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Best practice portal

 

 

Best practice portal

Discover what works (and what doesn't work) in the areas of drug prevention, treatment, harm reduction and social reintegration.

Keywords

Use the keywords below to help you find best practice information for a specific topic. Clicking on a keyword will modify the available selection on the left. To remove a keyword filter, just click on it again.

Substance: alcohol amphetamines cannabis cocaine new psychoactive substances (NPS) presecription medicines opioids tobacco

Specific target groups or settings: partygoers/nightlife pregnant women prison young people

Desired outcome: improve education improve employability prevent crime reduce mortality reduce risky behaviours reduce risky driving reduce substance use retain in treatment prevent risky injecting prevent infectious diseases

Explore all resources in the Best practice portal

Frequently asked questions

Frequently asked questions

We have put together a list of frequently asked questions from professionals and others working in the field. All answers link to a best practice answer sheet where you can find additional information.

Prevention for families

Prevention programmes can be delivered to families, with or without any prior screening for vulnerability. Vulnerable families are here considered as families where one or more members misuse alcohol and/or drugs, and/or families with high levels of parental conflict and violence where personal relationships are poor.

thumbs up symbol What works?

  • green tick mark Involving the whole family in prevention activities helps reduce the use of alcohol, tobacco and drugs
  • green tick mark Collaboration between parents and teachers supports smoking cessation
  • green tick mark Moreover, home visits for disadvantaged families reduce alcohol and cigarette consumption

question mark symbol What's unclear?

  • It is not clear why interventions focusing only on one dimension (for example only schools or only training for parents) are less helpful to reduce substance use in young people

thumbs down symbol What doesn't work?

  • We are not aware of any family interventions that cause harm

Prevention for school students

Prevention targeting schools offers a systematic and efficient way of reaching large numbers of young people.

thumbs up symbol What works?

  • green tick mark Multicomponent interventions delivered at school and based on social influence and/or on learning social skills are helpful for reducing alcohol and drug use, especially cannabis
  • green tick mark Moreover, interactive interventions targeted at problem students help reduce substance use and ‘drink-driving’ behaviour
  • green tick mark In addition, peer-led interventions reduce illicit substance use

question mark symbol What's unclear?

  • It is still unclear if school-based brief interventions can help to reduce substance use or improve behaviour in young people. School-based brief interventions showed no difference when compared with just the provision of information, yet when compared with no intervention at all, they showed weak evidence of reducing cannabis use
  • We cannot say if ‘booster sessions’ are really helpful in reinforcing the main messages of school-based prevention programmes
  • Interventions that teach social skills might not be helpful in discouraging hard drug use in students
  • In addition, programmes focused only on peers and those that just provide information  might not reduce alcohol and tobacco use

thumbs down symbol What doesn't work?

  • We are not aware of any school-based interventions that cause harm

Prevention for communities

Community here is understood to mean a group of individuals sharing a common geographical and administrative setting. Interventions within a community do not necessarily address all of the community concerned but may involve several key actors (for example health services, schools and sport facilities).

thumbs up symbol What works?

  • green tick mark Multicomponent and interactive interventions delivered in the community reduce drug, tobacco and alcohol use in high-risk youths
  • green tick mark Furthermore, community support groups, involving also other family members, help young people living in problem families
  • green tick mark Mentoring programmes reduce alcohol use in young people
  • green tick mark Computer-based programmes have the potential to reduce drug use when targeted at illicit recreational drug users, at least in the medium term

question mark symbol What's unclear?

  • It is not clear if programmes focused only on one component or mentoring programmes are helpful in reducing alcohol as well as drug use
  • More generally, it is not clear whether anti-alcohol and anti-cannabis community interventions reduce consumption

thumbs down symbol What doesn't work?

  • We are not aware of any community interventions that cause harm

Prevention for partygoers

The use of both new and more traditional substances occurs in people taking part in entertainment and recreational settings. Preventive interventions aim to protect the safety of these people in relation to car accidents, violence and risky behaviours.

thumbs up symbol What works?

  • green tick mark Multicomponent interventions involving the community reduce car accidents, public nuisance and crime related to alcohol consumption
  • green tick mark Programmes targeting ‘drink-driving’ and media campaigns reduce car accidents, including fatal crashes
  • green tick mark Police supervision in venues and their immediate surroundings reduces public disorder while training staff serving alcohol in ‘responsible serving’ reduces clients’ alcohol consumption and intoxication levels

question mark symbol What's unclear?

  • It is not clear if designated driving programmes (when one person in a group is designated to remain sober for the night and drive the others home) reduce drink-driving harms
  • Also it is not clear if drink-driving programmes discourage people from travelling in a car with an intoxicated driver and if the promotion of responsible drinking can change alcohol consumption
  • It is not clear if interlocks mechanisms (automatic mechanisms that lock a car’s engine, preventing it from starting) reduce driving under the influence of alcohol in the long term
  • We do not yet know if restricted opening hours can reduce alcohol-related injuries and if programmes involving police and law enforcement measures can control and reduce alcohol sales

thumbs down symbol What doesn't work?

  • Information provision does not prevent drug- and alcohol-related problems and educational interventions do not influence attitudes and drinking behaviour
  • Electronic Age Verification (EAV) devices do not help increase the frequency of age verification at recreational premises

Prevention for the general population

Typical interventions aimed at the general population are media campaigns and other interventions that target everyone (for example taxation and laws).

thumbs up symbol What works?

  • green tick mark Mass-media campaigns associated with other interventions, both school-based and/or community-based, can help reduce tobacco use
  • green tick mark They also reduce car accidents and drink-driving behaviours
  • green tick mark Computer-based programmes have the potential to reduce recreational drug use in universal drug prevention programmes, at least in the medium term

question mark symbol What's unclear?

  • It is not clear if mass media campaigns can change behaviours related to illicit drug use

thumbs down symbol What doesn't work?

  • Mass-media campaigns as standalone interventions (without any other component) do not reduce tobacco and alcohol consumption

Treatment for amphetamine users

Amphetamine dependence is associated with compulsive behaviours, chronic and episodic usage, and development of tolerance and thus a substantial rise in doses.

thumbs up symbol What works?

  • green tick mark Some of the drugs used to treat depression (fluoxetine and imipramine) can help amphetamine users stay in treatment in the short and medium term
  • green tick mark For pregnant women, medications to assist detoxification from stimulants can be used but should be reserved when specific symptoms emerge

question mark symbol What's unclear?

  • There are no data supporting a single treatment approach that can tackle the multidimensional facets of amphetamine addiction patterns

thumbs down symbol What doesn't work?

  • Pharmacotherapies based on psychostimulants are probably of little value in the treatment of amphetamine dependence
  • Pharmacotherapy for routine treatment of dependent pregnant women is not recommended

Treatment for cannabis users

Problem cannabis use can lead to difficulties performing at work and legal problems; cannabis dependence has been associated with adverse psychological and physical consequences.

thumbs up symbol What works?

  • green tick mark Any behavioural intervention (including cognitive behavioural therapy (CBT), motivational interviewing (MI) and contingency management) can help to reduce use and improve psychosocial functioning, both in adults and adolescents, at least in the short-term
  • green tick mark Multidimensional family therapy helps reduce use and keep patients in treatment, especially in high-severity young patients
  • green tick markWeb- and computer-based interventions can be effective in reducing cannabis use, at least in the short term

question mark symbol What's unclear?

  • Medical preparations containing THC seem of potential value but given the limited evidence these applications should be considered still experimental

thumbs down symbol What doesn't work?

  • Pharmacotherapies based on antidepressants, anxiolytics and anticonvulsant are probably of little value in the treatment of cannabis dependence
  • Pharmacotherapy for routine treatment of dependent pregnant women is not recommended

Treatment for cocaine users

Problem cocaine use and cocaine dependence can lead to numerous adverse psychological and physical consequences.

thumbs up symbol What works?

  • green tick mark Psychosocial interventions can help to reduce cocaine use by influencing the mental processes and the behaviours related to the addiction
  • green tick mark Medicines used to treat other diseases (such as disulfiram for alcohol addiction, antidepressants and antiparkinsonians) can help cocaine users to reduce use
  • green tick mark Various psycho-social treatment (including contingency management) interventions for crack abuse/dependence show some positive yet also some limited/short-term efficacy
  • green tick mark For pregnant women, medications to assist detoxification from stimulants can be used but should be reserved when specific symptoms emerge. Psychosocial interventions alone or in addition to the usual care do not make a difference in both treatment and obstetrical outcomes, when standard comprehensive care options are in place, eg prenatal care, counselling

question mark symbol What's unclear?

  • It is not clear whether antidepressants help reduce the craving for cocaine
  • It is also not clear if psycho-stimulants can help treat cocaine dependence

thumbs down symbol What doesn't work?

  • Pharmacotherapies based on dopamine agonists, anticonvulsants as well as antipsychotics are probably of little value in the treatment of cocaine dependence
  • Pharmacotherapy for routine treatment of dependent pregnant women is not recommended

Treatment for opioid users

Opioid dependence is the illicit drug related condition for which we have the strongest evidence of what works and what does not.

thumbs up symbol What works?

  • green tick mark Opioid substitution treatment, combined with psychosocial support, helps patients stay in treatment and reduces use and mortality. It also has a positive impact on the mental health of patients
  • green tick mark Methadone and buprenorphine are the recommended pharmacological treatments. Taking into account clinical practice, methadone is superior to buprenorphine in retaining people in treatment – particularly in the first weeks - and equally suppresses illicit opioid use
  • green tick mark Heroin-assisted treatment is recommended in adult chronic opioid users who failed previous methadone treatment attempts
  • green tick mark Opioid substitution treatment is also strongly recommended for pregnant women dependent on opioids, even more than attempting dexotification. Psychosocial interventions alone or in addition to the usual care do not make a difference in both treatment and obstetrical outcomes, when standard comprehensive care options are in place, eg substitution treatment, prenatal care, counselling
  • green tick mark When detoxification is indicated, methadone or buprenorphine at tapered dosages are used in association with psychosocial interventions. Detoxification with alpha2-adrenergic agonists (eg. Clonidine and similar medications) is also effective, but there are fewer adverse effects with methadone
  • green tick mark Relapse prevention is supported by naltrexone when relapse has major practical implications (for example professionals who risk losing their job or prisoners on probation)
  • green tick markMethadone or buprenorphine are equally effective for treatment of patients dependent on pharmaceutical opioids

question mark symbol What's unclear?

  • It not clear which option (methadone or buprenorphine) is the best choice in order to avoid drop-out when treating pregnant women
  • It is not clear if the opioid antagonist naltrexone, normally used to prevent relapse to use, works for long-term treatment
  • For detoxification, it is unclear if detoxification under minimal sedation can help users to complete treatment and avoid relapse
  • It is also unclear what helps more between detoxification or substitution treatment to reduce use when dealing with adolescents

thumbs down symbol What doesn't work?

  • Detoxification under heavy sedation does not work and can actually be harmful

What is unclear?

  • It is not clear why interventions focusing only on one dimension (for example only schools or only training for parents) are less helpful to reduce substance use in young people

What does not work?

  • We are not aware of any family interventions that cause harm in terms of increased drug use

Harm reduction for opioid injectors

Historically, harm reduction strategies were initiated to address the risks of contracting infectious diseases (namely HIV) among injecting drug users. The majority of evidence-supported interventions still address this target group.

thumbs up symbol What works?

  • green tick mark Infections caused by HIV and Hepatitis C among people who inject opioids can be prevented with opioid substitution treatment and the provision of clean needles and syringes
  • green tick mark People have less risky behaviours when they are in opioid substitution treatment, i.e. they inject less, and even when they continue to inject drugs they take less risks when participating in a needle and syringe programme, participate in outreach and education programmes as well as injecting in drug consumption rooms
  • green tick mark Death among drug users is reduced by keeping them in opioid substitution treatment.
  • green tick mark Hepatitis C treatment is effective in active drug users and opioid substitution treatment is not a contraindication to the treatment
  • green tick mark There is some evidence that education and training interventions with take-home naloxone provision decrease overdose-related deaths
  • green tick mark Intranasal administration of naloxone appears to be effective in treatment of opioid overdose when naloxone injection is not possible
  • green tick mark There is also some evidence that safer environment interventions (i.e. syringe exchange programmes, peer-based interventions and drug consumption rooms) help to reach, stay in contact and foster safer environments for highly marginalised target populations

question mark symbol What's unclear?

  • Is not clear if being in opioid substitution treatment can help patients adhere better to Hepatitis C treatment or achieve better results
  • It is also unclear whether drug consumption rooms can reduce HIV and Hepatitis C infections

thumbs down symbol What doesn't work?

  • We are not aware of interventions for injecting opioid users that cause harm

Harm reduction for stimulant injectors

The risks for people who inject stimulants differ from those of opioid injectors, mainly because the former tend to inject more times during a day (therefore needle and syringe exchange programmes need to be implemented differently).

thumbs up symbol What works?

  • green tick mark Outreach treatment programmes help stimulant injectors to reduce medical problems, such as skin infections

question mark symbol What's unclear?

  • It is not clear if provision of large volumes of sterile injection equipment (in general, stimulant injectors inject more often than opioid users, thus need more syringes), provision of condoms, outreach activities focusing on injecting and risky sexual behaviours can help stimulant injectors
  • It is not clear if injection kits adapted to local drug use patterns, such as for people that inject home-made stimulants (e.g. distribution of specific paraphernalia for the production of drugs), can help to reduce harms
  • It is not clear if dissemination of information on how to inject safely, basic hygiene (hand washing, short nails), vein care and simple wound care as well as distribution of antibacterial creams and ointments can help to reduce harms

thumbs down symbol What doesn't work?

  • We are not aware of interventions for stimulant injectors that cause harm

Harm reduction for non-injectors

Drugs can be taken by inhaling the vapour of a heated substance (chasing), spraying a dissolved substance into the nose, snorting a drug in powder form, or smoking. Each route of administration has specific associated risks.

thumbs up symbol What works?

  • green tick mark Interventions including, for example, the distribution of clean crack kits to prevent people sharing crack pipes, personal vaporisors for cannabis users, information, education and communication material and outreach activities may help these users, however more research is needed

question mark symbol What's unclear?

  • No interventions in this category

thumbs down symbol What doesn't work?

  • We are not aware of interventions for non-injectors drug users that cause harm

Social reintegration — drug treatment

Interventions aimed at the social reintegration of drug users can be provided in the early stages of treatment.

thumbs up symbol What works?

  • green tick mark Providing drug users with an incentive-based treatment (for example contingency management) together with some employment helps them to improve their social condition
  • green tick mark Residential treatment and therapeutic workplaces associated with contingency management improve work attendance and performance

question mark symbol What's unclear?

  • It is not clear if both residential treatment and therapeutic workplaces can specifically help pregnant women improve their employability
  • Moreover, it is also unclear whether therapeutic workplaces associated with training under simulated work conditions can help improve work attendance of drug users in treatment

thumbs down symbol What doesn't work?

  • So far, we are not aware of interventions which proved to cause harm

Social reintegration — criminal justice

Interventions in the criminal justice system can help to reduce re-offending and thus indirectly increase the employability of individuals, preventing homelessness and the disruption of families and other social networks.

thumbs up symbol What works?

  • green tick mark Drug court programmes (as assessed in the United States which is where most drug courts exist and where the vast majority of studies have been conducted) can help people be independent from financial assistance and find employment or enroll in education

question mark symbol What's unclear?

  • It is not clear if drug court programmes have a more direct impact on the employability of drug users, namely by increasing their employment rate and individual annual income
  • Furthermore, it is unclear whether drug court vocational training programmes reduce reoffending

thumbs down symbol What doesn't work?

  • So far, we are not aware of interventions that proved to cause harm

Social reintegration — housing

Housing support services provide drug users with short- or long-term accommodation, as well as access to other services such as medical care, drug treatment, social activities, education and training.

thumbs up symbol What works?

  • green tick mark Housing interventions to help the employability of drug users should be investigated further

question mark symbol What's unclear?

  • It is not clear if psycho-social treatment interventions can help crack-cocaine users to improve their housing conditions

thumbs down symbol What doesn't work?

  • So far, we are not aware of interventions that proved to cause harm

Social reintegration — education and vocational programmes

The learning or upgrading of literacy or numeracy skills (education) and vocational training to enhance employability, along with practical help, can help drug users in the process of social reintegration.

thumbs up symbol What works?

  • green tick mark Vocational training aimed at developing specific skills and job-seeking skills helps drug users to find employment
  • green tick mark Interventions based on motivational behavioural reinforcement can help methadone maintenance clients find employment

question mark symbol What's unclear?

  • Several ‘training and employment’ programmes have been implemented in the United States yet it is not clear if they can really help improve drug users’ employment motivation and outcomes
  • Furthermore, it is unclear whether drug court vocational training programmes reduce reoffending

thumbs down symbol What doesn't work?

  • Employment counselling does not help drug users in treatment find a full-time job

Social reintegration — employment

Special interventions can provide support for those who have found a job, as well as employment opportunities for those who are struggling to secure work in the open labour market, thereby also addressing other potential barriers, such as low self-confidence.

thumbs up symbol What works?

  • green tick mark Employee assistance programmes help drug users improve work performance
  • green tick mark Supported employment interventions help drug users with mental problems to get a job

question mark symbol What's unclear?

  • It is not clear if psycho-social treatment interventions can help crack-cocaine users to improve their employment conditions

thumbs down symbol What doesn't work?

  • So far, we are not aware of interventions that proved to cause harm

New psychoactive drugs

A new psychoactive substance (or NPS) is a narcotic or psychotropic drug that is not controlled by existing international conventions but that may pose a significant public health threat.

thumbs up symbol What works?

New psychoactive substances are an emerging topic. Research is ongoing in this area and we currently lack evidence on what works best.

  • green tick mark Generally, prevention interventions which stress skills and coping strategies are effective, independently of the substance concerned
  • green tick mark Harm reduction strategies in nightlife settings which have proved to be effective for alcohol may also be effective for new psychoactive substances

question mark symbol What's unclear?

Many research gaps still need to be filled in order to inform future policy responses to new psychoactive substances (Ferri et al., 2014):

  • A comprehensive insight on the scale and patterns of new psychoactive substance use
  • A better understanding of the new psychoactive substances market
  • Research into the short- and long-term consequences of new psychoactive substance use
  • Evidence of specific and/or appropriate treatment options for new psychoactive substance users
  • Outcome evaluations of current interventions and consideration of possible new approaches

thumbs down symbol What doesn't work?

  • New psychoactive substances are an emerging topic. Research is ongoing in this area and we currently lack evidence on what works best.

What can we do in the meantime?

Until today, at both European and international level countries have responded to the problem through consumer protection and law enforcement measures and namely with a range of different innovative legal responses.

Demand reduction initiatives are currently being implemented in Europe (e.g. specialist clinics for users of club drugs in the UK), yet we will need to wait for outcome evaluations of such initiatives before promoting them as European best practice. Standards for drug prevention interventions in recreational settings already exist and can be used as a reference point for new psychoactive substance prevention programmes.

Useful links

  1. Guidance on the clinical management of acute and chronic harms of club drugs and novel psychoactive substance - NEPTUNE Project (2015)
  2. Euro-DEN project - Guidelines on when to call the Emergency Services 112 for unwell recreational drug users
  3. Harms associated with new psychoactive drugs – EMCDDA European Drug Report 2014
  4. EMCDDA action on new drug
  5. Evidence review — New Psychoactive Substances – Evidence Review (2014), Scottish Government Social Research

Prescription medicines

The EMCDDA defines misuse of medicines the use of a psychoactive medicine with or without a prescription from an appropriate practitioner, clearly outside of accepted medical practice or guidelines, for either self-medication, recreational or enhancement purposes, including in the context of poly drug use.

thumbs up symbol What works?

  • green tick mark Cognitive behavioural therapy helps to reduce benzodiazepines use when added to tapering dosages in the short term as this is not sustained at 6 months follow-up
  • green tick mark Tailored letters sent by GPs to patients, standardised interview with GPs plus tapered doses and relaxation techniques are promising results of three small studies that deserve further investigation

question mark symbol What's unclear?

  • It is not clear if motivational interviewing helps to reduce benzodiazepine use

thumbs down symbol What doesn't work?

  • So far, we are not aware of interventions which proved to cause harm

Prison

Prisons are one of the most important settings to provide interventions aimed at drug users, both in terms of treatment and harm reduction.

thumbs up symbol What works?

  • green tick mark Opioid substitution treatment has a very strong protective factor against death in prison for opioid-dependent prisoners. This is also very important when drug users are released from prison and they need to find continuity of treatment in the community
  • green tick markSubstitution treatment is also particularly important in prison as it reduces injecting risk behaviours
  • green tick markPsychosocial treatments reduce the re-incarceration rates in female drug-using offenders
  • green tick markFor drug-using offenders the use of naltrexone seems to help to reduce their re-incarceration rates
  • green tick markEducation and training interventions with take-home naloxone provision help to decrease overdose-related deaths after release from prison
     

question mark symbol What's unclear?

  • It is unclear if pharmacological treatment can help drug-using offenders to reduce use and criminal activity. Studies results are showing this also for the specific sub-group of female drug-using offenders, yet caution should be taken as the conclusions are based on a small number of trials.
  • Moreover, it is unclear if the provision of needles and syringes in prison help prevent infections and reduce risky behaviours

thumbs down symbol What doesn't work?

  • So far, we are not aware of interventions which proved to cause harm

Treatment for dual-diagnosis patients

 Dual diagnosis is the temporal coexistence of two or more psychiatric disorders as defined by the International Classification of Diseases, one of which is problematic substance use.

thumbs up symbol What works?

  • green tick mark The therapeutic approach to tackle dual diagnosis, whether pharmacological, psychological or both, must take into account both disorders simultaneously and from the first point of contact in order to choose the best option for each individual
  • green tick mark Integrated treatment combining pharmacological and psychological interventions seems to help in cases of psychosis and substance use disorders as well as anxiety and opioid disorders
  • green tick markThe antipsychotic Clozapine helps to control both psychotic symptoms and reduce substance use in dual-diagnosis patients with schizophrenia

question mark symbol What's unclear?

  • It is not clear if pharmacological and psychosocial treatments for depression can also help to reduce substance use
  • Pharmacological treatment of attention deficit hyperactivity disorder helps reduce ADHD symptoms but has no effect on reducing substance use or improving retention in substance use treatment
  • It is not clear if any specific pharmacotherapy is particularly beneficial in the treatment of personality disorders and substance use comorbidity disorders

thumbs down symbol What doesn't work?

  • So far, we are not aware of interventions which proved to cause harm

 

Treatment for substance use disorders (not drug-specific)

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), substance use disorders occur when the recurrent use of alcohol and/or drugs causes clinically and functionally significant impairment, such as health problems, disability, and failure to meet major responsibilities at work, school, or home.

thumbs up symbol What works?

  • green tick mark Adolescent drug use is effectively reduced with family-based treatments. Behavioural therapies can also help, namely with cognitive behavioural therapies, both individual and in groups, as well as integrated models combining different approaches.
  • green tick mark Continuing care, i.e. interventions following the initial period of more intensive care aimed at managing and sustaining recovery can help to improve treatment outcomes, irrespective of the duration and intensity of the programme

question mark symbol What's unclear?

  • It is not clear if residential interventions can improve treatment outcomes
  • It is not clear if motivational interviewing can reduce illicit drug use in adolescents
  • Emergency department-based brief interventions showed promising effects in reducing use (mainly alcohol) and related harms, but a definitive statement about ‘what works’ cannot be made at this stage

thumbs down symbol What doesn't work?

  • Compulsory drug treatment does not seem to improve treatment outcomes (drug use and criminal recidivism), with some studies suggesting potential harms

 

 

 

 

 

 

 

 

 

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Best practice portal

intro

About the Best practice portal

The EMCDDA's Best practice portal is a resource for professionals, policymakers and researchers in the areas of drug-related prevention, treatment, harm reduction and social reintegration. The portal concentrates on illicit drugs and polydrug use and has a clear European focus.  More information >>

evidence

Available modules

The content in the portal is structured by thematic modules. Each module below provides the current scientific evidence base for the corresponding type of intervention.

news

News and recent updates

  • June 2013: Last update of standards and guidelines (prevetion, treatment, harm reduction).
  • June 2013: Standards and guidelines for treatment recoded to highlight interventions covering prisons and overdose prevention.
  • November 2012: Collaboration with the EU project DECIDE — acknowledgement of our meeting in the DEDICE monthly updates, we are now part of their advisory group and we will participate at the DECIDE meeting in February 2013.
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Collaborations

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  • Health Evidence Network, WHO Europe

    We are a source of evidence for the WHO Health Evidence Network (HEN)

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Page last updated: Thursday, 23 June 2016