SoR-Oct2006

Handbook of WMA Policies
World Medical Association ½ S-2006-06-2006

WMA STATEMENT
ON
THE RESPONSIBILITIES OF PHYSICIANS IN PREVENTING
AND TREATING OPIATE AND PSYCHOTROPIC DRUG ABUSE
Adopted by the 57th
WMA General Assembly, Pilanesberg, South Africa, October 2006
PREAMBLE
1. Opiate and psychotropic drugs are valuable therapeutic tools when used appropriately,
as medically indicated, for a variety of symptoms and conditions. Unfortunately, non-
clinical misuse of these addictive substances is an enormous problem worldwide. Drug
addiction is a complex social, economic and legal issue as well as a threat to public
health and safety globally. It affects people from all demographic and social groups
and economic spheres. In addition to exposing themselves to the direct health risks
related to the inappropriate use of these substances, persons addicted to drugs may en-
gage in high risk behaviour, such as needle-sharing and unprotected sex, and many
resort to criminal activity to finance their expensive addiction. These factors increase
transmission of viral infections, such as Hepatitis B and C and HIV/AIDS, among both
users and non-users alike. Other results of addiction include failure to maintain
employment or to function in social and family life.
2. The legal ramifications of non-medical drug use, which is illegal in most countries,
generally do little to assist users in breaking free from their addiction. Despite drug
programs in many correctional facilities, the availability of illegal substances is often
prevalent among inmates and, in fact, some users begin their addiction in these insti-
tutions. Addressing addiction therefore falls largely to society and the health profes-
sion.
3. The World Medical Association, concerned by the widespread misuse of psychotropic
and opiate drugs, urges physicians to prioritize this problem in the practice of medi-
cine and to adhere to the following guidelines.
PRINCIPLES
1. Responsible prescribing practices
a. Physicians should be aware of the addictive properties of certain psychotropic and
opiate drugs. Such drugs should be prescribed with the greatest restraint,
observing the strictest possible generally accepted medical indications. Physi-
cians must take all necessary measures to ensure that they are fully informed of
the effects of these drugs. This includes reviewing up-to-date research regard-
ing dosage, potential effectiveness for the specific condition, potential side affects
and interactions and prevalence of misuse.
S-2006-06-2006½ Pilanesberg
Opiate and Psychotropic Drug Abuse

b. When such drugs are medically indicated, their use must be carefully monitored
to ensure that the patient is following strict instructions regarding dosage, timing
and any other factors associated with the safe use of the particular drug. All ap-
propriate measures must be taken to prevent the stockpiling, resale or other il-licit
usage of the drug.
c. Patients must be fully informed of all potential therapeutic and non-therapeutic
effects of psychotropic and opiate drugs, including potential for addiction, and be
fully involved in the decision to take them. No competent patient should be
forced to take any psychotropic drug against his or her will.
d. Physicians should be aware of non-medical factors that may predispose patients
to addiction. These may include, among others, family history, past addiction,
emotional trauma, depression or other mental health conditions and peer pres-
sure, especially among young persons.
e. Physicians should learn to recognize ‘drug seekers’, addicted patients who attempt
to obtain psychotropic and opiate drugs under false medical pretences. Drug
seekers often consult more than one physician in an effort to obtain multiple pre-
scriptions. In extreme cases, drug seekers may harm themselves to create symp-
toms to obtain a prescription. All patient conditions and symptoms should be cli-
nically verified, to the extent possible, and meticulous records maintained regard-
ing the patient’s drug history. If databases containing patient drug records and
prescribing histories are available, they should be consulted.
f. When prescribing any psychotropic or opiate substance to minors, physicians must
ensure that the parents or guardians of the patient are fully informed of the
potential misuse of the drug and encouraged to monitor the child carefully to en-
sure adherence to the physician’s instructions. Parents or guardians should be in-
formed that, in some countries, it is increasingly common for children to sell pre-
scription drugs to their peers.
2. Non-drug therapy for addicts to opiate and psychotropic drugs
a. Physicians should be aware of all non-drug treatment options for addicts to opiate
and psychotropic drugs, including inpatient and outpatient programs and thera-
peutic communities, in which recovering addicts live in a supportive, drug-free
environment. Most treatment programs are focused on breaking the cycle of drug
dependence through detoxification, counselling – including ongoing peer support –
and permanent abstinence from the use of any addictive opiate or psychotropic
substance, including alcohol. Some offer educational and/or vocational programs
to facilitate successful reintegration into community life.
b. Physicians should encourage their patients to participate in drug treatment pro-
grams at the earliest possible stage of addiction.
c. All efforts should be made to respect the dignity and autonomy of addicted
patients. Involuntary inpatient treatment of addicted persons should be a last
resort, according to established guidelines and, where applicable, legal require-
ments.
Handbook of WMA Policies
World Medical Association ½ S-2006-06-2006

3. Drug therapy for addicts to opiate drugs
a. In some cases, persons addicted to opiate drugs may be treated using medications
that relieve withdrawal symptoms and cravings for the addictive substance without
producing the ‘high’ associated with opiates. These medications also provide cross
tolerance to other opioids. The objective of drug treatment is the immediate
cessation of the use of opiate drugs.
b. Drug therapy can assist the opiate-dependent patient to function in his or her
normal environment and activities while working to overcome the opiate addic-
tion. However, it should always be part of a multi-disciplinary approach that in-
cludes proven non-drug treatment elements, such as counselling and peer support.
c. Drug therapy should be administered according to established evidence-based
guidelines and supervised by specially trained physicians with an appropriate
support team.
4. Awareness raising and policy development
a. National Medical Associations (NMAs) should engage in cross-sectoral national
efforts to raise awareness of the risks associated with the abuse of opiate and
psychotropic drugs and to ensure the availability of appropriate treatment options
for addicted persons. NMAs should encourage their members to participate in
similar programs at the community level.
b. NMAs should promote appropriate drug prevention programming at all levels of
the educational system, recognizing that experimentation with drugs is increas-
ingly prevalent among younger age groups.
c. NMAs and physicians should participate in the development of evidence-based
guidelines that support a multi-disciplinary approach to the treatment of drug ad-
diction, including harm reduction strategies such as needle exchange programmes.
d. NMAs should participate in the development of legal procedures relating to ille-
gal drug use to ensure that addicted persons are recognized as entitled to receive
appropriate medical and rehabilitative care, including in correctional institutions.
CONCLUSION
1. Physicians have an important role to play in the treatment of drug addiction, both as
clinicians and as advocates for the treatment, rights and dignity of persons addicted to
these harmful substances. Treatment of addiction, like treatment for any disease or
condition, should be undertaken in the best interests of the patient and according to
established principles of medical ethics.