The role of standards on quality of treatment of drug use Lubomir Okruhlica Lisbon Addictions 2017

Theory of Minimum Quality Standards - Markets asymmetric information - Risk of quality deterioration - Set by profession / industry too high

Theory of Minimum Quality Standards - Sellers know, buyers do not know quality - Industry / Professionals – monopoly profits Example: It is difficult for patient to ascertain the quality of medical service. Leland (1979): Qacks, Lemons and Licensing: Theory of Minimum Quality Standards

"Substance dependence is not a failure of will or of strength of character but a medical disorder that could affect any human being. Dependence is a chronic and relapsing disorder, often co-occurring with other physical and mental conditions„ (WHO, 2004)

Many commonly used interventions do not follow scientific evidence: they are either ineffective or even harmful.

Uchtenhagen, A., Schaub, M.: Minimum Quality Standards in Drug Demand Reduction EQUS, Final Report. Research Institute for Public Health and Addiction A WHO collaborating center affiliated to Zurich University, 2011

Council of the European Union Brussels, 16 September 2015 11985/15 Council conclusions on the implementation of the EU Action Plan on Drugs 2013-2016 regarding minimum quality standards in drug demand reduction in the European Union.

EU minimum quality standards in drug demand reduction EMPHASISES THAT: − EU minimum quality standards in drug demand reduction must respect ethical principles, human rights, confidentiality, cultural and social characteristics, including gender issues and health inequalities;

Treatment, social integration and rehabilitation a. Appropriate evidence-based treatment is tailored to the characteristics and needs of service users and is respectful of the individual’s dignity, responsibility and preparedness to change; scientific EB experience EB no alternative treatment Tailored age / children dual dg. pregnant Voluntary no mandatory

Treatment, social integration and rehabilitation b. Access to treatment is available to all in need upon request, and not restricted by personal or social characteristics and circumstances or the lack of financial resources of service users. Treatment is provided in a reasonable time and in the context of continuity of care; Do not exclude : Poor Homeless Immigrants no judgmental OST befor , in, after prisons

Treatment, social integration and rehabilitation c. In treatment and social integration interventions, goals are set on a step-by-step basis and periodically reviewed, and possible relapses are appropriately managed; Acceptance of chronic, relapsing condition recovery is possible no discrimination by health insuarnace no moral paradigma

Treatment, social integration and rehabilitation d. Treatment and social integration interventions and services are based on informed consent, are patient-oriented, and support patients’ empowerment participatory treatment planning flexible alternatives no paternalistic no authoritative

Treatment, social integration and rehabilitation e. Treatment is provided by qualified specialists and trained staff who engage in continuing professional development; no lay terapists without EB education

Treatment, social integration and rehabilitation f. Treatment interventions and services are integrated within a continuum of care to include, where appropriate, social support services (education, housing, vocational training, welfare) aimed at the social integration of the person; harm reduction - treatment – social reintegration cooperation, information feed-back both ways

Treatment, social integration and rehabilitation g. Treatment services provide voluntary testing for blood-borne infectious diseases, counselling against risky behaviours and assistance to manage illness; „one shop stop“ no BBV therapy refusal to active users no economic barriers

Treatment, social integration and rehabilitation h. Treatment services are monitored and activities and outcomes are subject to regular internal and/or external evaluation. e. by clients (eg CSQ8) process e. out-come e. additional resources

Conclusions The tools for assessment of MQS implementation; MQS represent a minimum benchmark; future reassessment The aspirations should be higher.

Thank you for the attention. okruhlica@cpldz.sk