用于治疗和护理兴奋剂使用障碍的可扩展干预措施

2. #ScaleUp Initiative4. Expected global outcomes5. Background information &additional readingTable of contents© Nick Danziger for UNODCBackground1.3. Phases of implementation 23561 Thereis a growing concern in severalregionsoftheworldduetothesignificantlevels of substance use fornon-medicalpurposes.In2022,psychostimulants(includingamphetamines,cocaineandecstasy)thesecondmostusedinternationallycontrolledsubstanceclassworldwide,with cannabis beingthemost widely used(UNODC,2024).The total number of people having useddrugs worldwide was approximately 292millionthatyear,markinga20%increase over the past decade. Of these,anestimated 30 million people usedamphetamines,23.5million,cocaine,and20 million,ecstasy.Nearly as manywomenhad used synthetic stimulantsas men. Stimulant use has led to a highdemandfortreatment,withnotablevariationsacross subregions:stimulants(amphetamine-type stimulants, cocaine)beingthe primary drug for 7%seekingtreatment in Africa, 17% in Europe, 29%inthe Americas,42%in Oceania and52%in Asia.The European Drug Reportunderscoreshighcocaineavailabilityimpacting on public healthwith the prevalence of cocaine useBackground1.“There is an urgent need tobridge the global treatment gapfor stimulant use disorders”The United Nations Office on Drugs and Crime(UNODC), the World Health Organization (WHO) andthe European Drug Agency (EUDA) are suggesting amulti-country initiative and study on bothpsychosocial and pharmacological treatment ofstimulant use disorderwith a focus on feasibility,safety and effectiveness in different combinationsand contexts, to strengthen the evidence base forscalable interventionsbenefitting differentpopulation groups and regions. were2024 amongadults in 2023 being 1.4%,aswellas the potential for increased useof methamphetamine in Europe.Despitethe rising need for efficaciousinterventions,no medication has yetbeenapproved for the treatment ofstimulantusedependencetodate.Additionally,theimplementationofevidence-basedpsychosocial treatment,such as contingency management (CM),cognitive-behavioraltherapy(CBT),familytherapyandcontinuedsocialsupportforstimulantusedisordertreatment remains very limited.Thereis an urgent need to bridge theglobaltreatment gap for stimulant usedisordersbydevelopingandimplementingscalable treatment andcareinterventions.Whilesomecountriesareadvancingresearch(includingonpharmacologicaltreatments), coordination across clinicalstudieson key outcome measures,thatwouldmeettheregulatoryrequirements and the needs of affectedpopulations, would be crucial.© Nick Danziger for UNODC 0 1 0 22.#ScaleUp initiative#ScaleUpis a joint initiative of UNODC,WHOand EUDA,launched during theCommissionon Narcotic Drugs in March2024.It builds on previous work andpublications of UNODC, WHO, EUDA, otherpartneragenciesandinternationalresearchers, such as the Discussion Paper“StimulantUseDisorders:CurrentPracticesandCurrentPerspectives”(UNODC,2019),recommendationsfortreatmentof stimulant dependence inmhGAPguidelinesformental,neurologicaland substance use disorders(WHO,2023),aswellasclinicaldescriptionsand diagnostic requirements(CDDR)forICD-11disordersduetosubstanceuse and addictive behaviours.#ScaleUpcallsforthescaleupofeffectivepsychosocial treatment,as wellas increased research on pharmacologicaltreatmentoptionswithaviewtoincreasingtreatmentengagement,treatmentretentionandeffectivetreatmentoptionsforstimulantdependence.UNODC(2019)discussionpaperstemmedfrom an expert group meetingorganizedby the UNODC’s Prevention,TreatmentandRehabilitationSection(UNODCPTRS)in 2017,where leadingexperts in stimulant use disorders from 25countriesdiscussed integrated models oftreatmentthatmaybeeffectiveandsuitable for implementation in a variety ofsettingsonce translated and culturallyadapted.Following several presentationsexchangesonthetopic,theparticipatingexpertsconcludedthatwasevidencetocallformoreresearchonpsychosocialandpharmacologicaltreatment options andtoconduct multi-country effectiveness,feasibility and safety trials.Abriefing on#ScaleUp took place attheCNDDecember2024 to urge UN MemberStates to support the initiative to jointlydevelopandstrategiesontreatmentand care and to protect thehealthof our communities.InterestedMemberStates and other entities areinvitedtofeedback,informationon#ScaleUp,express theirinterestin participation and supportthe implementation of the initiative. onWHOTheandthere Reconvenedimplementstimulantproviderequest SessioninnovativeusedisordercommentsadditionalTo read the fullpublication, pleasescan the QR code. inand 1.1.Development of evidence-based treatment and researchprotocolsforpsychosocial/pharmacologicaltreatmentstimulantusedisordersinspecializedcommunity-basedsubstanceuse disorder treatment and care programs,adaptedforlocal environments,including in low-and middle-incomecountries,as feasible,and with a focus on multiple outcomes(drug use, treatment retention and satisfaction, quality of life).1.2.Assessment of availability of medications under rese