their own extensive experience in this area, it is always important for professionals to learn about the experience of other countries. We face diagnostic challenges every day, and with the NPS market growing, there is a high interest in new research and approaches.
We plan to and would love to establish a long-term relationship with the organizations visited during the study tour to exchange experiences with some treatment services that faced similar challenges. We aim to follow and establish partnership frameworks over the next 12 months with the support of our UNODC colleagues in Central Asia and UK.
What would you wish/hope for patients in the Republic of Kazakhstan in the future?
By the end of the study tour, it was clear that Kazakhstan would work towards the quality assurance of its integrated narcological services. Furthermore, representatives from all participating countries developed an action plan. Kazakhstan specifically included work on long-term drug treatment using buprenorphine (a long-acting opioid agonist used to treat opioid use disorders) as well as on treatment and care as an alternative to conviction or punishment available for people who use drugs and with drug use disorders in contact with the criminal justice system. The enthusiasm and passion of the Central Asian delegates showed their strong determination to develop more effective, evidence-based treatment services together with UNODC to ultimately leave no one behind.
