Marica Ferri

• PhD International Public Health
• Head of Sector at European Monitoring Centre for Drugs and Drug Addiction (EMCDDA)

Background: Given the accumulating research, evolving psychosocial treatment, and equivocal findings, updating WHO’s Mental Health Gap Action Programme-2015 was necessary to ensure guidelines reflect effective strategies for alcohol use disorder (AUD). Objective: To estimate the effects of psychosocial interventions on drinking and related outcome...

Background: In 1990, the United States’ Institute of Medicine promoted the principles of outcomes monitoring in the alcohol and other drugs treatment field to improve the evidence synthesis and quality of research. While various national outcome measures have been developed and employed, no global consensus on standard measurement has been agreed f...

UNSTRUCTURED In this viewpoint paper we explore the use of big data analytics and artificial intelligence (AI) in improving outcomes for people with opioid use disorder (OUD) and bring to the table relevant challenges that must be addressed if new technologies are to be utilised ethically, effectively and equitably. First, we explore the conceptual...

Treatment demand for Cannabis Use Disorder (CUD) has increased in the past decade in almost all European countries, and CUD is currently the most common reason for first-time drug-related treatment admission in the European Union. Even though several therapeutic approaches have been shown to benefit individuals with CUD, there is a lack of knowledg...

Addiction medicine is a dynamic field that encompasses clinical practice and research in the context of societal, economic, and cultural factors at the local, national, regional, and global levels. This field has evolved profoundly during the past decades in terms of scopes and activities with the contribution of addiction medicine scientists and p...

Purpose of review Forced displacement, from wars, terrorism, internal disputes and environmental disasters, has been witnessed throughout human history. Forcibly displaced people face unimaginable difficulties and atrocities in their attempts to survive. Provision of support often focuses on basic needs, such as food, shelter and essential health d...

Telemedicine could improve access to medications for opioid use disorder (MOUD). Telemedicine-delivered MOUD (TMOUD) has expanded substantially in response to the restrictions imposed by the COVID-19 pandemic on in-person clinical contact, yet this expansion has not happened consistently across all health systems and countries. This Review aims to...

Addiction medicine is a dynamic field that encompasses clinical practice and research in the context of societal, economic, and cultural factors at the local, national, regional, and global levels. This field has evolved profoundly during the past decades in terms of scopes and activities with the contribution of addiction medicine scientists and p...

Addiction medicine is a dynamic field that encompasses clinical practice and research in the context of societal, economic, and cultural factors at the local, national, regional, and global levels. This field has evolved profoundly during the past decades in terms of scopes and activities with the contribution of addiction medicine scientists and p...

Abstract Background: The COVID-19 pandemic has impacted people with substance use disorders (SUDs) worldwide and healthcare systems have reorganized their services in response to the pandemic. Methods: One week after the announcement of the COVID-19 as a pandemic, in a global survey, 177 addiction medicine professionals described COVID-19-related h...

Background and aims: COVID-19 has infected more than 13 million people worldwide and impacted the lives of many more, with a particularly devastating impact on vulnerable populations, including people with substance use disorders (SUDs). Quarantines, travel bans, regulatory changes, social distancing and ‘lockdown’ measures have affected drug an...

Since early 2020, the COVID-19 pandemic has had a dramatic impact on the way we live, with European countries having to introduce unprecedented measures to protect public health. As with all areas of life, drug consumption, related harms and drug markets have been impacted, as have the drug services established to respond to drug-related problems....

Background People who inject drugs (PWID) are frequently incarcerated, which is associated with multiple negative health outcomes. Aim We aimed to estimate the associations between a history of incarceration and prevalence of HIV and HCV infection among PWID in Europe. Methods Aggregate data from PWID recruited in drug services (excluding prison...

Background: The COVID-19 pandemic has impacted people with substance use disorders (SUDs) worldwide and healthcare systems have reorganized their services in response to the pandemic. Methods: One week after the announcement of the COVID-19 as a pandemic, in a global survey, 177 addiction medicine professionals described COVID-19-related health res...

The present chapter is aimed at enabling the readers to understand the methods and the available tools to ascertain whether an evidence-based recommendation is appropriate for real-world patients in specific contexts. In times of a wide availability of real-time information on potentially anything, it is crucial to develop an individual capacity fo...

Introduzione All'inizio del 2020 in Europa sono stati riscontrati i primi focolai epidemici di COVID-19, in risposta ai quali i Paesi europei hanno messo in atto misure di contenimento e mitigazione della diffusione del virus. I pazienti con disturbo da uso di sostanze (DUS) 1 (European Union, 2006) rientrano nella popolazione a rischio di infezion...

Background: The prevalence of opiate use among pregnant women can range from 1% to 2% to as high as 21%. Just in the United States alone, among pregnant women with hospital delivery, a fourfold increase in opioid use is reported from 1999 to 2014 (Haight 2018). Heroin crosses the placenta, and pregnant, opiate-dependent women experience a six-fold...

Background: The COVID-19 pandemic has impacted people with substance use disorders (SUDs) worldwide, and healthcare systems have reorganized their services in response to the pandemic. Methods: One week after the announcement of the COVID-19 as a pandemic, in a global survey, 177 addiction medicine professionals described COVID-19-related health re...

Aims: A recently completed Cochrane review assessed the effectiveness and cost-benefits of Alcoholics Anonymous (AA) and clinically delivered 12-Step Facilitation (TSF) interventions for alcohol use disorder (AUD). This paper summarizes key findings and discusses implications for practice and policy. Methods: Cochrane review methods were followe...

Background: Alcohol use disorder (AUD) confers a prodigious burden of disease, disability, premature mortality, and high economic costs from lost productivity, accidents, violence, incarceration, and increased healthcare utilization. For over 80 years, Alcoholics Anonymous (AA) has been a widespread AUD recovery organization, with millions of memb...

Commentary to: How should we set consumption thresholds for low risk drinking guidelines? Achieving objectivity and transparency using evidence, expert judgement and pragmatism.

The planned review outlined in this protocol has not been successfully converted into a full Cochrane Review within established timelines and for this reason has been withdrawn from the CDSR

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: The primary objective of this review is to evaluate the efficacy of Alcoholics Anonymous mutual help groups, operated by peers, and TSF interventions, operated by professionals. Both will be evaluated relative to other interventions for AUD by examining their ef...

Issues: Treatment outcomes for drug users are critical for informing policy and therapeutic practice. The coherence of outcomes, changes and drug use measures from observational studies on opioid use treatment were reviewed. Approach: Systematic review of the literature for longitudinal observational studies, from 1980 through November 2015, in...

Objective To compare the risk for all cause and overdose mortality in people with opioid dependence during and after substitution treatment with methadone or buprenorphine and to characterise trends in risk of mortality after initiation and cessation of treatment. Design Systematic review and meta-analysis. Data sources Medline, Embase, PsycINFO, a...

Appendix 3: Quality score

Appendix 1: Searches

Appendix 2: Supplementary tables A and B

BACKGROUND AND AIMS: Despite advances in our knowledge of effective services for people who use drugs over the last decades globally, coverage remains poor in most countries, while quality is often unknown. This paper aims to discuss the historical development of successful epidemiological indicators and to present a framework for extending them wi...

Community coalitions are a strategy to coordinate activities and resources to prevent adolescent substance use and delinquent behaviour. They can bring together diverse community stakeholders to address a common goal and have the benefit of mobilising communities in prevention and health promotion initiatives. The Communities That Care (CTC) approa...

The global substance use problem is a serious public health concern that affects not only health, safety and well-being of communities, but also social and economic development. It particularly affects children, young people and their families. All Member States should set substance use prevention measures and programmes as a priority in order to p...

Background: In the past decade, several smoking cessation interventions have been developed and implemented through information and communication technology (ICT). Evidence suggests that they might be suitable for large-scale public health interventions, based on updated communication media characteristics in terms of interplay between technology a...

by BMJ The Evidence Based Medicine Manifesto (EBM manifesto) has been launched to improve the implementation of evidence based interventions by pulling together a clear set of achievable goals, and a strong overview of the strategies that work best, to help deliver change better and faster. In some areas, such as the treatment of illicit drugs rela...

Background: The availability of new psychoactive substances (NPS) in Europe has rapidly increased over the last decade. Although prevalence levels of NPS use remain low in the general European population, there are serious concerns associated with more problematic forms of use and harms in particular populations and settings. It has thus become a...

Background: The EMCDDA, through its network of National Focal Points, collects information on the quality assurance systems for drugs-related interventions across European countries. European National Drug Strategies include recommendations for systems and approaches for the assurance of the quality of interventions. Methods: We searched National D...

Contingency management (CM) is a general behavioural intervention technique used in the treatment of drug dependence to systematically arrange consequences and it is designed to weaken drug use and strengthen abstinence. The main elements of CM interventions are behavioural reinforcers and monitoring, which aim to promote social reintegration by su...

Prevention is the activity of public health dedicated to prevent the occurrence of pathological conditions and promote health (Last 2006). The value of prevention is particularly self- evident whenever the condition of interest is chronic, difficult to treat and significantly harmful to health (Ferri et al., 2015). In this chapter, we will make the...

Background: Existing cannabis treatment programs reach only a very limited proportion of people with cannabis-related problems. The aim of this systematic review and meta-analysis was to assess the effectiveness of digital interventions applied outside the health care system in reducing problematic cannabis use. Methods: We systematically search...

Policy changes that increasingly permit the medical and recreational use of cannabis have important implications for society and drug policies overall (see Nature 524, 280–283; 2015 and Nature 525, S1–S18; 2015). There is an urgent need to set up collaborative international monitoring of the effects of these changes in different countries to achiev...

The present chapter is aimed at enabling the readers to master the methods to ascertain whether an evidence-based recommendation is appropriate for real-world patients in specific contexts. Nowadays it is crucial to develop an individual capacity for critical assessment and to know where to search for updated and reliable sources of evidence. The m...

Objective To determine whether there is evidence that mass-media campaigns can be effective in reducing illicit drug consumption and the intent to consume. Design Systematic review of randomised and non-randomised studies. Methods We searched four electronic databases (MEDLINE, EMBASE, ProQuest Dissertations & Theses A&I and CENTRAL) and further ex...

Introduction: We conducted a systematic review and meta-analysis to assess the effectiveness of digital-media interventions for cannabis users with a special focus on non-treatment seekers in non-clinical settings. Method: In November and December 2014, we systematically searched Cochrane Central Register of Controlled Trials Scholar (- 1.1.2015) w...

Psychosocial interventions are structured psychological or social interventions used to address substance-related problems. They can be used at different stages of drug treatment to identify the problem, treat it and assist with social reintegration. Psychosocial interventions are used to treat many different types of drug problems and behavioural...

An overview of the concept and types of Guidelines including a description of Guidelines for the treatment of Drug Addiction in Europe

EMCDDA Insight series publication on cannabis

Regional drug strategies and action plans are intergovernmental policy documents that address drug-related problems. This article analyses six of these strategies, involving 148 countries in four continents. We focus in particular on how the prevention of drug-related problems is described, and if a comprehensive approach (such as environmental pre...

Drug overdose is one of the major causes of death among young people in Europe. Naloxone is an effective antidote that can reverse opioid (including synthetic opioid) intoxication. As overdoses quite often occur in the presence of peers or family members, programmes that enable bystanders to provide first aid and administer naloxone before an ambul...

There is a perceived global need to bridge the existing gap between researchers and other stakeholders to make research more helpful and to realign “the mismatch between what clinical researchers do and what patients need”. The EMCDDA carried out a pilot analysis to explore the gaps in research on treatment for drug dependence as indicated by syste...

Background: People who inject drugs (PWID) are a key population affected by hepatitis C virus (HCV). Treatment options are improving and may enhance prevention; however access for PWID may be poor. The availability in the literature of information on seven main topic areas (incidence, chronicity, genotypes, HIV co-infection, diagnosis and treatmen...

http://www.emcdda.europa.eu/topics/pods/treatment-for-cocaine-dependence

This is the protocol for a review and there is no abstract. The objectives are as follows: To conduct an overview of Cochrane systematic reviews that assessed the effectiveness of any pharmacological treatments, alone or in combination with others, to treat cocaine abuse or dependence. Any pharmacological treatment will be assessed in terms of effe...

Background: Breast, cervical, and colorectal cancer screening are evidence-based interventions recommended by most governmental agencies and scientific societies. The aim of this review is to assess the quality of guidelines on screening and to describe differences according to the context in which they were produced.Methods: A literature search of...

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 …

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-...

Background: Substance-specific mass media campaigns which address young people are widely used to prevent illicit drug use. They aim to reduce use and raise awareness of the problem. Objectives: To assess the effectiveness of mass media campaigns in preventing or reducing the use of or intention to use illicit drugs amongst young people. Search...

Background: Opioid substitution treatments are effective in retaining people in treatment and suppressing heroin use. An open question remains whether slow-release oral morphine (SROM) could represent a possible alternative for opioid-dependent people who respond poorly to other available maintenance treatments. Objectives: To evaluate the effic...

Best practice is the best application of available evidence to current activities in the drugs field. The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) created a web-based tool aimed at bridging together scientific evidence and current practices in the drug addiction field. Beyond dissemination of evidence, the scope is to share...

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 d...

The evidence of tapered methadone's efficacy in managing opioid withdrawal has been systematically evaluated in the previous version of this review that needs to be updated To evaluate the effectiveness of tapered methadone compared with other detoxification treatments and placebo in managing opioid withdrawal on completion of detoxification and re...

Drug demand reduction: global evidence for local actions The development of evidence-based demand reduction interventions is a primary drug policy objective at national, European Union (EU) and global level. A particular discourse, with its own set of concepts, is used to discuss implementation of this objective, including terms such as: best pract...

Background: Dependent heroin users are characterised by the persistence of use in spite of the difficulties they experience with health, law, social achievements and personal relationships. The present review will consider maintenance treatment in which the patients enter programs of pharmacological administration tailored to achieve patient stabi...

Background: Best Practice is the best application of the available evidence to current activities in the drug field. Evidence-based knowledge and practice, i.e. the experience and lessons learned from the implementation of evidence-based intervention, are two key dimensions of the Best Practice concept. Objectives: To develop a knowledge-base on th...

Background: Best Practice is the best application of the available evidence to current activities in the drug field. Evidence-based knowledge and practice, i.e. the experience and lessons learned from the implementation of evidence-based intervention, are two key dimensions of the Best Practice concept. Objectives: To develop a knowledge-base on th...

Drug dependent heroin users are preoccupied with the desire to obtain and take heroin and so have persistent drug-seeking behaviours. Those with a long history of treatment attempts and failures may benefit from the provision of heroin and flexible doses of methadone in a maintenance program. When accepted, this treatment may help them to remain in...

Emergency Clinical Pathways (ECP) for stroke have never been tested in randomized controlled trials (RCTs). To evaluate the effectiveness of an ECP for stroke patients in Latium (Italy) emergency system. cluster-RCT designed to compare stroke patient referrals by Emergency Medical Service (EMS) and Emergency Room (ER) health professionals trained i...

Different pharmacological approaches aimed at opioid detoxification are effective. Nevertheless a majority of patients relapse to heroin use, and relapses are a substantial problem in the rehabilitation of heroin users. Some studies have suggested that the sorts of symptoms which are most distressing to addicts during detoxification are psychologic...

In recent decades, studies that evaluate training programmes have shown that continuing education for physicians is not very effective in improving performance and behavioural changes. One of our goals was to create a Continuing Medical Education Programme (CMEP) that would result in changing the behaviour of health professionals. In early 2005, a...

Maintenance treatments are effective in retaining patients in treatment and suppressing heroin use. Questions remain regarding the efficacy of additional psychosocial services offered by most maintenance programs. To evaluate the effectiveness of any psychosocial plus any agonist maintenance treatment versus standard agonist treatment for opiate de...

Different pharmacological approaches aimed at opioid detoxification are effective. Nevertheless a majority of patients relapse to heroin use, and relapses are a substantial problem in the rehabilitation of heroin users. Some studies have suggested that the sorts of symptoms which are most distressing to addicts during detoxification are psychologic...

The Public Health Agency (PHA) of the Lazio region is the research branch of the local health authority where the capital city, Rome, is located. It is responsible for informing decision makers in the entire region of about six million people, including Rome and several smaller cities and towns. The PHA has played a significant role in the developm...

to describe the overall and cause-specific mortality among heroin users attending Public Treatment Centers (PTCs) in Italy and to estimate the impact of heroin use on mortality in the general population. A cohort of 10,376 patients (8881 men and 1495 women) enrolled over a period of 18 months between september 1998 and september 2000 and followed-u...

VEdeTTE is a longitudinal study of heroin addicts recruited in 115 NHS treatment centres in Italy, 1998-2001; 11903 people were enrolled, 3876 refused to participate; data were analysed on 10454. The present monograph is focused on the results of the analysis of the overall and overdose mortality in and out of treatment.

As well as AA, there are also alternative interventions based on 12-step type programmes, some self-help and some professionally-led. AA and other 12-step approaches are typically based on the assumption that substance dependence is a spiritual and a medical disease. The available experimental studies did not demonstrate the effectiveness of AA or...

The provision of prescribed heroin to chronic heroin-dependent individuals failing other treatments has been supported during the last 70 years on the ground that the first goal of interventions on drug users is to keep them in treatment to protect them from criminal activities and to promote social integration. To assess heroin prescription effect...

Early interventions proved to be able to improve prognosis in acute stroke patients. Prompt identification of symptoms, organised timely and efficient transportation towards appropriate facilities, become essential part of effective treatment. The implementation of an evidence based pre-hospital stroke care pathway may be a method for achieving the...

To summarize the major findings of the five Cochrane reviews on substitution maintenance treatments for opioid dependence. We conducted a narrative and quantitative summary of systematic review findings. There were 52 studies included in the original reviews (12,075 participants, range 577-5894): methadone maintenance treatment (MMT) was compared w...

Despite widespread use in many countries the evidence of tapered methadone's efficacy in managing opioid withdrawal has not been systematically evaluated. 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. We sea...

Background: Many medications have been used for stabilizing heroin users: Methadone, Buprenorphine and LAAM. The present review focus on the prescription of heroin to heroin dependents. Objectives: To assess the efficacy and acceptability of heroin maintenance versus methadone or other substitution treatments for opioid dependence, in retaining...

Psychosocial interventions alone are offered to people with opiate use disorders indiscriminately across countries; sometimes representing the most prevalent treatment after substitution therapy. Despite its wide use in clinical practice, no systematic review of effectiveness has ever been carried out. This review demonstrated that there was inadeq...

Meta-analyses of randomized trials may incorporate new evidence, and estimated treatment effects changeover time. We evaluated whether the certainty and estimates of efficacy and tolerability of mental health interventions change over time, as more trials appear on the same topics. One hundred meta-analyses (1,024 trial entries; 99,303 participants...