Improving the quality of drug prevention interventions and systems internationally is a focus of the United Nations Office on Drugs and Crime (UNODC). Building on its International Standards on Drug Use Prevention, the UNODC has developed a tool for countries to assess their drug prevention systems and interventions in line with the standards.1,2 The Review of national prevention systems based on the UNODC/WHO International Standards on Drug Use Prevention: final report of the pilot in Norway was published in September 2023 and a webinar on the project findings held on 19 April 2024.2,3

Background to Review of Prevention Systems
In 2018, the UNODC in collaboration with the World Health Organization (WHO) published the International Standards on Drug Use Prevention.1 The standards present an overview of the international evidence for prevention interventions and policies that promote the health and well-being of children, young people, adults, families, and communities. They also identify the characteristics of an effective national drug prevention system, which has the overarching goal to support the healthy and safe development of individuals. The authors of the standards describe such a system as delivering ‘an integrated range of interventions and policies based on scientific evidence, taking place in multiple settings and targeting relevant ages and levels of risk’ (p. 41).1 It would have strategies that have ‘a mix of environmental and developmental components, with a minor component focusing on information’ (p. 41).1 To be effective, the system needs to be underpinned by strong structural foundations.1,4

Grounded in these standards, the Review of Prevention Systems (RePS) is a tool developed by the UNODC to assess ‘the extent to which the drug prevention system of a country or sub-national entity (e.g. a municipality) is in line with the Standards on Drug Use Prevention with a view to identifying areas of strength and weakness to allow improvement’ (p. 1).2 It was decided to pilot the tool in Norway.

Implementing RePS
The RePS tool is divided into two main components: interventions and prevention system. Each involves the collection and analysis of data from a variety of stakeholders working in drug prevention in the country/area of interest.

Component 1: Interventions

The first component focuses on the quality of implemented interventions. In the pilot, the Norwegian team used an online questionnaire to gather data, via a network of colleagues, from practitioners implementing drug prevention interventions across the country. The data gathered were screened to ensure that only appropriate interventions were included and there was adequate information provided upon which to make a quality assessment. Out of 187 entries, 130 were included in the final analysis. These were categorised according to age of target group, their level of risk, the setting of the implementation (family, school, workplace, health setting, or community), and geographical region. Each intervention was assessed for the extent to which it was evidence based, on the basis of the Standards, and according to a methodology illustrated in Figure 1. Interventions were labelled as ‘evidence-based’, ‘non evidence-based’, ‘strongly evidence informed’, and ‘weakly evidence informed’. Interventions that had a clear theoretical basis but no study yet carried out were labelled as ‘innovative’.

Source: UNODC and KORUS Oslo (2023, p. 9)2

Figure 1: Overview of the assessment process

Component 2: Prevention system

The second component assesses the quality of the prevention system as a whole. It identifies the strengths and weaknesses in the system. In Norway, it was based on data collected for the first component and from a questionnaire aimed at those with the mandate to coordinate and manage prevention at the national level. The methodology used describes a set of six elements (and 17 corresponding criteria) that need to be met for a system to be considered supportive of evidence-based practice.

The six elements are:

1. A range of interventions and policies based on evidence
2. Supportive policy and regulatory frameworks
3. Evidence-based planning and use of research
4. Coordination among different sectors and levels
5. Strong delivery system
6. Sustainability.

An assessment is made as to whether each of the criteria corresponding to these elements were met fully, partially, or not at all, as well as the option to say there was insufficient information to make an assessment.

Lessons from the pilot in Norway
The overall message from the report is that the pilot of this tool in Norway was a success. While the report does not unpack the strengths and weaknesses of the methodology in detail, there were some limitations and features identified that would have contributed to its success, such as:

The team leading the pilot was well-connected with those working in the sector in Norway. Their existing network facilitated the collection of data for both components, including where inadequate information was initially submitted and contacts needed to be followed up.

• The team had the appropriate skills to be able to assess the quality of the interventions and the system overall.
• It was unclear from the report the level of resources required to carry out the review. Data gathering could be labour-intensive.
• A limitation identified in the report was that the unit of analysis was a single intervention. Therefore, while two separate interventions may be delivered to the same target group, if they are assessed in isolation they may not be considered evidence-based according to the Standards (e.g. an information-only intervention).
• Another limitation identified was that it was not possible to analyse the coverage of the interventions in terms of population.
• The team also could not include analysis of the requirement of training and its existence to ensure fidelity of implementation. Further explanation of why these could not be included was not provided.

The findings of this pilot were positive for the range of interventions and the prevention system as a whole in the case of Norway. Among the findings were that there was a need for more evaluations of interventions; non-evidence-based interventions needed to be replaced; and more support was needed for those found to be effective.

Concluding comments
Overall, the output from this review would suggest that RePS could be a useful tool to explore the range of prevention interventions in an area/country and the system underpinning them.

Given the potential resources required to carry out a review, it would be important that stakeholders are committed to the process, support data collection, and have the resources to act on any findings and recommendations made. The findings would need to be linked into a strategy to support elements of the system and interventions that are working well and address those that are not. Given that one limitation was that the coverage of interventions could not be assessed, care would be needed not to suggest that there is more coverage through a particular intervention than is the case in reality. For example, in the Irish context, the intervention Know the Score is in theory available nationally; however, coverage is likely to be much more limited.

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

2    United Nations Office on Drugs and Crime (UNODC) and KORUS Oslo (2023) Review of national prevention systems based on the UNODC/WHO international standards on drug use prevention: final report of the pilot in Norway. Vienna: UNODC. Available from: https://www.drugsandalcohol.ie/41014/

3    International Society of Substance Use Professionals (ISSUP) (2024) Accelerating drug use prevention systems in drug policy: new initiatives [webinar]. Available from: https://youtu.be/5TDF3p4-Mho [RePS report at 0:45:20]

4    Dillon L (2019) Updated international standards on drug use prevention. Drugnet Ireland, 69 (Spring): 16–17. Available from: https://www.drugsandalcohol.ie/30639/