Background and aimsDespite 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 with additional indicators of coverage and quality of harm reduction services, for monitoring and evaluation at international, national or subnational levels. The ultimate aim is to improve these services in order to reduce health and social problems among people who use drugs, such as human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infection, crime and legal problems, overdose (death) and other morbidity and mortality.Methods and resultsThe framework was developed collaboratively using consensus methods involving nominal group meetings, review of existing quality standards, repeated email commenting rounds and qualitative analysis of opinions/experiences from a broad range of professionals/experts, including members of civil society and organisations representing people who use drugs. Twelve priority candidate indicators are proposed for opioid agonist therapy (OAT), needle and syringe programmes (NSP) and generic cross-cutting aspects of harm reduction (and potentially other drug) services. Under the specific OAT indicators, priority indicators included ‘coverage’, ‘waiting list time’, ‘dosage’ and ‘availability in prisons’. For the specific NSP indicators, the priority indicators included ‘coverage’, ‘number of needles/syringes distributed/collected’, ‘provision of other drug use paraphernalia’ and ‘availability in prisons’. Among the generic or cross-cutting indicators the priority indicators were ‘infectious diseases counselling and care’, ‘take away naloxone’, ‘information on safe use/sex’ and ‘condoms’. We discuss conditions for the successful development of the suggested indicators and constraints (e.g. funding, ideology). We propose conducting a pilot study to test the feasibility and applicability of the proposed indicators before their scaling up and routine implementation, to evaluate their effectiveness in comparing service coverage and quality across countries.ConclusionsThe establishment of an improved set of validated and internationally agreed upon best practice indicators for monitoring harm reduction service will provide a structural basis for public health and epidemiological studies and support evidence and human rights-based health policies, services and interventions.

Alcohol and tobacco use is a major health problem and one of the first causes of the burden of disease and mortality. School-based alcohol and tobacco use prevention programmes that have demonstrated efficacy are most often based on psychosocial skill development, individuals’ experiential learning strategies, and community resources. Furthermore, early and prolonged interventions have been recommended. Primavera is a pluri-annual, generic, multimodal, experiential-oriented prevention program. It runs over a three-year period from the last year of primary school to the second year of secondary school. This randomized controlled cluster study aimed at assessing the effects of the Primavera programme compared to a control prevention intervention among schoolchildren from 10 to 12 years in eight secondary schools in a particular French geographical area. The primary outcomes were lifetime tobacco use and past-month alcohol use. Data were collected at baseline and over three follow-up time points. In all, 287 and 266 questionnaires, respectively, were collected at baseline from the Primavera group and from the control group. Attrition was 45% and 41%, respectively. The SARS-COV2 pandemic crisis made it impossible for questionnaires to be collected during the final year. After adjustment, children from the Primavera group were less likely to report current alcohol use at the end of the first year (odds ratio = 0.39, 95% CI: 0.18–0.78) and past-month alcohol use at the end of the second year (odds ratio = 0.07, 95% CI: 0.01–0.66) compared to those from the control group. The results for psychosocial skills and alcohol and tobacco use denormalization were contrasted. Primavera is shown to be effective in reducing alcohol use among schoolchildren.

We did not observe a significant decrease in alcohol consumption among the youth. Further studies are needed to confirm the positive impact of a brief motivational intervention in the ED.

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Objectif : Les Consultations Jeunes Consommateurs (CJC) offrent un accompagnement aux jeunes présentant des addictions ainsi qu’à leurs familles. Une campagne de promotion de ce dispositif a été diffusée à deux reprises en 2015. Cet article se propose d’en évaluer l’impact sur la notoriété des CJC auprès des parents d’adolescents et sur le recours aux CJC. Méthodes : Trois sources ont été mobilisées : 1/ une enquête en trois vagues indépendantes (avant la campagne, après la première diffusion, après la seconde) par téléphone auprès de 500, 500 et 531 parents et adolescents afin d’évaluer l’impact sur la notoriété auprès des cibles, 2/ les données de sollicitations au service d’aide à distance Drogues Info Service, connecté à la campagne, pour observer les évolutions en matière de profils et de nombre, 3/ une enquête auprès des CJC, réunissant les informations de 3 747 consultations, pour comparer les profils des consultants venus grâce à la campagne ou non. Résultats : Avant la campagne, 15,98 % des parents avaient déjà entendu parler des CJC. Après les diffusions, cette part était inchangée parmi les parents non-exposés à la campagne et supérieure à 60 % parmi les parents exposés. Les autres sources ont montré notamment une plus grande implication des parents et une diversification des motifs de consultation. Conclusion : La campagne a permis d’augmenter la notoriété assistée du dispositif auprès des parents (public-cible). Les analyses secondaires suggèrent qu’elle a aidé à « décomplexer » le recours aux CJC par les parents, mais aussi par d’autres publics, comme les consommateurs de cocaïne.