# Presentation: 012336

## Update on WHO research and training activities on drug use Vladimir Poznyak, MD, PhDManagement of Substance Abuse Department of Mental Health and Substance Abuse World Health Organization, GenevaNIDA International Forum, Orlando, 18 June 2005

## Slide 2

## Support for Training and Research from WHO

- Possibilities of funding from:
- WHO country offices
- WHO regional offices
- WHO Headquarters in Geneva
- International collaborative research projects involving at least 2 WHO regions
- In line with strategic directions of WHO and approved areas of work

*World Health Organization*

## WHO Priority Areas for 2006-2010 on Substance Abuse 

- Global research and policy initiatives on alcohol
- Policy guidance and support for implementation and evaluation of strategies and programmes to reduce alcohol-related harm worldwide
- Prevention and management of substance use disorders in health care system
- Development and promotion of effective interventions for substance use disorders integrated within primary  health care (PHC) S
- Drug dependence treatment and HIV/AIDS
- Advocacy, normative guidance and capacity building on treatment and service delivery for IDUs directed towards HIV prevention and care

*World Health Organization*

## Areas of Educational/Training Activities 

- Alcohol and drug epidemiology
- Short training workshops, e.g. in Benin, 2005
- Training of researchers/professionals in the framework of particular research projects
- WHO Collaborative Study on Alcohol and Injuries
- Alcohol, Culture and Gender
- WHO Drug Injection Study Phase II
- Screening and brief interventions in health care settings
- Treatment of opioid dependence, including evaluation of treatment

*World Health Organization*

## WHO-sponsored Fellowship Programs

- WHO Mental Health Fellowship Programme (6-9 month training in WHO Collaborating Centers  (Australia, Canada, UK)
- International Travel Fellowship programmes
- WHO-CPDD-NIDA
- WHO-ISAM (International Society of Addiction Medicine)

## WHO HIN Access to Research Initiative (HINARI)

- One of four major initiatives of the UN Millennium Action Plan, Sept 2000
- Supports public health programs and priorities
- Partnership between WHO and journal publishers
- First Health InterNetwork success: major breakthrough in making content available
- Delivers over 2400 biomedical journals online, free or at low cost, to health institutions in 113 low-income countries

## WHO Research Projects on Drugs  

- Comparative quantification of disease burden attributable to illicit drug use** **(WHO, 2004)
- WHO Drug Injection Study Phase II
- WHO ASSIST Project: Phase III
- WHO Collaborative Research Project on Drug Dependence Treatment and HIV/AIDS

*World Health Organization*

## Disease burden (DALYs) in 2000 attributable to selected leading risk factors (world)

***Number of Disability-Adjusted Life Years (000s)***

- Source: WHR, 2002

*World Health Organization*

## Burden of Disease (DALYs) Attributable to Illicit Drug Use 

- World (in 2000): 11 488 000 (0.8%)
- 	 Males: 8 769 000 (76%)
- 		Females: 2 719 000 (24%)

*World Health Organization*

## Burden of Disease (DALYs) Attributable to Illicit Drug Use, by Age 

*World Health Organization*

| 5-14 | 15-29 | 30-44 | 45-59 | >60 |
| --- | --- | --- | --- | --- |
| 177000 | 5691000 | 4397000 | 1211000 | 12000 |
| 1% | 50% | 38% | 11% | 0.1% |

## Deaths Attributable to Illicit Drug Use

- Estimated mortality (in 2000): 194 058
- 	Males: 149 425 (77%)
- 	Females: 44 463 (23%)
- AIDS: 			59 000 (30.4%)
- Opioid overdose: 	69 152 (35.6%)
- Suicide: 		32 216 (16.6%)
- Trauma:		33 689  (17.4%)

*World Health Organization*

## WHO Alcohol, Smoking and Substance Involvement Screening Test (ASSIST)

- Developed by international group of researchers
- Initially 12 item and now (V3.0) 8 item instrument
- Screens for health risks & problems associated with any psychoactive substance use
- Designed to provide lifetime and current (past 3 months) estimates of substance use and related risk

*World Health Organization*

## Stages of the WHO ASSIST Project

- Phase I (1997-1999)
- Planning and ASSIST development
- International Feasibility and Reliability Study of the ASSIST
- Phase II (2000-2002)
- International Validity Study of the ASSIST
- Feasibility Study of Brief Interventions Linked to the ASSIST
- Phase III (2003-2005)
- International Study of Efficacy of Brief Interventions Linked to the ASSIST (randomized clinical trial)
- Study sites in: Australia, Brazil, India, Thailand, USA
- Phase IV (2006-...)

*World Health Organization*

## WHO ASSIST Study Group 

- Robert Ali# (Australia)
- Elia Awwad* (Palestinian Territory)
- Thomas Babor # (USA)
- Fiona Bradley* (Ireland)
- Tecla Butau* (Zimbabwe)
- Michael Farrell (UK)
- Maria L Formigoni (Brazil)
- Rachel Humeniuk**# (Australia)
- Richard Isralowitz* (Israel)
- Jaroon Jittiwutikarn** (Thailand)
- Roseli Boerngen de Lacerda (Brazil)

- Walter Ling** (USA)
- John Marsden (UK)
- Bonnie McRee* (USA)
- Maristela Monteiro #(WHO)
- Sekai Nhiwatiwa** (Zimbabwe)
- Hem Raj Pal (India)
- Vladimir Poznyak** #(WHO)
- Maritza Rubio-Stipec* (Puerto Rico)
- Sara Simon (USA)**
- Janice Vendetti (USA)*
- * 	- Phase I only
- ** 	-  Phase II only
- # 	-  Involvement in study development and coordination

*World Health Organization*

## ASSIST Manuals for Field Testing

- WHO-ASSIST. Guidelines for Use in Primary Care
- Brief Intervention for Problematic Substance Use. A Manual for Use in Primary Care
- The Substance Users Guide to Cutting Down or Stopping

*World Health Organization*

## Report on alcohol use and sexual risk behaviour (WHO, 2004)

**Overall objective:  **establish determinants of alcohol related sexual behaviours in diverse communities and cultures in the context of HIV.
**Study sites:**
- Belarus
- India
- Kenya
- Mexico
- Romania
- Russia
- South Africa
- Zambia

## Area of work: substance abuse and HIV/AIDS

- 	WHO Collaborative Project on Drug Dependence Treatment and HIV/AIDS
- Outcome and process evaluation of pilot or recently established ST programmes
- Study sites in: China (Beijing), Indonesia (Jakarta, Bali), Iran (Tehran), Lithuania (Vilnius, Kaunas, Klaipeda), Poland (Warsaw, Lodz), Thailand (Bangkok), Ukraine (Kherson, Kiev)
- Guide on HIV prevention in drug treatment settings

*World Health Organization*

## WHO Collaborative Project on Drug Dependence Treatment and HIV/AIDS

- 	WHO Opioid Substitution Therapy Study Group:
- 		Robert Ali, Rachel Humeniuk, David Newcombe (*Australia*), Sithisat Chiamwongpaet (*Thailand*), Sergey Dvoryak (*Ukraine*), Boguslaw Habrat, Jacek Moskalewicz (*Poland*), Ratna Mardiati, Riza Sarasvita (*Indonesia*), Azarakhsh Mokri (*Iran*), Vladimir Poznyak (*WHO Geneva*), Emilis Subata (*Lithuania*), Ambros Uchtenhagen, Ulrich Frick (*Switzerland*), Chengzheng Zhao, Shi Jie (*China*).

*World Health Organization*

## Overview of the samples in MMT in 2 sites (R. Mardiati, R. Sarasvita, S. Chiamwongpaet)

*World Health Organization*

| SITE | HIV | HCV | AVERAGE DOSAGE |
| --- | --- | --- | --- |
| Indonesia
  (N=99) |   57% 
 (N=65) |   92%
 (N=55) | 32 mg |
| Thailand
  (N=118) | 50%
(N=115) | 94%
(N=111) | 28 mg |

## Heroin use in patients in Indonesia and Thailand at 3 and 6 month follow up

## Drug injecting in patients in Indonesia and Thailand at 3 and 6 month follow up

## Other Recent WHO Activities on Substitution Therapy for Opioid Dependence 

- WHO/UNODC/UNAIDS Position Paper on Substitution Therapy in Management of Opioid Dependence and HIV Prevention
- The practices and context of pharmacotherapy of opioid dependence in Central and Eastern Europe. WHO, 2004
- Proposals for methadone and buprenorphine to be included in the WHO Model List of Essential Medicines
- Under "Psychotherapeutic medicines/*Medicines used in substance dependence"*
- Development of WHO guidelines on treatment of opioid dependence in collaboration with UNODC

## WHO Management of Substance Abuse

- www.who.int/substance_abuse/

- E-mail: poznyakv@who.int

*World Health Organization*