Alessandra Bo

New psychoactive substances: Current health-related practices and challenges in responding to use and harms in Europe

BACKGROUND The availability of new psychoactive substances (NPS) in Europe has rapidly increased over the last decade. Although prevalence levels of NPS use remain low in the general European population, there are serious concerns associated with more problematic forms of use and harms in particular populations and settings. It has thus become a priority to formulate and implement effective public health responses. However, considerable knowledge gaps remain on current practices as well as on the challenges and needs of European health professionals who are responding to use and harms caused by these substances. The aim of this study was to explore current health responses to NPS, and highlight key issues in order to inform planning and implementation of adequate responses. METHODS This scoping study was based on a targeted multi-source data collection exercise focusing on the provision of health and drug interventions associated with NPS use and harms, in selected intervention settings across Europe. RESULTS Findings revealed that in the absence of specific evidence, health professionals across most intervention settings rely primarily on acquired expertise with traditional drugs when addressing NPS-related harms. This study also identified a gap in the availability and access to timely and reliable information on NPS to users and health professionals. Health professionals in sexual health settings and custodial settings in contact with certain risk groups reported particular challenges in responding to NPS-related harms. CONCLUSION Immediate investments are required in expanding substance identification capabilities, competence building among professionals and dissemination of risk information among relevant stakeholders. The risks of neglecting under-served risk populations and failure to address the information needs of health professionals and users on NPS harms in a context of rapid changing drug markets in Europe may have unforeseeable consequences at societal level.

Are mass-media campaigns effective in preventing drug use? A Cochrane systematic review and meta-analysis

Objective To determine whether there is evidence that mass-media campaigns can be effective in reducing illicit drug consumption and the intent to consume. Design Systematic review of randomised and non-randomised studies. Methods We searched four electronic databases (MEDLINE, EMBASE, ProQuest Dissertations & Theses A&I and CENTRAL) and further explored seven additional resources to obtain both published and unpublished materials. We appraised the quality of included studies using standardised tools. We carried out meta-analyses of randomised controlled trials and a pooled analysis of interrupted time-series and controlled before-and-after studies. Results We identified 19 studies comprising 184 811 participants. Pooled analyses and narrative synthesis provided mixed evidence of effectiveness. Eight interventions evaluated with randomised controlled trials leaned towards no evidence of an effect, both on drug use (standardised mean difference (SMD) −0.02; 95% CI −0.15 to 0.12) and the intention to use drugs (SMD −0.07; 95% CI −0.19 to 0.04). Four campaigns provided some evidence of beneficial effects in preventing drug use and two interventions provided evidence of iatrogenic effects. Conclusions Studies were considerably heterogeneous in type of mass-media intervention, outcome measures, underlying theory, comparison groups and design. Such factors can contribute to explaining the observed variability in results. Owing to the risk of adverse effects, caution is needed in disseminating mass-media campaigns tackling drug use. Large studies conducted with appropriate methodology are warranted to consolidate the evidence base.

El portal de promoción de buenas prácticas en Europa del OEDT. Un instrumento de diseminación vía Internet

Best practice is the best application of available evidence to current activities in the drugs field. The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) created a web-based tool aimed at bridging together scientific evidence and current practices in the drug addiction field. Beyond dissemination of evidence, the scope is to share best practice among the European countries. The synthesis of the evidence is based on the methods of the Cochrane collaboration (the Drugs and Alcohol Group) and the Grade working group. As of February 2013 the portal encompasses four modules on the effectiveness of demand reduction interventions, a collection of European projects on prevention, treatment, harm reduction and social reintegration and an inventory of European Guidelines and Standards including a bank of instruments to evaluate interventions (http://www.emcdda.europa.eu/bestpractice). The summaries of evidence are presented in a plain language format and include brief explanation of the measures of effect supporting the evidence, but do not provide specific recommendations. The main future challenge of EMCDDAs best practice promotion is to become a service for those willing to implement best practice. The Best Practice Portal should become a platform where to find all is needed for successful implementation (handbooks, training materials, guidelines for evaluation and contacts for mentoring).

What is needed in future drug treatment research? A systematic approach to identify gaps on effectiveness of drug treatment from the EMCDDA.

Abstract There is a perceived global need to bridge the existing gap between researchers and other stakeholders to make research more helpful and to realign “the mismatch between what clinical researchers do and what patients need”. The EMCDDA carried out a pilot analysis to explore the gaps in research on treatment for drug dependence as indicated by systematic reviewers of studies on effectiveness of interventions together with a stakeholder’s consultation to ensure a broader participation in the definition of research needs. The rough comparisons of the gaps identified by the researchers in the reviews and those suggested by the stakeholders reflect their different perception of research. The reviewers focus on the quality of studies and on how this may impair reaching conclusive evidence, while the stakeholders are more concerned by the management of effective interventions and by the needs of specific patients. With this exercise, the EMCDDA wants to contribute to the broader debate on how to translate evidence into action and it offers a possible way to support decision makers to set the health research agenda.

Nine reasons why ecstasy is not quite what it used to be

This paper explores the recent resurgence in use of ecstasy/MDMA in Europe and highlights keys areas of continuity and divergence between the ecstasy market of the 1990s and the current MDMA market. Based on a scoping study involving a targeted multi-source data collection exercise on MDMA, it highlights nine areas that have undergone some level of change, linked with both supply and demand for the drug. Factors discussed include: innovation in production techniques; changes in precursor chemical availability; the role of online markets; competition with other stimulants and new psychoactive substances; the increased availability of high-strength MDMA; and the shift from subcultural towards more mainstream use of the drug. The paper proposes that the MDMA on Europes contemporary market is in some respects a third generation product with a different consumer profile, with implications that responses developed at the time of the drugs earlier iteration, may be in need of a review and revamp.

Best practice promotion in Europe: A web-based tool for the dissemination of evidence-based demand reduction interventions

Best practice is the best application of available evidence to current activities in the drugs field. In 2008, the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) set off the creation of a web-based tool which bridges together scientific evidence and current practices in the drug addiction field. The aim is to disseminate evidence-based interventions and promote sharing of best practice amongst the European countries. The synthesis of the evidence is based on sound procedures, implemented according to the methods of the Cochrane collaboration (the Drugs and Alcohol Group) and the Grade working group. As of October 2012, the portal is composed of four modules on the effectiveness of demand reduction interventions, a collection of European projects on prevention, treatment, harm reduction and social reintegration and an inventory of European Guidelines and Standards including a bank of instruments to evaluate interventions (http://www.emcdda.europa.eu/best-practice). The summaries of evidence are presented in a user-friendly format and provide plain language information on the interpretation of the measures of effect supporting the evidence, but do not provide specific recommendations. The main future challenge of EMCDDAs best practice promotion is to enhance the communication of evidence to better inform the decision making processes both at national and European level.

Selective Prevention: Addressing Vulnerability to Problem Drug Use in Europe.

Following the 2003 publication of the European Union (EU) Council Recommendations and the 2005–2008 and 2009–2012 EU Drugs Action Plans, increasing attention has been given in EU member states’ drug policies to populations that are vulnerable to problem drug use (PDU). Monitoring data reported to the EMCDDA by designated agencies from 30 countries highlight that vulnerable populations tied to institutions (e.g. young drug law offenders, pupils with academic problems, youth in care institutions) receive more attention in policy and intervention provision than vulnerable groups that are hard to reach (e.g. immigrants and homeless youth). The context of vulnerability to PDU in the EU is discussed, including the inadequacy in many member states of alternatives to imprisonment for underage drug law offenders, the difficulty of addressing the needs of ethnic and migrant groups and opportunities for prevention in culturally disadvantaged neighbourhoods.

Quality assurance in drug demand reduction in European countries: an overview

Abstract Background: The EMCDDA, through its network of National Focal Points, collects information on the quality assurance systems for drugs-related interventions across European countries. European National Drug Strategies include recommendations for systems and approaches for the assurance of the quality of interventions. Methods: We searched National Drug Strategies for elements related to quality assurance in drug demand reduction and summarised information through questionnaires administered to the EMCDDA Network of National Focal Points. Results: In total, 15 National Drug Strategies and 60 questionnaires were analysed. Almost all the strategies include quality-related topics. Frequently, the Ministry of Health leads quality assurance although sometimes jointly with the Ministries of Education, Labour, Family and Social Welfare. Accreditation systems are common, but implemented in different ways. Training and education are widely provided, for the vast majority of countries, consisting of short-term training to keep professionals updated. Guidelines and Standards are gathering momentum as the major tools for the implementation of evidence-based recommendations and are usually available across countries. Conclusions: Although the evidence base for interventions in drug demand reduction is becoming available and accepted, attention needs to be given to implementation issues. The European countries are rapidly moving towards paying greater attention to the quality of interventions.