"The number of accidental drug overdose deaths increased by 622% between 2000 and 2020, and age-standardized mortality rates increased nearly four-fold in both men and women. Age-period-cohort decomposition found rapid increases in mortality since 2012 in men and women, with higher mortality risk in cohorts born after 1990. The fastest increase occurred in Black Americans since 2012, and Americans of all races born after 1975 had significantly higher mortality risk, with mortality risk increasing rapidly in more recent cohorts.

"Five studies were identified that looked at prevention of methamphetamine use, ecstasy use, cocaine use and general drug use. Evaluated preventive interventions were family-centred programmes; school-based interventions; screening, brief intervention and referral to treatment (SBIRT); and motivational interviewing. The first four were evaluated in a universal population whereas motivational interviewing was evaluated in an at-risk or indicated population.

"Three studies evaluated cannabis use prevention interventions. Two studies evaluated school-based interventions and the third study evaluated two family-centred interventions and a web-based intervention.

"Four studies evaluated the cost-effectiveness of prescription opioid misuse prevention, three of which were conducted in the USA and one in South Korea. The interventions identified for the USA setting were a school-based programme, a family-centred programme and misuse-deterrent opioid formulations; a doctor's database assisting patient risk assessment was evaluated in the South Korean setting. All four studies utilised economic models to evaluate cost and benefit of intervention over 1- to 30-year time horizons.

"In this pilot pretest–posttest quasi-experimental study, we saw a lower proportion of SSP clients exclusively inject heroin and a higher proportion of SSP clients consume heroin through both injection and smoking after the implementation of a heroin pipe distribution program. The proportion of SSP clients who reported syringe reuse was also lower following the heroin pipe distribution intervention.

"People who use heroin (PWUH) have increased morbidity and mortality compared to the general population [1].

"Residential treatment is often considered the highest intensity of treatment for individuals with OUD [40], and may by particularly important for those with unstable housing, co-morbid mental health conditions, or high medical need [41].

"Growing evidence suggests that outpatient treatment, when coupled with MOUD, may be superior to other treatment settings.

"Methodology and Limitations

"The data available have limitations in respect to quality and coverage, however, the information available suggests that heroin was only present in the majority of overdose deaths in a relatively small number of EU countries. A significant share of overdose deaths was reported by Austria (67%), Italy (56%), Ireland (46% in 2017), Poland (44% in 2016) and Romania (43%).