1

CICAD: Demand Reduction, EU-LAC

2

CICAD: Demand Reduction, EU-LAC

3

CICAD: Demand Reduction, EU-LAC

Project Desrciption

 

Project Description:

The European Commission’s Latin American Regional Strategy calls for: increased attention to economically-deprived and socially-excluded populations who require access to drug treatment and rehabilitation services; decentralization of policies, plans and projects to the local level and improved capacities of local authorities and civil society to tackle local adverse consequences of drug use. The regional programming for the Caribbean under the European Development Fund, also highlights the importance of addressing demand reduction issues in the region. The project will strengthen synergies among civil society networks on both sides of the Atlantic, and help cities to promote ethical treatment of drug users.

CICAD’s priorities and programs in the area of drug treatment, detailed below, have focused thus far on creating regulations and the appropriate regulatory authority over drug treatment; helping CICAD member states diversify the types of drug treatment and rehabilitation programs available, and advocating the need for integration of drug treatment programs into the countries’ health care systems.  Through this Project, CICAD will promote this regulatory, good governance approach at the municipal level, and encourage local advocacy for improved drug treatment and rehabilitation.

Identification of perceived needs in drug treatment and rehabilitation in EU and LAC cities


Need to improve professional training in drug treatment and rehabilitation at the municipal level

In Latin America and The Caribbean, drug abuse and dependency problems and related health and social harms are treated largely by NGOs that function

independently, or with very weak ties to the government health and social services. This translates into a limited range of care, which does not meet the varied needs of drug-dependent individuals. At the same time, the government health care services, particularly at the local level, generally do not have sufficient staff trained to diagnose and treat health problems related to drug use. The project will contribute to awareness of the need for training, and provide opportunities for the exchange of best practices. 

Usefulness of cross-learning by EU and LAC cities

EU countries, cities and regions have invested considerable resources in drug treatment, rehabilitation and harm reduction* programs and research. That expertise and experience will be of significant help to drug treatment providers in the participating cities in LAC. But at the same time, particularly as regards cocaine, LAC countries have considerable experience with the treatment and rehabilitation of  vulnerable and socially excluded populations, such as street children and gang members, which will surely be of relevance to EU cities that may be experiencing similar problems.

Situation of drug treatment programs in LAC

Drug treatment, rehabilitation and aftercare services are still not fully regulated by local government authorities, are usually under-funded and insufficient for the number of potential clients.

With a few exceptions, drug treatment programs are not integrated into national health care services, and therefore there is virtually no continuum of care, and no matching of patient to treatment (both of which are critical to patient recovery). 

Record-keeping in drug treatment programs is sparse, and few data exist on, for example, clinical histories of patients, the extent to which they may be using drugs during or after treatment, co-morbidity, family issues, and social exclusion.

Many countries/cities have no system or structure to license drug treatment professionals, nor do they have fully comprehensive training programs that could lead to licensing.

Traditional harm reduction approaches, such as needle exchange and substitution treatment, are not yet relevant to or widely understood in most cities in LAC, since injecting drug use, according to CICAD studies, is statistically insignificant almost everywhere except Brazil. In the Caribbean and in some South American countries, where HIV infection rates are relatively high, some harm reduction measures are in place.  Recovery readiness models (low thresh-hold walk-in centers, for example), which treat health problems associated with drug use (e.g., tooth decay, sexually-transmitted diseases, Hepatitis A and C, etc.) and which do not require an individual to be drug-free before entering treatment are, however, appropriate and needed, and will be promoted through this Project.

Alternatives to incarceration for petty offenders who are also problematic drug users

Prisons in LAC and in the EU are often over-crowded, under-staffed and poorly equipped.  Alternatives to incarceration for drug-dependent petty offenders who are charged with misdemeanors may be an option that participating cities would wish to consider, legislation permitting.  In LAC, Kingston and Montego Bay (Jamaica) and Belmopan (Belize) have incipient drug courts or court-ordered community service for drug-dependent petty offenders. In Europe, the UK Youth Justice Board “sentences to the community”, including community service and drug treatment orders, can be particularly relevant to LAC experiences, as are the drug courts operating in Glasgow and Fife (Scotland), Leeds and West London.  Eire also has some experience with drug courts.

Most Latin American countries do not penalize drug use, but rather provide for “diverting” petty, first-time offenders into treatment.  However, lack of resources, experience and infrastructure make it difficult for the central and municipal governments to deliver effective care to drug-dependent offenders who are in court-ordered treatment.

A first step in developing such alternatives, when desired and feasible, is to sensitize family court judges and prosecutors in LAC to consider drug treatment as an alternative to incarceration for drug-dependent petty offenders.

EU issues in drug treatment and rehabilitation

The rise in cocaine shipments from LAC to the European Union has resulted in more new cases of cocaine use in the EU, and hence there is a need to provide appropriate early diagnosis and treatment of cocaine addiction. This Project will bring to bear LAC expertise and experience with the treatment of problematic cocaine use.

LAC immigrants to European Union countries are often culturally and ethnically different from the people in the host countries. These differences may be a barrier to effective treatment of drug dependency. Thus, LAC partners can provide advice and assistance to European host countries in dealing with these populations.  

EU countries’ public health and social welfare policies, in many cases, allow for publicly-funded drug treatment in a well-regulated environment, which may help LAC cities develop their own similar models.  

CICAD/EC Partners in the City Partnerships 

City mayors and councilors, as well as drug treatment providers are the major partners in this project. Officials’ decision-making and regulatory role and the NGOs’ efforts are key to the provision of improved drug treatment and rehabilitation programs in their cities.  In particular, elected mayors and city councilors who play the key role in the allocation of local resources, can respond to constituent demands for ethical treatment and well-qualified care, and can act to prevent abuses of human rights in drug treatment facilities and in prisons. Treatment providers will have the opportunity through the project to improve quality and accessibility of drug treatment, rehabilitation and  harm reduction* programs, and who can decide to organize better-integrated services.   

Local judges and prosecutors who typically work in “family” or juvenile courts and deal with petty offenders, some of whom have problems of drug and/or alcohol addiction and may also have mental health disorders. Sensitizing them to the local availability of drug treatment and rehabilitation programs, to the rehabilitative process itself, and to the concept of restorative justice could pave the way for better handling of drug addiction as well for humanizing the court systems and relieving the overcrowding of prisons.  

 Project Activities


Establishment of a network of EU/LAC partner cities  

CICAD will help establish a network of twinned cities in LAC/EU that will focus for three years on raising awareness and exchange best practices among city policy-makers of the health, social and cost benefits of providing quality drug treatment, rehabilitation and  harm reduction* programs and on exchanging experiences and best practices in this regard.  The network focal point in each city will be the mayor (or a top representative), who will participate in the high-level policy exchanges among EU and LAC cities.  

Two LAC-EU inter-regional fora on drug treatment, rehabilitation and harm reduction*

An inter-regional forum of city mayors and councilors and their senior technical staff will be held in April of 2008, Santo Domingo, Dominican Republic. The forum, which will last for two and a half days,  will be open to delegations from all interested cities, with up to four persons per delegation.  The goal will be to highlight best practices in drug treatment and rehabilitation; plan joint activities of mutual interest, and raise awareness of the need for quality care. Each participating city, in most cases, will defray the cost of travel and hotel accommodations of its own mayor.  The forum will feature an agora in which cities will broker their partnership agreements, and match their qualifications and needs with twin cities, and develop an action plan specifying their shared goals and anticipated results of the exchanges.  

The local technical teams will agree on exchanges and policy discussions to be carried out over the following two and a half years among the twinned cities.

A wrap-up forum will be held in the third year of the Project, in an EU city, to assess the results of the Project, and agree on a transition to local ownership and follow-through.  

Conclusion of agreements between CICAD and partner cities, and among twinned cities

CICAD will sign Memoranda of Understanding (MOUs) with partner cities to agree a plan of action and schedule for the execution of activities. CICAD will encourage partner (twinned) cities to conclude agreements amongst each other that will specify the activities that they will conduct together.

Exchanges and policy discussions among EU and LAC cities

In order to develop program exchanges among twinned EU and LAC cities, as per their letters of agreement or MOUs, CICAD will make available tools to facilitate these exchanges (online access to all participants with information about each partner, their interests, application forms, institutional support, etc).  

The initial exchange visits will be among city mayors, accompanied by two technical staff.  These high-level visits will give immediate impetus to the Project, with attendant public attention and visibility. A typical exchange visit, which would be programmed by the host city, would be for two or three days, and would involve the visiting mayor in a press conference, a TV/radio appearance, a visit to a drug treatment program, and a walk-about.  

The technical teams would at the same time work out specific plans for future cooperation on topics of mutual interest, for example:

  • Drug treatment for women, prisoners, adolescents;
  • Best practices in release from treatment, follow-up and aftercare;  
  • Structuring of city services, such as housing, education, health care, job training and placement, low threshold walk-in centres.

Subsequent EU/LAC exchanges with partner cities will be at the technical level.  Each technical team would typically consist of four individuals: a representative of the city Drug Commission; a representative of the city Board of Health (typically, the Head of Mental Health); a representative of the local court system, and a representative of an NGO treatment provider.  Such exchanges will, generally, last for four days.

City-wide directories of drug treatment and rehabilitation services  

When not already available, the local technical teams, under Mayoral direction, will gather information, based on a standard questionnaire furnished by CICAD, on the overall status of drug treatment, rehabilitation and harm reduction* in their respective city, the characteristics of the demand for these services, and the way in which the treatment and health care services are organized to meet that demand.  These city teams may contract local universities (typically, Schools of Public Health) to produce the directories.   

The resulting study will involve developing or updating a city-wide directory of all drug treatment, rehabilitation and  harm reduction* programs, specifying their characteristics, modalities of  care, cost, if any, and other information that a prospective patient/client and his/her family might need.  Participating cities will commit to publishing their directories, either on the Web, or in local newspapers, or through the distribution of flyers.  

This Project will make a significant contribution to improvement of the availability of drug treatment and rehabilitation services in LAC cities, the great majority of which have no directory of available services.  

Review, adaptation and publication of materials on best practices in drug treatment, rehabilitation and harm reduction*

The existing materials from EU and LAC on best practices will be gathered, reviewed and adapted for use at city level by CICAD and the local technical teams, who will produce basic templates and guidelines in English, Spanish, and, when appropriate, French and Portuguese. The content will emphasize how to operate an integrated network of services within the city; provide updates on drugs of abuse and complications deriving from drug use, and devote particular attention to the management of populations with special needs (e.g., dual diagnosis; adolescents with drug problems; women and prisoners in drug treatment; HIV/AIDS users  and drug-related emergencies). 

On-line shared workspace

CICAD will set up an on-line shared workspace.  The platform will enable program participants to use tools such as:

  • Communications (e.g., news, on-line fora, e-mail notifications)
  • Management of group work (e.g., shared documents with control of different versions, access rights, etc.)
  • Organization of tasks (e.g., diary entries for appointments, planning and scheduling, etc.)
  • Discussion of specific issues, with a monitored discussion.

Sustainability  

Sustainability of this Project will depend on the quality of the materials produced on best practices in the participating cities, on the extent to which local participants in exchanges can replicate the knowledge at home and, on the commitment of local authorities. Hence, the emphasis in this Project on the production of work plans for future cooperation, exchange of materials in English, Spanish, and whenever needed and possible, French and Portuguese via an on-line shared workspace, and structured agendas for meetings and exchanges.  

Program evaluation

CICAD will engage an external evaluator to design the ongoing evaluation of the program.  The evaluation will measure, inter alia, compliance with this plan of operations and its process indicators; intensity of intra- and inter-regional exchange through on-line workspace; number of exchanges and workshops held; improvements in drug treatment and rehabilitation policies and practices, etc.  This evaluation will take the findings and reports of the Multilateral Evaluation Mechanism (MEM), as well as the needs assessments performed in year one of the Project, as part of its baseline.

To the largest extent possible, each participating city will conduct its own evaluation, with its own funds, and following CICAD guidelines.

EU-LAC Drug Treatment City Partnerships is an initiative funded by the European Commission, and coordinated by the Inter-American Drug Abuse Control Commission (CICAD), Secretary for Multidimensional Security of the Organization of the American States (OAS). The content of this publication does not necessarily reflect the position of the EU or the OAS.

updated on 2/28/2011 4:44:16 PM