Co-operation Group to Combat Drug
Abuse and Illicit Trafficking in Drugs
Strasbourg, 14 August 2007 P-PG/TT(2007)2rev
6th MEETING OF THE
“EXPERT FORUM ON TREATMENT”
Oslo, Norway
30 May – 1 June 2007
REPORT
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EXECUTIVE SUMMARY |
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1. OPENING OF THE MEETING AND ADOPTION OF THE AGENDA
Ms. Lilly Sofie Ottesen started the meeting by introducing the agenda and organisational arrangements. The focus of the meeting is to set the priorities for the Treatment Platform work in 2007-2008 and discuss in details the outcomes of the review of the treatment systems in different countries and the role which the guidelines and recommendations play in the treatment systems. The role of the Pompidou Group in linking practice with policy and in promoting good practices was emphasized. This introduction was followed by tour de table when participants introduced themselves.
2. Presentation of the vision of the Treatment Platform by
Lilly Sofie Ottesen and Gabrielle Welle Strand
1.1 Ms Ottesen has presented the list of priorities for the Treatment Platform work in 2007-2010 (see Appendix 1 Vision for the treatment platform):
- To improve knowledge on treatment systems in different countries
- To improve knowledge on best practices for Recommendations and Guidelines in treatment of drug users in different European countries
- To improve knowledge on best practices on how to target specific patient groups - examples
a. Treatment targeting women (e.g. pregnant alcohol and drug users, drug users who care for children)
b. Treatment targeting cocaine users
c. Semi-cohersed treatment/compulsory treatment
- Linking the treatment platform more closely to other platforms (Research and Prevention)
1.2 Ms Ottesen also mentioned the topic of young people treatment. Since the platform focused its work on that topic in the past 3 years, it was suggested that it is time to move to other topics. Nevertheless, the Platform members will be ready to support the member States in projects or programmes in the young people treatment field, but it was agreed that this will not be the focus of the Platform in the upcoming years.
1.3 Other possible topics for consideration would be:
- e-treatment (use of modern communication technologies in treatment, suggested by the Netherlands), and
- recent findings in bio-medical research in relation to treatment (suggested by the Russian Federation).
3. Discussion of the Treatment Platform Working programme for 2007-2010
3.1 The presentation of the vision for the Platform work in 2007-2010 was followed by the tour de table discussion of the participants.
3.2 Mr Vladimir Altshuller commented on semi-coheresed treatment topic that all patients are under certain degree of pressure when they undertake treatment. He also informed participants about recent research on medico-genetic basis of addictions conducted in the Russian Federation.
3.3 Ms Dragica Katalinic stressed the importance of exchange of good practices in organisation of the treatment systems.
3.4 Mr Argyris Argyriou and Dr Gozlan underlined the interest in the treatment of specific addictions (such as cocaine) and treatment in prisons.
3.5 Dr Gozlan expressed interest in treatment of cocaine addiction, psychological co-morbidities, exchange of good practise, clinical research as well as evaluation of clinical treatment.
3.6 Mr Consoli highlighted some issues which should be taken into consideration in setting up priorities. Among them:
- epidemiological data on substitution treatment which suggests that this treatment is used in wrong way
- difficulties in elaborating treatment recommendations (for economic and political reasons, for example) and difficulties in adopting recommendations from the foreign countries
- importance of taking into account the social context and importance of considering treatment for legal drugs addictions
- importance of looking into how guidelines and recommendations are used in practice so that they do not remain just a purely theoretical papers.
3.7 Mr Kelleher supported the above points and suggested to remain pragmatic in defining the Platform’s priorities. For example, including alcohol and tobacco would broad the scope of consideration significantly. Although, sharing experience in treatment of alcohol and drugs addictions is important. Looking into existing systems of treatment in Europe is very helpful, especially those systems which are evidence based.
3.8 Mr Pirona pointed out the importance of considering how different treatment systems take into consideration the increased trend in polydrug consumption.
3.9 Ms Ottesen suggested to keep the priorities as identified in the presented vision of the Treatment Platform work with some changes. The participants of the meeting agreed to keep the following priorities for 2007-2008:
1 To improve knowledge on treatment systems in different countries
2 To improve knowledge on best practices for Recommendations and Guidelines in treatment of drug users in different European countries
3 To improve knowledge on best practices on how to target specific patient groups , such as:
a. Treatment targeting women (e.g. pregnant alcohol and drug users, drug users who care for children)
b. Treatment targeting cocaine users
c. Semi-cohersed treatment/compulsory treatment
4 Other possible topics for consideration:
a e-treatment (use of modern communication technologies in treatment)
b recent findings in bio-medical research in relation to treatment
As it is not clear how time and resource consuming activities related to the different topics will be, it was decided to start out by working on topic 1 and 2.
3.10 Ms. Welle-Strand pointed out that in considering treatment systems it is important to look not only at the medical doctors approach because in different countries different professions are involved in treatment.
3.11 Dr Argyriou suggested to look at how different services involved in treatment are co-operating.
4. Improving knowledge of the treatment systems in different countries
4.1 Ms. Welle-Strand gave a brief overview of the idea to publish an overview on how different treatment systems are organised in the member States. The idea came from the EMCDDA review of the substitution treatment systems which identified a gap in knowledge of the addiction treatment systems in Europe, which are organised differently from the medical treatment systems. The participants of the meeting agreed with the idea to organise a publication with an overview of how different countries organise their treatment system focusing on illicit drugs addiction (pure tobacco and alcohol treatment measures are excluded). This publication will NOT contain comparison or evaluation of different treatment systems but rather an authorised information collected through respective authorities (represented by the Permanent Correspondents of the Pompidou Group member States).
4.2 The participants agreed to the following:
- Ms Welle-Strand will elaborate a draft framework for the overview of the treatment system.
- As the participants of the meetings were so few, it was decided not to establish a working group to draft the framework, but to instead use all platform members as consultants on the draft provided by Ms Welle-Strand (by e-mail).
- the Permanent Correspondents of the Pompidou Group will be asked to submit, by the assistance of the relevant authorities in their countries, the overview of the treatment systems based on the elaborated framework (not more than 15 pages per country).
- in preparing information for submission to the Secretariat, it is advised to involve officials from both the treatment system and from the respective authority responsible for anti-drugs policy in the country.
- the Secretariat will be responsible for collection of the information.
- a paid consultant will be contracted by the Secretariat to consolidate collected information
- in September 2007 the draft framework will be presented to the Permanent Correspondents.
- the deadline for the publication is summer 2008
- the publication will be available through the Internet portal of the Pompidou Group.
- assess and make further decisions on the process at the 7th meeting of the Treatment Platform to be organised in Paris on 8-9 November 2007.
5. Discussion of the role played by Recommendations and Guidelines for Treatment Systems in Europe
5.1 Mr Pirona presented an overview of the EMCDDA work (presentation slides are available through the Secretariat). The mission of the EMCDDA is to collect, analyse and disseminate objective, reliable and comparable information on drugs and drug addiction and their consequences to provide an evidence based picture of the drug phenomenon at European level. The audience is policy makers, scientists and researchers, practitioners and the general public. The EMCDDA provides quantitative information and the Pompidou Group provides qualitative information.
5.2 Mr Altshuller presented an overview of the treatment system in the Russian Federation (presentation slides are available through the Secretariat). Mr Altshuller stressed that alcoholism represents the biggest problem in the Russian Federation today. Mr Altshuller informed that treatment and diagnostic standards were issued in 1999 and they provide with minimum standards which doctors should observe. In order to provide treatment doctors must be certified. Psychiatrists with at least 3 years of work experience could receive those certificates. There is also a practice of organising cross-functional teams (psychiatrists, psychologists and social workers). Mr Altshuller also informed that methadone is prohibited by law. At the moment, the prevailing view among Russian psychiatrists on the substitution treatment is that it is a way of minimal resistance.
5.3 Dr Gozlan informed about organisation of drugs treatment system in France. Interministry mission for the fight against drug and addiction, a service appended to the Prime Minister, is in charge of the co-ordination of drug policies in the various administrations. A new law of 2002 provides for statutory framework of treatment services and emphasises the rights of patients. General practitioners could provide substitution treatment. The network of GPs, hospitals and social workers is organised. Special consultations for young people who use cannabis are organised. They evaluate if young person has an addiction and could provide brief interventions or refer to special centres for treatment. Special centres to treat crack addiction are created in Paris and overseas. Therapeutic communities are organised (4 in total) for those who undergo substitution treatment with the idea to stop such treatment in the communities.
5.4 Ms Katalinic informed that in Croatia there are 21 branches of the Institute for Public Health in each county. Those centres collect information on drug addiction and send it regularly to the central office.
5.5 Mr Consoli informed that in Italy they created special services for gamblers and cocaine users. In certain parts of the country GPs could provide treatment to addicts. The Health Ministry and the Social/Welfare Ministry are jointly responsible for drug treatment. There is no standardisation on who is an addiction specialist.
5.6 Mr Atle Fretheim, Research Director of the Norwegian Knowledge Centre for Health Services, presented the results of the research on how guidelines are used in different European countries (the presentation slides are available through the secretariat). All reviews are also available at www.health-policy-systems.com
5.7 Mr Kelleher commented that in the UK researchers investigate through randomized control samples and come up with the solutions so that doctors will not prescribe the most expensive drugs for treatment. There is also contingency guidelines to treat those patients who are ready to pay more.
5.8 Dr Argyriou commented that sometimes decisions on treatment guidelines are taken for political, economic or other reasons and research is organised to support those decisions. This situation leads to development of opportunistic and selective guidelines.
5.9 Mr Pirona commented that the EMCDDA launched a website listing best practices and providing tools to evaluate them. The idea is to collect all guidelines existing in Europe.
6. OTHER BUSINESS
6.1 Ms. Ottesen suggested to present the topic of guidelines and recommendations at the PC meeting in spring 2008. This will be discussed further at the next platform meeting.
6.2 The expert forum on treatment decided to hold its 7th meeting on 8 and 9 November 2007 in the Council of Europe office in Paris to discuss the organisation of the conference on recommendations and guidelines. In the meantime, the Secretariat will inform the platform members on details of the meeting.
Appendix 1
FINAL LIST OF PARTICIPANTS
6th Meeting of the Treatment Platform
31 May – 1 June 2007
Directorate of Health and Social Affairs
Universitetsg. 2
Oslo, Norway
Final List of participants
EXPERTS
Croatia
Dr Draga KATALINIC
Croatian National Institute of Public Health
Rockefellerova 7,
HR-10000 ZAGREB
Tel : +385 14863240 - Fax : +385 14683011 - Email: [email protected]
Cyprus
Dr. Argyris ARGYRIOU
Mental Health Services
Ministry of Health
Tel : +357 99672285 - Fax : +357 22305011 - Email: [email protected]
France
Dr Ruth GOZLAN
MILDT
7 rue Saint Georges
F-75009 Paris
Tel : +33 (01) 44 63 20 52 - Fax : - Email: [email protected]
Italy
Mr Augusto CONSOLI
Dipartimento Dipendenze
Asl 4 Corso Vercelli 15
10152 TORINO
ITALIE
Tel : +39 (01) 12484016 - Fax : +39 (01) 1237458 - Email : [email protected]
Russian Federation
Prof. Vladimir ALTSHULLER
National Research Centeron Addictions
Maly Mogiltsevsky Per., 3
RF-119 002 MOSCOW
Russia
Tel : +7 (49) 52410603 - Fax : +7 (49) 52410981 - Email: [email protected]
United Kingdom
Dr Michael KELLEHER
Marina House
The Maudsley Hospital
63-65 Denmark Hill
Camberwell
SE5 8RS London
United Kingdom
Tel : - Fax : - Email: [email protected]
International Organisation / Organisation Internationale
EMCDDA
Mr Alessandro PIRONA
Rua da Cruz de Santa Apolonia
P-1149-045 Lisboa
Portugal
Tel : - Fax : - Email: [email protected]
Treatment Platform Coordinator & Resource Persons
Ms. Lilly OTTESEN
Ministry of Health and Care Services,Department of Public Health
PO Box 8011 Dep
N-0030 OSLO
Norway
Tel : +47 (22) 24 85 53 - Fax : +47 (22) 24 86 56 - Email: [email protected]
Mrs Gabrielle WELLE-STRAND
Norwegian Directorate for Health and Social Affairs
PO Box 7000 St. Olavs plass
N-0130 OSLO
Norway
Tel : +47 24163193 - Fax : +47 24163007 - Email: [email protected]
Mr Atle Fretheim
Research Director
Norwegian Knowledge Centre for the Health Services
POMPIDOU GROUP SECRETARIAT / SECRETARIAT DU GROUPE POMPIDOU
Council of Europe / Conseil de l’Europe
F – 67075 Strasbourg Cedex
Fax : +333 88 41 27 85
Mr Sergei BAZARYA, Administrator / Administrateur
Tel: +333 90 21 53 19 – Email: [email protected]
Mme Florence MANSONS, Assistant / Assistante
Tel: +333 88 41 38 42 – Email: [email protected]
Interpreter/Interprète
Ms Punam Puri-Léger
Appendix 3
Treatment Platform Draft Plan of Work 2007-2010
As provided by the secretariat
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Topic and activity |
anticipated outcomes |
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Addressing knowledge gaps in treatment systems and rehabilitation services |
Methods developed to target specific patient groups (pregnant women, cocaine users, semi-coerced treatment) with drug policies. Better understanding of culture and ethnicity related implications in treatment. |
Contributions from: CrimJ PF, EXASS Net Cooperation with EMCDDA and UNODC |
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Results of neuroscience, genetic and biomedical research impacting on treatment models and offers |
Anticipated impact on treatment, New perspectives for treatment, Guidance on ethics issues. |
Contributions from: Research and Ethics PFs |
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Identifying procedures and actors establishing and implementing treatment guidelines in Europe |
Variations in the establishment and use of treatment guidelines are analysed; Experience on effective preparation and use of guidelines is made available. |
Cooperation with EMCDDA |
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Making knowledge available about how treatment systems and rehabilitation services are organised across Europe |
Improved knowledge on treatment systems taking into account national and cultural specificities. |
Cooperation with EMCDDA |
Appendix 4
PROPOSED FRAMEWORK AND PLANS FOR ”OVERVIEW OF THE TREATMENT SYSTEM IN THE POMPIDOU COUNTRIES”
Target audience: Professionals/practitioners, researchers, user groups, policy makers
Treatment services to be included
Limitation of the assignment
Process
Framework
The chapters from each country should be maximum 10-15 pages and mainly describe the treatment systems.
i. Pregnant women/families with small children
ii. Other gender issues
Appendix 2
6th Meeting of the Treatment Platform
Oslo, Norway
Directorate of Health and Social Affairs
Universitetsg. 2
31 May- 1 June 2007
Programme
Purpose
- Platform members get to know each other
- Present and discuss topics for the Treatment Platform work in 2007-2008
- Discuss in details and agree upon outcomes for the following topics:
· Improve knowledge of the treatment systems in different countries
· Guidelines and recommendations
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Time: |
Thursday, 31 MaY |
Comments |
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09:00 09:30 10:20 |
Registration 1. Welcome and introduction of participants 2. Presentation of the vision of the Treatment Platform by Lilly Sofie Ottesen and Gabrielle Welle Strand |
Reference paper: Vision for the treatment platform: Improve the cooperation between European countries in the treatment of drug addiction |
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10:50 |
Coffee Break |
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11:10 |
3. Discussion of the Treatment Platform Working programme for 2007-2010: -topics -methods -products and outcomes |
Possible topics for consideration by the Treatment Platform: -overview of the treatment systems in different countries -role of recommendations and guidelines -targeting specific patient groups: a. Treatment targeting women (e.g. pregnant alcohol and drug users, drug users who care for children) b. Treatment targeting cocaine users c. Semi-cohersed treatment/compulsory treatment d. Polydrug users treatment -co-operation with other platforms (specifically Research and Prevention) Outcomes: -provisional list of topics and schedule of meetings are defined -defined products and outcomes of Platform work in 2007-2010 (pilot projects, media campaigns, publications, conferences, etc.) |
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12:00 |
Lunch Break |
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13:00 14:00 |
4. Improving knowledge of the treatment systems in different countries -plan from Co-ordinator -co-operation with international organisations (EMCDDA, UN) 5. Separation into 2 groups and discussion of publication on treatment systems: -content -framework of system descriptions -organisation of work |
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15:30 |
Coffee Break |
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15:50 17:15 |
6. Summary of the discussion END OF WORKIN DAY 1 |
Outcomes: - working group is organised and tasks distributed among members - list of questions to describe treatment systems is developed |
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FRIDAY, 1 JUNE |
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09:30 10:00 |
7. Discussion of the role played by Recommendations and Guidelines for Treatment Systems in Europe 8. Presentation of strategies on developing Recommendations and Guidelines |
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11:00 |
Coffee Break |
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11:20 12:00 12:30 |
9. Young People and Drugs: Care and Treatment publication- discussion on distribution, evaluation and improvements to the publication 10. Summary of the meeting including further plans and future meetings END OF THE MEETING |
Reference documents: Young People and Drugs: Care and Treatment (P-PG/TT (2006) 5) |