Showing papers by "European Monitoring Centre for Drugs and Drug Addiction published in 2013"

Mortality among people who inject drugs: a systematic review and meta-analysis

Abstract: OBJECTIVE: To systematically review cohort studies of mortality among people who inject drugs, examine mortality rates and causes of death in this group, and identify participant- and study-level variables associated with a higher risk of death. METHODS: Tailored search strings were used to search EMBASE, Medline and PsycINFO. The grey literature was identified through online grey literature databases. Experts were consulted to obtain additional studies and data. Random effects meta-analyses were performed to estimate pooled crude mortality rates (CMRs) and standardized mortality ratios (SMRs). FINDINGS: Sixty-seven cohorts of people who inject drugs were identified, 14 of them from low- and middle-income countries. The pooled CMR was 2.35 deaths per 100 person-years (95% confidence interval, CI: 2.12-2.58). SMRs were reported for 32 cohorts; the pooled SMR was 14.68 (95% CI: 13.01-16.35). Comparison of CMRs and the calculation of CMR ratios revealed mortality to be higher in low- and middle-income country cohorts, males and people who injected drugs that were positive for human immunodeficiency virus (HIV). It was also higher during off-treatment periods. Drug overdose and acquired immunodeficiency syndrome (AIDS) were the primary causes of death across cohorts. CONCLUSION: Compared with the general population, people who inject drugs have an elevated risk of death, although mortality rates vary across different settings. Any comprehensive approach to improving health outcomes in this group must include efforts to reduce HIV infection as well as other causes of death, particularly drug overdose.

Infection with hepatitis B and C virus in Europe: a systematic review of prevalence and cost-effectiveness of screening

Abstract: Treatment for chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infection is improving but not benefiting individuals unaware to be infected. To inform screening policies we assessed (1) the hepatitis B surface antigen (HBsAg) and anti-hepatitis C virus antibody (anti-HCV-Ab) prevalence for 34 European countries; and (2) the cost-effectiveness of screening for chronic HBV and HCV infection. We searched peer-reviewed literature for data on HBsAg and anti-HCV-Ab prevalence and cost-effectiveness of screening of the general population and five subgroups, and used data for people who inject drugs (PWID) and blood donors from two European organizations. Of 1759 and 468 papers found in the prevalence and cost-effectiveness searches respectively, we included 124 and 29 papers after assessing their quality. We used decision rules to calculate weighted prevalence estimates by country. The HBsAg and anti-HCV-Ab prevalence in the general population ranged from 0.1%-5.6% and 0.4%-5.2% respectively, by country. For PWID, men who have sex with men and migrants, the prevalence of HBsAg and anti-HCV-Ab was higher than the prevalence in the general population in all but 3 countries. There is evidence that HCV screening of PWID and HBsAg screening of pregnant women and migrants is cost-effective. The prevalence of chronic HBV and HCV infection varies widely between European countries. Anti-HCV-Ab screening of PWID and HBsAg screening of pregnant women and migrants have European public health priority. Cost-effectiveness analyses may need to take effect of antiviral treatment on preventing HBV and HCV transmission into account.

Maintenance agonist treatments for opiate dependent pregnant women

Abstract: Some women continue to use opiates when they are pregnant, yet heroin readily crosses the placenta. Opiate-dependent women experience a six-fold increase in maternal obstetric complications and give birth to low-weight babies. The newborn may experience narcotic withdrawal (neonatal abstinence syndrome) and have development problems. There is also increased neonatal mortality and a 74-fold increase in the risk of sudden infant death syndrome. Maintenance treatment with methadone provides a steady concentration of opiate in the pregnant woman's blood and so prevents the adverse effects on the fetus of repeated withdrawals. Buprenorphine is also used. These treatments reduce illicit drug use, improve compliance with obstetric care and improve neonatal birth weight but they are still associated with neonatal abstinence syndrome. This review found few differences in newborn or maternal outcomes for pregnant, opiate-addicted women who were maintained on methadone, buprenorphine or oral slow-release morphine from a mean gestational age of 23 weeks to delivery. Only four randomised controlled trials with 271 participants trials satisfied the inclusion criteria for the review: two from Austria (outpatients), one from the USA (inpatients) and the fourth a multi-centre, international study conducted in Austria, Canada and the USA. The trials continued for 15 to 18 weeks. Three compared methadone with buprenorphine (223 participants) and one compared methadone with oral slow-release morphine (48 participants). The number of women who dropped out from treatment was lower in the methadone group. However, there was no difference in the use of primary substance between the methadone and buprenorphine groups. The number of newborns treated for neonatal abstinence syndrome did not differ significantly between groups. Birth weight was higher in the buprenorphine group in two trials and no different in the third. Oral slow-release morphine seemed superior to methadone in terms of the number of women who used heroin in their third trimester. However, there was no clear improvement in infant birth weight or duration of neonatal abstinence syndrome. The number of participants in the trials was small and may not be sufficient to draw firm conclusions. All the included studies ended immediately after the baby was born. No severe complications were noted.

Methadone at tapered doses for the management of opioid withdrawal

Abstract: Objective: To evaluate the effectiveness of tapered methadone compared with other detoxification treatments and placebo in managing opioid withdrawal on completion of detoxification and relapse rate. Abuse of opioid drugs and dependence on them causes major health and social issues that include transmission of HIV and hepatitis C with injection, increased crime and costs for health care and law enforcement, family disruption and lost productivity. Addicts, particularly those aged 15 to 34 years, are also at higher risk of death. Managed withdrawal (or detoxification) is used as the first step in treatment. Withdrawal symptoms include anxiety, chills, muscle pain (myalgia) and weakness, tremor, lethargy and drowsiness, restlessness and irritability, nausea and vomiting and diarrhoea. Persisting sleep disturbances and drug craving can continue for weeks and months after detoxification and often lead to a return to opioid use. The number of addicts who complete detoxification tends to be low, and rates of relapse are high. For a tapered dose treatment to reduce withdrawal symptoms, illicit opioids are replaced by methadone or another agent using decreasing doses up to 30 days under medical supervision. The review authors searched the medical literature and identified 23 controlled trials involving 2467 adult opioid users in various countries. Trial participants were randomised to receive methadone or another pharmacological treatment. The other treatments were adrenergic agonists such as lofexidine, partial opioid agonists such as buprenorphine, opioid agonists such as LAAM (levo-AZ±-acetyl-methadol) and the anxiolytics chlordiazepoxide and buspirone. In the two studies that compared methadone with placebo, withdrawal symptoms were more severe and more people dropped out in the placebo group. The studies included in this review confirmed that slow tapering with temporary substitution of long- acting opioids, could reduce withdrawal severity. Nevertheless, the majority of patients relapsed to heroin use. The medications used in the included studies were similar in terms of overall effectiveness, although symptoms experienced by participants differed according to the medication used and the program adopted. The programs varied widely with regard to the assessment of outcome measures. Seventeen of the included trials were conducted in inpatient settings.

Economic recession and emergence of an HIV-1 outbreak among drug injectors in Athens metropolitan area: A longitudinal study

Abstract: Background During 2011, a dramatic increase (1600%) of reported HIV-1 infections among injecting drug users (IDUs) was noted in Athens, Greece. We herein assess the potential causal pathways associated with this outbreak.

Prevalence of, and risk factors for, HIV, hepatitis B and C infections among men who inject image and performance enhancing drugs: a cross-sectional study

Abstract: Objective: To describe drug use, sexual risks and the prevalence of blood-borne viral infections among men who inject image and performance enhancing drugs (IPEDs). Design: A voluntary unlinked-anonymous crosssectional biobehavioural survey.

Prescription opioid abuse in the UK

Abstract: The United States (US) is considered the center of prescription drug abuse. Since drug abuse is a worldwide phenomenon, it would be valuable to determine if the trend of increasing prescription opioid misuse and abuse seen in the US is developing in the United Kingdom (UK). To compare trends in deaths associated with prescription opioid drugs, mortality data was obtained online for England, Wales, and Scotland from the Office for National Statistics and the General Register Office and for the US from The National Vital Statistics System (NVSS). Mortality trends in the US show a relentless increase of deaths from unintentional drug poisoning with opioid analgesics in the last decade. In 2010, the number of deaths related to opioid analgesics was over 16,500, more than double the number of 2002 and more than twice the number of deaths from heroin and cocaine deaths combined [1]. Although the number of deaths related to drug poisoning reviewed from England and Wales is not as high as the US, the overall trends are remarkably similar (Figure 1). The prominent role of methadone in UK opioid deaths also is striking. In Scotland, methadone-related deaths increased from 71 in 2001 to 275 in 2011 [2] and they currently represent over half of all reported opioid deaths. However, this should be viewed in the context of a considerable increase in the availability of opioid substitution treatment in the UK [3]. In the US, most cases relate to opioid analgesics, and the number of oxycodone deaths slightly exceeds the number of methadone deaths. Tramadol presents interesting data in the UK: in 1996, England and Wales reported one death with the drug mentioned, but by 2011 there were 154 deaths [4]. In Scotland, tramadol-related deaths increased from 8 in 2001 to 34 deaths in 2011 [2]. The increase in tramadol-related deaths may reflect a rise in tramadol prescriptions, therefore availability, but also points to the need to monitor closely any increase in deaths caused by opioid analgesics as it may signal an emerging problem in the UK similar to the issue that is now well-established in the US. Language: en

The state of hepatitis B and C in the Mediterranean and Balkan countries: report from a summit conference.

Abstract: The burden of disease due to chronic viral hepatitis constitutes a global threat. In many Balkan and Mediterranean countries, the disease burden due to viral hepatitis remains largely unrecognized, including in high-risk groups and migrants, because of a lack of reliable epidemiological data, suggesting the need for better and targeted surveillance for public health gains. In many countries, the burden of chronic liver disease due to hepatitis B and C is increasing due to ageing of unvaccinated populations and migration, and a probable increase in drug injecting. Targeted vaccination strategies for hepatitis B virus (HBV) among risk groups and harm reduction interventions at adequate scale and coverage for injecting drug users are needed. Transmission of HBV and hepatitis C virus (HCV) in healthcare settings and a higher prevalence of HBV and HCV among recipients of blood and blood products in the Balkan and North African countries highlight the need to implement and monitor universal precautions in these settings and use voluntary, nonremunerated, repeat donors. Progress in drug discovery has improved outcomes of treatment for both HBV and HCV, although access is limited by the high costs of these drugs and resources available for health care. Egypt, with the highest burden of hepatitis C in the world, provides treatment through its National Control Strategy. Addressing the burden of viral hepatitis in the Balkan and Mediterranean regions will require national commitments in the form of strategic plans, financial and human resources, normative guidance and technical support from regional agencies and research.

Methods for Synthesizing Findings on Moderation Effects Across Multiple Randomized Trials

Abstract: This paper presents new methods for synthesizing results from subgroup and moderation analyses across different randomized trials. We demonstrate that such a synthesis generally results in additional power to detect significant moderation findings above what one would find in a single trial. Three general methods for conducting synthesis analyses are discussed, with two methods, integrative data analysis and parallel analyses, sharing a large advantage over traditional methods available in meta-analysis. We present a broad class of analytic models to examine moderation effects across trials that can be used to assess their overall effect and explain sources of heterogeneity, and present ways to disentangle differences across trials due to individual differences, contextual level differences, intervention, and trial design.

Getting up to speed with the public health and regulatory challenges posed by new psychoactive substances in the information age

Abstract: Until about a decade ago, most new psychoactive substances that emerged were typically sold on the illicit market. They were usually produced in clandestine laboratories and called ‘designer drugs’, or were sourced from diverted medicines. This continues to be the case, with some of these drugs simply acting as temporary substitutes—often unknown to users—for established controlled drugs that are in short supply, such as 3,4methylenedioxy-N-methylamphetamine (MDMA). The sale of new drugs on an open market, beginning with 1-benzylpiperazine (BZP) and methylone, followed by mephedrone, marked the start of what is now called the ‘legal highs’ market. We now know that many new drugs that are destined for the ‘legal highs’ market are produced in bulk in China and India and imported into Europe and elsewhere, where they are processed, packaged and sold. The marketing and distribution of these drugs has reached a new level of sophistication, including advertisement and sale on the open market, such as through the internet (with delivery via courier and postal services), as well as ‘head shops’ in towns and cities. They may also sold by streetlevel drug dealers [1]. Addiction has drawn together a collection of papers that have been published over the last few years, as a virtual issue which considers the challenges presented by these new psychoactive substances. Only a few years ago the issue of the ‘legal highs’ market was regarded as an area of limited significance. Things change rapidly, however, and today the question of how to respond to the challenges posed by the emergence of new drugs has become one of major international concern [2]. The papers begin the task of elaborating the policy challenges we now face, particularly in relation to public health and regulatory responses. Before introducing them, however, it is worth taking a brief moment to reflect upon why these things have come to pass, and in so doing ground this virtual issue within the wider social and contextual factors that not only help to shape contemporary patterns of substance consumption but also impact upon almost all other aspects of our modern life. Posting on an internet discussion forum on 26 September 2006, Mexican Seafood noted that some of his, or possibly her, friends had been smoking a herbal mixture called ‘Spice’ that was, by all accounts, surprisingly impressive. The post contained a list of the 14 herbal constitutes it was claimed to contain and sought advice on their provenance. This was swift in coming, with MadScientist claiming early the next day that none of these substances contained CB1 agonists and that laboratory testing had not revealed any cannabinoids to be present. It was further speculated that the product might contain ‘additional active compounds as there were many legal and structurally distinct CB1 agonist available’. This post was followed within hours by claims from Shamantra that ‘Spice’ contained the synthetic cannabinoid HU-210 and speculating that none of the herbal substances claimed on the labelling were likely to be present. It was also noted that the effects were similar to, but longer-lasting than, hashish [3]. While not the first online discussion relating to ‘Spice’, the excerpts above are examples of how modern communication has impacted upon drug use trends [1]. It also serves to highlight the speed at which developments can now occur in the drugs field and by contrast how lumbering remain our efforts to track them.To put these posts into historical perspective, it was only in December 2008 that three synthetic cannabinoids, JWH-018, CP-47 497 and its active homologue, were identified in ‘Spice’ products [4]. Addiction was among the first journals to open the scientific debate on this topic, and by the time the editorial on ‘Spice’ products was published in 2010 nine synthetic cannabinoids had been reported to the European Union Early warning system on new psychoactive substances [4]. By June 2013, more than 80 synthetic cannabinoids

Slow-release oral morphine as maintenance therapy for opioid dependence.

Abstract: pioid dependence is associated with public health and social problems. People injecting opioids are particularly at risk, not only because they become dependent faster than with other routes of administration but also because they are exposed to consequences such as an increased risk of overdose mortality, infective diseases and health issues. At least three-quarters of global opiate users consume heroin. Opioid substitution treatment involves prescribing an opioid to replace street heroin or other opioids. This is a long-term treatment that has been shown to reduce injecting of street heroin and the risk of death and blood-borne virus transmission, and to reduce involvement in crime. Maintenance treatments that are effective in retaining people in treatment and suppressing heroin use include methadone, buprenorphine, and dyacethilmorphine, alone or combined with psychosocial treatments. In order to diversify the treatment possibilities, it is important to clarify the benefits that each specific intervention can bring to patients. Slow release oral morphine (SROM) is given once daily and has been proposed for people who cannot tolerate methadone or who respond poorly to other available maintenance treatments. This review did not identify sufficient evidence to assess the effectiveness of SROM for opioid maintenance. Only three randomised controlled trials involving 195 participants met our inclusion criteria. The findings of two studies suggested a possible reduction of opioid use in people taking SROM. In another study, the use of SROM was associated with fewer depressive symptoms. Retention in treatment was not clearly different among the compared interventions. Adverse effects were more frequent with SROM than buprenorphine or methadone, including stomach cramps, headache, toothache, constipation, vomiting and insomnia. These studies had small numbers of participants, very short follow -up and were designed to answer different questions. Overall, the quality of the evidence can be judged as low.

Media campaigns for the prevention of illicit drug use in young people

Abstract: Media campaigns to prevent illicit drug use are a widespread intervention. We reviewed 23 studies of different designs involving 188,934 young people and conducted in the United States, Canada and Australia. The studies tested different interventions and used several questionnaires to interview the young people about the effects of having participated in the studies brought to them. As a result it was very difficult to reach conclusions and for this reason we are highlighting the need for further studies.

Cocaine-Related Health Emergencies in Europe: A Review of Sources of Information, Trends and Implications for Service Development

Abstract: Background: Cocaine-related health consequences are difficult to observe. Data on drug users in health-emergency settings may be a useful source of information on

Treatment expectations and satisfaction of treatment-refractory opioid-dependent patients in RIOTT, the Randomised Injectable Opiate Treatment Trial, the UK's first supervised injectable maintenance clinics

Abstract: Introduction and Aims The study investigates patients' pre-treatment expectations of, and post-treatment satisfaction with, supervised injectable opiate treatment delivered within UK's first such clinics within the Randomised Injectable Opiate Treatment Trial (RIOTT) (ISRCTN0133807). Design and Methods Data were collected from 127 chronic heroin addicts recruited to RIOTT and randomised to receive supervised injectable (heroin or methadone) treatment or optimised oral maintenance treatment at supervised injectable maintenance clinics in London, Darlington and Brighton. Results Of 127 RIOTT patients, 113 (89%) provided responses to structured enquiry about treatment expectations, and 94 (74%) subsequent responses about treatment satisfaction (at six months). Patients were hoping that injectable heroin treatment would: reduce substance misuse (81%); help achieve normality, routine and structure (16%); and increase education and work prospects (15%). At six months, an area of treatment satisfaction most commonly reported by all three trial groups was reduced substance misuse (supervised injectable heroin 59%, supervised injectable methadone 56%, optimised oral methadone 54%). Most found supervision acceptable, but some desired modifications were also identified. Discussion and Conclusions Patients previously considered non-responsive to treatment appear to have similar treatment expectations and aspirations as other drug users in treatment. Supervised injectable opioid treatment patients consistently reported treatment satisfaction but also that more could be done to optimise aspects of current arrangement. This raised the challenging issue of the extent to which opinions of patients need to be taken into consideration in shaping future treatment provision. Future research may need to examine the extent of expectations ‘fit’ and the relationship between treatment sought and received. [Groshkova T, Metrebian N, Hallam C, Charles V, Martin A, Forzisi L, Lintzeris N, Strang J. Treatment expectations and satisfaction of treatment-refractory opioid dependent patients in Randomised Injectable Opiate Treatment Trial, the UK's first supervised injectable maintenance clinics. Drug Alcohol Rev 2013;32:566–573]

Legal Classification of Novel Psychoactive Substances: An International Comparison

Abstract: In recent years, the appearance on the illicit market of large numbers of novel psychoactive substances has created legislative problems for governments. Stemming from the international drug control treaties, a central principle is that harmful properties need to be demonstrated before a substance can be scheduled. Yet for many of these substances, little is known about their pharmacology and toxicology. Furthermore, reliable population surveys and information on prevalence may not become available until a substance is well-established. While not requiring extensive resources, the basic properties of new substances could be investigated, but governments often wish to act before use becomes widespread. The existing systems of drug legislation are discussed, some of which (i.e. generic definitions and analogue control) originated in an earlier period of concern about ‘designer drugs’. There is a common view in many countries that existing drug law is inadequate and that new solutions must be found. Some of these new approaches to drug control are described here.

Human immunodeficiency virus among people who inject drugs: is risk increasing in Europe?

Abstract: In most European Union (EU)/European Economic Area (EEA) countries, between 2010 and 2012, reports of new human immunodeficiency virus (HIV) diagnoses among people who inject drugs have been stable or declining. HIV outbreaks in Greece and Romania, first reported in 2011, continue and economic conditions hinder provision of effective response coverage. When measured against some established thresholds, prevention coverage remains inadequate in at least one-third of EU/EEA countries. Urgent consideration to scale up prevention efforts is merited.

Chapter 11 – Aminoindane Analogues

Abstract: One of the less well known compound classes of the so-called novel psychoactive substances are represented by analogues and derivatives that are based on the 2-aminoindane nucleus, which due to its structure, is a conformationally rigid analogue of amphetamine. Published animal and in vitro studies of the pharmacological profile of various aminoindanes indicate an involvement of serotonin release and re-uptake. In addition, drug discrimination studies carried out in rats pointed towards some pharmacological properties that are also shared with 3,4-methylenedioxymethamphetamine (MDMA). At first glance, one might be tempted to consider whether such substances would display empathogenic or entactogenic effects similar to MDMA and/or whether drug users might consider these substances as potential MDMA-replacements, particularly those on the lookout for substances that are not under control in most countries. At present there is very limited information about the acute and chronic human toxicity of various aminoindane derivatives, with the extent of current availability and trends in recreational use of this class of drugs being uncertain. However, from a clinical and forensic toxicology perspective, it is important to be able to identify the possible presence of such compounds and their potential metabolites in biological fluids and tissues, also to follow any trend in their use and need for control measures to be introduced. This chapter will provide an account of selected aminoindanes regarding their chemistry, pharmacology and toxicology and concludes that, so far, aminoindanes appear to play a minor role.

Epidemiology of Use of Novel Psychoactive Substances

Abstract: The rapid emergence of novel psychoactive substances (NPS) poses a number of challenges to the professional field, not least because little is known about the extent of use in different populations. This lack of insight means that it is difficult to plan intervention resources or to monitor the effects of policy and drug control. In this chapter we present the best available evidence on NPS epidemiology in both general and targeted populations of users. Whilst use of the majority of NPS is limited to small, specialist groups of drug enthusiasts, there is some evidence that drugs such as mephedrone are beginning to disperse into the general population. We also describe how the nature of the NPS market, often designed to circumvent legal controls, means that establishing robust estimates of use will be difficult.

Monitoring Novel Psychoactive Substances: A Global Perspective

Abstract: A globalised, networked world has led to novel psychoactive substances becoming widely available at an unprecedented pace. This development poses serious challenges to the current policies and procedures for detecting, identifying, monitoring and responding to their use. This chapter examines the key role that drug monitoring systems can play at the national, regional and international level in responding to this challenge. First we focus on the European Union early warning system on new psychoactive substances of the European Monitoring Centre for Drugs and Drug Addiction. In addition, national, regional and international drug monitoring systems are reviewed. The chapter also presents a number of the more promising new approaches that may be useful in monitoring novel substances in the face of a sophisticated, highly innovative and fast moving drug market. Finally, a review of findings from some of the first European studies on the prevalence of use of novel psychoactive substances is presented.

Hepatitis C among injecting drug users is two times higher in Stockholm, Sweden than in Rotterdam, the Netherlands.

Abstract: This study assessed risk behavior and preventive measuresforhepatitisCamonginjectingdrugusersinRotterdam, the Netherlands (452 participants, 2002–2003) andStockholm,Sweden(310participants,2004–2006), two cities with contrasting drug policies. Uni- and multivariate logistic regression models were used. We found that the prevalence of hepatitis C was almost two times higher in participants from Stockholm than in participants from Rotterdam, even after adjustment for sex sharing paraphernalia (adjusted relative risk: 1.92, 95% confidence interval: 1.60–2.29). Follow-up comparative studies are needed to determine if policies with structured health programs can decrease transmission of hepatitis C.

The Choice of Screening Instrument Matters: The Case of Problematic Cannabis Use Screening in Spanish Population of Adolescents

Abstract: The aim of this study was to examine the feasibility of problem cannabis use screening instruments administration within wide school surveys, their psychometric properties, overlaps, and relationships with other variables. Students from 7 Spanish regions, aged 14–18, who attended secondary schools were sampled by two-stage cluster sampling (net sample 14,589). Standardized, anonymous questionnaire including DSM-IV cannabis abuse criteria, Cannabis Abuse Screening Test (CAST), and Severity of Dependence Scale (SDS) was self-completed with paper and pencil in the selected classrooms. Data was analysed using classical psychometric theory, bivariate tests, and multinomial logistic regression analysis. Not responding to instruments' items (10.5–12.3%) was associated with reporting less frequent cannabis use. The instruments overlapped partially, with 16.1% of positives being positive on all three. SDS was more likely to identify younger users with lower frequency of use who thought habitual cannabis use posed a considerable problem. CAST positivity was associated with frequent cannabis use and related problems. It is feasible to use short psychometric scales in wide school surveys, but one must carefully choose the screening instrument, as different instruments identify different groups of users. These may correspond to different types of problematic cannabis use; however, measurement bias seems to play a role too.

El portal de promoción de buenas prácticas en Europa del OEDT. Un instrumento de diseminación vía Internet

Abstract: Las buenas practicas resultan de la mejor aplicacion de la evidencia disponible en relacion con las actividades en curso en materia de drogas. El Observatorio Europeo de las Drogas y las Toxicomanias (OEDT) ha creado una herramienta basada en la web destinada a combinar adecuadamente las evidencias cientificas y las practicas actuales en el campo de las drogodependencias. Mas alla del proposito de dar difusion a las evidencias existentes, el objetivo es tambien compartir las buenas practicas entre los paises europeos. Para sintetizar la evidencia existente se toma como referencia los metodos de la Colaboracion Cochrane (Grupo de drogas y alcohol) y el Grading of Recommendations Assessment, Development and Evaluation (GRADE). En febrero de 2013, el portal incluye cuatro modulos de la efectividad de las intervenciones de reduccion de la demanda, una coleccion de proyectos europeos sobre prevencion, tratamiento, reduccion de danos y reinsercion social y un inventario de directrices y normas europeas incluyendo un banco de instrumentos para evaluar las intervenciones (http://www.emcdda. europa.eu/best-practice). Los resumenes sobre las evidencias se presentan en un lenguaje sencillo y directo e incluye una breve explicacion acerca de los datos que dan soporte a estas evidencias, pero no proporcionan recomendaciones especificas. El principal reto futuro del portal de promocion de buenas practicas de la OEDT es llegar a ser un servicio de referencia para aquellos interesados en aplicar las buenas practicas. El portal debe convertirse en una plataforma donde encontrar todo que se necesita para la implementacion exitosa de las buenas practicas (manuales, materiales de formacion, guias para la evaluacion y contactos para tutorias).

Involving patients in setting the research agenda in drug addiction

Abstract: The involvement of patients and other stakeholders in decision making is crucial in daily medical practice and priority setting for research.1 After the inheritance left by Alessandro Liberati (1954-2012) some members of the Cochrane Collaboration led by the Italian Cochrane Network decided to …

Stimulant use among clients entering drug treatment in Europe

Abstract: The aim of this article is to explore the prevalence of primary illicit stimulant use among people who enter drug treatment in Europe. Drawing on information provided by European Union treatment centres in 2009 (excluding Latvia, Lithuania, Portugal and Norway), the European Monitoring Centre for Drug and Drug Addiction showed data in relation to the analysis of two of the most problematic drugs: cocaine and stimulants other than cocaine. The analysis reached three conclusions: the primary use of stimulants (cocaine and amphetamines) among clients entering treatment appears to be widespread throughout Europe; stimulant use including different forms of stimulants varied from country to country and two geographical patterns emerge across Europe: North-Eastern European countries show high levels of prevalence of problematic use of amphetamines and methamphetamines, while South-Western countries report high levels of problematic use of cocaine.

Best practice promotion in Europe: A web-based tool for the dissemination of evidence-based demand reduction interventions

Abstract: Best practice is the best application of available evidence to current activities in the drugs field. In 2008, the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) set off the creation of a web-based tool which bridges together scientific evidence and current practices in the drug addiction field. The aim is to disseminate evidence-based interventions and promote sharing of best practice amongst the European countries. The synthesis of the evidence is based on sound procedures, implemented according to the methods of the Cochrane collaboration (the Drugs and Alcohol Group) and the Grade working group. As of October 2012, the portal is composed of four modules on the effectiveness of demand reduction interventions, a collection of European projects on prevention, treatment, harm reduction and social reintegration and an inventory of European Guidelines and Standards including a bank of instruments to evaluate interventions (http://www.emcdda.europa.eu/best-practice). The summaries of eviden...

Co-morbidity of substance use and mental disorders. What do we know on the prevalence of psychiatric comorbidity in Europe and what are the ways forward?

Abstract: Co-morbidity is defined as the occurrence of two disorders or illnesses in the same person, either at the same time or with a short time difference (WHO, 1994). In the field of psychiatry, despite ...

Computer-aided (in silico) approaches in the mode-of-action analysis and safety assessment of ostarine and 4-methylamphetamine.

Abstract: Objective This study exemplifies computer-aided (in silico) approaches in assessing the risks of new psychoactive substances emerging in the European Union. In this work, we (i) consider the potential of Ostarine exhibiting psychoactivity and (ii) anticipate potential activities and toxicities of 4-methylamphetamine. Method The approach, termed in silico target prediction, suggests potential protein targets modulated by compounds given their chemical structure. This is achieved by first establishing the associations between chemical structure and protein targets using data from the bioactivity database, ChEMBL, via the use of two different computational algorithms. On the basis of the associations, protein targets and consequently the mode of action of novel compounds were predicted. Results For Ostarine, none of the targets anticipated are currently known to elicit psychoactivity. Furthermore, Ostarine is unlikely to cross the blood–brain barrier to reach relevant target sites on the basis of its physicochemical properties. For 4-methylamphetamine, toxicities were anticipated, that is, serotonin syndrome (based on the prediction of SERT) and other effects similar to related substances, that is, methamphetamine. Conclusion From the two case studies, we showed that in silico target prediction appears to have potential in assessing new psychoactive compounds where experimental data are scarce. The applicability domain of target predictions when applied to psychoactive compounds needs to be established in future work. Copyright © 2013 John Wiley & Sons, Ltd. key words—new psychoactive substances; Ostarine; 4-methylamphetamine; amphetamine; in silico target prediction