RESUMO
Quality standards have been recognized as an important tool for improving the quality of drug use prevention, treatment, and harm reduction services and for bridging the gap between science and practice. The aim of this paper is to describe the state of implementation of quality standards in drug demand reduction in the European Union and to identify barriers, needs, and challenges to implementation and future pathways. Between June and November 2021, an online survey (n = 91) and follow-up interviews (n = 26) were conducted with key informants - experts in drug demand reduction and quality assurance. Data were analyzed using descriptive statistics and thematic analysis. The survey showed that most countries have implemented the European Drug Prevention Quality Standards (EDPQS) in the prevention domain and the Minimum Quality Standards (MQS) in drug demand reduction. A variety of standards are applied in the treatment area and the EQUS minimum quality standards are widely known. The application of quality standards is least reported in the harm reduction service area. Mentioned challenges and barriers to implementation included lack of funding, unrecognized importance of evaluation, professional competencies, and system fragmentation. Mentioned supportive factors included appropriate materials and training, as well as political support and professional networks. The study shows that quality standards are inconsistently implemented in all areas of drug demand reduction. According to respondents, implementation could be improved by advocating for the need to implement quality standards, ensuring sustainable funding for interventions, and providing education and training.
Los estándares de calidad constituyen una herramienta para mejorar la calidad de la prevención, el tratamiento, y la reducción de daños del uso de drogas y para unificar ciencia y práctica. Este artículo tiene como objetivo describir el estado de la implementación de los estándares de calidad en la reducción de la demanda de drogas en la Unión Europea e identificar las barreras, las necesidades y los desafíos para su implementación. Entre junio y noviembre (2021) se realizó una encuesta en línea (n = 91) y entrevistas de seguimiento (n = 26) con informantes clave, expertos en reducción de la demanda de drogas y sistemas de garantías de calidad. Se emplearon estadísticos descriptivos y análisis temáticos. La mayoría de los países ha implementado los Estándares europeos de calidad en prevención de drogas (EDPQS) en el ámbito de la prevención y las Normas mínimas de calidad (MQS) en la reducción de la demanda de drogas. En el área de tratamiento, los estándares mínimos de calidad EQUS son ampliamente conocidos. La aplicación de estándares de calidad es menor en la reducción de daños. Se identificaron distintos retos y barreras: la falta de financiación e importancia concedida a la evaluación, las competencias profesionales y la fragmentación del sistema. Los factores de apoyo fueron materiales y formación, apoyo político y redes profesionales. Los estándares de calidad no se implementan en todas las áreas de reducción de la demanda de drogas. Los informantes clave sugirieron la necesidad de fomentar la implementación de los estándares de calidad, asegurar financiación y formación.
RESUMO
BACKGROUND AND OBJECTIVES: Substance use in women is associated with unique psycho-social and physical vulnerabilities and poses complex challenges during pregnancy and motherhood. Gender-sensitive drug policy which considers the needs of women and their children could address these concerns. The objectives of this study were: (1) to systematically explore national-level drug policies' sensitivity and responsiveness to women, pregnant women, and children; and (2) to examine the adherence of drug policies with international guidelines for gender sensitivity in drug policy. METHODS: The research team was diverse professional backgrounds and nine countries. A summative content analysis of national drug policy documents, action plans, and strategies was performed. Specific documents focusing on women, pregnancy, and children were analysed. Specific themes and how frequently they appeared in the documents were identified. This quantification was an attempt to explore usage indicating the relative focus of the policies. A thematic map was developed to understand how national-level drug policies conceive and address specific concerns related to women who use drugs. We adapted the UNODC checklist for gender mainstreaming to assess policies' adherence to international guidelines. RESULTS: Twenty published documents from nine countries were reviewed. The common themes that emerged for women, pregnancy, and children were needs assessment, prevention, treatment, training, supply reduction, and collaboration and coordination. Custody of children was a unique theme for pregnant women. Specific psycho-social concerns and social reintegration were special themes for women, whereas legislation, harm reduction, research, and resource allocation were children-specific additional themes. For women-specific content analysis, special issues/concerns in women with drug misuse, need assessment, and prevention were the three most frequent themes; for the children-specific policies, prevention, training, and treatment comprised the three most occurring themes. For pregnant women/pregnancy, prevention, treatment, and child custody were the highest occurring themes. According to ratings of the countries' policies, there is limited adherence to international guidelines which ensure activities are in sync with the specific needs of women, pregnant women and their children. CONCLUSION: Our analysis should help policymakers revise, update and adapt national policies to ensure they are gender-responsive and address the needs of women, pregnant women and their children.