Drug demand reduction management models - an EU perspective. Jane Mounteney EMCDDA

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1 Drug demand reduction management models - an EU perspective Jane Mounteney EMCDDA

2 Programmes v Management models Interventions, programmes etc BEST PRACTICE 2

3 Programmes v Management models Interventions, programmes etc BEST PRACTICE Strategies, systems, coordination mechanisms etc BEST PROCESS 3

4 Good and bad news We do have EDDRA database on evaluated programmes, Cochrane reviews - best practice No database of management models best process! We do have some tools 4

5 The European picture. Drug demand reduction practice & processes vary considerably. 5

6 Factors influencing drug management systems? Management system 6 6

7 Factors influencing drug management systems National drug policies & strategies Existing services & organisations Politics Media Public opinion Budget & resources Management system Local drug policies & strategies Drug problem Best Practice/ Process 7 7

8 Factors influencing drug management systems National drug policies & strategies Existing services & organisations Politics Media Public opinion Budget & resources Management system Local drug policies & strategies Drug problem Best Practice/ Process Drug field Management/ business studies Health service organisation Public adminitration 8 8

9 Factors influencing drug management systems National drug policies & strategies Existing services & organisations Politics Media Public opinion Budget & resources Management system Local drug policies & strategies Drug problem Best practice 9 9

10 Drug demand reduction strategies in EU (Source: EMCDDA 2008) National level Treatment strategy all countries Drug-related-infectious-diseases (DRID) the majority Drug-related-deaths (DRD) less than half. Local level Treatment strategies - less than half DRID strategies - less than half DRD strategies - just a few. 10

11 Availability of demand reduction strategies in Europe Treatment Only national strategy Local strategies No information Source: EMCDDA SQ27,

12 Factors influencing drug management systems National drug policies & strategies Existing services & organisations Politics Media Public opinion Budget & resources Management system Local drug policies & strategies Drug problem Best Practice/ Process 12 12

13 Number of countries Diversity of treatment providers in Europe Psychosocial outpatient Psychosocial inpatient Detoxification Opioid substitution treatment 5 0 Public institutions Private providers NGOs GPs Providers Source: EMCDDA SQ27,

14 Factors influencing drug management systems National drug policies & strategies Existing services & organisations Politics Media Public opinion Budget & resources Management system Local drug policies & strategies Drug problem Best Practice/ Process 14 14

15 Main funding sources for drug treatment in Europe Only state funding Only regional funding Only health insurance funding Mixed models No information Source: EMCDDA SQ27,

16 Treatment costs (Source: EMCDDA 2008) Big differences across countries depending on: treatment system insurance and welfare system Example Opioid substitution treatment 15 countries: free of costs 3 countries: free for methadone but contribution for buprenorphine treatment 9 countries: depends on the provider (2 countries no info, Turkey no OST) 16

17 No one model fits all 17

18 Factors influencing drug management systems National drug policies & strategies Existing services & organisations Politics Media Public opinion Budget & resources Management system Local drug policies & strategies Drug problem Best Practice/ Process 18 18

19 Best process : 3 angles Good governance principles Process evaluation research/ tools Standards & guidelines 19

20 Good governance principals Most common: 8 principles put forward by United Nations organisations Good governance should be participatory, consensus-oriented, accountable, transparent, responsive, equitable and inclusive, effective and efficient and follow the rule of law. Key proponents include the United Nations (1997; 2007), the Organisation for Economic Co-operation and Development (2005), and the World Bank. 20

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22 Process evaluation research Vandam et al Drug policy responses need to be integral (global) and integrated (involvement of all relevant actors/services) 27 evaluations of cross-cutting interventions Success criteria: coordination; formal agreement; demarcation of tasks; regular meetings. 22

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34 Quality standards & Guidelines should be seen within the context in which they were developed. checked for validity and, if necessary, adapted locally. 34

35 In summary Many factors influence demand reduction management models Good practice & process Diversity no one model fits all Some tools around to help. 35

36 Thank you! 36

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