Health and Social responses
Last week (24 October 2017) the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) published a 188-page report: Health and social responses to drug problems: a European guide, the first time the agency has provided an overview of actions and interventions currently available to address the consequences of illicit drug use. It is designed to benefit those approaching drug problems from a public health planning perspective as well as frontline workers and practitioners.
The new guide acknowledges the swiftly changing nature of drug use and provides practical guidance on how responses a can be better conceived, targeted and delivered, furnishing the building blocks for developing, and successfully implementing, interventions.
The guide views health and social responses to drug problems from the three perspectives of responding to:
- problems associated with different types of drug and patterns of use;
- the needs of different groups (e.g. women, young people, migrants, ageing drug users); and
- problems in different settings (e.g. prisons, nightlife, festivals, schools, workplace, local communities).
Designed as an initial reference point, the publication includes summaries and user-friendly signposting to highlight key information, best practice examples and implications for policy and practice. It also acts as a gateway to a wide range of online resources, providing links to evidence and tools.
Evidence-based responses gaining ground in Europe
Evidence-based responses appear to be steadily gaining ground in Europe, and within the current financial climate, there appears to be greater interest than ever in ensuring that scarce health resources are well spent.
The guide underlines the importance of understanding what evidence exists to support a specific intervention, and how to use it. It provides ‘evidence ratings’ for the different actions explored, but stresses that what works in one group or setting may fail in a different context. A key message emerging from the guide is that using evidence is an ‘ongoing process’ and that it is essential to develop the knowledge base through collaboration in research, monitoring and the sharing of best practice.
The benefits of reaching out and forming new partnerships
Drug problems often interact or co-exist with other health and social problems. The guide therefore underscores the value of drug services forming partnerships with other areas (e.g. sexual and mental health care, housing services) to improve effectiveness and efficiency. Some groups have a particular need for integrated services, such as ageing opioid users who are vulnerable to health problems, or drug users with mental health issues.
The guide provides examples of a range of collaborative approaches in Europe, including partnerships between prison and community healthcare providers, which facilitate treatment delivery in prison as well as continuity of care upon release. Also, club owners, the police, health and emergency services and municipalities are teaming up with drug services to prevent and reduce the harms associated with drug and alcohol use in nightlife settings.
The value of engaging with local communities and drug users to improve the delivery of services is also explored. Examples include collaboration around drug consumption rooms, which can reduce harms to the community and drug user, and user-led interventions for recovery and reintegration.
Harnessing the potential of new technologies
The internet, social networking apps, new payment technologies and encryption software are changing the way in which drugs can be bought and sold. These changes not only affect drug markets and consumption patterns but also offer new opportunities for health and social responses.
The guide spotlights e-health interventions, which can use digital technologies to provide harm-reduction advice, train treatment professionals and reach out to vulnerable young people who may be reluctant to engage with formal services.
Reducing drug-related harms: opportunities and gaps
The guide reviews progress to date in preventing and reducing drug-related harms (e.g. the expansion of opioid substitution treatment) but highlights areas where opportunities exist for further improvement. Hepatitis C infections account for a considerable share of drug-related health costs in Europe. The publication highlights the benefits of better coordination between drug and specialist liver services to guarantee adequate treatment coverage and protect those at risk from future reinfection.
Figure 2.5 Hepatitis C treatment before and after the advent of direct-acting antiviral agents
Risk factors associated with fatal overdoses are now well known and there have been some notable advances in life-saving interventions, such as the provision of the opioid-overdose-reversal drug, naloxone. However, the increasing number of overdose deaths in Europe suggests a need to expand the provision of these, and other, interventions which reduce the risk of opioid-related deaths.
Figure 2.3 Interventions to reduce the risk of opioid-related deaths
Figure 2.4 Interventions in place in European countries that can reduce opioid-related deaths
New policy perspectives and modern drug problems call for flexible responses
Recent challenges include the rapid emergence of new psychoactive substances, such as highly potent opioids (e.g. fentanils) and synthetic cannabinoids. As more new substances enter the drugs market, toxicological and forensic capacity must also be improved as part of the frontline response.
Against the contemporary backdrop of socio-demographic and economic change, the guide explores the potential vulnerability of migrants and asylum seekers to drug problems and the need for services which recognise diversity and build trust. Recent changes in the regulatory framework for cannabis occurring in parts of the Americas are also generating interest among policymakers and the public in Europe and there is a growing interest, in both regions, in exploiting the therapeutic potential of cannabis-based medicines. Developments in the cannabis policy area may have knock-on effects for prevention, treatment and harm reduction responses to this drug, and valuable lessons may be learnt from innovations outside Europe.
The guide is an essential read for anyone working in the drugs field, be it as researcher, policy maker, commissioner or service provider. For those of you who don’t have the time to read all 188 pages, the EMCDDA also published a range of policy and practice briefings on specific issues which I will be featuring in a series of blog posts over the next few weeks.
Blog posts in the drug and alcohol category are kindly sponsored by Breaking Free Group which has developed a powerful and adaptable digital health platform which targets the underlying psychological and lifestyle factors that drive addictive behaviours. Breaking Free has no editorial influence on the contents of this site.