Home > EMCDDA publishes guide on evidence-based responses to drug problems.

Galvin, Brian (2018) EMCDDA publishes guide on evidence-based responses to drug problems. Drugnet Ireland , Issue 64, Winter 2018 , pp. 18-20.

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The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) aims to provide a comprehensive picture of the drug phenomenon in Europe and the responses to drug problems to help policy-makers and practitioners develop and implement effective policies and interventions. The recently published Health and social responses to drug problems: a European guide1 forms an important part of this overall picture and provides practitioners with a useful roadmap for managing interventions.

 

Responses can be defined as ‘any actions or interventions that are undertaken to address the negative consequences associated with the illicit drugs phenomenon’ (p. 9). Responses on the supply side are covered in the EU drug markets report.2 

 

 

The authors of the guide were faced with a number of challenges. Within Europe the drug situation is very varied, many different drugs are being used, the contexts of this usage vary, and there are different stages of development of drug problems in different areas. So, there is no simple blueprint for the responses that should be put in place. Further, drug problems can change rapidly and vary over time, so a regular review of the policies and responses is necessary.

 

To address these challenges the report provides: 

  • A way of thinking about how to respond to drug problems in a particular country or local area and identify what is needed and likely to be appropriate to a particular situation.
  • A brief overview of current knowledge that attempts to answer what can be done, what works, and what we know about what is currently being provided in Europe.
  • A highlight of some key issues, for example, developing areas such as e-health, and links to more detailed information on these topics.
  • A platform for ongoing work in the health and social responses area. 

The report is part of a package which includes a range of additional materials online that will be added to and regularly updated.3

 

These policy and practice briefings provide: 

  • A summary of the main issues, response options, and some information about what is happening in Europe
  • A summary of the evidence for responses in that particular area
  • The key implications for policy and practice
  • Links to further resources 

The webpage provides links to a range of background papers that were commissioned to help in drafting the report. These include an evidence review summary, and others dealing with a range of ‘hot topics’, such as addressing the needs of the ageing cohort of opiate users seen in many countries, drug-checking services, e-health, and how to use behavioural insights to improve the effectiveness of responses.

 

The best practice links include: 

  • The Best Practice Portal evidence registry where you can search for evidence on particular topics; and
  • The Xchange registry, which provides information on individual programmes and the people and places in which they have been used. This is currently mainly prevention programmes but will be expanded to include other types of interventions in the future.

This report is not in the traditional report style and adopts a new format inspired by the idea of a travel guide. It is focused on how to respond to different drug problems rather than giving details about the extent and nature of drug problems. This information is covered in the European drug report 2017.4

 

It is action-orientated rather than in textbook style. It is, inevitably, a brief overview of each topic, but easy to read and providing links to more detailed information.

 

The guide is intended as a reference document with clear signposting, and uses boxes and colour coding to make it easier to scan. Boxes and sections have different icons depending on the type of material they contain.

 

The report has five main chapters, topped and tailed by an introduction and concluding remarks. Chapter 1 discusses the different factors that need to be considered in developing responses to drug problems. Chapters 2, 3 and 4 consider what we know about responding to different drug problems, viewed from three different perspectives: responding to problems arising from use of different drugs or types of use; responding to the needs of particular groups of individuals; and, responding in different settings. Chapter 5 looks at ways of supporting the successful implementation of responses. 

 

 

Chapter 1 presents a way of thinking about the whole process of responding to drug problems.

 

An example from this chapter is tackling opioid-related deaths, which are increasing in a number of countries. The chapter highlights a range of response options that seek to reduce the risk of death: 

  • At the bottom of the ‘pyramid’ are wider public health interventions that aim to make opioid users less vulnerable to overdose.
  • In the middle are interventions that make it less likely that people who use opioids will overdose — retaining them in opioid substitution treatment, assessing their risk of overdose, and raising their awareness of the dangers of overdose.
  • Finally, at the top, are interventions that can prevent deaths when overdoses do occur — the widespread availability of naloxone, which can reverse overdoses, and supervised drug consumption rooms in which immediate first aid can be given if overdose does occur. 

The implications for policy and practice highlight the importance of improving provision of the programmes already mentioned. For example: improving drug users’ awareness of overdose risk situations and behaviour, such as the dangers of combined use of central nervous system depressants — opioids, alcohol and benzodiazepines; and training potential bystanders to detect overdose signs and to respond accordingly. These include drug users, peers, family, healthcare and social services staff, and the police.

 

Another aspect is improving prison-to-the-community throughcare. This is a period of particularly high risk of overdose deaths. This section also looks at barriers to the establishment of drug consumption rooms in areas with lots of street injecting and addressing legal obstacles to calling the police (Good Samaritan laws).

 

Chapter 3 looks at responses from the perspective of different target groups.

 

As an example, one section of this chapter looks at responses in nightlife, festivals and other recreational settings. Here there are a range of response options, and multi-component, multiagency approaches appear most successful. These will often target alcohol as well as drug use

 

These responses include: 

  • Providing information and education to drug users to reduce harms.
  • Environmental strategies, such as regulating venues, e.g. limiting happy hour promotions and other factors that promote dangerous consumption patterns; providing chill-out rooms, free water and cheap soft drinks; training of staff and ensuring first aid and emergency responses are available.
  • Establishing drug-checking services that can provide alerts, advice and brief interventions to reduce harms as well as information for early warning systems and market monitoring.

There is increasing interest across Europe in establishing drug-checking services, for which there are many different models. One background paper provides more detail on these (including the map in Figure 3).

 

Chapter 5 focuses on ways to support successful implementation

 

An evidence-based programme will only be successful if it is well implemented. The first section of this chapter looks at ways of encouraging the use of evidence in practice, and it considers the challenge of transferring programmes into different cultural contexts, how quality standards and guidelines can be used to improve the effectiveness of services, and the importance of sharing best practice.

 

It highlights as implications for policy and practice the potential benefits of: 

  • Implementing the European minimum quality standards for demand reduction and the establishment of national standards and guidelines; and
  • The further development of best practice exchange websites and other e-health support tools. 

Section 5.2 focuses on the importance of supporting the people and organisations involved and considering systems and partnerships in order to promote effective delivery. It highlights the importance of training and staff development, service user and community involvement, promoting multiagency working and taking a systems-wide perspective of responses in order to, as we would say, make the whole greater than the sum of its parts.

 

The final section is on the importance of monitoring and evaluation to promote learning from experience and continuous improvement in outcomes.

 

 

1  European Monitoring Centre for Drugs and Drug Addiction. (2017) Health and social responses to drug problems: a European guide. Luxembourg: Publications Office of the European Union. https://www.drugsandalcohol.ie/28040/

2  European Monitoring Centre for Drugs and Drug Addiction and Europol. (2016) EU drug markets report: in-depth analysis. Luxembourg: Publications Office of the European Union. https://www.drugsandalcohol.ie/25357/

3  The report and the other materials can be accessed through a webpage on the EMCDDA website: http://www.emcdda.europa.eu/responses-guide. From there you can download an electronic version of the guide as a PDF (an e-book format will be available in the future). From the second tab, you can get access to policy and practice briefings, covering each of the topics in the guide. From the fourth tab, there are links to a range of further resources, including best practice databases, topic pages, and more detailed reports related to the topics in the guide.

4  European Monitoring Centre for Drugs and Drug Addiction. (2017) European drug report 2017 trends and developments. Luxembourg: Publications Office of the European Union. Available online at https://www.drugsandalcohol.ie/27401/

Item Type:Article
Issue Title:Issue 64, Winter 2018
Date:February 2018
Page Range:pp. 18-20
Publisher:Health Research Board
Volume:Issue 64, Winter 2018
EndNote:View
Accession Number:HRB (Electronic Only)
Subjects:A Substance use, abuse, and dependence > Prevalence > Problem substance use
HJ Treatment method > Substance disorder treatment method
J Health care, prevention and rehabilitation > Substance use prevention > Substance use harm reduction
J Health care, prevention and rehabilitation > Health related prevention > Health information and education > Communicable disease control
J Health care, prevention and rehabilitation > Health care administration > Health care quality control
N Communication, information and education > Information transfer > Information transfer from research to practice
P Demography, epidemiology, and history > Population dynamics > Substance related mortality / death
VA Geographic area > Europe

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