Commissioning pharmacological treatments for drug users: a brief review of the evidence base

Abstract

Aims: To provide a brief review of relevant existing evidence regarding pharmacological treatment for drug users, in order to enable commissioners and service providers to make informed decisions that are evidence based wherever possible. Methods: The review process involved an examination of key reference texts and literature derived from literature searches of the standard databases and including all the relevant Cochrane Reviews. Clinical relevance was of paramount importance. Findings: There are particular problems with the evidence base regarding drug treatments which make a total reliance on treatments with an established evidence base virtually impossible. The best evidence remains that for methadone maintenance treatment but there is emerging evidence for the effectiveness of a range of other treatments. This is evidence is summarized. Conclusions: Commissioners should be aware of the strong evidence base for some treatments and relative lack of evidence for others, although less well evidence based interventions may be commissioned for pragmatic reasons.