BEST PRACTICE PORTAL project presentation to the Scientific Committee

1. BEST PRACTICE PORTAL project presentation to the Scientific Committee Lisbon, 16th July 2010 Ferri et al

2. Contents Best Practice definitionsRole of the portalThe treatment moduleThe Harm Reduction: conceptualization of the moduleQuestions to the ScC

3. Role of the Portal EU action plan EU Drugs Action Plan for 2009-2012 …enhance the quality and effectiveness of drug demand reduction activities(…) • Action 17 To develop, implement and exchange good practice guidelines/quality standards for prevention, treatment, harm reduction and rehabilitation interventions and services • Action 19 To develop an EU consensus on minimum quality standards and bench-marks for prevention, treatment,harm reduction and rehabilitation interventions and services taking into account needs of specific groups and the work done at national and international level

4. Best Practice definition Evidence does not make decisions, people doHaynes RB BMJ 2002;324:1350

5. Best Practice definition Best Practice: a provisional definition There is no universally accepted definition of a "best practice."  However, (…), a "best practice" is a practice that upon rigorous evaluation, demonstrates success, has had an impact, and can be replicated (Knowledge for health. Johns Hopkins Bloomberg School of Public Health) Best Practices are innovative, make a difference, have a sustainable effect, have the potential for replication (serves as a model for generating policies and initiatives elsewhere) (UNESCO Management of Social Transformations (MOST) Programme)

6. Best Practice definition Best Practice: a provisional definitionhttp://www.businessdictionary.com/definition/best-practice.html Best Practices: Methods and technique that have consistently shown results superior than those achieved with other means, and which are used as benchmarks to strive for. There is, however, no practice that is best for everyone or in every situation, and no best practice remains best for very long as people keep on finding better ways of doing things.

7. Best Practice definition Best Practice: provisional definition Practice of best available evidence

8. Added value of a EMCDDA Best Practice Portal • Build the information around the specific European context by using data on clients and treatments • Interactivity with countries • Accessed by policy makers

9. Role of the Portal Structure of the information • Simplicity is the ultimate sophistication. • Perfection is attained, not when no more can be added, but when no more can be removed • Persons are the starting point and the ultimate destination of the process • Interventions are not “effective” per se’: • they are effective in affecting some outcomes • in some patients/clients • under certain circumstances

10. Role of the Portal Key points • Question ⇨EU strategy documents • Population ⇨ EPI data • Interventions ⇨ Treatment Profile • Outcomes ⇨ GL and Systematic Reviews • Study designs ⇨ GRADE logic

11. The Treatment Module The treatment module

12. The Treatment Module Next steps:(short term) add GRADE Profilecollection of new studies and assessment with GRADE…

15. Harm Reduction: conceptualization of the module Population ⇨ clients (mainly) by route of administration • Injecting drug users • opioid injectors • stimulant injectors • Other routes of administration • Prisoners

16. Harm Reduction: conceptualization of the module Interventions ⇨ HR monograph • Needle Syringe Programs (NSPs) • Opioid Substitution treatment (OST) • Community based outreach interventions • Peer Naloxone Distribution • Information, Education and Communication • Voluntary Counselling and Testing

17. Harm Reduction: conceptualization of the module Outcomes (Risks) ⇨ HR monograph • Reduction of Incidence of HIV, HCV, STI • Reduction of mortality • Reduction of morbidity • Criminality • Nuisance

18. Harm Reduction: conceptualization of the module Study designs ⇨ GRADE logic Systematic Reviews RCTs Cohort studies Observational studies Ecological studies

19. Harm Reduction: conceptualization of the module Scoring of interventions (1) ⇨ Convincing – results from systematic reviews or consistent evidence across many, methodologically assessed, studies. These interventions are very likely to obtain the desired effects in different contexts. (1) Evidence for the effectiveness and cost–effectiveness of interventions to reduce alcohol-related harm. (WHO 2009).

20. Harm Reduction: conceptualization of the module Scoring of interventions ⇨ Probable – results from a small number of, methodologically assessed, studies or from a number of weaker study designs. Results from conflicting studies, provided the conflicts are easily explained. These interventions are effective in principle but some considerations about their applicability under different contexts need to be addressed before implementation.

21. Harm Reduction: conceptualization of the module Scoring of interventions ⇨ Limited suggestive – recommendation generated from weaker studies and experts opinions about the probable effect of an intervention in presence of evident ethical or feasibility limitations to perform an appropriate study design. These interventions should be considered with cautions due to the risk of unintended effects.

22. Harm Reduction: conceptualization of the module Scoring of interventions ⇨ Unknown effects – not enough studies to assess an intervention. These interventions need to be studied to assess the effects.

23. Questions to the Scientific Committee Provide feed-back on the contents (rounds of consultations, or specific questions to individual members) • Are the information provided comprehensive? Do you know about systematic reviews or guidelines that should be included here? • Are you aware about studies published or ongoing that should be kept into consideration? • Would you be available for prompt reactions to questions that may arise during the process? • Would you indicate other colleagues, institutions that you think should be consulted for some specific questions?