New review on drugs and driving

Cited from Drugnet Europe No 87, July–September 2014

An estimated 28,000 lives are lost on Europe’s roads every year and a further 1.34 million people are injured. Many of these accidents and deaths are caused by drivers whose performance is impaired by a psychoactive substance. Alcohol remains the number one substance endangering lives on European roads, but use of drugs and medicines behind the wheel, particularly when combined with alcohol, is a major challenge for policymakers. A new EMCDDA report — Drug use, impaired driving and traffic accidents — reviews the latest research in this field.1

Released to mark International day against drug abuse and illicit trafficking (26 June), the report updates an EMCDDA literature review released in 2008. The new edition includes the results of the European Commission-funded DRUID project (2006–11), which contributed key evidence to road safety policy by mapping Europe’s drink- and drug-driving problem across 13 countries. Also examined are over 500 studies, published in Europe and internationally up to 2013, with a greater emphasis placed on meta-analyses and systematic reviews, which combine and summarise the latest findings.

The report explores methodology, prevalence and the effects of substances on performance. It concludes: ‘The chronic use of all illicit drugs is associated with some cognitive and/or psychomotor impairment and can lead to a decrease in driving performance, even when the subject is no longer intoxicated’. Among concerns raised in the report is the variety of drugs available today: ‘The range of psychoactive substances available for illicit use is increasing, and recent studies are finding evidence of their use among drivers.’

1 Verstraete AG, Legrand SA and EMCDDA Project Group (Vandam L, Hughes B and Griffiths P) (2014) Drug use, impaired driving and traffic accidents 2nd edition. Lisbon: EMCDDA. Available at www.emcdda.europa.eu/publications/insights

WHO–Europe launches new guide on prisons and health

Cited from Drugnet Europe No 87, July–September 2014

On 27 May, the World Health Organization’s Regional Office for Europe (WHO–Europe) launched its latest guide for professionals working in the area of prison healthcare. The manual, entitled Prisons and health, was presented in Strasbourg at an expert meeting, co-organised by the Council of Europe’s Pompidou Group and the WHO’s Health in Prisons Programme, on the theme: ‘Prison health in Europe: missions, roles and responsibilities of international organisations’.2

The manual is based on contributions from a large number of experts and international partners, including the EMCDDA. The guide outlines important proposals to improve the health of those in prison and to reduce the risks posed by imprisonment to health and society. In particular, it aims to facilitate better prison health practices in the fields of: human rights and medical ethics; communicable diseases; non-communicable diseases; oral health; risk factors, vulnerable groups; and prison health management.

Based on the principles of prison health being a key factor of public health, the meeting also adopted the ‘Strasbourg conclusions’. These highlight, among others: the right for prisoners to enjoy the same level of healthcare as others in society and the effectiveness of placing prison health services under the jurisdiction of health (rather than justice) ministries. In the text, international organisations pledge their support for prison health reform by strengthening and coordinating their efforts to ensure implementation of these conclusions.

2 Enggist S, Moller L, Galea G and Udesen C (eds) (2014) Prisons and health Copenhagen: WHO Regional Office for Europe. Available at www.euro.who.int/en/publications/abstracts/prisons-and-health  

New report examines residential treatment for drug use in Europe

Cited from Drugnet Europe No 87, July–September 2014

In most European countries today, residential treatment programmes are an important element in the range of treatment and rehabilitation options available to drug users. A new EMCDDA Paper, released in July, provides the latest Europe-wide overview of the history and availability of this type of treatment within wider national drug treatment systems.3

Residential treatment programmes are defined in the paper as those ‘involving therapeutic interventions aimed at long-term change in drug use, usually alongside other rehabilitative activities, within a residential setting’. The study describes how countries differ in the level of residential treatment provision — over two-thirds of the 2 500 reported facilities in Europe are concentrated in just six countries.

Highlighted in the paper are the various treatment approaches currently used to treat drug-using clients in these settings. The main types of residential treatment used are the 12-step/ Minnesota model; the therapeutic community approach and psychotherapy-based models. The review shows how residential treatment programmes today often provide a mix of services reflecting the philosophy of one or more approaches.

Although, historically, these programmes have been drug-free, current data point to the growing importance of providing opioid substitution medications to help drug-dependent individuals.

3 Vanderplasschen W, Vandevelde S and Broekaert E (2014)  Therapeutic communities for treating addictions in Europe: Evidence, current practices and future challenges. Lisbon: European Monitoring Centre for Drugs and Drug Addiction. Available at www.emcdda.europa.eu/publications/emcdda-papers/residential-treatment

New study on HCV infection

Cited from Drugnet Europe No 87, July–September 2014

 ‘Hepatitis: Think again’ was the theme of this year’s World Hepatitis Day commemorated on 28 July. To mark the occasion, the open-access online journal PLoS ONE published a new EMCDDA systematic review of data for scaling up treatment and prevention among injecting drug users infected with hepatitis C in the EU.4  People who inject drugs (PWID) are a key population affected by the hepatitis C virus (HCV). Treatment options are improving and may enhance prevention; however, access for PWID may be poor. The new study, one of the largest conducted on this topic and involving over 80 collaborators, concludes that data on HCV epidemiology, care and disease burden among PWID in Europe, while sparse, suggest many undiagnosed infections and poor treatment uptake. The burden of disease, where assessed, was high and is expected to rise in the next decade.

The authors reviewed the published literature from 2000, as well as data provided by the EMCDDA’s drug-related infectious diseases (DRID) expert network. Data availability was found to be highly variable across countries and topic areas, while important limitations exist both in comparability and representativeness. The study concludes that stronger efforts are needed to improve data availability to guide the scale-up of HCV treatment among PWID.

4 Wiessing L, Ferri M, Grady B, Kantzanou M, Sperle I, Cullen KJ, EMCDDA DRID group, Hatzakis A, Prins M, Vickerman P, Lazarus JV, Hope V and Matheï C (2014) Hepatitis C virus infection epidemiology among people who inject drugs in Europe – A systematic review of data for scaling up treatment and prevention PLoS One 28 July  9(7): e103345. Available at www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0103345.

The role of take-home naloxone in reducing overdose deaths

Cited from Drugnet Europe No 87, July–September 2014

The role of take-home naloxone (THN) in reducing opioid-related fatalities will be the focus of an EMCDDA meeting held in Lisbon on 14 October. Leading experts on the issue will come together at the event to focus on the scaling up of interventions using this medication across Europe.

Naloxone is an opioid antagonist used worldwide in emergency medicine to reverse respiratory depression caused by opioid overdose. The drug, listed by the World Health Organization (WHO) as an essential medicine, is currently available in injectable form, while a new device for nasal application is under development. When used in peer programmes, naloxone distribution is accompanied by training for drug users, their peers and family in First Aid and in how to administer the medicine in order to reverse the effects of opioid overdose. The upcoming meeting will explore the rationale for THN as part of a comprehensive response to reducing overdose deaths. The WHO will present at the meeting its new Guidelines on the management of suspected opioid overdose while the EMCDDA will review its upcoming paper on the Effectiveness of take-home emergency naloxone to prevent heroin overdose. The meeting is a satellite event of the EMCDDA annual expert meetings on drug-related deaths and drug-related infectious diseases.

For more, see www.emcdda.europa.eu/topics/pods/preventing-overdose-deaths   

Exploring therapeutic communities for treating addictions in Europe

Cited from Drugnet Europe No 87, July–September 2014

Therapeutic communities (TCs) first appeared in Europe in the 1960s, largely in response to an emerging heroin problem, and have continuing relevance in the world of drug treatment today. In the latest edition in its Insights series, the EMCDDA presents how these communities have developed since that time and offers an overview of research into their effectiveness as a treatment option and their impact on society.5

In the 50 years since TCs appeared, the situation of drug use and drug treatment has changed considerably. A wide variety of treatment interventions is now on offer and the choice of substances available to drug users continues to evolve. Against this backdrop, the EMCDDA set out to investigate the experience gained so far with these communities, which constitute one of the longest standing modalities for the treatment of drug addiction.

The term therapeutic community has been linked to a range of treatment traditions and approaches. All share the idea of using relationships and activities of a ‘purposefully designed social environment or residential treatment setting to promote social and psychological change’. Traditionally, TCs offered a drug-free environment in which people with addictive problems lived together in a structured way in order to achieve abstinence. In recent years, TCs have adopted more integrative systems.

The report shows that TC programmes for the treatment of addictions exist in most European countries, but that the use of this approach is unequally distributed. Overall, around 1 200 facilities using TC-type interventions were identified across Europe. While the number of programmes applying the TC approach was low (around five) in around a third of European countries, the TC appeared to be a prevalent treatment modality in most south, and some east, European countries. Typically, the capacity of facilities offering a TC programme in Europe was between 15 and 25 residents, while the planned length of treatment in TCs ranged between 6 and 12 months.

To determine the effectiveness of TCs, the EMCDDA undertook a literature review for this report. This drew on 28 scientific articles reporting 16 randomised controlled studies or quasi-experiments (conducted in North America) and 21 articles reporting 14 observational studies (conducted in Europe). The publication reveals some evidence for the effectiveness of TCs in reducing substance use and criminal activity, at least in the USA. A small number of studies also showed positive effects on employment, social functioning and general mental health.

While the clinical- and cost-effectiveness of other treatment options, such as opioid substitution treatment (OST), has been repeatedly confirmed, the evidence base behind TCs still needs to be strengthened. In recent years, TCs have been seen to have moved into specific niche areas, such as treatment of drug users with dual diagnoses, mothers with children and prison inmates. The future of TCs, states the report, will depend on how well these programmes continue to target areas where they can make the most impact and achieve the most good at adequate cost.

5 Vanderplasschen W, Vandevelde S and Broekaert E (2014) Therapeutic communities for treating addictions in Europe: Evidence, current practices and future challenges Insights 15. Lisbon: EMCDDA

Available at www.emcdda.europa.eu/publications/insights/therapeutic-communities

Drugnet Europe is the quarterly newsletter of the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). Drugs in focus is a series of policy briefings published by the EMCDDA.  Both publications are available at www.emcdda.europa.eu.

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