best practice

Computer-based interventions targeting specifically recreational drug users were found in a systematic review (Wood et al., 2014) to have general positive results in:

• reducing use of drugs both immediately and in the mid-term when targeting specifically recreational drug users

The Communities That Care (CTC) approach (i.e. community coalitions that develop a common strategy and mobilise communities in prevention and health promotion initiatives) was found in a systematic review (EMCDDA 2017, studies = 5) to be effective in:

• reducing substance use and delinquency behaviours (USA trials)

Coordinated, widespread, multi-component community interventions include age restrictions on tobacco purchase, programs for prevention of disease (like heart disease), mass media and school programs. Such interventions were found in a systematic review of 17 studies (Sowden and Stead, 2003) to:

• reduce smoking prevalence when compared to no intervention control and to school-based programmes only;
• reduce the rate of increase in smoking prevalence when compared to mass-media campaign alone.

Street-level law enforcement approaches (including community-wide policing, problem-oriented policing, hot spots policing and standard model of policing) were found in a systematic review (EMCDDA 2017 - not published, based on Mazerolle et al., 2007) to be effective in:

• reducing drug offences (OR 1.53, 95% CI  0.75 to 3.13)
  • problem-oriented policing (OR 2.44, 95% CI  1.30 to 4.60)
  • community-wide policing (OR 1.85, 95% CI  1.53 to 2.22)
• reducing drug-related calls for service (OR 1.33, 95% CI  1.07 to 1.65)
  • problem-oriented policing (OR 1.44, 95% CI  1.16 to 1.77)

Comprehensive approaches involving community and school, were found effective in a systematic review (Jones et al., 2006, 222 studies - 14 systematic reviews; 103 RCTs; 52 Controlled non-randomized studies; 18 CBA; 35 BA) at preventing/delaying/reducing:

• all substances when compared with community-only programmes and school-community programmes targeting high-risk youth (SMD = 0.38 and 0.36 respectively), and in high-risk individuals when compared with low-risk individuals (SMD = 0.42 and 0.08);
• tobacco when compared with community-only programmes and school-community programmes targeting high-risk youth (SMD = 0.46 and 0.48), and in high-risk individuals when compared with low-risk individuals (SMD = 0.49 and 0.03);
• alcohol when compared with community-only programmes and school-community programmes targeting high-risk youth (SMD = 0.49 and 0.49), and in high-risk individuals when compared with low-risk individuals (SMD = 0.56 and 0.05);
• cannabis when compared with community-only programmes and school-community programmes targeting high-risk youth (SMD = 0.82 and 0.79), and in high-risk individuals when compared with low-risk individuals (SMD = 0.84 and 0.22);
• all illicit drugs when compared with community-only programmes and school-community programmes targeting high-risk youth (SMD = 0.56 and 0.54), and in high-risk individuals when compared with low-risk individuals (SMD = 0.65 and 0.05).

There was no difference in effectiveness between ‘school-community’ programmes and ‘community-only’ programmes. Moreover, low risk population effect sizes were significantly greater across all types of interventions (‘comprehensive’, ‘school-community’, ‘community-only’) for tobacco (SMD = 0.05, SMD = 0.13); and cannabis (SMD = 0.04, SMD = 0.10). No other significant differences were reported.

A review of reviews (MacArthur et al., 2014, N=25 reviews), without meta-analysis, concluded that there is:

• insufficient evidence to support the effectiveness of pharmacy based NSP in preventing HIV infections (N=4 studies, 4 positive)
• insufficient evidence to support the effectiveness of syringe provision through vending machine in preventing HIV infections (N=1 study, 1 no association) and reducing injecting risk behaviours (N=3 studies, 1 positive, 2 no association)
• insufficient evidence to support the effectiveness of syringe provision through mobile vans in preventing HIV infections (N=1 study, 1 negative)

A review of reviews (MacArthur et al., 2014, N=25 reviews), without meta-analysis, concluded that there is:

• insufficient evidence to support the effectiveness of outreach including IEC activities in reducing HIV infections (N=3 studies, 3 positive)
• insufficient evidence to support the effectiveness of outreach including IEC activities in reducing HCV infections (N=1 study, 1 positive)

Opioid Substitution Treatment (OST) to increase compliance to HCV treatment and to  to increase HCV treatment virological response  were considered not possible to assess due to the lack of ad-hoc studies in a synthesis based on a narrative review (Hellard et al., 2009, cited in EMCDDA - ECDC 2011) including 30 observational studies with a total number of patients superior to 4,000.

A review of reviews (MacArthur et al., 2014, N=25 reviews), without meta-analysis, concluded that there is:

• insufficient evidence to support the effectiveness of drug consumption rooms in reducing HIV infections (N=1 study, 1 no association)
• insufficient evidence to support the effectiveness of drug consumption rooms in reducing HCV infections (N=1 study, 1 no association)

A review of reviews (MacArthur et al., 2014, N=25 reviews), without meta-analysis, concluded that there is:

• tentative evidence to support the effectiveness of the provision of sterile injecting paraphernalia in reducing injecting risk behaviour (N=15 studies, 10 positive, 5 no association).