The Work of the WHO Program on Substance Abuse and Psychedelic Drugs The Work of the World Health Organization Program on Substance Abuse and Psychedelic Drugs
Maristela G. Monteiro, M.D., Ph.D.
Medical Officer, Treatment and Care Unit
WHO Program on Substance Abuse
20 Avenue Appia 1211
Geneva 27
Switzerland
Tel: 41-22-791-47-91
Fax: 41-22-791-48-51
Introduction
The World Health Organization (WHO) is a specialized agency of the United Nations with primary responsibility for international health matters and public health. Its main objective is the attainment by all peoples of the highest possible level of health. Health is defined as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. Reduction of the health and socially adverse consequences of psychoactive substance use is an essential part of that objective.
Over the years WHO has regularly issued information and recommendations on research, training and the provision of health services to deal with alcohol and other drug-related problems.
The Program on Substance Abuse (PSA) was established in 1990 to intensify the response to these worldwide problems, in the areas of Regulatory Control, Prevention, Advocacy and Promotion, and Treatment and Care. In the area of public health, PSA has responded by designing a global strategy modeled on methodologies proven successful with other health and social problems, stressing the relevance of primary health care, and the need to promote healthy lifestyles.
WHO recognizes that people who take such substances do so for a wide variety of reasons, and these may vary from time to time for the same individual. Some of the reasons given for drug taking include the need to alleviate stress and pain, to foster a sense of easy relaxation, to facilitate relationships, to escape from something, to reduce hunger or fatigue, to seek euphoria or increased vigor, energy or courage, to search for new realities, to gain access to mystical and religious experiences, to achieve better insight or creativity, or to satisfy curiosity about drug effects.
Such motives are not necessarily associated with individual pathology or with adverse social influences. They can be functional for normal as well as abnormal persons, whether or not such persons are satisfied with the social structure and situation in which they find themselves. In addition, these motives do not necessarily lead to drug-taking.
The availability of psychoactive substances is a necessary but not sufficient condition for their use. As the efforts to control the supply of drugs have not been successful, the problem is to learn how to reduce the negative effects of the use of drugs to the lowest possible level without undue detriment to society. Although no use would be ideal, the reality is that communities must learn to live with drugs, that is, by helping people, particularly the young, to live with the presence of psychoactive substances without being negatively affected by them.
To increase the understanding of health and social consequences of substance use and be able to recommend appropriate and effective strategies to Member States, the Program on Substance Abuse has a variety of projects in the areas of prevention, health promotion, service development, community empowerment, action-oriented research, biomedical research, treatment, and regulatory control. Below, two projects related to psychedelic substances are detailed.
Use of indigenous plants
Herbal medicine is one important resource which had contributed to manŐs struggle against diseases and has been an important component of health care systems for thousands of years. Especially in developing countries, people recognize the value of medicinal plants in the treatment and prevention of several diseases. Among the hundreds of species which have been used in traditional medicine and by indigenous populations, the use of psychoactive plants has long been recognized. These plants have been used for a variety of purposes, ranging from sleep problems, to increase a sense of well being, to calm, to alter mood and levels of consciousness, in rites of passage or initiation, and to induce transitory visionary states which would indicate solutions for the community's or individual problems.
Apparently, the traditional uses within a culture of psychoactive substances have not been associated with major health problems, including dependence or harmful consequences. However, relatively little have been investigated and it is likely that for some of them, therapeutic applications could be proven effective in clinical practice. Recent advances in the neurosciences in the last 20 years have also created opportunities for using psychoactive plants, including hallucinogens, as tools to understanding the brain and the neurobiological basis for some psychic functions, and hopefully to develop more effective treatment for mental disorders.
As a result, WHO has a project aimed at documenting the botanical, pharmacological, toxicological and therapeutic properties of selected psychoactive plants. It is proposed to collect current information on the extent, nature and consequences of use of these plants in different regions of the world with a particular focus on traditional patterns of use. Selected psychoactive plants would then be further investigated, including khat, ayahuasca, kava, betel nut and San Pedro cactus.
The information collected from different regions of the world will be compiled in a publication, which would also indicate gaps in knowledge and recommend strategies for action for Member States and interested individuals and institutions.
Drug Substitution and Treatment
The AIDS epidemic has called attention to the need for alternative treatment for dependent users of psychoactive substances, especially those who inject drugs. While reduction in consumption would be ideal, many of these dependents are not willing or ready to do so; however, the risk of HIV infection and spread to others cannot be ignored as it has become a public health problem of great importance. Harm reduction approaches, including syringe exchange programs have flourished and have been effective in controlling the transmission of HIV through i.v. drug use. Heroin is the most common injected drug and heroin dependence is a problem in several parts of the world. The most widely used treatment is methadone maintenance, an opioid substitute which can be given orally as well. However, some heroin dependents, usually chronic patients with severe health problems, do not accept such treatment, diverging the methadone to illegal sale in order to obtain heroin. For these patients, other treatment approaches are needed.
Substitution treatments have been tried for other drugs as well: coca tea for cocaine dependents or anxyolitics for alcohol dependence. The definition of substitution which has been adopted is: "for people dependent on a psychoactive substance, the administration of a prescribed drug, pharmacologically related to that substance, to achieve defined treatment aims, usually improved health and well-being."
There are some criteria for a drug to be appropriate for substitution:
It is also desirable that the substance:
Oral use of cocaine for chewing or infusions is a common practice in Andean countries such as Peru and Bolivia; it taken by more than 5 million people. There are, however, no comparative studies on physiological and psychological effects after ingested cocaine by oral route with other routes. People who use oral