drug demand reduction management models - an eu perspective · best practice/ process . 9 9 factors...
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Drug demand reduction management models - an EU perspective
Jane Mounteney
EMCDDA
2
Programmes v Management models
• Interventions, programmes etc
BEST PRACTICE
3
Programmes v Management models
• Interventions, programmes etc
BEST PRACTICE
• Strategies, systems, coordination
mechanisms etc
‘BEST PROCESS’
4
Good and bad news…
• We do have EDDRA database on evaluated
programmes, Cochrane reviews - best
practice
• No database of management models – best
process!
• We do have some tools…
5
The European picture….
…Drug demand reduction practice &
processes vary considerably.
6 6
Factors influencing drug
management systems?
Management
system
7 7
Factors influencing drug
management systems
Management
system
Politics
Media Public opinion
National drug
policies & strategies
Local drug
policies & strategies
Budget &
resources
Existing
services &
organisations
Drug problem Best
Practice/ Process
8 8
Factors influencing drug
management systems
Management
system
Politics
Media Public opinion
National drug
policies & strategies
Local drug
policies & strategies
Budget &
resources
Existing
services &
organisations
•Drug field
•Management/ business studies •Health service organisation •Public adminitration
Drug problem Best
Practice/ Process
9 9
Factors influencing drug
management systems
Politics
Media Public opinion
National drug
policies & strategies
Local drug
policies & strategies
Budget &
resources
Existing
services &
organisations
Drug problem Best
practice
Management
system
10
Drug demand reduction strategies in EU
(Source: EMCDDA 2008)
National level
• Treatment strategy all countries
• Drug-related-infectious-diseases (DRID) the majority
• Drug-related-deaths (DRD) less than half.
Local level
• Treatment strategies - less than half
• DRID strategies - less than half
• DRD strategies - just a few.
11
Availability of demand reduction
strategies in Europe
Treatment Local strategies
Only national strategy
No information
Source: EMCDDA SQ27, 2008
12 12
Factors influencing drug
management systems
Politics
Media Public opinion
National drug
policies & strategies
Local drug
policies & strategies
Budget &
resources
Existing
services &
organisations
Drug problem Best
Practice/ Process
Management
system
13
0
5
10
15
20
25
30
Public
institutions
Private
providers
NGOs GPs
Providers
Nu
mb
er
of
co
un
trie
s
Psychosocial outpatient
Psychosocial inpatient
Detoxification
Opioid substitution treatment
Diversity of treatment providers in Europe
Source: EMCDDA SQ27, 2008
14 14
Factors influencing drug
management systems
Politics
Media Public opinion
National drug
policies & strategies
Local drug
policies & strategies
Budget &
resources
Existing
services &
organisations
Drug problem Best
Practice/ Process
Management
system
15
Source: EMCDDA SQ27, 2006
Main funding sources
for drug treatment in
Europe Only regional funding
Only state funding
No information
Only health insurance
funding
Mixed models
16
Treatment costs (Source: EMCDDA 2008)
Big differences across countries depending on:
• treatment system • insurance and welfare system
Example – Opioid substitution treatment
15 countries: free of costs
3 countries: free for methadone but contribution for buprenorphine
treatment
9 countries: depends on the provider (2 countries no info, Turkey no OST)
18 18
Factors influencing drug
management systems
Politics
Media Public opinion
National drug
policies & strategies
Local drug
policies & strategies
Budget &
resources
Existing
services &
organisations
Drug problem Best
Practice/ Process
Management
system
19
‘Best process’: 3 angles
• Good governance principles
• Process evaluation research/ tools
• Standards & guidelines
20
Good governance principals
Most common: 8 principles put forward by United
Nations organisations
Good governance should be participatory,
consensus-oriented, accountable, transparent,
responsive, equitable and inclusive, effective and
efficient and follow the rule of law.
•Key proponents include the United Nations (1997; 2007), the Organisation for Economic Co-operation and
Development (2005), and the World Bank.
22
Process evaluation research Vandam et al. 2010
• Drug policy responses need to be integral
(global) and integrated (involvement of all
relevant actors/services)
• 27 evaluations of cross-cutting interventions
• Success criteria: coordination; formal
agreement; demarcation of tasks; regular
meetings.
34
Quality standards & Guidelines
… should be seen within the context in which
they were developed. … checked for
validity and, if necessary, adapted locally.
35
In summary…
• Many factors influence demand reduction management models
• Good practice & process
• Diversity – no one model fits all
• Some tools around to help.
36
www.emcdda.europa.eu/best-practice
Thank you!