Substitution treatment for stimulants users?

Finding a pharmacological treatment for stimulant users has been a research priority for the last decade. Many classes of drugs have been tested: antidepressants, dopamine agonists, antipsychotics, anticonvulsants, disulfiram, opioid agonists, N-Acetylcysteine; without conclusive results.

However in the past couple of years reviews have started to point out the promising effects of psychostimulants. Studies have mainly focused on prescription psychostimulants (PPs) such as modafinil, methylphenidate,or amphetamines (mixed amphetamine salts, lisdexamphetamine, and dextroamphetamine). Psychostimulant treatment has a similar pharmacological rationale as other evidence-based substitution treatments like nicotine replacement and opioid agonist therapies. An “agonist” medication would have a similar pharmacologic and behavioral effect as the drug of abuse, providing relief of craving and other symptoms of acute and protracted withdrawal. Treatment with PPs should be implemented cautiously due to the potential for euphoric effects and the risk of misuse and diversion. However, these medications are widely used for the treatment of attention-deficit hyperactivity disorder (ADHD) and have overall good safety profile when used in healthy children and adults

In our latest Best Practice Portal update we highlight a very recent meta-analysis that systematically reviewed trials testing selected PPs as treatment for patients with cocaine or amphetamine-type substance use disorder (PSUD). The pooled analysis found that prescription psychostimulants, particularly prescription amphetamines given in higher doses, have a clinically significant effect to promote abstinence in the treatment of individuals with PSUD, specifically the population with cocaine use disorder.
The review suggests that a structured model of care using PPs similar to methadone clinics could be an alternative for outpatient medication-based intervention for patients with PSUDs, and calls for feasibility studies of this “agonist-type” pharmacological intervention. In real-world scenarios, one possible strategy is to offer treatment with prescription amphetamines in the setting of an opioid treatment programmes.

Evidence summaries are available at the Best practice portal (BPP).

Mindfulness for substance use disorders

A new BPP update highlights structured mindfulness-based interventions (MBIs) beneficial effects on craving management, as well as promising effects on psychiatric outcomes, including depression and anxiety symptoms. One of the key components of SUD is a desire (i.e. craving) to engage in substance use due to habit or a desire to increase momentary enjoyment or avoid discomfort. One of the primary aims of the manualised mindfulness-based protocols reviewed in the BPP is bringing focused attention to whatever is arising in the present moment (i.e. craving, sadness, pain, etc.) without judgment, and without a need to engage with, including actively avoiding, those feelings. Mitigating the sustained, motivated focus on substance-related cues, as well as the individual’s reaction to these cues, may prove to be one of the most beneficial aspects of MBIs in the treatment of SUD.

mHealth: good news from the future

Mobile health (mHealth) is defined as the use of mobile and wireless devices to deliver healthcare. Reactive or connected mHealth interventions collect data to provide customized responses to user input in real time. A new BPP entry highlights the results of a recent systematic review confirming the mounting evidence that mHealth interventions can be effective in reducing craving and substance use. Connected interventions may serve as an adjunct and/or an extension of traditional clinician delivered interventions. A more cost efficient and flexible alternative to in-person behavioral health services for individuals whose access to these services is impaired due to financial or logistic reasons.

European Drugs Winter and Summer Schools

Following the big success of the online Drugs Summer School 2020, and in order to keep our very popular face-to-face Summer School in Lisbon in 2021, next year we will organize two different Drugs School Events:

• an online Winter School (1-12th March 2021) with a special focus on ‘Responses and preparedness to health related threads (COVID-19 lessons learnt)
• a face-to-face Summer School in Lisbon (28th June-2nd July 2021) with a special focus on ‘Responses for Vulnerable groups’.

For the Drugs Spring School, live sessions with experts and practitioners will be held in the early afternoon (Lisbon Time, GMT +1 to GMT +3/4). Virtual tours to field work will be included. Individual exercises sessions will be organised every day which will be corrected within 24 hours

Webinar series

The EMCDDA series of webinars will start again on the 12th of November with the Launch of the ESPAD report. The new series will include three types of webinars always in the form of conversation with key invitees: to launch EMCDDA products, to discuss new topics and with strategic partners. In all of them an EMCDDA chairperson will discuss with invitees who will also answer questions from the public.

ESPAD webinar registration form.
Check the EMCDDA’s calendar of events for upcoming webinars.

This content was published in the Best pratice portal update briefing on 20.10.2020

The European Investment Bank (EIB) and the United Nations Development Programme (UNDP) have signed a new partnership agreement to scale up their support to countries facing situations of emergency caused by epidemics, natural disasters, conflict and other types of fragility.  This agreement will enable both institutions to reinforce the resilience of partner countries and contribute to achieve the Sustainable Development Goals (SDGs). The immediate focus will be to address setbacks, mainly caused by the COVID-19 crisis, in Eastern and Southern neighborhood, Central Asia and Africa.

In situations of emergency, conducting project procurement can represent a challenge too high to ensure a timely response to populations’ urgent needs. This new agreement will enable the UNDP to carry out the procurement required for the implementation of projects financed by the EIB in such situations. UNDP’s presence in fragile and conflict countries will greatly help EIB financing to reach the most vulnerable and allow both organizations to respond quicker to pressing requests.

During the online signing ceremony, Werner Hoyer, EIB president, and Achim Steiner, UNDP Administrator, exchanged their views on these challenging times.

EIB President Werner Hoyer said: “A coordinated response is paramount to help the most vulnerable countries recover from the COVID-19 crisis. The EIB, as part of “Team Europe”, has quickly reacted to the health crisis with the aim to build the grounds for a green and sustainable recovery. This Procedural Framework is a fundamental step towards a stronger cooperation with UNDP. It will allow us to leverage our respective strengths to get projects off the ground in situations of emergency and fragility, where time is of the essence to save lives and livelihoods.”

“We are facing an unprecedented crisis. As millions of people lose their jobs, it is estimated that the pandemic will cause the first ever increase in global poverty since 1998,” UNDP Administrator Achim Steiner said. “The health, economic and social impact of COVID-19 can only be addressed by fast, efficient response and targeted funding – all of which require specific technical expertise that EIB and UNDP can offer jointly to our partners.”

UNDP’s partnership with EIB is essential to help countries access and leverage COVID-19 response financing and better prevent future crises.  In 2016, the two institutions signed a Memorandum of Understanding enabling them to jointly address global challenges and share knowledge with each other in areas such as migration, climate change and crisis response.

Since then, EIB and UNDP have cooperated on a number of projects, including an Integrated Border Management Project and energy efficient public building refurbishment in Armenia, and the recovery and reconstruction of critical infrastructure, such as schools, clinics and centres which are accommodating internally displaced persons in eastern Ukraine. The two organizations also collaborate in other parts of the Globe. Earlier this year, the EIB and UNDP organized a large survey across Africa to understand better the digital solutions that can help the continent face the COVID-19 crisis and estimated the investment required. The study Africa’s digital solutions to tackle COVID-19 provided more than 100 high-impact digital solutions that can help curb the spread of COVID-19 in Africa.  This include a self-diagnostic app available in 15 African countries.

About the United Nations Development Programme

UNDP is the leading United Nations organization fighting to end the injustice of poverty, inequality, and climate change. Working with our broad network of experts and partners in 170 countries, we help nations to build integrated, lasting solutions for people and planet.

Learn more at www.undp.org or follow at @UNDP.

In a new survey commissioned by the European Parliament and conducted at the beginning of October 2020, nearly eight out of ten participants (77%) across the EU support the concept that the EU should only provide funds to Member States if the national government implements the rule of law and democratic principles. At least seven in ten participants agree with this statement in 26 EU Member States.

An absolute majority of Europeans continues to call for a larger EU budget to fight COVID-19

54% of Europeans believe the EU should have greater financial means to be able to overcome the consequences of the Coronavirus pandemic. In 20 EU Member States, a majority of the participants agrees with this claim; in 14 EU Member States, an absolute majority of participants supports a larger EU budget.

Asked about which policy fields this enlarged EU budget should be spent on, more than half of participants (54%) say that public health should be a priority, followed by economic recovery and new opportunities for businesses (42%), climate change and environmental protection (37%) and employment and social affairs (35%). At EU level, climate change and the environment has replaced employment in the top three spending priorities compared to the last survey conducted in June 2020.

Public health is the top spending priority for respondents in 18 countries. Estonia, Latvia and Czechia put the economic recovery on top, whilst in Austria, Denmark and Germany citizens favoured most the fight against climate change. In Croatia, Slovakia and Finland, participants chose employment and social affairs as their top spending priority.

Broad majority of citizens fear direct impact on their personal financial situation

Taking the necessary decisions on the Recovery Package and the MFF as soon as possible is clearly vital, as demonstrated by the worrying personal financial situation of European citizens since the beginning of the pandemic. A broad majority of citizens fear the pandemic will a direct impact on their personal financial situation –or have already suffered it: 39% of participants say that the COVID-19 crisis has already impacted their personal income, while a further 27% expect such an impact in the future. Only 27% expect the COVID-19 situation not to have an impact on their personal income. In 20 countries, most participants say that the current crisis has already impacted their personal income.

Citizens continue to see the EU as part of the solution to this crisis

Two-thirds of participants (66%) agree that the EU should have more competences to deal with crises such as the Coronavirus pandemic. Only a quarter (25%) disagrees with this statement. These findings are consistent with the results from both previous surveys conducted by the European Parliament in April and June 2020 respectively.

Note to Editors

Since the beginning of the pandemic, the European Parliament has commissioned three dedicated surveys measuring European public opinion in times of COVID-19. The latest survey was conducted online (and via telephone in Malta) by Kantar between 25 September and 7 October 2020, among 24,812 participants in all 27 EU Member States. The survey was limited to those aged between 16 and 64 (16-54 in Bulgaria, Czechia, Croatia, Greece, Hungary, Poland, Portugal, Romania, Slovenia and Slovakia). Quotas on gender, age, and region at national level ensure the survey is representative. The total EU results are weighted according to the size of the population of each country surveyed.

The publication of the full report for this survey, including the complete data set, is planned for early November 2020.

• The EIB Group is subscribing a total of €198 million of the securitisation issued by Santander to support SMEs and mid-caps affected by the COVID-19 crisis.
• The EU bank is granting this loan as part of its package of emergency measures to support European companies.
• Some of these funds will be provided under the European Fund for Strategic Investments (EFSI).

The European Investment Bank (EIB) is joining forces with Santander to provide financing on favourable terms to the Spanish small and medium-sized enterprises (SMEs) and mid-caps affected by the economic impact of COVID-19. To this end, the EIB and the European Investment Fund (EIF) will subscribe several tranches of a synthetic securitisation of a SME loan portfolio originated by Banco Santander, enabling the Spanish bank to provide more than €900 million of financing to inject liquidity and support SME investments.

The EIB will subscribe €193 million from Banco Santander’s securitisation, with the latter committing to offer financing on favourable terms to the SMEs affected by the pandemic. This will boost the recovery of Spanish industry and support SMEs projects with an innovative focus, such as information and communication technologies (ICT). Part of this EIB financing is supported by the European Fund for Strategic Investments (EFSI).

In addition, the EIF (the EIB Group subsidiary specialising in SME financing) will subscribe a further €5 million from the same securitisation. Under this agreement, Santander will finance the investments of Spanish SMEs that aim to support climate change mitigation and adaptation.

The EIB Group is carrying out this operation as part of the initiatives it launched in March as a rapid response to the crisis caused by the pandemic. The EIB has also taken extraordinary measures to speed up its processes and make its internal policies more flexible in order to – among other things – deploy its support as quickly as possible and finance expenses that it would not normally cover, such as the operating costs of European businesses. The agreements signed with Banco Santander fall under this strategy.

EIB Vice-President Ricardo Mourinho Félix, who is responsible for the EU bank’s operations in Spain, said: “I am very proud that my first official announcement as EIB Vice-President is the signature of an operation aimed at supporting SMEs to cope with the systemic impact of COVID-19, one of the key priorities for the EIB Group. The participation of the EU Bank in this securitisation will support Santander to mobilise more than €900 million, fostering the green investments of Spanish SMEs as well as their projects focused on innovation and digitalisation. Agreements like these are essential for driving productivity and safeguarding jobs, and for boosting a sustainable and inclusive recovery of the Spanish economy.”

European Commissioner for the Economy, Paolo Gentiloni, said: “Once more the Investment Plan is joining forces with the EIB and EIF to support lending to SMEs hit hard by the COVID-19 crisis. The newly available financing from Banco Santander in Spain will benefit a large number of small and medium-sized companies, especially those operating in the digital sector or seeking to adapt to climate change.”

EIB response to COVID-19

To combat the economic impact of this crisis and as part of the package of measures the EU is deploying to tackle the economic effects of the pandemic, on 23 April the European Council approved the EIB Group’s creation of a €25 billion pan-European COVID-19 guarantee fund focusing primarily on supporting SMEs across the EU. The fund will make it possible to mobilise up to an estimated €200 billion of additional financing.

Under the initial package of financial measures approved in March, the EIB is offering an asset-backed securities (ABS) purchase programme to enable banks to pass on the risk of their SME loan portfolios to the EIB, with the aim of mobilising €10 billion. The EU bank is also adapting its existing financing instruments shared with the European Commission to mobilise up to €10 billion in additional financing for European SMEs and mid-caps. For its part, the EIF (the venture capital specialist subsidiary of the EIB Group) is offering specific EU-backed guarantees to financial intermediaries that will help to mobilise up to €8 billion.

The EIB Group is playing a key role in directly combating COVID-19 by supporting EU efforts to halt the spread of the pandemic, find a cure for the illness and develop a vaccine. To this end, the EU bank is prioritising all investments related to the health sector and research and development programmes focusing on this goal. The EIB’s current project portfolio for supporting both critical healthcare infrastructure and research and development investments in the EU health sector stands at around €6 billion. The EIB and the World Health Organization also recently signed an agreement to drive cooperation between the two institutions and work together to strengthen healthcare systems in the countries most vulnerable to the pandemic.

More detailed information on the support offered by the EIB and EIF

Supporting small and medium-sized enterprises (SMEs) is one of the EIB Group’s key priorities in Spain. The Bank dedicated over €4.8 billion to this goal last year, representing 57% of the EIB Group’s activity in Spain, which received more support for SMEs than any other country. These funds benefited more than 82 600 Spanish companies employing 766 000 people.

Banco Santander (SAN SM, STD US, BNC LN) is a leading retail and commercial bank, founded in 1857 and headquartered in Spain. It has a meaningful presence in 10 core markets in Europe and the Americas, and is one of the largest banks in the world by market capitalisation. Its purpose is to help people and businesses prosper in a simple, personal and fair way. Santander is building a more responsible bank and has made a number of commitments to support this objective, including raising over €120 billion in green financing between 2019 and 2025, as well as financially empowering more than 10 million people over the same period. At the end of the first half of 2020, Banco Santander had over €1 trillion in total funds, 146 million customers, of which 21.5 million are loyal and 40 million are digital, 11 800 branches and 194 000 employees.

Spain requested support from the European Globalisation Adjustment Fund (EGF) after 960 workers were laid off in 38 small and medium-sized companies in the shipbuilding ancillary sectors in Galicia between May 2019 and February 2020. Around 500 redundant workers are expected to participate in the support measures co-financed by the EGF.

The EU’s declining market share in global ship production and increased external

competition in the sector have had dire consequences on the ancillary shipbuilding industry in Galicia, according to the Commission’s proposal.

This is the first application to be examined under the 2020 EU budget and the seventh in the shipbuilding sector. The EGF aid will cover 60% of the total cost, which amounts to €3.4 million. The package aims to provide the former workers with career guidance, support in their job search, opportunities to learn new skills through vocational training, and tutoring and guidance after finding another job.

The report by rapporteur Valérie Hayer (RENEW, FR) recommending that Parliament approve the aid was passed by 645 votes to 33, with 9 abstentions (roll call vote results here).

Background

The European Globalisation Adjustment Fund was set up to help workers made redundant due to major changes in world trade patterns or as a result of unexpected financial and economic crises. Since its conception in 2007, the Fund has received 161 applications. Some €636 million has been requested to offer help to more than 151,000 workers and 4,429 young people who are not in employment, education or training.

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