Management of substance abuse

Drugs

Guidelines on community management of opioid overdose

An estimated 69 000 people die each year from opioid overdose. Opioid overdose is easily reversed with the opioid antidote naloxone and with basic life support. Such care is generally only available in medical settings, however. These guidelines recommend that people who are likely to witness an opioid overdose, including people who use opioids, and their family and friends should be given access to naloxone and training in its use so that they can respond to opioid overdose in an emergency if a medical response is not available. Naloxone can be injected or administered intra-nasally and has minimal effects in people who have not used opioids. While naloxone administered by bystanders is a potentially life-saving emergency interim response to opioid overdose, it should not be seen as a replacement for comprehensive medical care.

Opioid overdose: preventing and reducing opioid overdose mortality

In 2012, the Commission on Narcotic Drugs resolution 55/7 on promoting measures to prevent drug overdose, in particular opioid overdose, called upon Member States to include effective measures to prevent and treat drug overdose in national drug policies. In that resolution, the Commission requested the United Nations Office on Drugs and Crime (UNODC), in collaboration with the World Health Organization (WHO), to collect and circulate available best practices on the prevention and treatment of and emergency response to drug overdose, in particular opioid overdose, including on the use and availability of opioid receptor antagonists such as naloxone and other measures based on scientific evidence. Following the resolution, a Discussion paper titled: Opioid overdose: preventing and reducing opioid overdose mortality is being launched by the United Nations Office on Drugs and Crime and the World Health Organization to promote and enhance the Member States responses to the increasing problem of opioid overdose deaths. The discussion paper outlines the facts about opioid overdose, the actions that can be taken to prevent and treat (reverse) opioid overdose and areas requiring further investigation, whilst promoting the dissemination of best practices on the prevention and treatment of opioid overdose.


Guidelines for the Psychosocially Assisted Pharmacological Treatment of Opioid Dependence

The Guidelines for the Psychosocially Assisted Pharmacological Treatment of Opioid Dependence review the use of medicines such as methadone, buprenorphine, naltrexone and clonidine in combination with psychosocial support in the treatment of people dependent on heroin or other opioids. Based on systematic reviews of the literature and using the GRADE approach to determining evidence quality, the guidelines contain specific recommendations on the range of issues faced in organizing treatment systems, managing treatment programmes and in treating people dependent on opioids.


WHO/UNODC/UNAIDS position paper. Substitution maintenance therapy in the management of opioid dependence and HIV/AIDS prevention, 2004

The World Health Organization (WHO), the United Nations Office on Drugs and Crime (UNODC) and the Joint United Nations Programme on HIV/AIDS (UNAIDS), have developed a joint position on substitution maintenance therapy for opioid dependence. Based on a review of scientific evidence and oriented towards policymakers, the WHO/UNODC/UNAIDS position paper covers a wide range of issues, from the rationale for this treatment modality, to the specific considerations regarding its provision for people with HIV/AIDS.


The Practices and Context of Pharmacotherapy of Opioid Dependence in Central and Eastern Europe, 2004

This publication presents an overview of the practices and the context of pharmacotherapy of opioid dependence in selected countries in Central and Eastern Europe and the Newly Independent States. Based on reports provided by professionals involved in the treatment of opioid dependence in these regions, this document describes the current situation with opioid use in Central and Eastern Europe and the Newly Independent States, the role of pharmacological treatment of opioid dependence in public health responses to opioid dependence and associated health consequences in the region, as well as priorities and recommendations for development of treatment services and responses. The publication contains key informant reports from Belarus, Bosnia and Herzegovina, Bulgaria, Croatia, Czech Republic, Estonia, Kyrgyzstan, Hungary, Latvia, Lithuania, Poland, Russian Federation, Slovakia and Ukraine. This publication has been prepared in conjunction with another WHO document that is focused on pharmacotherapy of opioid dependence in selected countries of South-East Asia and Western Pacific regions and both documents are a part of the global activity on treatment of opioid dependence which is currently being implemented by the WHO Department of Mental Health and Substance Abuse.


A Report from the WHO Drug Injection Study Phase II. RAR-Review: an international review of rapid assessments conducted on drug use, 2003

This report proposes that ‘rapid assessment’ methods have the potential to generate important public health information that can be used to develop intervention programmes. Drawing on both qualitative and quantitative research techniques, such assessments are typically undertaken in situations where data are needed quickly, where local resource constraints rule out more conventional research approaches, and where agencies require information to develop, monitor and evaluate intervention programmes. The potential of rapid assessment is now the subject of debate within the substance use field. First introduced in the early 1990s, the last three years have seen the approach attract increasing interest as a means of quickly profiling drug-related problems, mobilising HIV prevention efforts among injecting drug users, initiating policy change and service re-orientation, and, more recently, as a potential component of ‘second generation’ surveillance systems. However, there is still much that is not known about rapid assessment in the substance use field. This report aims to address this under-developed knowledge base by addressing three key questions:

  • what are the origins of rapid assessment in the substance use field, and how has it subsequently developed?
  • what different models of rapid assessment practice are used?
  • what impact and outcomes has the approach had, and in which situations are rapid assessments most profitably employed?

To achieve this, this report draws upon the findings of research conducted as part of the WHO Drug Injection Study Phase II. This research employed (i) an analysis of published and unpublished literature on rapid assessments conducted in the drug use field; (ii) an audit survey of individuals and organisations conducting or sponsoring rapid assessments on drug use; and (iii) in-depth interviews with rapid assessment practitioners.


The Practices and Context of Pharmacotherapy of Opioid Dependence in South-East Asia and Western Pacific Regions, 2002

This publication presents an overview of the practices and the context of pharmacotherapy of opioid dependence in selected countries of the South East Asia and Western Pacific regions of WHO. It describes the current situation with opioid use and its health consequences, the role of pharmacological treatment of opioid dependence in public health responses to opioid dependence and associated health consequences in the region, as well as priorities for development of treatment responses. The publication contains key informant reports from Australia, China, Hong Kong, Indonesia, Lao People's Democratic Republic, Malaysia, Myanmar, The Philippines, Thailand and Viet Nam.


Systematic Review of Treatment for Amphetamine-Related Disorders, 2001

The ease of synthesis from inexpensive and readily available chemicals makes possible the wide-spread of amphetamine dependence and abuse. The objective of this review is to search and determine risks, benefits and costs for a variety of treatments for amphetamine dependence or abuse, psychosis and withdrawal. This review was conducted using the Cochrane Collboration standards for preparing systematic reviews.


Ecstasy - MDMA and other ring-substituted amphetamines, 2001

Given the sustained high level of interest in ecstasy and recent findings relating to neurotoxicity, it was considered timely to undertake a specific review of the health effects of ecstasy. The primary focus of this review is 3,4-methylenedioxymethamphetamine (MDMA). However, some consideration is given to structurally related ring-substituted amphetamines, particularly those that are used or sold as ecstasy, either intentionally or through manufacturing errors.


Systematic Review of Pharmacological Treatment of Cocaine Dependence, 2000

Cocaine dependence is a common and serious condition, associated with severe medical, psychological and social problems, including the spread of infectious diseases. This series of systematic reviews (conducted using the Cochrane Collaboration standards) will critically assess the efficacy of pharmacotherapy for treating cocaine dependence.


Volatile Solvent Abuse: A global overview, 1999

This report provides an overview of current views about the problem of the use of volatile substances to achieve intoxication in a variety of settings. It includes discussions on the history and context of volatile solvent use, prevalence, health effects, prevention approaches, risk factors and targeted interventions, approaches to treatment and, monitoring and evaluation of interventions.


Opioid Overdose: Trends, Risk Factors, Interventions and Priorities for Action, 1998

This document briefly reviews international data on trends in illicit opioid use and opioid overdose deaths, in order to identify research priorities and strategies for preventing such. The report begins with an overview of international trends in the nature and extent of the illicit use of opioids. A description is then given of mortality related to illicit opioid use and the difficulties in defining and recording dug overdoses. An analysis is provided of the risk factors that have been identified to date for illicit opioid overdose deaths. The document concludes with priorities for action to better define and record overdose and other drug-related deaths and to reduce the toll of overdose deaths due to the illicit use of opioid drugs.


Drug Injecting and HIV Infection: global dimensions and local responses, 1998

This book is a definitive account of drug injecting behaviour and HIV infection in cities across the world. The book is based on an important study initiated by WHO in 1989, launched against a background of the rapid spread of HIV infection in a number of major cities. It uses data gathered from the collaborating sites. Considerable further information has been added from other studies, thuse presenting a comprehensive overview of what is currently known about drug injecting, HIV infection, epidemic dynamics, and possibilities for prevention. The WHO study has already played a vital role in informing national policies and placing drug injecting, HIV and related health and policy issues on the international agenda. This book will extend the findings of the study, stressing the importance of linking research to intervention and policy. It will be an essential addition to the library of researchers, practitioners and policy-makers in the fields of health policy, drug dependence and HIV/AIDS.

Only available in hardcopy [Contact us: msb@who.int]


Cannabis: A Health Perspective and Research Agenda, 1997

This report provides a review and summary of current knowledge about cannabis use and health effects, and is likely to be relevant for policy makers, public health officials, educators and other individuals concerned with health promotion.


Amphetamine-type Stimulants: A report from the WHO Meeting on Amphetamines, MDMA and other Psychostimulants, 1997

This report summarizes both: the findings of a WHO meeting on Amphetamines, MDMA and other psychostimulants held in Geneva, Switzerland from 12 to 15 November 1996, and background papers prepared for that meeting and subsequently revised. This report presents key issues relating to ATS: epidemiology and social context, pharmacology and toxicology, health effects and social consequences, treatment approaches, prevention approachse and policy responses. It concludes with receommendations regarding WHO providing assistance in the development of strategic responses to ATS use.


Multi-City Study on Drug Injecting and Risk of HIV Infection, 1994

This is a report of the WHO Drug Injecting Study: Phase I launched in 1989. This was a comparative study of drug injecting behaviour and HIV infection which involved 12 cities: Athens, Bangkok, Berlin, Glasgow, London, Madrid, New York, Rome, Rio de Janeiro, Santos, Sydney and Toronto. This study was the largest international project of its kind. Apart from the wealth of data collected in each of the participating cities, the study has contributed much to the development of research methods, informing national policies, establishing international collaborative networks and placing drug injecting, HIV and related health and policy issues on the international agenda.


Volatile Solvent Use: A Strategy for Community Involvement

This document is the second part of a report prepared with the objective of disseminating current knowledge about the use of volatile solvents around the world. The first part was a global overview of the impact of volatile solvent use. In the present document, a community-based strategy is proposed to change community attitudes towards solvent users, to improve community knowledge about acute and long-term effects of volatile solvent use, and to provide skills to develop and evaluate a comprehensive approach to reach these goals.

Only available in hardcopy [Contact us: msb@who.int]


WHO Multi-Site Collaborative Project: Longitudinal Cohort Studies on Health Implications of Drug Use. Report of the Phase I Planning Meeting in Rome, Italy, 23-24 September 1998

In order to examine mortality and other health consequences of drug use, WHO planned to establish cohorts of drug users in different geographical and cultural settings. This report is from a meeting of experts who convened to discuss research methodologies and experiences in assessing mortality and other health implications of drug abuse in both prospective and retrospective cohorts.

Only available in hardcopy [Contact us: msb@who.int]


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