WHO Expert Committee on Drug Dependence – WHO Technical Report Series, No. 836 - Twenty-eighth Report
(1993; 52 pages)


Evaluates various strategies and approaches for reducing the harm to health and social functioning caused by the use of psychoactive drugs, including alcohol and tobacco. Drawing on a wide range of experiences in different parts of the world, the report aims to assist governments in formulating effective public health approaches based on a sound understanding of the various options for preventive action and the likelihood of success in different circumstances. With this goal in mind, strategies for prevention and treatment are assessed in the light of several recent trends in global patterns of drug dependence and drug-related harm. Apart from the burden of health and social problems caused by escalating drug use, the report's recommendations take on special urgency in view of the new risks posed by HIV infection and AIDS. The report opens with a brief discussion of terminology, followed by a review of global trends in the consumption of psychoactive drugs, including alcohol and tobacco, and in the development of measures for control. Trends cited include an enormous growth in the world supply of illicit drugs, with illicit cocaine traffic showing the most dramatic growth. The main factors that have influenced changing patterns of use are also briefly described. The next section discusses different types of drug-related problems and outlines indicators that can help determine the extent of these problems. A section concerned with approaches to prevention reviews the effectiveness of public health regulations, deterrence, and educational, community, and environmental approaches. On the basis of this review, the report draws a number of important conclusions concerning which approaches can be considered in different circumstances. Treatment responses are evaluated in the next section, which argues for a multi-pronged, integrated approach and explains the importance of primary care and general health services in the treatment of dependence and other drug-related problems. The need to adopt treatment approaches that are appropriate to the evolving problems posed by HIV and AIDS is also underscored. The remaining sections discuss the types of research and evaluation that can help identify effective interventions, offer advice on the development of national control policies, and set out a number of conclusions and recommendations. In line with newly adopted procedures for the review of psychoactive drugs by this Committee, the report concludes with an initial assessment of ten substances, of which seven are recommended for further review in order to determine the need for their control under the international treaties

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