best practice

Digital interventions for substance were assessed in a narrative review (Boumparis and Shaub, 2022). Programmes considered were both add-on interventions or standalone interventions and substance-specific (mainly cannabis interventions), were found:

• to have good feasibility among target groups

However most studies were underpowered to assess effectiveness.

Police-based diversion measures defined as measures involving “the police initiating and leading the intervention and the [people who use drugs] receiving a diversionary scheme to avoid a criminal record and any consequences that may result from continued formal contact with the criminal justice system”, have been evaluated in a narrative systematic review (Blais et al., 2022, 27 studies, US =17, Portugal = 5, Australia = 5) and found insufficient evidence to draw conclusionson:

• on drug use, drug accessibility, or changes in participants’ socioeconomic conditions.

However police-based interventions were found to be effective in preventing criminal offending or future contacts with the criminal justice system. The analysis also showed promising results for improving participants' health and diminishing social costs as well as costs associated with processing drug-related offenses. 

Findings from qualitative studies suggest that program acceptance by police officers, constructive intersectoral collaboration, clear eligibility criteria, and timely access to services seem to facilitate the implementation and delivery of police-based diversion measures.

The review solely focused on diversion measures that offered an alternative to a formal arrest (i.e., measures where arrest and criminal prosecution were only replaced by an administrative fine were not considered) and included

• the Commissions for the Dissuasion of Drug Addiction (CDDA) in Portugal where drug use is decriminalized, 
• police-based diversion programs implemented in jurisdictions where drug use is still a criminal offense, such as the Law Enforcement Assisted Diversion (LEAD) program, which creates a de facto decriminalization of drug use and is implemented in several US cities,
• police-based diversion programs rest on a mixture of de jure and de facto decriminalization implemented in Australia where the most common type of program is “cannabis cautioning”, where minor cannabis offenders are diverted away from the criminal justice system into education or treatment programs

Police-based diversion measures defined as measures involving “the police initiating and leading the intervention and the [people who use drugs] receiving a diversionary scheme to avoid a criminal record and any consequences that may result from continued formal contact with the criminal justice system”, have been evaluated in a narrative systematic review (Blais et al., 2022, 27 studies, US =17, Portugal = 5, Australia = 5) and were found to be effective in:

• preventing criminal offending or future contacts with the criminal justice system

The analysis also showed promising results for improving participants' health and diminishing social costs as well as costs associated with processing drug-related offenses. 

There was insufficient evidence to draw conclusions about the effect of police-based diversion measures on drug use, drug accessibility, or changes in participants’ socioeconomic conditions.

Findings from qualitative studies suggest that program acceptance by police officers, constructive intersectoral collaboration, clear eligibility criteria, and timely access to services seem to facilitate the implementation and delivery of police-based diversion measures.

The review solely focused on diversion measures that offered an alternative to a formal arrest (i.e., measures where arrest and criminal prosecution were only replaced by an administrative fine were not considered) and included

• the Commissions for the Dissuasion of Drug Addiction (CDDA) in Portugal where drug use is decriminalized, 
• police-based diversion programs implemented in jurisdictions where drug use is still a criminal offense, such as the Law Enforcement Assisted Diversion (LEAD) program, which creates a de facto decriminalization of drug use and is implemented in several US cities,
• police-based diversion programs rest on a mixture of de jure and de facto decriminalization implemented in Australia where the most common type of program is “cannabis cautioning”, where minor cannabis offenders are diverted away from the criminal justice system into education or treatment programs

A narrative systematic review (Dalton et al., 2021) assessed the interventions for emerging adults (age 18 -25) showing more promise to retain these patients in treatment. The results indicate that the interventions with the most promise for retention in treatment were:

• behavioural therapy such as cognitive behavioural therapy and contingency management for cannabis and alcohol use disorders
• cognitive behavioural therapy paired with opioid-agonist-therapy for opioid use disorder

Different pharmacotherapy options for methamphetamine withdrawal were assessed in a systematic reivew with meta-analysis (Acheson et al., 2022, 9 RCTS of 6 medications, N= 242). Results found that:

• Amineptine may reduce discontinuation rates (RR 0.22, 95% confidence interval [CI] 0.07, 0.72, p = 0.01), and improve global state (MD -0.49, 95% CI -0.80, -0.17), compared with placebo, however, this medication is no longer approved.
• No other medications improved any domain when compared with placebo.

Community distribution of naloxone was the focus of a systematic reviews of economic evaluations (Cherrier et al., 2022, 10 studies, one cost-effectiveness analysis, eight cost-utility analyses, and one cost-benefit analysis) and results showed that:

• all studies concluded that community distribution of naloxone was cost effective, with an incremental cost-utility ratio range of $US111-58,738 (year 2020 values) per quality-adjusted life-year gained.

 Education and naloxone distribution was found in an umbrella review of systematic reviews (Razaghizad et al., 2021, 6 SR containing 87 unique studies) effective in:

• producing long-term knowledge improvement regarding opioid overdose,
• improving participants' attitudes toward naloxone
• providing sufficient training for participants to safely manage overdoses.

Interventions to reduce intimate partner violence perpetration by men who use substances (mainly CBT and MI therapies) were found in a systematic review with meta-analysis (Stephens-Lewis et al., 2021, 9 RCTs, N = 1 014 men) to have no effect compared to treatment as usual in:

• reducing substance use or intimate violence partner violence 

Family focused, psychosocial, preventive interventions targeting parents/carers at risk of, or experiencing, parental domestic violence and abuse, mental ill-health, and substance misuse were assessed in a systematic review (Allen et al., 2022, 37 studies, studies were included if they measured impacts on two or more of these issues). Results showed that:

• none had a combined positive impact on all three outcomes and only one study demonstrated a combined positive impact on two outcomes.
• The analysis also found studies that had combined adverse, mixed, or singular impacts.