Health and social responses
The European Monitoring Centre for Drugs and Drug Addiction is in the process of publishing a large series of “miniguides” to support practitioners and policymakers in tackling the negative consequences of drug use. The guides are organised in different categories. There is a series of miniguides considering problems from the perspective of particular patterns of drug use and the specific substances that are of concern in many EU countries. The guides on cannabis, non-medical use of medicines, opioids, stimulants and poly drug use have already been published. The guide on new psychoactive substances is “coming soon”.
There is also a forthcoming series on drug-related harms – one on drug-related deaths and one on infection diseases. There are also forthcoming miniguides on different settings (local communities, prisons, recreational settings, schools and workplaces) and on vulnerable groups (families, homeless people, migrants, older people, women and young people).
Finally, in addition to the miniguides, a series of short ‘Spotlights’ focus on a number of hot topics requiring special attention:
- Spotlight on… Addressing sexual health issues associated with drug use
- Spotlight on… Comorbid substance use and mental health problems
- Spotlight on… Fentanils and other new opioids
- Spotlight on… Health and social responses to drug problems during the Covid-19 pandemic
- Spotlight on… Non-medical use of benzodiazepines
- Spotlight on… Performance- and image-enhancing drugs
- Spotlight on… Synthetic cannabinoid
- Spotlight on… Understanding and using evidence
Each mini-guide in the substance series includes the same seven content areas:
- Substance overview
- Key issues
- Evidence and responses
- The European picture
- Implications for policy and practice
- Data and graphics
- Further resources
By way of illustration, I share some contents from the miniguide on Stimulants below.
The stimulant guide supports practitioners and policymakers in tackling the negative consequences of drug use. The stimulants miniguide provides an overview of what to consider when planning or delivering health and social responses to stimulant-related problems, and reviews the available interventions and their effectiveness. It also considers implications for policy and practice. It was last updated this Monday 25 October 2021.
Overall, cocaine is the most commonly used stimulant in Europe, although in some countries MDMA, amphetamine or methamphetamine may have higher levels of prevalence.
Many harms arising from stimulant use are associated with intensive, high-dose or long-term consumption. Route of administration is an important mediating factor, with both stimulant injecting and the smoking of crack cocaine or methamphetamine particularly linked to more problematic patterns of use. However, acute problems can affect even those who experiment with stimulants or use them occasionally.
Stimulants may be used functionally, for example, to stay awake when driving, working long hours or socialising in nightlife settings. This means that some of the responses appropriate to stimulant use are setting-specific or overlap with more generic public health measures. The settings in which stimulants are used and the fact that they are sometimes used in a sexual context also mean that drug-related responses may overlap with responses to sexual health issues, particularly in certain groups.
Evidence and responses
- When people who use stimulants seek help at emergency departments for problems related to intoxication or high-dose use, referral to treatment programmes or harm reduction services can be offered.
- Psychosocial interventions, especially contingency management, can improve treatment outcomes for problematic stimulant use. There are currently no pharmacological treatments showing evidence of effectiveness in treating people engaged in problematic stimulant use.
- People who inject stimulants need regular access to needle and syringe programmes. During a binge they may inject more often than those who use opioids.
- Drug-checking services may reduce harms by providing information and advice to people who use stimulants, for example, highlighting potentially hazardous contaminants or tablets containing dangerously high doses of drugs.
- Other harm reduction services may need to be adapted to cater for people who smoke stimulant drugs, and outreach programmes may be necessary to deliver harm reduction interventions to people who use stimulants and who would not otherwise access services.
- Cocaine is the main stimulant drug for which people seek treatment in the European Union, with the majority of these cases in Spain and Italy. Typically, around 55 000 people enter treatment for problems related to cocaine annually, and among these the number entering for the first time in their life has been increasing in recent years, after a period of decline. A small proportion of those entering treatment for cocaine problems cite crack cocaine as their primary problem drug, mainly in Belgium, Spain and France.
- Typically, around 20 000 people enter treatment annually for problems associated with the use of amphetamines. Of these, more than a third enter for methamphetamine-related problems, mostly in Czechia, Germany and Slovakia. Around half of those in treatment for amphetamines use are first-time clients.
- In a few countries, drug consumption rooms also cater for people who smoke crack cocaine. These programmes may provide crack cocaine kits, including pipes and filters, to encourage safer smoking practices.
- Very few people enter specialised drug treatment for MDMA-related problems; harm reduction responses in drop-in services and in festival and nightlife settings are more relevant to this group.
Policy and practice
The miniguide goes on to examine the different issues associated with stimulant use, differentiated by drug, type of use (long term or binge) and method of administration as well as issues relating to stimulants and chemsex. It then provides a detailed account of best practice covering both harm reduction and treatment approaches and summarises the effectiveness of different interventions before looking at opportunities and gaps in provision for services for stimulant users across the continent.