Strang J., Babor T., Caulkins J. et al.
Lancet: 2012, 379(9810), p. 71–83.
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Review of relevant research by an international team of leading researchers offers policymakers guidance on the interventions most likely on the evidence to achieve national policy aims in respect of illegal drug use.
Summary This review by an international team of researchers critically assesses the scientific basis of interventions intended to prevent or at least minimise the damage that illicit drugs do to the public good, including social benefits such as better public health, reduced crime, and greater stability and quality of life for families and neighbourhoods. It aims to help policymakers make informed decisions about which options will maximise the public good. Values and political processes (eg, voting) are important drivers of drug policy, but evidence of effectiveness and cost-effectiveness can help the public and policy makers to select policies that best achieve agreed goals.
Contemporary drug-related public policy attempts to promote the public good through a broad range of administrative actions designed to prevent the initiation of drug use by non-users, help heavy drug users change their behaviour or reduce the consequences of their drug use, and control the supply of illicit drugs (and the supply of diverted prescription drugs used for non-medical purposes) through laws, regulations, and enforcement.
Some of the evidence on such initiatives comes from randomised trials and quasi-experimental designs with similar control A group of people, households, organisations, communities or other units who do not participate in the intervention(s) being evaluated. Instead, they receive no intervention or none relevant to the outcomes being assessed, carry on as usual, or receive an alternative intervention (for the latter the term comparison group may be preferable). Outcome measures taken from the controls form the benchmark against which changes in the intervention group(s) are compared to determine whether the intervention had an impact and whether this is statistically significant. Comparability between control and intervention groups is essential. Normally this is best achieved by randomly allocating research participants to the different groups. Alternatives include sequentially selecting participants for one then the other group(s), or deliberately selecting similar set of participants for each group. conditions, but this review also considered other types of evidence when randomised controlled trials could not be implemented or would be politically challenging to implement.
After reviewing the evidence the authors offered this set of key messages:
• Drug policy should aim to promote the public good by improving individual and public health, neighbourhood safety, and community and family cohesion, and by reducing crime.
• The effectiveness of most drug supply control policies is unknown because little assessment has been done, and very little evidence exists for the effectiveness of alternative development programmes in source countries.
• Supply controls intended to affect illegal drug markets by targeting suppliers' activities can result in higher drug prices, which can reduce drug initiation and use, but these changes can be difficult to maintain.
• Wide-scale arrests and imprisonments have restricted effectiveness, but drug testing of individuals under criminal justice supervision, accompanied by specific, immediate, and brief sentences (eg, overnight), produce substantial reductions in drug use and offending.
• Prescription regimens minimise but do not eliminate non-medical use of psychoactive prescription drugs. Prescription monitoring systems can reduce inappropriate prescribing.
• Screening and brief intervention programmes have, on average, only small effects, but can be widely applied and are probably cost-effective.
• The collective value of school, family, and community prevention programmes is appraised differently by different stakeholders.
• Opiate substitution therapy for addicted individuals has strong evidence of effectiveness, although poor quality of provision reduces benefit. Peer-based self-help organisations are strongly championed and widely available, but have been poorly researched until the past two decades.
• Health and social services for drug users covering a range of treatments, including needle and syringe exchange programmes, improve drug users' health and benefit the broader community by reducing transmission of and mortality due to infectious disease.
Last revised 06 February 2013. First uploaded 06 February 2013
DOCUMENT 2014 Time limiting opioid substitution therapy
DOCUMENT 2014 Needle and syringe programmes