European Commission Justice Date | # EQUS Conference, June 2011 Building an EU Consensus for minimum quality standards in drug demand reduction - Setting the Scene - EQUS Conference 2011 European Commission Justice

European Commission Justice Date | # EQUS Conference, June 2011 Basic principles EU approach on drugs… Balanced, integrated approach between drug demand and drug supply reduction Based first and foremost on the fundamental principles of EU Law, and; Upholds the founding values of the Union: Respect for human dignity, liberty, solidarity, proportionality, the rule of law and human rights

European Commission Justice Date | # EQUS Conference, June 2011 Drug policy is primarily the competence of EU Member States The European Commission has a complementary role in this field The EU Drug Strategy and Action Plans provide objectives and a framework with actions in drug demand reduction Member States adapt these actions in accordance with their own national policies, needs and culture Scientific research and information are important resources for further cooperation and coherence between Member State policies The EU drug strategy does not prescribe national drug policy, but promotes collaboration, exchange and convergence between Member States EU drug policy cooperation…

European Commission Justice Date | # EQUS Conference, June 2011 Initiate and propose objectives and actions in EU drug policy Monitor and evaluate the implementation of EU drugs policy Initiate legislation within legislative framework of the EU Treaties Initiate EU control measures for new drugs based following EMCDDA/ Europol risk assessments Enforce the EU laws to control and prevent the use of chemical precursors for the manufacture of illicit drugs Foster European cooperation through funding Support data collection, exchange of information and best- practices, e.g. through EMCDDA Cooperate with civil society organisations Role of the European Commission

European Commission Justice Date | # EQUS Conference, June 2011 Activities to enhance knowledge base Information & Monitoring Research EvaluationStudies

European Commission Justice Date | # EQUS Conference, June th & 7 th RTD Framework Programme Prevention: Quality Standards in Drug Prevention Addiction Alice Rap ( ) Public Health Programme Drug Prevention & Information Programme Innovative projects Research Development standards & guidelines European Research Area Network ( ) Expanding the knowledge base… funding projects Prevention: Healthy Nightlife Toolbox/ club health Prevention & harm reduction for vulnerable groups Health promotion/ harm reduction in prisons E-health interventions COCINEU – Needs driven support for Cocaine users Driving under the Influence of Drugs (DRUID) Promoting harm reduction cooperation Prevention of poly-drug use, family based School-based Drug Prevention ICT Prevention targeting use of new substances Harm reduction for vulnerable groups Analysis of new psychoactive substances SPICE

European Commission Justice Date | # EQUS Conference, June 2011 Implementation 2003 CR Harm Reduction (2007/ 2012) Evaluation EU Drugs Action Plan (2008) Gaps in EU illicit drug research (2009) EU Quality Standards Drug Demand Reduction (2012) External Evaluation EU Drugs Strategy (2012) Effectiveness of Drug Treatment & Prisons (2007) Further Analysis EU Illicit Drugs Market (2012) Overview studies EU Drug Policy 2013 & beyond Policy Evaluation Development standards & guidelines Expanding the knowledge base…recent studies

European Commission Justice Date | # EQUS Conference, June 2011 EU Legal basis in drug demand reduction (1) Lisbon Treaty (Art. 168 (1),(6) TFEU) Union Action, which shall complement national policies, shall be directed towards improving public health, preventing physical and mental illness and diseases (…). Such action shall cover the fight against the major health scourges, by promoting research into their causes, their transmission and their prevention, as well as health information and education, and monitoring, early warning of and combating serious cross-border threats to health. (…) The Union shall complement the Member States action in reducing drugs-related health damage, including information and prevention

European Commission Justice Date | # EQUS Conference, June 2011 EU Legal basis in drug demand reduction (2) Lisbon Treaty (Art. 168 (1) TFEU) Member States, in liaison with the Commission, coordinate among themselves their policies and programmes (…). The Commission may, in close contact with the Member States, take any useful initiative to promote such coordination, in particular initiatives aiming at the establishment of guidelines and indicators, the organisation of exchange of best-practice, and the preparation of the necessary elements for periodic monitoring and evaluation (…) (Art. 168 (6) TFEU) The Council, on a proposal from the Commission, may also adopt recommendations for the purposes set out in this Article.

European Commission Justice Date | # EQUS Conference, June 2011 The EU Drug Strategy and Action Plans provide objectives and a framework for actions in drug demand reduction Member States adapt these actions in accordance with their own national policies, needs and culture Scientific research and information is an important basis for further progress and coherence between policies in Member States The EU drug strategy does not prescribe national drug policy, but promotes collaboration, exchange and convergence between Member States EU Drugs Strategy

European Commission Justice Date | # EQUS Conference, June 2011 EU Drugs Action Plan Objectives and actions in demand reduction covering.. Prevention (universal, selective, indicated) Early detection & early intervention Drug treatment Harm reduction (incl. prison settings) Rehabilitation and reintegration Key words: Innovation, evaluated, effectiveness, evidence-based, best practice, accessibility, availability, coverage, quality, measurable outcomes, needs based

European Commission Justice Date | # EQUS Conference, June 2011 EU consensus on quality standards & benchmarks in drug demand reduction (action 19) Develop an EU consensus on minimum quality standards and benchmarks for prevention, treatment, harm reduction and rehabilitation interventions and services; Take into account the differences between countries in terms of drug use and drug problems and healthcare systems European Commission will make proposal for an EU consensus on minimum quality standards in drug demand interventions and services by 2013

European Commission Justice Date | # EQUS Conference, June 2011 Why quality standards & benchmarks…? (1) Subsequent EU drug strategies and EU drug action plans since 1996 have promoted innovation, best-practice and/ or evidence-based interventions, as well as research & evaluation At EU level alone, projects and studies have been funded in the field of drug demand reduction since 1996 Many of them developing innovative approaches to prevention, harm reduction, treatment; in different settings, for different groups A considerable number of them have identified best-practices and evidence-base on different aspects of drug demand reduction

European Commission Justice Date | # EQUS Conference, June 2011 Why quality standards & benchmarks…? (2) EU projects have clear added value in developing innovative approaches, but the translation, adaptation and scaling up of the project results is not necessarily guaranteed Evidence-based research findings and experiences with best- practices at national level not necessarily disseminated and brought into practice This is not unique for the EU… US ONDCP estimates that less than 5% of treatment programmes in the field of alcohol in the US are actually evidence based; situation for drugs even worse Need to collaborate is not only rational but necessary

European Commission Justice Date | # EQUS Conference, June 2011 Why quality standards & benchmarks…? (3) Findings evaluation EU Drugs Action Plan : The setting of prevention standards (universal prevention) could be an important step for the future developments of prevention policies at EU level. For the most relevant vulnerable groups (…) the actual level of implementation (of selective and indicated prevention) appears not to have increased since (..) numerous cannabis users in Europe are treated within the same settings as other drug users with more severe drug problems, which results in a number of difficulties for these users. The level of drug treatment provision in prison remains low, compared to that in the community, though the prevalence of drug use is high among prisoners.

European Commission Justice Date | # EQUS Conference, June 2011 Why quality standards & benchmarks…? (4) In 2005, 22 of 24 Member States reported that social rehabilitation programmes for drug users were available, however none of them rated the availability of these programmes as being very good and one third considered the general availability of such reintegration services to be low. Despite the known connection between release from prison and drug- induced deaths, few countries are systematically investing in educating prisoners on the risk of overdose on release from custody. Existing data provide basic picture of the availability of quality assurance mechanisms among MS, although they show that efforts to develop quality standards and guidelines are being made in most countries The content and scope of these measures should be investigated further and the development of definitions and quality models at EU level could also be further considered.

European Commission Justice Date | # EQUS Conference, June 2011 Why minimum quality standards & benchmarks…? Developing and implementing quality standards is current practice in a limited number of Member States for a limited number of services/ interventions Implementing the highest quality standards in every EU Member State may require major resources, while less ambition may offer better return on investment in the short run and have more support from key stakeholders Evidence base is still underdeveloped for standards in many services and interventions Implementation of quality standards requires long-term investment Important gains may already be made by raising the overall level across the EU

European Commission Justice Date | # EQUS Conference, June 2011Quality Raising the level of quality… Time 19xx EU Avg Successful implementation Raise the bottom level MS with limited resources/ know how

European Commission Justice Date | # EQUS Conference, June 2011 But of course … what is quality?

European Commission Justice Date | # EQUS Conference, June 2011 There is more similarity than one might think..

European Commission Justice Date | # EQUS Conference, June 2011 Summarizing… There may be scope for collaboration and exchange on quality standards in drug demand reduction at EU level There are cultural, traditional and ideological differences between Member States, but these may be more relevant for the selection and implementation of services and interventions rather than for basic quality standards for common drug-related health and social problems The national prevention, treatment and harm reduction systems may differ, but the range of effective services an interventions is relatively limited

European Commission Justice Date | # EQUS Conference, June 2011 Lets ask ourselves…? Does a problem drug user not have the right to the same standard of care compared to a lung-cancer patient? Are these systems of comparable quality today? Why not?

European Commission Justice Date | # EQUS Conference, June 2011 What this conference is about … Discussing the need for and usefulness of having (minimum) quality standards in drug demand reduction at national level Consider the proposed draft minimum quality standards, their relevance and usefulness and acceptability for specific services and interventions Discussing barriers and challenges to the implementation of quality standards as well as models of good practice To make best use of the multidisciplinary audience in this conference to exchange views and perceptions that allow for a better understanding of these barriers and challenges

European Commission Justice Date | # EQUS Conference, June 2011 What this conference is NOT about… Making final decisions about the list of minimum quality standards; the input from the conference will contribute to the consensus building process Discussing which service or intervention is most effective; the evidence presented in the conference concerns available evidence for a given standard Discussing divergent views of the acceptability of specific services or interventions; the services and interventions presented in the conference are existing in the EU and therefore relevant

European Commission Justice Date | # EQUS Conference, June 2011 A future proposal of the Commission Commission will not recommend to Member States which services and interventions should be implemented Possible proposal is likely to identify minimum quality standards and benchmarks in prevention, treatment/ rehabilitation and harm reduction relevant for different services, interventions and system level Member States can use the proposed minimum quality standards and benchmarks to improve the existing services and interventions in their country, and/ or when considering to implement new ones

European Commission Justice Date | # EQUS Conference, June 2011 The next steps … Final report and deliverables of the EQUS project available by the end of 2011, early 2012 Commission will consider proposing Council Recommendation on minimum quality standards by end 2012/ early 2013 Further collaboration with EMCDDA Further development of insights on minimum quality standards, benchmarks and implementation in practice Funding available under call for proposals 2011 Drug Prevention and Information Programme, supporting implementation Possible gaps in quality standards for process, intervention and system level further researched Member States may obtain funding from current European Social Fund provided they make it a national priority

European Commission Justice Date | # EQUS Conference, June 2011 THANK YOU !