Development of the UNODC-WHO quality assurance mechanism and standards for the treatment of drug use disorders

Background: Following the launch of the UNODC-WHO International Standards for the Treatment of Drug Use Disorders (2016) and the approval of resolution 59/4 by the Commission of Narcotics Drugs, which urges UNODC and WHO to support a systematic process of national adaptation and the adoption of national standards for the accreditation of services. There is a need for new globally applicable tools to ensure a qualified and effective response to DUDs around the world.

One of the tools developed for this purpose is Quality Assurance (QA) standards for the treatment of DUDs that is designed to evaluate good practices informed by science and ethical principles and to help people with DUDs enjoy the same quality standards and treatment opportunities that are provided for other chronic diseases. The standards need to be globally applicable and aligned with the International Standards and serve the purpose of supporting policy makers, treatment services managers and practitioners to improve their capacity to deliver quality treatment and care services.

Methods: After an initial literature review on the quality of drug programs and services, a technical consultation meeting was convened on the development of the QA standards. Draft tools were developed through a remote peer review process with support from drug treatment professionals. The tools were further improved and field-tested through trainings of experts from and piloting in some project countries.

Results: UNODC, in coordination with WHO, convened the technical consultation in November 2016, Vienna, which brought 18 experts from 10 countries, where the experts identified key elements of the quality drug treatment systems and services. The draft standards were enhanced through a peer review process. The developed QA standards consist of 5 system standards with 21 criteria (a strategic multi-sectorial partnership group, routine comprehensive needs assessment, strategic planning of a system, work with funders to ensure the on-going quality and performance improvement of the local drug treatment system) and 6 service standard areas (core management, core care, patients’ rights’ and responsibilities, interventions, setting specific standards, target group specific considerations) with 28 standards and 122 criteria. Furthermore, the tools detailed evidence required for each criterion and indicative ‘scoring’ using a ‘culturally transferable BRAG scoring system’ (Blue, Red, Ambar, Green). The standards were field-tested and further improved through piloting in Afghanistan in 2017 and evaluation of seven training workshops of expert groups from 11 countries (Afghanistan, UAE, Egypt, Indonesia, Lao PDR, Vietnam, Nigeria, Uzbekistan, Kyrgyzstan, Kazakhstan, and Tajikistan).

Conclusions: UNODC has, in close collaboration with WHO and drug treatment experts worldwide, developed the UNODC-WHO QA standards for the treatment of DUDs. Harmonization of the two different QA standards by UNODC-WHO and COPOLAD is being processed to develop core QA treatment standards in preparation for its global roll-out and scaling up.