Best practice portal Psychostimulants to reduce stimulant use — evidence summary
Summary of the evidence
Substitution therapy has already proved to be effective for smoking and opioid use. Evidence is emerging around the effectiveness of pychostimulants prescription for stimulants related problems.
Psychostimulants, namely modafinil, methylphenidate, or amphetamines (mixed amphetamine salts, lisdexamphetamine, and dextroamphetamine) were found in a systematic review (Tardelli et al., 2020, 38 RCTs, N = 2889) to be effective in:
- increasing rates of sustained abstinence [risk ratio (RR) = 1.45, 95% confidence interval (CI) = (1.10, 1.92)] and duration of abstinence [mean difference (MD) = 3.34, 95%CI = (1.06, 5.62)], particularly in patients with cocaine use disorder (although very low-quality evidence).
- Prescription amphetamines were particularly beneficial in promoting sustained abstinence in patients with cocaine use disorder [RR = 2.44, 95% CI = (1.66, 3.58)], and
- higher doses of PPs (eg. >60 mg/dose of dextroamphetamine) were particularly efficacious for treatment of cocaine use disorder [RR = 1.95, 95% CI = (1.38, 2.77)].
- Treatment with prescription amphetamines also yielded more cocaine-negative urines [MD = 8.37%, 95% CI = (3.75, 12.98)].
There was no effect of PPs on the retention in treatment.
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Best practice definition
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.
Acknowledgments
- Alan Lodwick
- Angelina Brotherhood
- Artur Malczewski
- Ave Tallu
- Charlotte Davies
- Elias Allara
- Fabrizio Faggiano
- Franz Trautman
- Joao Goulao
- John Strang
- Laura Amato
- Marina Davoli
- Marion Weigl
- Maurizio Coletti
- Michael Farrell
- Peer Van der Kreeft
- Richard Velleman
- Tim Pfeiffer-Gerschel
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Below are some of the ongoing collaborations and partnerships involving the EMCDDA's Best practice portal and external organisations.
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