Acceptability of using mobile Health (mHealth) as an intervention tool for people with drug use disorders in Tanga, Tanzania.

Evidence on the additional benefit in treatment and recovery process among PWDUD using digital health interventions is lacking. This study aimed to describe the acceptability of using a digital intervention to increase information access for PWDUD in Tanga region, Tanzania. This study was conducted among 465 participants in Tanga, a coastal region on the Northeast of Tanzania has the second highest number of PWDUD in Tanzania. This cross-sectional descriptive study used both quantitative and qualitative approaches. The majority of the PWDUD 67.6% do not own mobile phones. Out of the 156 participants with mobile phones, only 6.4% owned a smartphone. Most of the participants, 83.6%, reported living with someone who owns a mobile phone. Importantly, a significant number of participants, 98.5% from both areas showed readiness to use mobile phones to access information about the harmful use of substance and substance use disorder treatment options. Participants described how mobile phones can be useful to them in accessing information related to treatment and access to treatment options. The findings of this study helped to inform the target audience for the developed Huru App that should not be only PWDUD but the community at large.

Assessing the Efficacy of a Brief Universal Family Skills Programme on Violence and Substance-Use Indicators in Youth in Trentino and Parma, Italy: Study Protocol for a Multi-Centre, Non-Blinded, Cluster-Randomised Controlled Trial (cRCT) of Family UNited.

Homes in which families are experiencing stressful and challenging circumstances can foster a social space that engenders violent behaviours in parents, inadequate childcare, and the exposure of children to criminal and antisocial behaviours at an early age in addition to many other negative social and health consequences throughout their development. Family Skills Training offers a combination of parenting knowledge, skill building, competency enhancement, and support to strengthen family protective factors, such as communication, trust, problem-solving skills, and conflict resolution. Through over a decade-long experience piloting evidence-based family skills packages globally, we developed a universal open-source family skills package, "Family UNited" (FU), designed for families with children aged 8 to 15 years living in low- and middle-income countries (LMIC). The current study aims to explore the efficacy, fidelity, and acceptability of FU in Trentino and Parma, Italy. We plan to conduct a multi-site, non-blinded, two-armed, cluster-randomised controlled trial to assess efficacy in 160 families: the intervention group receiving FU and the waitlist/control group only receiving FU after the completion of all data collection points. We will prospectively collect outcome data, assessing changes in parenting skills and family adjustment in caregivers, children's behaviour, resilience capacities, and attitudes towards peer violence. To assess programme delivery, fidelity, feasibility, and acceptability we will include an embedded process evaluation. This study aims to evaluate the improvement in parenting skills, child well-being, and family mental health after participation in FU, compared to no intervention. Even though this trial is to be conducted in a high-income country, such results complement the existing piloting experience in LMIC. with impact-related measures encouraging the adoption of such approaches globally and beyond the EU borders.

Drug use and associated factors in a North Eastern region of Tanzania: a cross-sectional study.

Introduction: Tanzania has experienced an increase in the number of people who use drugs (PWUDs) and people who inject drugs (PWIDs). Understanding the characteristics of PWUDs is crucial to addressing the increasing burden of drug use in Tanzania. This study was set to examine drug use and its related factors among PWUDs in a North Eastern region of Tanzania. Methods: a cross-sectional study conducted among 481 PWUDs in Tanga region, Tanzania. R statistical language was used for analysis and plotting. Logistic regression was performed to establish associations between knowledge and practice scores with drug use. A p-value of < 0.05 was considered statistically significant. Results: people who inject drugs comprised mostly of male (97.5%) and those with primary level education (71.1%). About three in four PWUDs had poor knowledge and practices towards drug use. Factors associated with adequate knowledge and practices towards drug use included residing in urban setting (aOR: 0.47, 95% CI; 0.29 - 0.74, p=0.001) while low level of education and use of drugs for less than 10 years were independent predictors for poor practices. Conclusion: drug use poses a significant threat among male and individuals with low education in Tanga region. Poor knowledge and practices towards drug use was more pronounced among rural and lowly educated PWUDs. Owing to variabilities of predictors, tailored and innovative interventions are needed to curb this growing drug use and associated effects in Tanga and other settings with similar contexts.

An observational prospective cohort study of naloxone use at witnessed overdoses, Kazakhstan, Kyrgyzstan, Tajikistan, Ukraine.

Objective: To determine whether participation in the United Nations Office on Drugs and Crime (UNODC) and the World Health Organization's (WHO) Stop Overdose Safely (S-O-S) take-home naloxone training project in Kazakhstan, Kyrgyzstan, Tajikistan and Ukraine resulted in naloxone use at witnessed opioid overdoses. Methods: An observational prospective cohort study was performed by recruiting participants in the implementation of the S-O-S project, which was developed as part of the broader S-O-S initiative. Training included instruction on overdose responses and naloxone use. Study participants were followed for 6 months after completing training. The primary study outcome was participants' naloxone use at witnessed overdoses, reported at follow-up. Findings: Between 400 and 417 S-O-S project participants were recruited in each country. Overall, 84% (1388/1646) of participants were interviewed at 6-month follow-up. The percentage who reported witnessing an overdose between baseline and follow-up was 20% (71/356) in Tajikistan, 33% (113/349) in Kyrgyzstan, 37% (125/342) in Ukraine and 50% (170/341) in Kazakhstan. The percentage who reported using naloxone at their most recently witnessed overdose was 82% (103/125) in Ukraine, 89% (152/170) in Kazakhstan, 89% (101/113) in Kyrgyzstan and 100% (71/71) in Tajikistan. Conclusion: Implementation of the UNODC-WHO S-O-S training project in four low- to middle-income countries resulted in the reported use of take-home naloxone at around 90% of witnessed opioid overdoses. The percentage varied between countries but was generally higher than found in previous studies. Take-home naloxone is particularly important in countries where emergency medical responses to opioid overdoses may be limited.

More than saving lives: Qualitative findings of the UNODC/WHO Stop Overdose Safely (S-O-S) project.

BACKGROUND: The Stop Overdose Safely (S-O-S) initiative-developed in compliance with WHO guidelines-aims to prevent opioid overdose deaths. Under the umbrella of this initiative a multi-country project was implemented in Kazakhstan, Kyrgyzstan, Tajikistan, and Ukraine, that involved overdose recognition and response training, including the provision of take-home naloxone (THN). More than 14,000 potential overdose witnesses were trained and more than 16,000 THN kits were distributed across the participating countries. This paper reports on the qualitative component of an evaluation aiming to understand the views and experiences of S-O-S project participants. METHODS: Data were drawn from focus group discussions with 257 project participants from across all four countries, including people who use and inject drugs, and others likely to witness an opioid overdose. Data were analysed thematically. RESULTS: Findings revealed how past experiences of trauma and loss related to overdose death were common, as was appreciation and gratitude for the opportunity to participate in the S-O-S training. Participants described how they shared knowledge and skills with others. Empowerment and destigmatising narratives featured prominently, and highlighted how for people who use drugs, feeling valued and cared about-not only by families and friends, but by health care providers, and sometimes police-was a positive outcome of their participation. Nevertheless, findings also revealed how real experiences of fear regarding police intervention was a barrier to carrying naloxone and intervening when faced with an overdose situation. CONCLUSION: Our analysis found that the S-O-S project produced positive outcomes that go well beyond saving lives. Despite identifying barriers to THN uptake, our findings support a growing body of evidence that broad access to THN as part of a continuum of care can enhance the health and wellbeing of people who use drugs and their communities, in low- to middle-income countries.

Priorities for addressing substance use disorder in humanitarian settings.

BACKGROUND: Populations affected by humanitarian emergencies are vulnerable to substance (alcohol and other drug) use disorders, yet treatment and prevention services are scarce. Delivering substance use disorder treatment services in humanitarian settings is hampered by limited guidance around the preparation, implementation, and evaluation of substance use disorder treatment programs. This study aims to identify and prioritize key gaps and opportunities for addressing substance use disorder in humanitarian settings. METHODS: UNODC convened a consultation meeting (n = 110) in coordination with UNHCR and WHO and administered an online survey (n = 34) to, thirteen program administrators and policymakers, eleven service providers, nine researchers, and one person with lived experience to explore best practices and challenges to addressing substance use disorder in diverse populations and contexts. Participants presented best practices for addressing substance use disorder, identified and ranked challenges and opportunities for improving the delivery of substance use disorder treatment interventions, and provided recommendations for guidelines that would facilitate the delivery of substance use disorder treatment services in humanitarian emergencies. RESULTS: Participants agreed on key principles for delivering substance use disorder treatment in humanitarian settings that centered on community engagement and building trust, integrated service delivery models, reducing stigma, considering culture and context in service delivery, and an ethical 'do no harm' approach. Specific gaps in knowledge that precluded the delivery of appropriate substance use disorder treatment include limited knowledge of the burden and patterns of substance use in humanitarian settings, the effectiveness of substance use disorder treatment services in humanitarian settings, and strategies for adapting and implementing interventions for a given population and humanitarian context. Participants emphasized the need to strengthen awareness and commitment related to the burden of substance use disorder treatment interventions among communities, practitioners, and policymakers in humanitarian settings. CONCLUSIONS: Results from this consultation process highlight existing gaps in knowledge related to the epidemiology and treatment of substance use disorders in humanitarian emergencies. Epidemiological, intervention, and implementation research as well as operational guidance are needed to fill these gaps and improve access to substance use treatment services in humanitarian settings.

Fidelity Assessment of the Treatnet family (TF): A family-based intervention for adolescents with substance use disorders and their families.

INTRODUCTION: In transporting family-based interventions to community settings, establishing and maintaining fidelity to intervention is important. This exploratory study was implemented in the framework of a United Nations Office on Drugs and Crime (UNODC) global programme on Drug Dependence Treatment and Care. It is the first to examine an evidence-informed family-based intervention ("Treatnet Family"; TF) adherence for the treatment of adolescents with substance use disorders (SUD) among practitioners in community settings in Jakarta, Indonesia. METHOD: Twenty-three practitioners at five community-based counselling centres were trained in Treatnet Family and delivered it to 19 adolescents with SUD and their family members over a 6-week period. One of the five local Treatnet Family-trained supervisors randomly selected one session of the family-based intervention (TF) and observed the extent to which the practitioner's adhered to the TF manual. RESULTS: According to the supervisors' observation, all the practitioners used the Treatnet Family core skills such as positive reframing, positive relational reframing, perspective taking, relational questions, and going with resistance. There was a high level of agreement between practitioners' and supervisors' rating on the practitioners' use of specific therapeutic skills as measured using the Inventory of Therapy Techniques (ITT). CONCLUSION: Results suggest that Treatnet Family can be delivered with adherence by practitioners in community-based settings.

The Role of Law Enforcement Officers/Police in Drug Prevention within Educational Settings-Study Protocol for the Development of a Guiding Document Based on Experts' Opinions.

The United Nations Office on Drugs and Crime-World Health Organization International Standards on Drug Use Prevention-reflects the value of safe, nurturing and supportive social institutions around the lives of youths to benefit from the prevention of risky behavior extending beyond individually-developed resilience for healthy adolescent development. Schools are valuable social institutions to this effect and school safety and adolescent health outcomes can be threatened by drug use and violence. As such, collaborative, multi-level, evidence-based, developmentally sensitive, substance use prevention programs are imperative. The International Standards, in their latest version, did not reflect specific evidence of law enforcement officer-based programs with effect on drug use prevention, including in school settings. Nevertheless, the collaboration between law enforcement agencies and school-based substance use prevention programs continue to be the focus of research and policy. In this project, we aim to explore in more detail the role of law enforcement in preventing substance use in schools. We use mixed methods, including three phases: (i) scoping review on the best practices for effective law enforcement in school-based drug and crime prevention; (ii) interviews with experts, using the Delphi method, in substance use prevention and training law enforcement in school-based drug prevention; and iii) developing guidelines for law enforcement based on the findings. Initially, we identified a total of 17 papers that were categorized in four categories based on their results (negative or null effect n = 11 studies, positive effect n = 1 study, mixed effects n = 4 studies and indefinite conclusion n = 1 study). However, the authors of the studies with negative or null effect did recommend being cautious about these results due to the respective studies' methodological limitations. The actual and perceived roles of police are largely unclear and/or variable. Therefore, clear outlines regarding law enforcement's role within schools are crucial as one study showed that an officer's role influences how they respond to student conduct. A secondary emergent theme from this review indicates that there is potential for positively impacting a youth's perceptions of police through collaborative and engaging school-based programs. Currently the project is gradually moving to Phase II, where we are identifying the key experts based on scientifically published peer reviewed and grey literature/guidelines to investigate elements that make the role of law enforcement officers in school-based prevention more effective. Given the frequency with which policy makers around the world request information about the role of law enforcement in effective prevention efforts, guidelines on their roles within schools is a gap that needs to be filled. Such efforts would improve drug prevention in schools and better orient law enforcement's role in drug prevention within educational settings.

The United Nations Office on Drugs and Crime's Efforts to Strengthen a Culture of Prevention in Low- and Middle-Income Countries.

This article discusses how decision-makers can be supported to strengthen a culture of prevention. This article presents an example of the United Nations Office on Drugs and Crime's (UNODC) work to engage with decision-makers to create readiness, demand, and capacity for evidence-based prevention programming among them, particularly in low- and middle-income countries. First, we utilized two of the UNODC's data sources to describe the context where the UNODC's prevention efforts take place. Analysis of the first dataset on prevention activities implemented globally revealed a gap in translating evidence into practice on a global scale. The second dataset consisted of UNODC policy documents mandating and guiding global action to address substance use. The analysis showed that at the level of political frameworks, prevention is gradually gaining more attention but is still frequently left in the shadow of health- and law enforcement-related issues. In addition, these guiding documents did not reflect fully the current scientific understanding of what constitutes an effective prevention response. Against this background, the feasibility of the UNODC's efforts to bridge the science-practice gap in the field of prevention was discussed by presenting the results from the UNODC's regional capacity-building seminars focused on the role of monitoring and evaluation in prevention programming. The results showed potential of this capacity building to affect the attitudes and knowledge of targeted decision-makers. Such efforts to increase decision-makers' readiness and ultimately their endorsement, adoption, and ongoing support of evidence-based preventive interventions should be continued and intensified.

COVID-19 and Substance Use Disorder: Study Protocol for the International Society of Addiction Medicine Practice and Policy Interest Group Global Survey.

INTRODUCTION: As one of the major health problems in the present century, the COVID-19 pandemic affected all parts of the global communities and the health of substance users are potentially at a greater risk of harm. This global study has been designed and conducted by the International Society of Addiction Medicine Practice and Policy Interest Group (ISAM-PPIG) to understand better the health related issues of people with Substance Use Disorders (SUD) as well as responses of the relevant health care systems during the pandemic. METHODS: This is a cross-sectional study using convenient sampling. The data gathering was carried out with two follow-up stages each two months apart through an online conducted survey prepared using Google platform. The survey started by emergence of COVID-19 as a pandemic in March 2020 and respondents were followed till September 2020 when most of the initial lockdowns by most countries are supposed to be reopened. ETHICS AND DISSEMINATION: The study was approved by the ethics committee of University of Social Welfare and Rehabilitation Sciences, Tehran, Iran. The results will be published in relevant peer reviewing journals and communicated with different international stakeholders.

Lions Quest Skills for Adolescence Program as a School Intervention to Prevent Substance Use-a Pilot Study Across Three South East European Countries.

Development of personal and social skills in a classroom prevents later drug use and alcohol abuse, and influence-related risk factors. However, clinical trials on the potential impact of such programs from low- or middle-income countries remain limited. Lions Quest Skills for Adolescence (LQSFA), a school-based prevention intervention supporting life skills, was implemented in three South East European countries. This was a collaboration between the United Nations Office on Drugs and Crime, the Lions Clubs International Foundation, and the Ministries of Education of Serbia, the Former Yugoslav Republic of Macedonia and Montenegro. The pilot was a multisite non-randomized trial. A total of 2964 elementary school students received the intervention through 232 instructors trained by the same internationally certified trainer. These were compared to 2232 students following the regular curriculum, which does not include LQFSA, in the same elementary schools. The assessment was done at the beginning and at the end of the same academic year (period of 10 months). Despite limited fluctuations, the overall results indicated an encouraging outcome on the current use of substances (alcohol, cigarettes, and marijuana) as well as intention to using these substances in the next 3 months among current users. This study attempts to address this aforementioned gap in literature and contributes to the body of research demonstrating the value, feasibility, and transferability of life skills programs in achieving prevention outcomes in South East Europe. Moreover, it paves the way to a future randomized clinical trial to further corroborate the results, overcoming limitation in current study design.

Report on the International Workshop on Drug Prevention and Treatment in Rural Settings Organized by United Nation Office on Drugs and Crime (UNODC) and World Health Organization (WHO).

Very little evidence has been reported in literature regarding the misuse of substances in rural areas. Despite the common perception of rural communities as a protective and risk-mitigating environment, the scientific literature demonstrated the existence of many risk factors in rural communities. The Drug Prevention and Health Branch (DHB) of the United Nations Office on Drugs and Crime (UNODC), and the World Health Organization (WHO), in June 2016, organized a meeting of experts in treatment and prevention of SUDs in rural settings. The content presented during the meeting and the related discussion have provided materials for the preparation of an outline document, which is the basis to create a technical tool on SUDs prevention and treatment in rural settings. The UNODC framework for interventions in rural settings is a technical tool aimed to assist policy makers and managers at the national level. This paper is a report on UNODC/WHO efforts to improve the clinical conditions of people affected by SUDs and living in rural areas. The purpose of this article is to draw attention on a severe clinical and social problem in a reality forgotten by everyone.