best practice

Programmes targeting drink-driving were found to have no impact on client behaviours in a systematic review (Jones, Hughes, Atkinson and Bellis, 2010), namely:

• community programmes targeting drivers and resorting to media campaigns and promotions revealed no change in frequency of being in a car with a driver with .05 BAL (1 low quality study UCBA).

‘Designated driver’ programmes were found to have little evidence supporting their efficacy in two narrative reviews (Calafat, 2010; Calafat, Juan and Duch, 2009) in:

• reducing drink-driving.

Promotion of sensible alcohol consumption and/or prevention injuries policy were found in narrative review (Calafat Juan and Duch, 2009) and in a systematic review (Ker and Chinnock, 2008) including 23 studies (RCT, 10 non-randomised controlled trials and 5 CBA) to be more effective than no intervention in:

• reducing Single Vehicle Night crashes 4 % after six months, 11 % after 12 months, 18 % after 24 months, and 23 % after 36 months.

Drink-driving programmes targeting recreational settings encompassing compulsory training for all alcohol servers and owners/managers were found in a narrative review (Calafat, Juan and Duch, 2009) to lead to:

• statistically significant reductions in single-vehicle night-time traffic accidents (those with high percentages of alcohol involvement).

Mandated server training was found in two systematic reviews (Jones et al 2010; Ker and Chinnock, 2008) and in a narrative review (EMCDDA, 2012), to lead to:

• reductions in Single Vehicle Night crashes and alcohol-related crashes (23 % by the end of the third year).

Alcohol server interventions were found in a systematic review (Bolier  et al 2011) to have significant effects in:

• reduction of road accidents (narrative results).

Combined enforcement checks and management training programmes were found in one study included in a systematic review (Bolier et al 2011) to be effective in:

• reducing the service to under-age clients (relatively non-significant decrease in intervention group, from 46 % to 42 %).

The Community Trials project including community mobilisation, media advocacy, RBS training, and enhanced enforcement efforts against drink-driving and under-age drinking was found to be effective in two narrative reviews (Calafat, 2010; Calafat, Juan and Duch, 2009) in:

• reducing the rate of night time traffic injuries and the number of hospital admissions due to traffic accidents (116 fewer injury accidents in 38 months in the experimental site compared with the control community) .

The project STAD (Stockholm Prevents Alcohol and Drug Problems), a multicomponent programme that has been active for ten years based on community mobilisation, training in RBS for servers and stricter enforcement of existing alcohol laws, was found in two narrative reviews (Calafat, 2010; Calafat, Juan and Duch, 2009) to be effective in:

• decreasing police-reported violent crimes by 29 % in the intervention area, compared with the control area.
• decreasing alcohol-related problems at licensed premises (only narrative results).
• increasing refusal of alcohol to intoxicated clients (from 5 % in 1996 to 47 % in 1999 and 70 % in 2001) in licensed premises and in increasing refusal to serve minors (from 55 % in 1996 to 59 % in 1999 and 68 % in 2001).

A more recent systematic review (Bahji et al., 2021, 24 RCTs) performed a network meta-analysis of the different medications tested with individuals diagnosed with Cannabis use disorder. The results confirm the previous systematic reviews, that there is largely insufficient evidence to support any particular pharmacological treatment.

A narrative systematic review (Kondo et al., 2020, 26 RCTs - 14 trials more than the first Marshall et al. review) included trials with cannabinoids, hormones, fatty acid amide hydrolase inhibitor and galantamine. The results confirm the previous systematic reviews, that there is largely insufficient evidence to draw conclusions about the effectiveness of any drug classes tested so far. The review actually found low- to moderate-strength evidence that buspirone, cannabinoids, and SSRIs were ineffective for decreasing cannabis use or improving abstinence.

Pharmacotherapies with different medications (eg. preparations containing tetrahydro-cannabinol (THC) (2 studies), selective serotonin reuptake inhibitor (SSRI) antidepressants (2 studies), mixed action antidepressants (3 studies), anticonvulsants and mood stabilisers (3 studies), atypical antidepressant (2 studies), anxiolytic (1 study), norepinephrine reuptake inhibitor (1 study), glutamatergic modulator (1 study)) for cannabis depending users were assessed in a systematic review (Marshall et al., 2014) finding no conclusive results on:

• completion of treatment;
• reducing the use of substances; and
• improving withdrawal symptoms and craving.

An update to Marshall et al 2014 (Nielsen et al 2019) also found no conclusive results; evidence of investigated pharmacotherapies remains incomplete.

Mass-media campaigns in combination with school-based, community-based or national programmes were found in a systematic review (Ferri et al., 2013, 23 studies, N= 188 934) to have no statistically significant different effect in:

• reducing substance use 
  • pooled results of 5 RCTs (N = 5470) show no effect of media campaign intervention (standardised mean difference (SMD) -0.02; 95% confidence interval (CI) -0.15 to 0.12)
  • pooled results of 4 out of 5 ITS studies (N = 26 405) focusing  on methamphetamine use showed  a reduction only in past-year prevalence of methamphetamine use among 12 to 17 years old
  • a further 5 studies (N = 151 508), which could not be included in meta-analyses, reported a drug use outcome with varied results including a clear iatrogenic effect in one case)

Another systematic review (Stead et al 2019) of the effectiveness of mass-media campaigns to communicate public health messages found no evidence of impact on illicit drug behaviours.

A systematic review (Wilson et al 2019) found no evidence to support an association between prescription monitoring programmes (PMPs) and:

• reduced opioid prescribing and dispensing;
• reduced non-medical prescription opioid use.

There were limited but inconsistent evidence supporting an association between PMPs and reduced Scedule II opioid prescribing and dispensing and reduced multiple provider use. Further studies are needed to determine the effectiveness of PMPs.