Co-operation Group to Combat Drug
Abuse and Illicit Trafficking in Drugs
Strasbourg, 13 December 2007 P-PG/TT(2007)4
7th MEETING OF THE
“EXPERT FORUM ON TREATMENT”
Paris, France
8-9 November 2007
REPORT
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EXECUTIVE SUMMARY |
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1. OPENING OF THE MEETING AND ADOPTION OF THE AGENDA
1.1 Ms. Lilly Sofie Ottesen started the meeting by introducing the agenda and organisational arrangements. The focus of the meeting is to discuss the organisation and agenda of the conference on recommendations and guidelines as well as framework for the description of the treatment systems in the member States. Ms. Ottesen also presented the Pompidou Group, its mission and Treatment Platform priorities for 2007-2010 to the new members of the Platform. This introduction was followed by tour de table when participants introduced themselves.
1.2 Ms Ottesen has presented the Pompidou Group to the new members of the Treatment Platform as well as priorities of the Platform for 2007-2010:
- 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)
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).
2. Organisation of a conference on recommendations and guidelines by Gabrielle Welle Strand
2.1 Ms. Gabrielle Welle Strand, Norway, suggested to have a tour de table introducingsituation with guidelines and recommendations in each country before discussing agenda of the conference on guidelines and recommendations. In Norway, Ministry of Health and Care Services commissioned guidelines on substitution treatment, psychiatric treatment and treatment of young people. The main challenge is to use evidence based approach in developing guidelines.
2.2 Mr. Theo Wessel, Germany, informed about 3 types of treatment guidelines founded on evidence-based recommendations: earlier intervention, acute treatment, post-acute treatment. Substitution treatment is included in recommendations.
2.3 Mr. Michael Kelleher, United Kingdom, currently the purchase and providers of the treatment services are separated in the UK. It is difficult to observe common standards. As a result, standards setting is based on randomized control samples only. Guidelines on psychological intervention were just released. Evidence (based on the USA research only) proves that contingency treatment (rewarding patients for treatment) is effective.
2.4 Mr. Augusto Consoli, Italy, informed that guidelines on methadone treatment, psychotherapy and efficiency of therapeutically communities are under development in Italy.
2.5 Mr. Argyris Argyriou, Cyprus, informed about commissioned evaluation of the treatment services in Cyprus. The evaluation of the state provided services was ready and private services to be done in 2008.
2.6 Mr. Lubomir Okruhlica, informed that Slovak Republic has adopted European guidelines on methadone treatment. Insurance companies are very important stakeholders interested in guidelines and recommendations because of the standard setting value and legal significance.
2.7 Mr. Vladimir Altshuller, Russian Federation, informed about publication of 2 volumes of guidelines on addictions (both drugs, alcohol and non-chemical addictions). The publication is popular among practitioners and in its 1000 plus pages covers epidemiology, psychology and treatment of addictions.
2.8 Ms. Welle Strand summarized discussion by noting that it will be a great challenge to make a conference interesting for all countries because different countries are at different stages of guidelines development. She suggested to focus the conference on the following issues:
- legal status of guidelines and recommendations
- who are decision-makers
- for whom guidelines are developed
- who is involved in development of guidelines (researchers, clinicians, policy makers)
- evidence-based principle and its implication
- balance between general and specific guidelines
- local/regional guidelines vs. national/international
- how guidelines are implemented, evaluated and reviewed.
2.9 Mr. Okruhlica suggested to use the term ‘’good practice’’ instead of ‘’best practice’’ in describing guidelines and recommendations. He was supported by Mr. Kelleher who stressed the importance of not being judgmental in describing different treatment systems.
2.10 Mr. Altshuller pointed out that evidence-based principle does not necessary apply to guidelines and recommendations. Unlike in writing scientific article where evidence-based principle is necessary, in developing guidelines the nature of work is more general.
2.11 Mr. Consoli posed a question of why good practices are often not implemented. He suggested looking at why it is difficult to disseminate guidelines. Country-specific differences should be taken into account when one talks about guidelines and recommendations on psychiatric treatment. If in some countries insurance system is interested in guidelines and recommendations for their standard-setting value, in some countries insurance system cannot drive their development (e.g. in Italy national insurance system does not cover psychiatric treatment and thus cannot be a driving force in development of treatment guidelines on addictions).
2.12 Ms. Welle Strand suggested organising an international advisory conference on guidelines and recommendations between 1 and 15 November 2008. The draft programme of the conference to be sent to PCs in February 2008. In March-April the programme to be finalized based on the PCs feedback. The PG Secretariat is charged with setting the exact date and finding a venue for the conference.
3. Treatment systems in the member countries
3.1 Ms. Ottesen briefly described the work done so far concerning an overview of the treatment systems in the PG member States. The overview will show how different countries organise their treatment system focusing on illicit drugs addiction (pure tobacco and alcohol treatment measures are excluded). The publication will not contain evaluation or comparison of the systems but rather an authorised information collected through respective authorities (represented by the Permanent Correspondents of the Pompidou Group member States). Ms. Ottesen requested the PG Secretariat to send a reminder to PCs about submission of the drafts and extension of the deadline until 15 January 2008. She also informed participants that Mr. Richard Muscat, PC of Malta, agreed to edit the publication.
3.2 Mr. Okruhlica posed a question of how to define ‘’treatment system’’- in broader terms or more specific. For example, should we include treatment of non-addicts, needle exchange and low threshold services in broader definition of ‘’treatment system’’?
3.3 Mr. Altshuller suggested to focus on medical aspects of treatment system in the publication.
3.4 Ms. Welle Strand suggested to exclude harm reduction and earlier intervention from description of treatment system.
3.5 Mr. Okruhlica suggested to describe treatment system for drug users, not only for drug addicts. He also suggested to exclude outreach work from description.
3.6 Ms. Gozlan commented that a brief description of the outreach work could be included in historical and cultural context of treatment system. Cultural differences influence the way in which treatment systems are developed in different countries and it is important to take this aspect into account.
3.7 Ms. Ottesen suggested to amend paragraph 3 of the framework for description of the treatment system as follows:
Short history of drug treatment with focus on changes in recent years. Should also say something about the philosophy of treatment/cultural context. Please include information on what is meant by ”treatment” in the description of your country (only medical or including what aspects of other services (care, social etc.) and what is meant by ”illicit drug users” in the description of your country (only addiction treatment or including what other aspects of problematic drug use).
4. Further work of the treatment platform
4.1 Ms. Ottesen referred to the report of the 6th Treatment Platform meeting (P-PG/TT (2007) 2 REV) which describes the priorities of the Treatment Platform work for 2007-2010. She asked to share the ideas on what possible topics the Platform should consider in its work and what outcomes (publications, conferences, pilot projects) are expected from the work of the Platform.
4.2 Mr. Consoli suggested to consider the topic of cocaine users treatment. Such aspect as use of telematics (e-mail and sms) in treatment of cocaine users is worth consideration. Mr. Consoli also suggested to look at the results of recent biological research on differences in treatment women and men. Also, possible topic to consider is a research on differences on how addictions influence social behaviour of men and women.
4.3 Ms. Gozlan supported the Mr. Consoli suggestions. Treatment of women is a topic which is not very well developed in France. Although there is a lot done in France regarding treatment of cocaine users it is very interesting to share the experience and ideas from other countries.
4.4 Mr. Wessel informed participants that in Germany the use of cocaine is decreasing but the use of methamphetamines is on the rise. Mr. Wessel suggested to consider the topic of treating stimulants addictions rather than treating specific substances addictions. He also suggested to consider the topic of gender sensitive treatment rather than treatment of women and men. We can begin with treatment of women, but we also should look at men’s treatment.
4.5 Mr. Okruhlica commented that specific focus on certain substances is mainly for political reasons. He suggested to be more inclusive in considering various aspects of treatment. We should look at treatment of human beings. For example, marginalised groups treatment are on the agenda because they cause social disturbances. But as doctors they are often treating elderly people who are neglected because they are better socially integrated.
4.6 Ms. Ottesen suggested to take into account comments on gender sensitive treatment and stimulants treatment in setting the agenda for the Platform meetings in the future. She suggested to hold next, 8th, meeting of the Platform on 15-16 May 2007, possibly in Oslo. She also asked Platform members to inform the PG Secretariat about experts who can contribute to the discussion of the Platform and whom the Secretariat could use as consultants in preparing Platform meetings.
Appendix 1
FINAL LIST OF PARTICIPANTS
7th Meeting of the Treatment Platform
Paris, France
Paris Office of the Council of Europe
55 Avenue Kléber, room 1
8-9 November 2007
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]
Germany
Dr. Theo Wessel
Gesamtverband für Suchtkrankenhilfe
im Diakonischen Werk der EKD,
Altensteinstr. 51, 14195 Berlin,
Tel: +49 (30) 843 123 55 – Fax: +49 (30) 844 183 36; - Email: [email protected]
Hungary
Prof. Dr. József RÁCZ
Institute of Psychology
Budapest, Hungary
Tel: +36 (20) 925 6568: -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]
Slovak Republic
Mr. Lubomir Okruhlica, M.D., Ph.D.
Institute on Drug dependencies, CPLDZ,
Bratislava, Slovak Republic
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]
Treatment Platform Coordinator & Resource Person
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]
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]
Appendix 2
7th Meeting of the Treatment Platform
Paris, France
Paris Office of the Council of Europe
55 Avenue Kléber, room 1
8-9 November 2007
Programme
Purpose
- Platform members get to know each other
- Organisation of conference on recommendations and guidelines
- Framework for description of the treatment systems in the member States
Day 1
8th November 2007 1400 - 1800
1400 – 1430 Welcome and introduction of participants
1430 – 1530 Organisation of a conference on recommendations and guidelines
Introduction to the theme – Gabrielle Welle-Strand
Brainstorm- session
1530 – 1600 Coffee break
1600 – 1700 What is the situation regarding guidelines and recommendations in the member countries?
1700 – 1800 Use of evidence based principles in the process of making guidelines and recommendations
Brainstorm – putting up the programme
Day 2
9th November 2007 0900 – 1630
0900 – 1030 Program for the Conference – to be settled:
- Venue and date
- Possible sub-themes for the conference – what speakers to invite etc.
Who are we making guidelines for?
Who should take part in the guideline process (the government, researchers, practitioners?)
Best practice for making guidelines
Etc.
1030 – 1100 Coffee break
1100 – 1230 Program for the conference – cont
1230 – 1400 Lunch
1400 – 1500 Treatment systems in the member countries
1500 – 1600 Further work of the treatment platform
1600 – 1630 Planning of the next meeting
Appendix 3
P-PG/TT (2007) 3 Revised
OVERVIEW OF THE TREATMENT SYSTEM IN THE POMPIDOU GROUP COUNTRIES
FRAMEWORK FOR COUNTRY REPORTS
Draft
Target audience: Professionals/practitioners, researchers, user groups, policy makers
Limitation of the assignment
Treatment systems for illicit drug users. Treatment for alcohol, prescribed drugs and tobacco users should only be included where the treatment systems are common (reference is made to the Pompidou Group mandate)
Framework
The chapters from each country should be maximum 10-15 pages and mainly describe the treatment systems for illicit drugs
i. Substitution treatment
ii. Drug-free treatment services (TC, collectives, etc)
iii. Dual diagnosis treatment
iv. In/out-patient
v. Drug and/or alcohol and prescribed drugs – are patients treated in the same facilities
vi. Availability/link to somatic and psychiatric treatment
vii. Rehabilitation services linked to treatment (vocational services, housing etc)
viii. Treatment of young people
i. Pregnant women/families with small children
ii. Other gender issues