Medical Education 1991, 25, 279

Editorial

WHO recommendations for improved training in the drugs field

The care and treatment of drug users have long been marginalized by mainstream medicine, and a number of specialties have divided between them the task of providing treatment for drug dependence and for the morbidity associated with injecting drug use. Psychiatry, infectious disease units, general practice and accident and emergency departments have all played their part but, with the exceptions of psychiatry and, variably, general practice, specific training for the comprehensive management of the injecting drug user has not been provided. With the arrival of symptomatic HIV disease and AIDS in this population, however, a reappraisal of the wide- ranging health needs of drug users has begun; the training needs of their careers immediately follows in the wake of such a reappraisal. In a recent WHO European Regional Office reportt, the recommendation that drug users should not be restricted in their access to general and specialized health services is supported by reference to the training of health care workers, and in particular the development of guidelines to management in the context of improved prophylactic and antiviral therapies for HIV infection. WHO has also called for the setting up of national workshops, with training as their focus, in member states.

Moving from the perspective of providing rather than receiving training, however, the

+Strategy for HIV/AIDS Prevention and Control in Drug Users. World Health Organization, Regional Office for Europe, Copenhagen 1991.

Correspondence: Dr Graham Hart, Academic Department of Genito-Urinary Medicine, University College & Middlesex School of Medicine, James Pringle House, The Middlesex Hospital, London W I N SAA, UK.

report also highlights recent developments in Central and Eastern Europe. Here the need is for expertise in the drugs field, as some of the less desirable products of Western society are expor- ted to areas previously unaffected by illicit drug use (although alcohol dependence has long been highlyprevalent in some of these countries). The report rightly cautions against the wholescale transfer of methods of dealing with drug prob- lems and HIV to these countries, and is more concerned to establish areas of mutual benefit and cooperation for East and West.

The advent of HIV has resulted in a major overhaul of our assumptions about drug users, and in particular their potential for behavioural change. It has also made us reconsider the nature ofand access to health services for this group, and the training needs of professionals caring for drug users. Working papers and reports such as this are to be encouraged if they help to galvanize those of us in the field actively to design training programmes, and exploit the multidisciplinary expertise available in the drugs field to the benefit not only of our own health professionals but also those in the emerging democracies beyond the European Community. What is less certain, however, is whether the funding and resources will be made available to realize the goals of such worthy publications, and actually put into prac- tice the recommendations that are made. We must be vigilant in ensuring that such reports do not end up, like so many others, as noble words unconnected to real deeds.

GRAHAM HART Lecturer in Medical Sociology,

Academic Department of Genito- Urinary Medicine, University College and Middlesex School of Medi-

cine, London

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