Professor Min Zhao
Shanghai Jiao Tong University, China
Plenary: Neuromodulation for Substance Use Disorders: Current Situation and Future Direction
Neuromodulation has recently shown significant promise as an effective treatment for substance use disorders. This approach to treatment involves altering nerve activity through the targeted delivery of a stimulus, such as electrical stimulation, to specific neurological sites in the body. In addiction medicine, non-invasive neuromodulation primarily includes repetitive transcranial magnetic stimulation (rTMS), transcranial electrical stimulation, and vagus nerve stimulation. There have been more than thirty rTMS studies for substance use disorders to date. In this session, Professor Min Zhao of Shanghai Jiao Tong University will review the efficacy of transcranial magnetic stimulation in the treatment of substance use disorders. She will consider the current limitations and future direction of rTMS for addiction, and share results from her own research group, along with a series of rTMS intervention protocols they have developed for methamphetamine use disorder.
Dr. Devora Kestel
Director of Mental Health and Substance Abuse, World Health Organization
Dr. Devora Kestel is responsible for leading the World Health Organization’s work in the areas of mental health and substance abuse. She studied psychology in her native Argentina before moving to Italy where she worked in the mental health field for 10 years before joining the WHO office in Kosovo in 2000. She was Unit Chief in Mental Health and Substance Abuse at the Pan American Health Organization before her appointment as the WHO Director of Mental Health and Substance Abuse in 2018.
Plenary: Strengthening the Global Response to Substance Use and Addictive Behaviours: Recent Developments and Post-Pandemic Future
Professor Rajita Sinha
Yale University School of Medicine and Founding Director Yale Interdisciplinary Stress Center, United States
Plenary: Addiction and Stress Vulnerabilities: Relationship to Risk and Relapse Outcomes
Stress and trauma has long been associated with addiction risk and relapse, but specific neural and biobehavioral processes by which stress interacts with chronic drug use to promote and increase drug seeking, addiction relapse and other addictive behaviors have only recently received attention. Individuals with substance use disorders (SUD), including opioid use disorder (OUD), have higher rates of trauma, stress and stress-related mood and anxiety disorders. Drawing from human laboratory, brain imaging, longitudinal outcomes, real world daily data, and clinical treatment development research, Dr. Sinha will focus on specific adaptations in peripheral hypothalamic pituitary-adrenal (HPA) axis responses, brain reward and stress pathways, and show how these alterations map on to functional changes that promote increased craving, greater drug withdrawal and abstinence symptoms and risk of relapse and poor treatment outcomes.
She will then focus on the need for interventions to address such stress-related pathophysiology of substance use disorders and provide clinical outcome research examples of potential targets for treatment to improve outcomes in SUD, including OUD. She will also discuss and present behavioral intervention strategies to reduce risk of stress-related poor treatment outcomes in OUD. Finally, she will highlight the heterogeneity and diversity in substance use disorders and present precision medicine models utilized in other diseases to discuss their application in the treatment of and recovery from substance use disorders.
Dr. Joao Castel-Branco Goulao
Ministry of Health, Portugal
Plenary: Drug Policy: Do's and Dont's
The global nature of the drugs phenomenon demands national, regional and multilateral approaches, as individual national efforts are likely to prove ineffective. Countries can learn from each other, by sharing research and best practices and always taking into account that a specific policy that works in one country may not turn out well in another. In this plenary session, Dr. Joao Castel-Branco Goulao will discuss the clear consensus that drug policies must be pragmatic, based on facts rather than on ideology, and seek to reduce the harm that drug use causes. It is our common responsibility to pursue a comprehensive approach that combines health, criminal justice and social services, and that respects and protects human rights.
Caste-Branco Goulao will argue that this should be done by advocating a balanced, integrated and multidisciplinary approach to address drug-related challenges, in which actions towards reducing drug supply and demand for drugs are mutually reinforcing and equally important. Civil society has a crucial role to play in drug policies, as a platform to increase awareness regarding drug use, stigma and discrimination and to promote dialogue and exchanges of best practices among the various actors. Solid evidence on all aspects of the drug situation worldwide is critical to boost timely and proactive responses, to inform policy and measure results. There is a need, more than ever, for reliable and robust drug-monitoring information which should be the basis for defining reliable and clear policy priorities and for investing in areas of proven effectiveness.
Professor Patrice Forget, M.D. Ph.D
University of Aberdeen, Scotland
Plenary: Opioids After Surgery and Trauma in Europe: Is There an Opioid Epidemic?
Are post-surgical opioids a problem or a solution? Can we do better? What are the best practices and current research priorities and questions? In this plenary presentation, Professor Patrice Forget of Scotland’s University of Aberdeen will present evidence regarding the persistent use of postoperative opioids, as well as recent multidisciplinary consensus statements on the use of opioids for acute pain at both patient and policy levels. Finally, he will discuss ongoing studies and projects to illustrate how we could improve our knowledge.
Dr. Mindy Fullilove
New School for Social Research, United States
Plenary: Displacement, Intergenerational Trauma and Addiction
Displacement is a monumental global problem — according to the United Nations Refugee Agency (UNHCR), more than 82.4 million people were forcibly displaced in 2020 alone. Today, long-standing causes of displacement including war and development are compounded by the upheavals caused by climate change. Displacement disrupts generational bonds and takes generations to heal, and displaced people are highly vulnerable to addiction. In this talk, Dr. Mindy Fullilove of the New School for Social Research will discuss the social integration that is needed to heal these harms.
Professor Atul Ambekar
National Drug Dependence Treatment Centre, India
Plenary: The International Scheduling System for Narcotic Drugs and Psychotropic Substances: Does it Need an Overhaul?
The three United Nations Drug Conventions form the bedrock of the international drug control framework, the stated aim of which is to curb diversion and misuse of controlled products while ensuring access for medical and scientific purposes. It has been unsuccessful on both counts. Production, trafficking and consumption of so-called ‘illicit’ drugs continues unabated, while there are gross inequities in the availability of controlled medications for genuine medical indications.
In this session, Professor Atul Ambekar of India’s National Drug Dependence Treatment Centre will explain the system that exists for evaluating and classifying drugs under the United Nations conventions. He will examine the roles of the World Health Organization’s Expert Committee on Drug Dependence and the Commission on Narcotic Drugs (CND), a political body. He will offer a critical analysis of the review process, the framing of recommendations and the debate and manoeuvring that take place during CND deliberations. In particular, he will focus on the CND’s recent decision to accept the ECDD’s recommendation to reclassify cannabis while rejecting additional recommendations to change the classification of other cannabis-related substances designed to ensure their availability for medical use whilst preventing harms associated with non-medical use.
Dr. Magdalena Harris
London School of Hygiene and Tropical Medicine, United Kingdom
Plenary: Skin and Soft Tissue Infections Among People who Inject Drugs: Reinvigorating a Needed Harm Reduction Response
Skin, soft tissue and venous infections (SSTVIs) are an increasing cause of acute and chronic morbidity among people who inject drugs globally. SSTVI-related complications are a leading cause of hospitalisation for this group, with delays in care precipitating systemic infections such as septicaemia and endocarditis. For many people who inject drugs, SSTVIs constitute a hidden epidemic of suffering that impacts the most marginalised: those who are unstably housed, economically insecure and living with multiple morbidities. SSTVI complications are exacerbated by and can entrench experiences of social exclusion.
In this plenary presentation, Dr. Harris will present an overview of SSTVIs among people who inject drugs and introduce data generated for a recent London-based study with 455 participants. Findings include those related to a hypothesised causal pathway between overuse of acidifier for injection, venous damage and SSTVI risk; environmental constraints to safe injecting practice; and the role of opioid withdrawal in delaying or interrupting hospital-based SSTVI treatment. Capacitating culturally safe care can reduce treatment interruption and serious SSTVI complications among people who inject drugs, while enhancing trust and reducing shame among a highly stigmatised and marginalised population.
George F. Koob, Ph.D.
National Institute for Alcohol Abuse and Alcoholism, United States
Plenary: Alcohol and Drug Addiction: The Gain in the Brain is in the Pain
In this session, George Koob of the National Institute for Alcohol Abuse and Alcoholism will explore the role that hyperkatifeia plays in addiction and deaths of despair. Hyperkatifeia (derived from the Greek katifeia, for dejection or sadness) is an increase in intensity of the constellation of negative emotional or motivational signs and symptoms of withdrawal from drugs of abuse. He will introduce compelling evidence that hyperkatifeia triggered by excessive drug intake is sensitized during the development of compulsive alcohol use, persists into protracted abstinence, and contributes to the development and persistence of compulsive drug seeking. Finally, he will explore how significant overlap in the engagement in addiction of circuits mediating brain emotional pain and brain physical pain may help explain the prominent role of alcohol and drugs in deaths of despair.
Professor John Dillon
University of Dundee, Scotland
Plenary: Community-Based Approaches to Eliminating Hepatitis C
The Hepatitis C Virus (HCV) is a fatal infectious disease that affects the most vulnerable, deprived and stigmatised members of our society and disproportionately affects people with addictions. In this session, Professor John Dillon will introduce new methodologies and care pathways to deliver support, treatment and cure to people affected by HCV. He will show how the combination of these new care pathways and patient-focussed treatment have delivered high levels of HCV cure and placed leading sites on the verge of HCV elimination, while also improving outcomes for patients across a range of health and social outcomes.
Dr. Dan Lubman
Monash University, Australia
Plenary: Rethinking Addiction: Confronting Stigma and Harnessing the Power of Real Stories
Addiction remains one of the most stigmatised health conditions globally. It affects people of all ages and all backgrounds, yet common stereotypes prevail. The politicisation of drug use, coupled with negative stories in media and film, reinforce these stereotypes and perpetuate stigma.
A devastating consequence of the shame, discrimination and judgement that many individuals and families experience is an almost two-decade delay in in help-seeking, compounded by multiple barriers to treatment. Yet society refuses to have an honest conversation about how we respond to alcohol, drug and gambling-related harm. How do we start to change the conversation and counter the many myths associated with addiction?
In this presentation, Dr. Dan Lubman of Australia’s Monash University will discuss how the recent Australian documentary series Addicted Australia has challenged stigma and stereotypes through humanising narratives and increased community awareness. He will also explore learnings from the national Rethink Addiction campaign in Australia, which has been an important platform for helping to tell the real stories of addiction and to advocate for change.