Abstract: Within the Swiss Detoxification Coordination (SwiDeCo) framework, a number of randomised clinical trials on opiate detoxification took place, comparing different settings (in- and outpatient), medications (antagonists under anaesthesia, methadone, buprenorphine high/low dosage) and duration of treatment (fixed and flexible). A standard assessment with validated instruments and standard follow-up was used throughout all the studies. One study concerned neonatal opiate detoxification. The scientific framework offered by SwiDeCo provided an opportunity for links and exchange between different drug treatment centres (over 20 centres participated in the studies) and persons working in the field of substance abuse in Switzerland. Overall, 279 patients were included in the different trials, of whom three-quarters were male, on average 30 years old; multi substance abuse was frequent. All procedures to withdraw patients from opiates tested in the different trials resulted in an equally poor outcome regarding abstinence after 3 months (22%). There were no patient baseline characteristics predicting differences in outcome. However, in-patient detoxification resulted in higher short-term abstinence rates, but this advantage disappeared over time. Patients’ level of distress at baseline evaluation decreased independently of treatment outcome during the first three months. Therefore, there seems to be a beneficial, but outcome-independent, treatment initiation effect. Two patients died within 3 months of detoxification. Although we cannot formally conclude whether withdrawal treatment resulted in an excess mortality, this fact is disquieting. During the detoxification phase overdose prevention should be discussed. Finally, based on our study results and on similar results from other groups, we cannot recommend the UROD procedure for withdrawal. We would rather suggest engaging patients who insist on this treatment modality in outpatient treatment, where tapering of substitution opiates could be performed while monitoring resumption of heroin consumption or the consumption of other substances. Given the high relapse rates independent of the specific detoxification treatment offered, it is important to offer flexible treatment goals to patients undergoing withdrawal treatment, so that substitution treatment might be offered in case of failure. The technique is simple and can be applied by trained family doctors.

Abstract: This ‘Selected issue’ looks at the current situation in injecting drug use in Europe. Overall, two questions guide the report: What are the prevalence and trends in injecting drug use in today’s Europe? How do European countries try to prevent or reduce this type of drug use and the harms associated with it? Data from a variety of sources are analysed to estimate prevalence and trends in drug injecting in Europe. The most recent data point to injecting drug use remaining stable or declining in most European countries. Measures such as opioid substitution treatment and needle and syringe programmes, which aim to reduce injecting-related harms, now reach many of those who need them.

Abstract: Despite the long-standing prominence of the problem, relatively coherent strategies and substantial investment, the United Kingdom remains at the top of the European ladder for drug use and drug dependence. This study by Professor Peter Reuter of the University of Maryland, USA, and Alex Stevens of the University of Kent, England, assesses the evidence relation to the UK drug problem and analyses the impact of current policies.

Abstract: Illicit drug markets have global dimensions and require coordinated responses on a comparable scale. In this context, the World Drug Report aims to improve understanding of the illicit drug problem and contribute to more international cooperation for countering it. This year’s edition begins with an overview of recent trends and the current situation in terms of production, trafficking and consumption and the consequences of illicit drug use in terms of treatment, drug-related diseases and drug-related deaths. The second chapter presents a long-term perspective: it looks at the main characteristics of the contemporary drug problem, the ways it has changed over the last few decades, the driving factors that shaped this evolution, and the directions it is likely to take in the future.

Abstract: Many illicit drug markets have reached global dimensions and require control strategies on a comparable scale. In that context, there is a need to better understand these transnational markets and the manner in which they operate. The yearly World Drug Report is a contribution towards that objective. This year’s edition starts with an overview of the illicit drug situation worldwide and regionally, followed by more comprehensive discussions and statistical trends for the key transnational drug markets, namely opium/heroin, coca/cocaine, amphetamine-type stimulants and cannabis.