Amphetamine-Type Stimulants (ATS) are the second most commonly used illicit drugs worldwide as well as in Europe. In Europe, the highest last-year prevalence for amphetamine use among young adults aged 15-34 years is found in Germany (2.9%) and for MDMA in the Netherlands (6.9%). Methamphetamine has been a main drug of use for over four decades in the Czech Republic, and increasing use has been reported in Cyprus, (eastern) Germany, Slovakia and Spain, as well as in parts of Northern Europe. Long term ATS use can lead to physical, mental and social harms, including (psychological) dependence. Harms may include cardiovascular complications, neurological damage, liver damage and intoxication and memory impairment.  Mental health issues, such as induced paranoia and psychosis, as well as sleep disorders, depressed mood and persistent anxiety are also reported by ATS users. Besides, people who use ATS are more likely than those who use opioids to engage in risky sexual activities, increasing their risk for contracting various sexually transmitted infections (STIs).  

No single intervention can address the variety of issues experienced by people who use ATS. Any comprehensive package needs to consider the specificity of different ATS substances and patterns of use. Contextual variations, such as social, cultural, and legal aspects, also define the type and feasibility of interventions. Despite the increasing use of ATS and the specificities related to these substances, most interventions directed to prevent, treat or reduce the harms of illicit drug use currently focus on (injected) opioids (14,15). Yet people who use ATS usually do not identify with (problematic) opioid use, often belong to different user networks and do not perceive opioid-focused services as relevant to them (16). They are likely to develop different trajectories of drug use, face different drug-related harms, and have different needs than those using opioids, thus requiring specific or adapted services (17). 

This policy brief aims at contributing to the reduction of the harms of ATS use by describing different trajectories of ATS use and offering a set of evidence-based interventions for different groups of ATS users. The different ATS trajectories are based on qualitative findings of large multinational research, the ATTUNE study, conducted between February and August 2017 in five European countries – the Netherlands, UK, Germany, Poland and the Czech Republic. The evidence-based interventions recommended in this brief are based on a literature review. In this document, we combine both ATS trajectories and interventions  from  previous  studies/programmes to propose tailor-made recommendations for people who use ATS and those providing services to them.