best practice

Technology-based interventions for  women between 18 and 44 years old were found in a systematic review with meta-analysis (Hai et al., 2019, 15 studies, N = 3 488) to have an effect when compared to control conditions in:

• reducing substance use (alcohol and/or drugs) in the short term (follow-up ranged from 2 to 6 months) (d = 0.19, 95% CI = 0.02, 0.35, 13 studies)

The effect size estimates calculated separately for alcohol use and illicit drug use were 0.13 and 0.30 respectively and neither was statistically significant possibly due to low power of the studies.

Interventions examined included brief interventions modeled after the motivational interviewing approach or involving  periodically sending participants text messages to provide educational information to reduce substance use.

Brief interventions for non-treatment seeking young adults (17-25 ys) were found in a systematic review with meta-analysis (Halladay et al., 2019) to have some promising but not conclusive effects when compared to no intervention or usual care in:

• improving short-term abstinence - 3 months follow-up (OR 1.73, 95 % CI 1.13 to 2.66, 3 studies, N=666)
• reducing the risk of cannabis use disorders (as measured by the CUPIT tool, a brief self-report screening instrument for detection of currently and potentially problematic cannabis use) (SMD -0.14, 95 % CI -0.26 to -0.01, 7 studies, N=1173)

The results were confirmed in a new systematic review with meta-analysis (Steele et al., 2020) that synthetised the evidence regarding the effects of brief behavioral interventions for adolescents (12–20 years) with problematic substance use. Brief interventions were categorized into motivational interviewing (MI), psychoeducation, and treatment as usual.  The analysis found that:

• use of MI did not reduce cannabis use days, with a net mean difference of 20.05 days per month (95% CrI: 20.26 to 0.14; moderate SoE)
• while it confirmed the effectiveness of brief interventions, especially MI, in reducing heavy alcohol use and alcohol use days

Mood stabilizers (namely anticonvulsants) were found in a systematic review (Coles et al., 2019) to have promising but not conclusive effects in:

• improving treatment outcomes (reducing use and improving mood outcomes)

Pharmacotherapies (namely 23 different medications, including anticonvulsants, antidepressants, antipsychotics, dopamine agonists, medications for OUD, medications approved by the FDA for other substance use disorders (SUDs), psychostimulants, and various other pharmacotherapies) were found in a systematic review (Chan et al., 2020, 34 RCTs) to have no effect in:

• reducing stimulant use
• improving abstinence

The review found moderate-strength evidence that antidepressants (desipramine, bupropion, and fluoxetine) worsened retention. There was moderate- strength evidence that disulfiram worsened treatment retention (N = 605, RR 0.86, 95 % CI 0.77 to 0.95).

Treatment with psychostimulants warrant further study as the review found promising results that it may reduce cocaine use.

The majority of studies used methadone concurrently with the study medication, three studies used buprenorphine, and one study used diacetylmorphine. Also the majority of the studies enrolled participants who were already receiving opioid maintenance treatment.

Drug consumption rooms were found in a systematic review without meta-analysis (Kennedy et al., 2017, 47 studies) to have a promising but not significant effect in:

• reducing public disorders associated with illicit drug use (people injecting drugs in public, publicly discarded syringes and injection-related litter) (5 studies).

Results of 6 studies also found no change in drug-related offences (drug dealing, thefts or robbery incidents, drug possession) within the area of the DCRs.

Combined OST and high NSP coverage has been found to be effective in a systematic review with meta-analysis (Platt et al., 2017, 28 studies, N= 11 070 PWID) in:

• reducing the risk of HCV acquisition by 74 % (RR 0.26 95% CI 0.07 to 0.89).

Primary care-based models for opioid substitution treatment were analysed in a systematic review (Legisetty et al., 2017, 35 studies) to identify models' structures and processes associated
with improved patient outcomes. While some models, namely multidisciplinary and coordinated care delivery models were common to most studies and showed positive association with some outcomes, overall the review could not find a significant correlation between models and/or components in:

• improving patients' treatment outcomes

Pharmacological interventions have been found to have no significant effect in a systematic review (Baandrup et al., 2018, 35 studies, N= 2 295) on:

• ceasing benzodiazepine use in chronic benzodiazepine users

Naloxone is recommended in an evidence-based guidance (Neptune, 2018) to be used in case of suspected synthetic opioids, both in community and hospital settings.

Specificities with regard to fentanyls in comparison to heroin overdoses are the followings:

• a more rapid administration of naloxone is warranted because of the rapid onset of fentanyls,
• a more rapid escalation of additional doses for naloxone may be needed in comparison with heroin or other opioids,
• overall, higher doses of naloxone may be needed for fentanyl patients in comparison with heroin patients,
• Fentanyl patients may require a longer period of observation in hospital than heroin patients.