Policy and practice briefingsResponding to problems related to stimulant use

icon stimulants

Issues

Overall cocaine is the most commonly used stimulant in Europe, though in some countries MDMA, amphetamine or methamphetamine may be the dominant stimulant.

Many of the harms from using stimulants 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 associated with more problematic patterns of use. However, acute problems can affect even experimental or occasional stimulant users.

Stimulants may be used functionally, for example, to stay awake when driving, working long hours, or when 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 they are used and the fact that stimulants are sometimes used in a sexual context also mean that drug-related responses may overlap with responses to sexual health issues, particularly in some groups.

Response options

  • Brief interventions, referral to treatment programmes or harm reduction services can be offered when users seek help at emergency departments for problems related to intoxication or high-dose use.
  • Stimulant injectors need regular access to needle and syringe programmes because they may inject more often than opioid users during the course of a binge.
  • Outreach programmes may be necessary to deliver harm reduction interventions to stimulant users who would not otherwise access services.
  • Treatment using psychosocial interventions can be effective for problematic stimulant use. There are no pharmacological treatments with good evidence of effectiveness in treating problematic stimulant users, but some drugs used to treat depression have been shown to help retain amphetamine users in treatment.

European picture

  • Cocaine is the main stimulant drug for which people seek treatment in Europe (63 000 people in 2015), with the majority of these cases in Spain, Italy and the United Kingdom. The number of new treatment entrants is stable. A further 7 400 entered treatment for primary crack cocaine problems, mostly in the United Kingdom.
  • About 34 000 people entered treatment for problems with use of amphetamine in 2015, and 9 000 for methamphetamine, mostly in Czech Republic and Slovakia. There has been an increase in first-time treatment entrants for amphetamines since 2009.
  • Very few people enter specialised drug treatment for MDMA use; harm reduction responses in festival and nightlife settings are more relevant to this group.

Summary of the available evidence

Treatment for problematic stimulant use

Response option Quality of evidence

Psychosocial interventions can reduce cocaine use by influencing mental processes and the behaviours related to the addiction.

moderate quality evidence

Disulfiram for alcohol addiction and antiparkinsonian medications may help cocaine users to reduce their use.

lower quality evidence

Psychosocial treatments (including contingency management) show positive short-term efficacy for crack abuse/dependence.

moderate quality evidence

Some drugs used to treat depression (fluoxetine and imipramine) have been found to retain amphetamine users in treatment in the short and medium term.

lower quality evidence

For pregnant women, medications to assist detoxification from stimulants can be used but are only recommended for those experiencing withdrawal symptoms.

lower quality evidence

Key

  • speedometer at high High quality evidence — one or more up-to-date systematic reviews that include high-quality primary studies with consistent results. The evidence supports the use of the intervention within the context in which it was evaluated.
  • speedometer at medium Moderate quality evidence — one or more up-to-date reviews that include a number of primary studies of at least moderate quality with generally consistent results. The evidence suggests these interventions are likely to be useful in the context in which they have been evaluated but further evaluations are recommended.
  • speedometer at low Low quality evidence — where there are some high or moderate quality primary studies but no reviews available OR there are reviews giving inconsistent results. The evidence is currently limited, but what there is shows promise. This suggests these interventions may be worth considering, particularly in the context of extending services to address new or unmet needs, but should be evaluated.

Implications for policy and practice

Basics

  • Problems associated with stimulant use vary depending on patterns of use, the groups who are using them and the setting in which they are used. Responses therefore need to be tailored to the local patterns of use and problems experienced.
  • Core responses for stimulant problems currently include psychosocial treatment or brief interventions and harm reduction for people who inject drugs.

Opportunities

  • Improving links between sexual health and drug treatment services could improve efficiency and effectiveness of both.

Gaps

  • Harm reduction interventions for stimulant users need development and evaluation.
  • Research into effective pharmacological treatments for stimulant dependence should be prioritised at EU level.

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