In 2013, the United Nations Office on Drugs and Crime (UNODC) published the first edition of its International standards on drug use prevention.1 The standards present an overview of the international evidence for prevention interventions and policies. A second, updated version produced in collaboration with the World Health Organization (WHO) is now available.2 

The authors note that the standards are presented in a context where there is a renewed emphasis on the health and wellbeing of people in international approaches to dealing with drug issues. These are, for example, in the United Nations (UN) Sustainable Development Goals to be achieved by 20303 and the Outcome document from the 2016 United Nations General Assembly Special Session on the world drug problem (UNGASS).4 This has raised the profile of prevention in global drug policy and reinforces the need for prevention strategies to be based on a sound evidence base, which is sometimes lacking. The primary objective of prevention is defined as: 

…to help people, particularly but not exclusively of younger age, to avoid or delay the initiation of the use of psychoactive substances, or, if they have started already, to avert the development of substance use disorders (harmful substance use or dependence).     (p. 2)2 

Methodology

The standards draw on a number of evidence sources. At their core is a summary of the current scientific evidence base gathered by means of an overview of recent systematic reviews, combined with the findings of a similar exercise upon which the first edition is based. They also draw on international expertise through the work of an international group of experts, and refer to existing guidance, in particular that of WHO.

The document should be a useful reference for policymakers and practitioners interested in the area of prevention. It does not go as far as making recommendations about specific programmes, instead it gives a brief description of: 

• The intervention or the policy, its main activities and theoretical basis
• The available evidence from the systematic reviews on the intervention or policy, in particular its effects on primary (substance use) and secondary (mediating factors/intermediate outcomes of prevention) outcomes
• The existing WHO guidance on the strategies
• The characteristics of the strategies associated with efficacy and/or effectiveness, or lack thereof
• A list of any relevant guidelines or tools for further information.
• Interventions and policies are grouped by the developmental stage of the target group: pregnancy, infancy and early childhood (0–5 years); middle childhood (6–10 years); early adolescence (11–14 years); adolescence (15–18/19 years); and adulthood (20+ years). 

An effective prevention system

In the final section of the report, the authors outline the characteristics of an effective national drug prevention system, which has the overarching goal to support the healthy and safe development of individuals. They describe it as delivering ‘an integrated range of intervention and policies based on scientific evidence, in multiple settings, targeting relevant ages and levels of risk’ (p. 50).2 It would have strategies that have ‘a mix of environmental and developmental components, with a minor component focusing on information’ (p. 50).2 To be effective, the system needs to be underpinned by strong structural foundations. There are a number of elements to this, including:

A supportive policy and legal framework that is health-centred and which ensures the availability of controlled drugs for medical and scientific purposes, while preventing diversion and non-medical use. Elements of the framework would include: national (quality) standards for drug prevention interventions and policies; national professional standards for prevention policymakers and practitioners, possibly with an accreditation system; and policies requiring schools and employers to implement evidence-based programmes or policies.

Scientific evidence and research are key elements when making decisions about the elements of a prevention system, and ensuring those being delivered are having the desired impact.

Coordination of multiple sectors and levels are required with clearly defined roles and responsibilities. This needs to be supported by effective infrastructure, for example, a clear mechanism that would provide decision-makers with strong technical assistance to guide them in implementing evidence-based policies and interventions.

Training of policymakers and practitioners in prevention needs to be supported on an ongoing basis. The Coordinator Series of the Universal Prevention Curriculum5 is identified in this context.

Commitment to provide adequate resources and to sustain the system in the long term. This includes (financial) support for the interventions and those delivering them; the technical assistance required to support implementation and continuous quality improvements; and the academic and research institutions responsible for monitoring and evaluating the activities.

Concluding comment

The prevention element of Ireland’s drug and alcohol strategy, Reducing harm, supporting recovery: a health-led response to drug and alcohol use in Ireland 2017–20256 fits well with the general approach outlined in the standards in terms of the national strategy’s overall health-centred objective: ‘To promote and protect health and wellbeing’ (p. 7). Similar to the primary objective of the standards, the Irish strategy 

aims to protect the public from threats to health and wellbeing related to substance misuse by preventing early use of alcohol and other drugs among young people, influencing behaviour and challenging social norms and attitudes, and providing targeted interventions aimed at minimising harm for those who have already started to use substances. (p. 17)6 

The standards should be useful in providing an overview of the range of interventions for which there is evidence of effectiveness and the nature of support required to deliver an effective system of prevention. 

2  United Nations Office on Drugs and Crime (UNODC) and World Health Organization (WHO) (2018) International standards on drug use prevention. 2nd edn. Vienna: UNODC. https://www.drugsandalcohol.ie/30048/

3  For further information on the goals, visit: https://www.un.org/sustainabledevelopment/sustainable-development-goals/

4  United Nations Office on Drug and Crime (2016) Outcome document of the 2016 United Nations General Assembly Special Session on the world drug problem. Vienna: United Nations Office on Drug and Crime. https://www.drugsandalcohol.ie/27442/

5  For further information, visit: https://www.issup.net/training/universal-prevention-curriculum

6  Department of Health (2017) Reducing harm, supporting recovery: a health-led response to drug and alcohol use in Ireland 2017–2025. Dublin: Department of Health. http://www.drugsandalcohol.ie/27603/