International drug control efforts cannot be successful in the long term without continuous efforts to reduce illicit drug demand. That is why the drafters of the international drug control conventions made demand reduction an obligation for Governments. Another important step forward was the adoption in 1998 of the Declaration on the Guiding Principles of Drug Demand Reduction, a globally accepted set of standards, at the twentieth special session of the General Assembly.
The first chapter of the present report of the International Narcotics Control Board focuses on preventing drug abuse, a crucial area of demand reduction. Primary prevention encompasses measures taken to prevent and reduce drug abuse in populations that are either not abusing or not seriously involved with drugs. There is good reason for society to take concerted action to prevent drug abuse. Even a single early experience with drug abuse can have serious consequences, such as unintentional injury, overdose or arrest.
Primary prevention strategies need to address both the general population and groups that are particularly vulnerable to drug abuse. While large-scale efforts can go a long way towards raising awareness and can reduce illicit drug demand, they may lack the focus or intensity to address effectively the needs of vulnerable population groups. An effective drug abuse prevention strategy should include both types of measures: measures targeting the general population and measures targeting the more vulnerable population groups.
For primary prevention strategies to be effective, it must be possible to put them into action. All too often, priority is given to highly visible but short-lived responses such as a stand-alone media campaign. To result in significant social and economic benefits, prevention measures need to be complemented by other measures.
As drug abuse is a continuous challenge, it requires constant attention and action. Drug abuse prevention is a fundamental health issue. Drug abuse prevention activities should be integrated into public health, health promotion and child and youth development programmes. Policymakers need to commit resources to such activities.
Primary prevention efforts that involve the Government alone cannot be effective. Partnerships with civil society need to be forged at the local, national and international levels to ensure the most efficient use of scarce resources and to increase effectiveness in reducing the prevalence of drug abuse. Credible nongovernmental organizations promoting children and youth and accustomed to working alongside community representatives can lead prevention efforts at the local level that are evidence-based and culturally appropriate. Because of their extensive direct involvement in that area, such organizations have an important perspective that needs to be heard at the policymaking level.
One disturbing trend highlighted in the present report is the increasing abuse of pharmaceutical preparations containing substances under international control. In the United States of America, where the problem is well documented, the abuse of prescription medicines is more prevalent than the abuse of cocaine, heroin or methamphetamine. One matter of particular concern is that people often do not associate any particular risk with the non-medical use of pain medication. The extent of such abuse is underreported and not adequately studied. The Board recommends that Governments launch prevention programmes to make youth and families more aware of the dangers of abusing controlled medicines.
Drugs containing substances such as oxycodone, methadone and hydrocodone are subject to strict international control. States that are parties to the international drug control conventions are obliged to regulate access to those drugs and prevent their abuse. Illegal Internet pharmacies violate those regulations by making prescription drugs available to persons without the necessary prescription, which puts consumers of those substances at an inordinate risk. To assist Governments in addressing that problem, the Board issued, in 2009, the Guidelines for Governments on Preventing the Illegal Sale of Internationally Controlled Substances through the Internet, together with a framework of action to help Governments to prevent the illegal online sale of prescription drugs. Governments should make use of the Guidelines and take further action to control the illegal sale of prescription drugs. The Board is ready to support Governments in their efforts to combat the abuse of prescription medicines.
The Board has been the leading advocate of increasing the licit use of opioid-based medications. The consumption of those substances for medical purposes is regularly reviewed in the reports of the Board. The Board has worked with the World Health Organization (WHO) in preparing guidelines for the assessment of national laws and policies with a view to identifying ways to improve the availability of medications. The Board has developed with WHO the Access to Controlled Medications Programme. In addition, the Board has convened a joint working group with WHO to assist Governments in establishing more realistic estimates of requirements for medications containing internationally controlled substances. Overly restrictive policies are contrary to one of the principles enshrined in the international drug control conventions: that the medical use of narcotic drugs is indispensable for the relief of pain and suffering and that adequate provisions must be made to ensure their availability for such purposes.
Sevil Atasoy, President International Narcotics Control Board