best practice

A systematic review without meta-analysis (Lin et al 2019, 13 studies) found no evidence of effect of telemedicine-delivered treatment (psychotherapy or pharmacotherapy) interventions for substance use disorders.

Studies examined suggest this type of intervention is an effective alternative, particularly where face-to-face treatment is less available, but more research is needed on their effectiveness.

A systematic review without meta-analysis  (Vold et al 2019, 7 RCT and 3 cohort studies, high risk of bias), found uncertain results on the effects of integrated care models on the treatment of infectious diseases in people with substance use disorders.

A systematic review without meta-analysis (Penzenstadler et al 2019, 5 datasets) found no clear superiority of results of assertive community treatment (ACT) in reducing substance use (compared to control group).

ACT originally developed for patients with severe mental illness, providing personalized, high intensity, holistic and integrated multidisciplinary community care services.

A recent systematic review (MacArthur et al 2018) of 70 RCTs addressing two or more risk behaviours (with a follow-up period of at least six months) and targetting children up to 18 years of age, found that:

• universal school-based multiple risk behaviour interventions were beneficial in preventing tobacco use (OR 0.77, 95% CI 0.60 to 0.97; n=9 studies; 15,354 participants) at up to 12 months' follow-up.

Opioid substitution treatment with methadone provided during incarceration was found in a systematic review (Moore et al 2019) to

• have no significant effect in reducing recidivism (4 studies; n=400; OR= 0.93, 95% CI=0.51; 1.68)

Opioid substitution treatment with methadone provided during incarceration was found in a systematic review (Moore et al 2019) to be effective in:

• increasing community treatment engagement after release from prison (3 studies; n= 216; OR= 8.96, 95% CI=2.46; 30.75)

A systematic review (Siefried et al., 2020, 43 RCTs, N = 4065) addressing 23 different types of pharmacotherapy for amphetamine and/or methamphetamine use, alone or in combination, found:

• no evidence of effectiveness of any pharmacotherapy in treating amphetamine and/or methamphetamine dependence. While some drugs demonstrated results that were statistically significantly better than placebo outcomes, the studies were generally small and the samples biased and study protocol completion was low making it impossible to recommend any intervention.

Some weak but positive findings have been demonstrated with stimulant agonist treatment (dexamphetamine and methylphenidate), naltrexone and topiramate.
Future research should address the heterogeneity of AMPH/MA dependence (e.g. coexisting conditions, severity of disorder, differences between MA and AMPH dependence) and the role of psychosocial intervention.

Opioid substitution treatment with methadone provided during incarceration was found in a systematic review (Moore et al 2019) to be effective in:

• reducing post-incarceration injection drug use (3 studies; OR= 0.26, 95% CI=0.12; 0.56)

A systematic review with meta-analysis (Lo Coco et al 2019, 33 RCTs, n= 3951) of substance use treatment interventions in group settings found:

• significant small effects on abstinence when compared to no treatment (SMD 0.28, 95% CI 0.04 to 0.52), individual therapy (SMD 0.34, 95% CI 0.06 to 0.62), and other treatments (SMD 0.29, 95% CI 0.07 to 0.50).
• no significant effects on substance use frequency when compared to individual therapy (SMD 0.52, 95% CI -0.25 to 1.28), and other treatments (SMD 0.01, 95% CI -0.14 to 0.16).
• significant moderately sized effects for mental state when compared to no treatment (SMD 0.64, 95% CI 0.38 to 0.90).
• no difference in abstinence rates when compared to control groups.

Interventions addressed the use of alcohol, cocaine, heroin or opioids, and cannabis.

Opioid substitution treatment with methadone provided during incarceration was found in a systematic review (Moore et al 2019) to be effective in:

• reducing post-incarceration illicit opioid use (4 studies; n= 407; OR= 0.22, 95% CI= 0.15; 0.32)