Opioid dependence is the illicit drug related condition for which we have the strongest evidence of what works and what does not.
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
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
Heroin-assisted treatment is recommended in adult chronic opioid users who failed previous methadone treatment attempts
Opioid substitution treatment is also strongly recommended for pregnant women dependent on opioids, in preference to attempting detoxification. 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
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 or buprenorphine
Relapse prevention is supported by naltrexone when relapse has major practical implications (for example professionals who risk losing their job or prisoners on probation)
Methadone or buprenorphine are equally effective for treatment of patients dependent on pharmaceutical opioids
Internet interventions can support opioid substitution treatment to reduce opioid use, at least in the short term
Contingency management is useful to reduce cocaine use and to improve continuous cocaine abstinence among clients in substitution treatment. It also helps to retain patients in opioid detoxification
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.