Werb, D., Buxton, J., Shoveller, J., et al. Drug and Alcohol Dependence (September 2013), E-publication ahead of print.
The authors systematically examined peer-reviewed evaluations of interventions to prevent initiation of injection drug use (IDU) to assess their effectiveness and inform development of preventive policies. Of 78 candidate studies, eight studies published between 1992 and 2011 were included. The findings suggested that interventions involving peer-based behavior change or enrollment in treatment addiction programs may be effective in preventing IDU initiation. However, further research and new approaches to prevention are warranted, given the limited evidence and the proven risks of IDU, including HIV. Five studies were implemented in North America, and one each in Europe, Australia, and Central Asia. Four types of prevention interventions were evaluated: social marketing, peer-based behavior change, access to addiction treatment programs, and drug law enforcement/deterrence. Half of the studies found that peer-based behavior change and treatment-based approaches had significant impacts in reducing the exposure of injection-naïve drug users to injection environments. Interventions that applied drug law enforcement as a deterrent were less effective. The positive impact of peer-based behavior modification interventions shows that the impact of social networks should not be overlooked. Overall, though, there is insufficient evidence on these interventions to inform scale-up. The authors called for further research, concluding that there must be clear scientific evidence of impact before taking broad actions to scale up policies or interventions to prevent IDU initiation.