1. Essential elements for regulation Bylaw on drug demand reduction

2. Working methode for drafting the bylaw  Identify the essential elements for regulation of demand reduction  Which elements are already regulated in Serbian legislation?  Model regulations in Europe  Need for regulation through the bylaw

3. Topics which need to be regulated I.General Provisions II.Prevention III.Treatment of addiction IV.Harm reduction V.Rehabilitation and social reintegration VI.Justice system (prosecution, courts, prisons..) VII.Sanctions / penalties

4. General Provisions 1.Scope of the bylaw : The aim of the regulation should be: – to prevent and counteract drug addiction, – to establish a legal framework for dealing with consumers of psychoactive substances, – to establish tasks and prerogatives of relevant institutions/organisations/entities involved in preventing and counteracting drug addiction, – to establish sanctions for violating the provisions

5. General Provisions 2.Areas to be regulated: Prevention of drug abuse, reduction of the number of drug users as well as the amount of drugs consumed, Treatment of drug users and addicts, Reduction of the health and social harm associated with drug use, Rehabilitation, reintegration of addicted persons into society.

6. General Provisions 3.Guiding principles (I): Programmes and measures in the field of Demand Reduction should – ensure health and security of individuals and society, – acknowledge that addiction is a disease which can and should be treated, – respect Human Rights, in particular guarantee the right to be treated

7. General Provisions 3.Guiding principles (II): Programmes/measures in the field of demand reduction should – provide help to drug users (treatment, counselling, rehabilitation, reintegration) in principle on a voluntary basis, notwithstanding other legal regulation, – constitute a comprehensive, integrated and coherent system of Demand Reduction, – be easily accessible to all those who need them

8. General Provisions 3.Guiding principles (III): Programmes and measures in the field of Demand Reduction should – comply with the International Drug Control Conventions of the UN, – be complementary to Supply Reduction programmes ("Balanced Approach") – be based on (scientific) evidence and on the relevant standards of conduct, – be systematically monitored.

9. General Provisions 4.Relevant institutions/ entities / organisations (I) – Government administration, – Regions, Local Communities, Special drug related institutions – Educational institutions (Kindergartens, Schools, Universities, Training institutions) – Health care system – Judicial system (Police, Courts, Prisons)

10. General Provisions 4.Relevant institutions/ entities / organisations (II) – Welfare organisations – NGO’s – Civil Society – Media Responsibilities and competences should be clearly defined within the legal framework

11. General Provisions 5.Coordination – All the relevant stakeholders should participate in planning, organisation and implementation of programmes and measures – All relevant activities should be coordinated on the local, regional, national level by respective coordinating bodies – Demand Reduction policy should be matched with Supply Reduction policy ("balanced approach”)

12. General Provisions 6.Strategy and Action Plan Strategy and Action Plan should form the basis for measures for counteracting drug addiction

13. General Provisions 7.Research – Research in all the sectors of demand reduction is necessary and must be funded by the State and other institutions – International cooperation in drug research is essential. Results of research performed in other countries should be taken into account.

14. General Provisions 8.Monitoring – National Monitoring Centre is to be established – Records on: consumption, drug related diseases, treatment, drug related deaths

15. Prevention of drug use 1.Forms of prevention a)Universal prevention (Programmes and measures to avoid that population take drugs) b)Selective and indicated prevention (Programmes and measures targeting at-risk groups and individuals)

16. Prevention of drug use 2.Means of prevention a)Universal prevention: educational activities, health promotion programmes, informational and awareness raising activities b)Selective and indicated prevention: counselling early intervention support/assistance

17. Prevention of drug use 3.Institutions/organisations responsible for / dealing with prevention 4.Financing of Prevention Financing of prevention is needed to ensure the sustainability of prevention activities

18. Treatment of addiction Treatment of addiction disease = scope of the bylaw Treatment of other diseases with narcotics (e.g. pain) – symptomatic treatment = to be regulated elsewhere Drug addiction treatment must be integral part of the health and social care system

19. Treatment of addiction Range of treatment methods – Detoxification – Medically assisted treatment (substitution treatment) – Abstinence-oriented treatment – Psycho-social assistance Any method must comply with the agreed professional standards (state of the art)

20. Treatment of addiction Settings for treatment: – Outpatient – Inpatient (residential) – Outreach work

21. Treatment of addiction Aim of the treatment: – (Gradual) reduction of drug consumption with the ultimate goal of abstinence – Improvement of the health status and the quality of life of the addict – Treatment of (psychiatric) co-morbidities

22. Treatment of addiction Institutions / organisations / persons providing treatment – Medical doctors / nurses / psychologist / social workers – Healthcare centres, hospitals, reference centres, prisons – Social services, offices for youth ← Qualification or certification required for institutions and/or professionals

23. Treatment of addiction Special provisions for substitution treatment (I) – Special licence for ST required for medical doctors – List of psychoactive substances that are expressively admitted for ST – Registration of all medical doctors with substitution licence and of all cases of substitution treatment (in anonymised form) in order to avoid double treatment

24. Treatment of addiction Special provisions for substitution treatment (II) – Titration of dose and quantities of substitution substances to be administered – Indications, contraindications and refusal of treatment – Medical treatment should be combined with psycho- social assistance wherever needed by the patient, – Administrative requirements / control measures

25. Treatment of addiction Financing of Treatment Financing of treatment is needed to ensure the sustainability of treatment activities

26. Harm reduction Definition – Programmes and measures aiming primarily at reducing the adverse health and social consequences associated with the use of psychoactive substances – “Aid for survival” (GER) – Must be an integral part of a comprehensive and coherent continuum of demand reduction measures – Must be complementary to prevention, treatment and rehabilitation, not replace them

27. Harm reduction Types of measures, interventions and services(I): – Low threshold facilities, drop-in centres, shelters, contact and information units – Medication and emergency kits for management of overdoses in appropriate places (e.g. naloxone distribution programmes), – Vaccination programmes (against Hepatitis a.o.), – Voluntary HIV and HCV counselling and testing, – Needle/syringe exchange programmes – Measures to ensure safer use,

28. Harm reduction Types of measures, interventions, services (II): – Services for the management of sexually transmitted infections, particularly to those involved in sex work, – Diagnostic and treatment of HIV, HCV and TB in injecting drug users – Well-equipped street-workers and peer outreach workers units, – Medically supervised outreach facilities (so called “Drug consumption rooms”) – Violence prevention programmes – Others....

29. Harm reduction Types of measures, interventions and services: – Services for the management of sexually transmitted infections (particularly for sexworkers), – Diagnostic and treatment of HIV, HCV and TB in injecting drug users – Street-workers and peer outreach workers units, – Medically supervised outreach facilities (so called “Drug consumption rooms”) – Violence prevention programmes – Others….

30. Harm reduction Integration of harm reduction into public health system and cooperation between e different stakeholders and actors is essential Financing of harm reduction is needed to ensure the sustainability of harm reduction activities

31. Rehabilitation and Social Reintegration Measures aiming at assisting persons using drugs in participating in social interaction, particularly in work life. Institutions/organisations providing Rehabilitation and Reintegration: social care institutions and welfare system unemployment offices prisons after-care programmes, therapeutic communities NGOs others...

32. Rehabilitation and Social Reintegration Cooperation between institutions is absolutely essential All existing and appropriate programmes and measures of Rehabilitation and Reintegration should be accessible for drug users Special programmes and measures for the Rehabilitation and Reintegration of drug users should be established Sustainable financing is needed

33. Justice system Principle: Treatment instead of prison Rules for preventing and counteracting of drug addiction within prisons Equal rights for addiction care in and out-side the prison Reintegration into society after prison

34. Essential elements for regulation Thank you for your attention!