June 9 – 10, 2022
NIDA International Program leadership, Dr. Lindsey Friend and Dr. Jennifer Hobin co-chaired the 2022 NIDA International Forum, which was held virtually in conjunction with the College on Problems of Drug Dependence (CPDD) Annual Scientific Meeting. More than 400 attendees from 74 countries participated in this year’s virtual Forum and 102 posters from 47 countries were presented on the meeting’s virtual platform. Two virtual plenary sessions featured presentations by 29 researchers from 13 nations and seven time zones. The NIDA International Program and the European Monitoring Centre for Drugs and Drug Addiction supported 17 travel awards to researchers from 14 countries to attend the in-person Annual CPDD Scientific meeting held June 11 to 15, 2022.
Drs. Friend and Hobin opened day one of the meeting with an update of NIDA’s programs. This was followed by sessions on university addiction education programs in the age of COVID-19 in several countries, the United Nations Office on Drugs and Crime (UNODC) and the World Health Organization (WHO) Informal Scientific Network (ISN) and how they support the translation of science into policy, and harm reduction research and policy.
The second day started with a discussion of lack of integrity and transparency in drug treatment services and the adverse effects on treatment outcomes and infringement of human rights that resulted from this lack. The next session discussed several approaches to developing alternatives to conviction or punishment for drug use and provided an overview of drug use in the Americas. The final session of the day, which focused on the Community Anti-Drug Coalitions of America, featured two former Humphrey Fellows, who described their efforts to establish community coalitions in their home countries of Uganda and Republic of Togo.
Following is a brief summary of each of the topic sessions presented this year.
Welcome and NIDA Update
Dr. Hobin provided an overview of the breadth and depth of NIDA’s activities that focus on four main areas including drug use, behavior, and the brain; implementation of evidence-based strategies; innovative health applications; and prevention, treatment, and recovery. In addition, overarching topics such as co-occurring conditions, stigma, health disparities, and sex and gender differences are a focus of NIDA’s activities. A major focus of NIDA’s work in recent years has been addressing the evolving U.S. overdose crisis. Research on the intersection of substance use disorder (SUD) and COVID-19 have had an important role, with NIDA funding more than 100 studies related to COVID-19.
As Dr. Hobin noted, about 7% of NIDA grants support international research, primarily in the form of domestic grants with a foreign component. Direct awards to foreign principal investigators and with research conducted outside the United States are rare.
Dr. Friend summarized the activities of the NIDA International Program, specifically the training and research programs, including INVEST postdoctoral fellowships, NIDA Hubert H. Humphrey Fellowships,
and the Distinguished International Scientist Collaboration Program (DISCA). INVEST postdoctoral fellowships last 12 months and offer professional development activities that help establish personal relationships between the fellows and NIDA grantees and NIDA officials. They are for international researchers with a doctoral degree and a minimum of 2 years postdoctoral experience. Hubert H. Humphrey Fellowships are mid-career fellowships that include a 10-month research fellowship at Virginia Commonwealth University as well as 6-week professional affiliations to allow fellows to make connections to advance their ongoing work. DISCA awards aim to enhance international collaborative research on drug abuse and drug-related consequences through a 4-week exchange visit between a U.S. NIDA-funded researcher and a non-U.S. senior researcher.
University Addiction Programs in the Age of COVID
In this session facilitated by Dr. Kevin P. Mulvey from the International Consortium of Universities for Drug Demand Reduction (ICUDDR), Dr. Michal Miovský from the Charles University in Prague, Czech Republic, reported on new trends in education and training programs in addictions at the higher education and university levels. As the infrastructure of addiction sciences has grown over the past 150 years, there has also been an emergence of academic training programs with a special focus on addiction, although their content, level, and form differ widely. A 2015/2016 global mapping survey identified hundreds of programs in Europe, the United States, Africa, and other parts of the world. In 2016, the ICUDDR was established as a network of universities with academic programs in addiction studies, with the aim of engaging students in addiction studies programs and continuing education as well as advancing research in addiction prevention and treatment. ICUDDR oversaw the formulation of the first international curricula for treatment and prevention, with the development of manuals that have been adapted to and translated for numerous countries. Currently, 306 academic institutions from 48 countries are ICUDDR members. A first implementation study of these international curricula in national programs was conducted at Charles University in Prague. Implementation support and an implementation guide are also being developed. Additional focus needs to be on the quality, focus, and real impact of addiction science programs. Overall, the emergence of academic programs with higher quality will have a large potential impact on the workforce in addiction services.
Dr. Susana Henriques from the Universidade Aberta (Open University), Portugal, described the design and evaluation of an online training course for the prevention workforce based on the European Prevention Curriculum. The course is delivered at the Portuguese Open University, the only public distance learning university in Portugal. The program design is based on guidelines for student-centered learning, flexibility, interaction, and digital inclusion. Its content is centered around five themes, including lifestyle decisions and prevention; epidemiology and etiology; prevention science; monitoring and evaluation; and models of applied prevention. Dr. Henriques noted that it was important to design the program to meet both the 2011 European Drug Prevention Quality Standards (EMCDDA) and the 2018 European Standards and Guidelines for Quality Assurance of E-Learning Provision–HEI (ENQA) with respect to timeline of the program and program design, quality and effectiveness, recruitment and retainment of participants, and information dissemination about the program. The program also fulfills various dimensions of openness, including science education, educational resources, and technology.
Dr. Ma Veronica Felipe from Pamantasan ng Lungsod ng Maynila, Philippines, reported on the adaption of the Universal Treatment Curriculum (UTC), which is aimed at service providers in Asia or Africa, to the
Philippine context and an online environment. A first evaluation of the adapted program was conducted with 52 participants (students, teachers, and administrators) from 22 universities. The program adaptation addressed redundancies and condensed the content, added local data (e.g., on existing laws and policies), integrated the content into existing academic courses, and converted the program to a virtual format. The program was implemented in two phases, both of which contained synchronous and asynchronous sections and included breaks between different modules. Dr. Felipe reported that overall, participants were satisfied with the design, content delivery, and learning platform of the adapted UTC. Despite initial skepticism toward online learning, the incorporation of tools like guest speakers or educational videos resulted in high learner engagement. However, in general, respondents preferred face-to-face teaching due to limitations of internet connectivity in the country, which often limited video capacities. Thus, online learning can be a problem in countries like the Philippines. Nevertheless, a comparison of online and face-to-face classes from different cohorts showed no significant differences. Dr. Felipe concluded that the program offers the advantage of reaching participants in all parts of the Philippine archipelago while requiring lower operational costs but does not allow for certain components requiring in-person availability. Adapting and transforming a curriculum to an online format requires careful selection of topics and activities, as well as the technological tools that help engage participants in distance learning.
The UNODC-WHO Informal Scientific Network
Ms. Giovanna Campello from the UNODC Prevention, Treatment and Rehabilitation Section, Austria, introduced the organization and function of the Informal Science Network (ISN), which was established in 2014 and is implemented jointly by UNODC and WHO. As the name implies, it is completely informal in nature and currently includes 30 renowned scientists from around the world who are nominated by member states. The goal of ISN is to provide a platform for dialog between scientists and international policymakers on issues related to the world’s drug problems. ISN also contributes to the dissemination of the UNODC-WHO International Standards for the Treatment of Drug Use Disorders and the International Standards on Drug Use Prevention. ISN has numerous collaborations, including NIDA, and NIDA Director Dr. Nora Volkow has been ISN Chair since its inception. ISN members are also active in numerous other organizations and networks. ISN also addresses the UNODC Commission on Narcotic Drugs, which is the leading entity within the United Nations to take measures related to international drug policies, bringing the voice of science to the Commission’s decisions.
Ms. Anja Busse from the UNODC Drugs, Laboratory and Scientific Services Branch, Austria, reviewed the ISN Statements that have been published since 2016; these statements elaborate the topics that emerged from within ISN as priorities.
- The 2022 Statement addressed substance use prevention and SUD treatment and care for girls and women, with a call for gender-sensitive drug policies.
- The 2021 Statement focused, unsurprisingly, on recommendations for prevention, treatment, and care of SUD in times of COVID-19.
- The focus in 2020 was management of psychiatric comorbidities in drug use disorders; the resulting Statement informed a related technical document in 2022.
- The 2019 Statement addressed socioeconomic inequalities and SUD, focusing particularly on humanitarian settings; it informs the focus of the 2022 World Drug Day.
- The 2018 Statement was dedicated to addressing the opioid crisis globally.
- The 2017 Statement examined the impact of a public health rather than criminal justice approach to drug use disorders, which triggered more actions in the following year.
- The 2016 Statement was addressed at the United Nations General Assembly Special Session on Drugs (UNGASS 2016). The outcome document included more than 100 recommendations and informed decision making, prevention, and treatment recommendations in the following years.
Dr. María Elena Medina Mora from National Autonomous University of Mexico, elaborated on the 2019 ISN Statement on “Socioeconomic Inequalities and Drug Use Disorders.” More people use drugs in developed countries and among wealthier segments of society, but people who are socially and economically disadvantaged are more likely to develop drug use disorders. Socioeconomic disparities increase not only the risk of SUD but also exacerbate the consequences. The relationship between poverty and substance use is complex, involving not only biological, demographic, and constitutional factors but also lifestyle factors. In addition, gene–environment interactions can play a role, and protecting individuals from adverse experiences will reduce the likelihood of the genetic potential of drug use disorders becoming expressed. As Dr. Medina Mora noted, the Statement also included numerous recommendations. With respect to policies and legislation, decision makers should prioritize strategies and interventions that aim to minimize inequalities and recognize human rights. Health care services should strive to reduce inequities as outcomes and quality of health care are worse for people who are socioeconomically deprived. Finally, communities and social systems should prioritize social support systems, which provide resilience and improve health and social outcomes of people with SUD.
Harm Reduction Research and Policy
Dr. Bryce Pardo from the RAND Corporation Drug Policy Research Center, United States, facilitated the session. Professor Sir John Strang from the National Addiction Center at King’s College London, United Kingdom, described a trial conducted in the United Kingdom (RIOTT trial) that compared the effectiveness of injectable pharmaceutical heroin (diamorphine) with injectable methadone and oral methadone for the treatment of refractory heroin addiction. The RIOTT trial was conducted following a 2002 Strategy Paper in the United Kingdom recommending use of prescription heroin for individuals who have a clinical need for it. The trial enrolled about 130 participants with intractable heroin addiction who had failed other available treatment approaches. The primary outcome analyzed was reduction in use of street heroin (defined as less than 50% of urine samples testing positive for compounds found in street heroin); the researchers also determined the rate of complete cessation of street heroin use. Dr. Strang reported that supervised injectable heroin treatment provided the greatest benefits. At 4 to 6 months, almost 75% of the injectable heroin group produced at least 50% urine samples free of street heroin, compared with about 30% in the other two groups. Moreover, almost 20% of the injectable heroin group had completely stopped street heroin use, and a total of almost 60% only submitted zero to two positive urine samples, compared with less than 10% in the other two groups. The beneficial effects of injectable heroin were seen within 4 to 6 weeks of treatment initiation. Despite high implementation costs, the intervention was also shown to be cost effective.
Dr. Eugenia Oviedo-Joekes from the University of British Columbia, Canada, presented evidence from two trials on the role of medically prescribed injectable opioid agonist treatment for select individuals with opioid use disorder (OUD). In the North American Opiate Medication Initiative (NAOMI) trial, conducted in Vancouver and Montreal, 251 individuals with OUD were randomly assigned to oral methadone or injectable diacetylmorphine (heroin). After 12 months, treatment retention was significantly higher in the injectable diacetylmorphine group, which also showed a higher response rate (i.e., less use of street heroin, less illegal activity). After discontinuation of diacetylmorphine, street heroin use increased again, although not to the pre-trial level. Dr. Oviedo-Joekes also presented data from the Study to Assess Long-term Opioid Medication Effectiveness (SALOME), a non-inferiority trial comparing treatment with injectable hydromorphone and injectable diacetylmorphine. Both had high retention rates and reduced use of street-acquired opioids. Retention remained high when all participants were switched to hydromorphone at the end of the study. Moreover, hydromorphone was associated with significantly fewer adverse effects than diacetylmorphine. Overall, with more than half a million injections delivered in the NAOMI and SALOME studies as well as a cohort study, there were only 73 overdoses. Dr. Oviedo-Joekes noted that both injectable hydromorphone and injectable diacetylmorphine are approved for treatment of OUD in Canada, and several sites for supervised injection have been set up. She further noted that daily visits for supervised injection offer an opportunity for comprehensive care and to connect individuals with other services.
Dr. Elaine Hyshka from the University of Alberta, Canada, described efforts to advance implementation science on supervised consumption services (SCS) in Canada. SCS provide a safe environment for individuals to consume illegal drugs and to receive emergency care in case of an overdose or other health and social services. There are about 120 sanctioned SCS globally, including 37 in Canada. In addition to these sanctioned sites, overdose prevention sites exist that are often unsanctioned and less permanent; these typically operate with fewer rules and intake procedures than SCS and thus pose lower barriers. These sites can be implemented quickly and with minimal resources and may be able to attract individuals at higher risk of overdose because they are often peer-led. Dr. Hyshka also described other innovative models that have integrated SCS and overdose prevention sites into hospitals, primary care facilities, housing facilities, or set up temporarily at events; such approaches may also be expanded to correctional settings. Mobile models have also been implemented but are challenging to operate. SCS approaches are being investigated for non-injection routes of consumption (e.g., inhalation). She noted that, overall, the Canadian experience shows that SCS models are highly adaptable; however, the heterogeneity of SCS models and the inconsistent outcome definitions make comparative research difficult.
Dr. Brandon Marshall from Brown University, United States, reported on overdose prevention centers as a harm reduction approach in the United States against the backdrop of increasing numbers of overdose deaths. Until 2021, these centers were unsanctioned, limiting their capacity and scope of services. An evaluation of such an unsanctioned site found evidence of positive outcomes such as reduced needle sharing, fewer emergency department visits, and increased treatment access. In 2021, two sanctioned overdose prevention sites opened in New York City that are embedded into existing syringe service programs and offer a range of services, including access to buprenorphine. Within the first 6 months, they were used more than 20,000 times by more than 1,200 individuals, and more than 300 overdoses were successfully reversed. Dr. Marshall also mentioned that Rhode Island has become the first state to officially authorize overdose prevention sites—including on-site premises, mobile units, and short-term
units—for a 2-year pilot program. The Rhode Island Department of Health has finalized a regulatory and licensing framework for these sites; for example, the facilities must provide services for both injection and inhalation. The first sites are expected to open in 2022. Researchers are planning to evaluate the effects that these overdose prevention centers have on the individuals who use them (e.g., reductions in overdose rates and other health problems, increased treatment initiation) and on the surrounding communities (e.g., effects on public health, public safety, and economic conditions), as well as barriers and facilitators to program success.
Lack of Integrity and Transparency in Drug Treatment Services: Adverse Effects on Treatment Outcomes and Infringement of Human Rights
Dr. Elizabeth Saenz from UNODC Switzerland, who facilitated the session with Ms. Alice Uhl from UNODC Austria, noted that addiction treatment in too many locations suffers from serious deficiencies. Treatment programs are often of poor quality, understaffed, and fragmented; lack governance; and are associated with stigma and corruption. UNODC seeks to identify factors that contribute to these deficiencies. As Ms. Uhl explained, corruption can take multiple forms but always includes three key elements, namely authority and power, advantage, and abuse or misuse. Corruption has been defined in the United Nations Convention Against Corruption, the only legally binding, universal anti-corruption instrument. Corruption in the health sector is a severe threat that can mean the difference between life and death. People with drug use disorders are particularly vulnerable, and vulnerability facilitates corruption.
Ms. Alexandra Plante from the National Council for Mental Wellbeing, United States, explained that substance use treatment can be considered a distress industry—an industry that serves individuals under duress and thus has a high potential for corruption and abuse. Six forms of corruption and abuse can be seen in the SUD treatment field. They include:
- Patient brokering, where individuals who can identify patients looking for treatment (e.g.,because they are contacting call centers in emergency situations) receive monetary rewards forselling those leads to treatment providers.
- Listing hijacks, where the online listings for legitimate treatment facilities are compromised andchanged to those of other providers, so that the client does not reach the provider they arelooking for.
- Patient enticement, in which unethical incentives such as money, gifts, housing, etc., are offeredto potential patients.
- Insurance overbilling and fraud, such as charging for services not rendered.
- Violation of patient privacy policies, such as those specified in the United States’ HealthInsurance Portability and Accountability Act.
- Misleading language or misrepresentation of services available at treatment facilities.
Ms. Plante reported that in response to gaps in federal and state regulations of unethical addiction treatment marketing practices, private monitoring services have developed, such as the partnership between Google Ads and LegitScript. More research is needed to determine the prevalence and type of corruption in the SUD treatment arena and to identify gaps in regulations. Greater standardization of addiction treatment delivery is also needed.
Mr. Alan Johnson, Chief Assistant State Attorney in Palm Beach County, Florida, introduced efforts to combat fraud and abuse in the Sober Homes and treatment industries in the county. “Sober Homes” represent a transitory step in the treatment process where groups of people with SUD live together for a certain amount of time between outpatient care and a return to their own homes. In practice, treatment facilities frequently cooperate illegally with marketers and Sober Home owners to direct patients, frequently from out of state, to treatment centers for lucrative reimbursements. To address this type of corruption, Palm Beach County instituted a “Sober Homes Task Force” that included both a civilian workgroup (doctors, clinicians, patient advocates, industry lawyers, other organizations) and a law enforcement group (prosecutors, investigative teams, sheriff’s office, Florida Department of Law Enforcement) and whose work resulted in a Grand Jury report and a report to the Legislature. Since November 2016, the work of the Task Force has resulted in more than 120 arrests, more than 100 convictions, more than $1.8 million in fines, and more than $1.5 million in forfeitures, demonstrating the effectiveness of the approach. Additionally, the Florida Legislature has passed more robust legislation for certification of Sober Homes.
Dr. Carmen Albizu Garcia from the University of Puerto Rico described structural factors that endanger the human rights of people with OUD in Puerto Rico, based on a study “Vulnerability in Persons with Addiction Disorders in Puerto Rico and its Relationship with Human Trafficking.” Few treatment options for SUD are available in Puerto Rico, many of them based on a “character re-education” inpatient program that is confrontational and shaming. As a result of the lack of treatment, many of the affected individuals are offered relocation to the mainland United States for treatment. However, often the treatment they receive there is substandard and does not offer the promised services. Interviews with individuals who had been relocated identified elements suggestive of human trafficking. The initiation of these transfers coincided with reductions in treatment capacities in Puerto Rico and increasing gaps between demand and supply of SUD treatment. Puerto Rican authorities support the relocation efforts to “clean up” their communities. It is important to deconstruct stereotypes of drug use as “evil,” eliminate structural factors in policies and regulations that hinder treatment availability, professionalize services, and increase the availability of science-based and respectful treatment services.
Ms. Daniela Cepeda Cuadrado from the U4 Anti-Corruption Resource Centre, Norway, provided an overview of corruption in the health sector, particularly the substance misuse and mental health fields. Corruption in this field is common because mental health disorders, including SUD, are most prevalent among the groups most vulnerable to corruption, including migrants, women, young people, poor individuals, and other marginalized groups, and the vast majority live in low- and middle-income countries. Additionally, various forms and consequences of corruption can exacerbate mental health problems. Characteristics of both the mental health care space (e.g., stigma and discrimination) and the health sector in general contribute to a lack of transparency and accountability, which reinforces corruption opportunities. Corruption can manifest in different ways, including over-prescribing of medications for financial gain, lack of transparency regarding conflicts of interest in clinical trials, transnational corruption, falsified medical products, fraud, and embezzlement. Research and raising awareness are essential for reducing corruption, as is greater regulation of the relationship between pharmaceutical companies and health care professionals.
Developing Alternatives to Conviction or Punishment
Ms. Kara Rose from the U.S. Department of State, Bureau of International Narcotics and Law Enforcement Affairs, who chaired this session, reviewed alternatives to incarceration programming that are being developed globally. The earlier people are diverted out of the justice system into treatment, the better their outcomes are; even short incarceration increases risk of future incarceration. Diversion from the justice system into community-based services and recovery support can occur at the time of the offense, during initial detention and court hearings, as well as during and after adjudication (e.g., drug courts). Several courses on developing and implementing alternatives to incarceration exist, including the Alternatives to Incarceration Policy Makers Course, which has been piloted in Jamaica, Guyana, Kenya, and Chile and is available in English, Spanish, and French; and the Case Care Management (CCM) Course aimed at policy makers and professionals in the judiciary, health, and social services sector, which has been piloted in Trinidad, Tobago (see presentation below by Ms. Maharaj), and Jamaica and is available in English and Spanish. Core quantitative and qualitative metrics as well as supplemental metrics have been developed to measure the success of alternatives to incarceration.
Ms. Anja Busse from the UNODC Drugs, Laboratory and Scientific Services Branch explained how UNODC supports public health and justice system collaboration. Many people with SUD are in contact with the criminal justice system, and drug use among prison populations is four times higher than in the general population. Most individuals in the criminal justice system are incarcerated for drug possession for personal use rather than drug trafficking; these individuals can be diverted into alternative measures. UNODC together with WHO had already developed International Standards for the Treatment of Drug Use Disorders. Based on a mandate by the UNODC Commission on Narcotic Drugs, they also developed Guidelines for the Treatment and Care for People with Drug Use Disorders in Contact with the Criminal Justice System. The handbook, which is available in English, French, Spanish, Russian, and Arabic, presents treatment alternatives to conviction and punishment and is based on the concept that treatment is an effective public safety strategy by reducing involvement in criminal behavior. The guidelines include alternatives at the pre-arrest, pretrial, trial/sentencing, and post-sentencing levels. Their implementation is based on seven overarching principles. Ms. Busse noted that in a survey of UN member countries, out of 77 responding countries, 62 offered at least one alternative to conviction or punishment for some drug-related offenses committed by adults, and two-thirds of these offered alternatives at more than one stage of the criminal justice continuum. Thus, there is a high agreement on the need for alternatives to conviction and punishment. However, it is also important to note that compulsory treatment is ineffective and legally not considered an alternative because it is a custodial measure. UNODC provides technical assistance for the implementation of alternatives to incarceration at the country level (e.g., Kenya, Nigeria, Cote D’Ivoire)
Dr. Kate Elkington from Columbia University and New York Psychiatric Institute, United States, introduced Project Opioid Court REACH, an implementation research project to evaluate an innovative Opioid Intervention Court model. To support immediate, targeted, and intensive treatment and court supervision for individuals at high risk of opioid overdose, the first Opioid Intervention Court was established in Buffalo, New York, in 2017. It is based on voluntary participation in treatment that happens before a plea is entered and incorporates rapid evaluation of an individual’s overdose risk as well as access to medication treatment for OUD. This court was shown to be more effective than traditional drug courts in linking participants to treatment. In 2019, a statewide roll-out of the model was announced, which is evaluated in Project Opioid Court REACH (Research on Evidence-based
Approaches to Court-based Health care). The study is conducted in 10 counties and uses administrative data to drive practice change to achieve successful implementation and evaluate court performance. Dr. Elkington explained that the evaluation uses the opioid care cascade model to measure court performance, which is based on collaboration between the court and treatment systems. It is hoped that Opioid Intervention Courts will enhance participant retention at each step of the cascade. Project Opioid Court REACH involves local court stakeholder groups (e.g., judges, prosecutors, defense attorneys, law enforcement, treatment providers, peer recovery advocates), technical assistance providers from the Center for Court Innovation, and the research team. The study follows an EPIS model, with an exploration phase resulting in a needs assessment report; a preparation phase resulting in an action plan; and implementation and sustainment phases where data are collected, data reports are generated, and action plans are adjusted by the stakeholder group as needed based on the data reports. Initial analyses found that enrollment of referred participants in the opioid care cascade is high, but that treatment initiation, retention, and completion are relatively low and are the targets of action plans from the local systems. Scale-up of this model likely requires integrated implementation strategies.
Ms. Sintra Maharaj from the Ministry of National Security of Trinidad and Tobago reported on the integration of a CCM approach into probation services in her country. Probation services currently oversee around 160 clients. Their probation and community services officers serve to implement and monitor the probation process and help with implementation of the treatment plan, including ancillary services (e.g., obtaining necessary documents, helping with educational, vocational needs). The CCM curriculum (described earlier by Ms. Rose) was introduced in 2019 and is being implemented through the Probation Services Division. It serves to enhance the division’s existing coordination and integration systems and allow them to deliver more efficient and timely services, without incurring additional costs. The system involves a multi-step process from intake and screening to completion, after-care, and follow-up. An important component is mentorship of the clients by the probation officers as an additional layer of support. The program is guided by a CCM operational plan that supports implementation of all steps and includes a Mapping Report that lists 16 categories of available services from government and civil society organizations. The Trinidad and Tobago team was the first team to be trained in the CCM approach in 2020, with 59 participants from 18 organizations and government agencies participating in the training. The pilot project was launched in September 2021, with numerous activities initiated since then, although certain challenges exist (e.g., access to vocational/educational programs, difficulties for mentees to access mentors in certain geographical areas; cultural challenges such as high acceptance of alcohol and marijuana consumption). To date, 24 clients have been enrolled, the mentor matching process has begun, and the testing of the CCM database is ongoing.
Drug Use in the Americas
Ms. Marya Hynes from the Inter-American Drug Abuse Control Commission (CICAD) at the Organization of American States, provided an overview of drug use in the Americas based on analyses by CICAD’s research unit, the Inter-American Observatory on Drugs. The research, which analyzed information for secondary school students, college students, and households collected between 2006 and 2015, used standardized data among the countries to allow comparison. With respect to alcohol consumption, research in secondary-school students found that the gender gap between males and females has been
decreasing. Moreover, among those high school students who consumed alcohol, more than 50% engaged in binge drinking. Cannabis use has increased both among high school students and the general population in most countries. Cocaine use has the highest priority in Latin American countries. Cocaine use trends among secondary school students differed among countries, with no clear overall trend. Among college students, cocaine use increased in 3 out of 4 countries, and among the general population it increased in about half of the countries. Emerging drugs in the hemisphere included methamphetamine and other synthetic drugs; new psychoactive substances; counterfeit or diverted medications; and isolated cases of new synthetic opioids such as fentanyl. Increasing risk also stemmed from adulterated drugs, with adulterants found in cocaine, heroin, ecstasy, and LSD. Misuse of prescription medications, particularly tranquilizers and sedatives, also was common in the analyzed countries, and in most countries was more common among women than among men. Benzodiazepines were the most commonly adulterated drugs on the black market.
Community Anti-Drug Coalitions of America (CADCA) Session
In this session chaired by Dr. Lindsey Friend and Dr. Randy Koch from Virginia Commonwealth University, Mr. Eric Siervo from CADCA provided some background information on the organization. CADCA is a non-governmental organization of grassroots movements across the United States. To date, more than 5,000 community coalitions have been established in the United States, as well as more than 300 coalitions in 28 other countries. Since 2005, CADCA has been partnering with the Hubert H. Humphrey Fellowship program, offering training and information to Humphrey fellows on community coalitions and their methodology and operation, so that these fellows can then apply this knowledge in their home countries. CADCA’s model for community change has the goal of increasing collaboration between community sectors to develop social capital to address community problems as well as to reduce substance use and address related problems. Community coalitions are formal agreements and collaborations between community groups or sectors working together to achieve the common goal of building safer and healthier communities by sharing knowledge and resources. According to their model, community coalitions should include at least 12 community sectors; involve a strategic planning process and training in prevention science; and generate and implement comprehensive strategies at both the individual and the environmental level. To date, Humphrey fellows have developed community coalitions in Togo, Ghana, Uganda, and Mauritius.
Mr. Rogers Mutaawe from the Uganda Youth Development Link (UYDEL) described the project he initiated following his 2015-2016 fellowship year at Virginia Commonwealth University. UYDEL provides services for youth in Uganda and serves as an advocate for them. Their community coalition pilot project started in 2017 and, to date, coalitions have been established in the cities of Bwaise and Nansana. In Bwaise, 65% of the population are young people ages 15 to 25 years, and many girls are involved in the sex trade. UYDEL managed to establish a coalition that represented 12 community sectors. This coalition first identified an existing problem (i.e., excessive alcohol use) and its root causes (i.e., high alcohol availability) as well as local conditions contributing to the problem (i.e., easy access to alcohol in stores). They then developed comprehensive strategies for community change to reduce alcohol use. In cooperation with the local governments, several coalitions were launched, and although adaptations had to be made during the COVID-19 pandemic, the activities of these coalitions (such as community awareness sessions, prevention through sports, outreach at primary schools, or community clean-ups)
have resulted in several achievements. These include new bylaws that limit the sale of alcohol to minors, activities that stimulate a sense of belonging to the community, improved partnerships with several groups, and increased knowledge and information.
Mr. Mawouena Bohm from the Togo Interministerial Anti-Drug Committee, who also was a Humphrey fellow in 2015-2016, reported that several community coalitions have been established in Togo. CADCA chose non-governmental organizations in Togo as partners in 2016, and a tailoring visit took place in the fall of that year. The first two community coalitions were established in January 2017, with five more coalitions following in 2018. Trainings began in June 2019. Coalition core team leaders for all sites were chosen based on recommendations from local organization. For example, one coalition was established in the canton of Sanguera, which comprises 19 villages and has a population of 40,000 people, with 26% living at the poverty level. Sanguera is a hotspot for drug use and petty crime, making it a good site for community coalitions as a prevention measure. Since its inception in 2019, the coalition grew from 12 to 132 members that represent 12 community sectors and has four working committees. The main problem identified by the coalition was marijuana use, which is driven by both easy access and community disorganization; they also identified local conditions contributing to these causes. Based on these findings, they developed comprehensive strategies for community change that have resulted in achievements such as collaboration with the law enforcement to dismantle the network of marijuana sellers and discourage consumption; activities to raise awareness of the coalition and its goals; and monthly capacity-building sessions for coalition members.