EQUS - Building a European Consensus on Minimum Quality Standards for Drug Treatment, Rehabilitation and Harm Reduction

All approaches to drug demand reduction have expanded and diversified considerably during the last two decades. New intervention types are developed and evaluated, new settings are included in the treatment and prevention networks, special target populations have gained more attention. A main focus was and is on capacity building in order to reach out to those in need of interventions and to increase coverage of prevention, treatment and harm reduction services. However, services must be of good quality in order to be effective. The quest for quality standards is essential. Using available knowledge from research evidence on «what works», overriding discriminatory and negative attitudes towards people with substance abuse problems, respecting human rights and medical ethics are all part of quality. But while research evidence on efficacy and effectiveness of interventions is growing and can be accessed through reviews and guidelines, a consensus on quality standards still needs to build up. The European Action Plan on Drugs 2009-2012 agreed by the EU member governments therefore asked the European Commission to develop an EU consensus of minimum quality standards in the field drug demand reduction. To underpin its work, the European Commission (DG Justice) contracted the Swiss Research Institute for Public Health and Addiction (ISGF) to carry out a study to collect information on quality standards and benchmarks in Member States and to propose options for minimum quality standards for drug demand reduction. The options proposed by the ISGF consist of the three lists of proposed minimum quality standards in drug prevention, treatment/rehabilitation and harm reduction, and of reflections and recommendations for the implementation of those standards. The project contract did not envisage new research to develop best-evidence or bestpractices in those areas where this is not already available. The list proposed by the ISGF describes quality standards at the intervention level (mainly of interest for professionals working in prevention, treatment and harm reduction services), at the service level (mainly of interest for service directors) and at the system level (mainly of interest for policy planners and managers). This project is understood as the start of a longer term consultation process with stakeholders to build a consensus on minimum quality standards for drug demand reduction interventions and services which EU Member States have or are planning to implement in their own country. It is important to note that the project gives no information about the benefits of any specific service or intervention in the field of drug demand reduction, or about the acceptability of implementing those, but only on the acceptability of minimum quality standards in case a specific intervention or service is already implemented or will be implemented.

The main objectives of the EQUS project are to collect existing national and international information on quality standards and benchmarks in drug demand reduction, to set up an inventory of these standards and benchmarks, and to extract from the inventory lists of minimum quality standards to be submitted to a range of relevant stakeholders for approval. The result is intended to facilitate a quality awareness and improvement process throughout the EU Member States.

In the fields of treatment/rehabilitation and harm reduction, the collection of relevant documents for setting up the inventory of existing quality standards and benchmarks was organised in collaboration with a range of experts as project partners. They received detailed instructions for the selection of relevant documents and for transmitting structured information from these via on-line templates to a central electronic file at the coordinating institute.

Treatment/rehabilitation and harm reduction: On the basis of the inventory, a set of quality standards (24 for treatment/rehabilitation, 25 for harm reduction) was extracted and submitted to the collaborating project partners in an expert seminar and then to 514 stakeholders from all Member States in two on-line surveys. The participant stakeholders rated the proposed standards as already implemented, acceptable without problems, acceptable with problems or unacceptable. The ratings resulted in separate lists of minimum quality standards with high consensus of acceptability (<80% of acceptance), with moderate consensus (50-80% of acceptability) and low consensus (>50% of acceptability). The online questionnaire included also questions about the expected implementation problems (political, professional, legal, ethical, financial problems). The results were presented at the European Conference, and examples of establishing good quality systems at national level were explained. The debate pointed out a general consensus that there is no major opposition against implementing minimum standards and benchmarks, but that further steps at national and regional level must follow to bring the consensus building process and the implementation of minimum standards further ahead. The stakeholders participating in the European Conference on the EQUS project (Brussels, June 15-17 2011) discussed these lists and some modifications. The final list of proposed minimum quality standards and benchmarks is ready for free download with detailed results.