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.
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
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 services such as a needle and syringe programmes, outreach and education programmes and/or injecting in drug consumption rooms
Death among drug users is reduced by keeping them in opioid substitution treatment.
Hepatitis C treatment is effective in active drug users and opioid substitution treatment is not a contraindication to the treatment
There is some evidence that education and training interventions with take-home naloxone provision decrease overdose-related deaths
Intranasal administration of naloxone appears to be effective in treatment of opioid overdose when naloxone injection is not possible
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 with and foster safer environments for highly marginalised target populations
Pre-exposure prophylaxis (PreP) of HIV in adults at high risk is effective in reducing HIV acquisition in high-risk people who are HIV-negative. However, issues relating to uptake, adherence, sexual behaviour, drug resistance, prioritisation for prophylaxis and cost-effectiveness are also important to consider, especially at a population level.
Best practice is the best application of available evidence to current activities in the drugs field.
underlying evidence should be relevant to the problems and issues affecting those involved (professionals, policymakers, drug users, their families);
methods should be transparent, reliable and transferable and all appropriate evidence should be considered in the classification process;
experience in implementation, adaptation and training should be systematically collected and made available;
contextual factors should be studied by modelling different prevalence levels so as to assess the impact of an intervention on the population; and
evidence of effectiveness and feasibility of implementation should both be considered for the broader decision-making process.
This definition was agreed by a group of experts including the Chairman of the EMCDDA Management Board João Goulão; members of the EMCDDA Scientific Committee; policymakers and top-level researchers in the areas of treatment, prevention and harm reduction.
Best practice portal
The Best practice portal is a resource for professionals, policymakers and researchers in the drugs field. We provide information on the available evidence on drug-related prevention, treatment and harm reduction, focusing on the European context. The evidence is compiled following an explicit methodological process, and is presented according to client profiles. The client profiles are designed according to the European data on illicit drug users collected at the EMCDDA. Currently, the profiles are organised around the main substance of use. We acknowledge that in reality people often use multiple drugs and the interventions provided might reflect this. We are therefore working on how best to accommodate this aspect in the future. In the portal we also provide an overview of the available quality standards and guidelines in the European Union (EU) Member States.
The portal was developed to respond to the EU drugs action plan (2009–12) and specifically to ‘enhance the quality and effectiveness of drug demand reduction activities, taking account of specific needs of drug users according to gender’. In particular, actions 17 and 19 aimed at exchanging ‘good practice guidelines/quality standards for prevention, treatment, harm reduction and rehabilitation interventions and services’ and ‘to develop an EU consensus on minimum quality standards and benchmarks for prevention, treatment, harm reduction and rehabilitation’.
The portal will be continuously updated as information and research on interventions emerges.
Peer Van der Kreeft
Collaborations and patnerships with external organisations
Below are some of the ongoing collaborations and partnerships involving the EMCDDA's Best practice portal and external organisations.