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Different  forms  of  information,  communication  and  education  have  been  largely  used  in  the   prevention   of   drug   use   and,   in   minor   scale,   in   the   prevention   of   drug-­‐related   harms   (e.g.   overdose).   Messages   are   usually   conveyed   by   leaflets,   posters,   advocacy   events   and   social   marketing  campaigns,  and  are  normally  integrated  in  broader  interventions  (e.g.  mass  media   campaigns,  harm  reduction  and  treatment  interventions,  etc.).  

The   literature   dedicated   to   the   assessment   of   the   efficacy   of   this   kind   of   interventions   is   scarce,   as   well   as   evidences   that   can   support   these   measures’   effectiveness,   despite   some   suggestions   that   in   some   cases,   they   can   have   a   short-­‐term   effect   in   raising   awareness   and   changing  the  way  these  phenomena  are  understood  (but  not  in  changing  behaviours;  Trimbos   Institute,  2006).  In  order  to  enhance  these  approaches’  effectiveness,  it  is  currently  accepted   that  they  need  to  be  inserted  in  more  comprehensive  prevention  or  harm  reduction  packages   (Aggleton,  Jenkins  &  Malcolm,  2005).  Also,  they  have  to  contain  messages  and  use  strategies   tailored  to  the  needs  of  specific  target  groups  (ibidem).  A  good  example  of  this  comes  from  the   Public   Health   Agencies   of   Catalonia   and   Barcelona,   with   the   creation   of   an   overdose-­‐ awareness  video  to  be  broadcasted  in  the  waiting  rooms  of  drug  facilities  (available  in  several  

languages  at:  http://vimeo.com/album/1655129).    

Among  the  channels  used  to  convey  information  on  the  drug  consumption  topic,  it  is  relatively   common  to  find  the  use  of  mass  media  campaigns,  normally  provided  by  public  bodies.  They   range  from  the  isolated  use  of  one  campaign  to  the  integration  on  complex  social  marketing   programs.   The   major   potential   of   mass   media   campaigns   is   associated   to   their   ability   to   express   messages   to   large   audiences   with   a   low   cost   per   capita.   However,   the   use   of   these   media   resources   faces   several   challenges   until   achieving   the   goal   of   changing   health-­‐related   behaviours:   messages   can   be   counterproductive   and   their   homogeneous   nature   can   fail   to   achieve   heterogeneous   groups   of   interest;   they   could   get   “asphyxiated”   by   the   increasing   fractured  media  environment;  there  could  be  inappropriate  or  poorly  evidence-­‐based  formats   and  contents,  and  sometimes  they  focus  on  behaviours  that  are  hardly  addressed  by  the  target   groups    (Wakefield,  Loken,  &  Hornik,  2010).    

Currently,   there   is   a   debate   and   controversy   surrounding   the   effectiveness   and   cost-­‐ effectiveness   of   recurring   to   mass   media   strategies   for   addressing   health   behaviours,   in   particular  (risky)  drug  use  behaviours  (Ferri,  Allara,  Bo,  Gasparrini  &  Faggiano,  2013).  Usually,  if   we   consider   the   target   groups   (and   not   the   cost   per   capita)   mass   media   campaigns   are   expensive   universal   prevention   strategies   and   the   scarce   studies   dedicated   to   assess   their   effectiveness   are   not   conclusive   or   don’t   support   their   positive   impact   (Ferri   et   al.,   2013;   Trimbos  Institute,  2006;  Hornik  et  al.,  2003).  In  addition,  there  are  methodological  challenges   in  the  study  of  this  topic,  being  difficult  to  isolate  the  effect  of  mass  media  campaigns.  In  the   European   context,   there   is   no   systematic   assessment   about   the   impact   of   mass   media   campaigns   in   behaviour   associated   with   drug   use   and   harms.   Also,   few   of   those   have   been   formally  evaluated,  and  in  the  ones  that  were  (e.g.  campaigns  from  Bulgaria,  Denmark,  France,   Netherlands,   Sweden,   United   Kingdom)   only   data   concerning   understanding,   empathy   and   retention   of   the   message   conveyed   was   analysed   (Ferri   et   al.,   2013).   In   the   specific   case   of   overdose  prevention  campaigns,  inconclusive  or  discouraging  results  regarding  the  efficacy  of   mass  media  campaigns  are  mirrored  in  the  scarce  literature  on  the  topic  (e.g.  UK  “Lifeguard”   social  marketing  campaign,  Roberts  &  McVeigh,  2004;  Canadian  “It’s  more  about  the  heroin”   warning  campaign,  Kerr,  Small,  Hyshka,  Maher  &  Shannon,  2013).  This  way,  solid  conclusions   about   the   effects   of   media   campaigns   on   preventing   overdose   are   not   currently   possible.   However,  if  included  in  intervention  packages,  information  and  communication  strategies  can   enhance  the  results  achieved  by  those,  especially  if  they  are  targeted  and  have  some  sort  of   meaning   to   the   population   they’re   trying   to   reach.   The   likelihood   of   improving   media   campaigns’   success   increases   according   to   the   availability   of   multiple   interventions   (e.g.   overdose   videos   in   outreach   teams   mobile   units);   the   access   to   key   services   (where   the   promotion  of  these  services  is  done  by  the  media;  e.g.  overdose  prevention  training);  and  the   creation   of   policies   that   support   the   change   in   behaviours   (e.g.   dichotomy   between   the   promotion   of   treatment   as   protective   factor   for   overdose   and   impose   strict   rules   of   access)   (Wakefield   et   al.,   2010).   Messages   promoting   overdose   prevention   must   be   regular   and   targeted,  aiming  to  raise  awareness  about  risk  and  protective  factors.  They  should  focus  on  the   “main  areas  of  risk;  be  time-­‐limited  and  change  regularly;  only  attempt  to  address  one  priority   issue  at  a  time,  rather  than  having  many  issues  competing  for  attention”  (National  Treatment   Agency,   2004,   p.   14).   To   those   characteristics,   we   add   another   fundamental   one:   the   meaningfulness   and   proximity   of   messages   conveyed.   Also,   media   messages   that   aren’t   paternalistic  and  invite  people  to  make  choices  according  to  their  own  insights  have  proven  to   be   more   effective   (Trimbos   Institute,   2006).   An   example   of   these   initiatives   is   the   “I   am   the   Evidence”   Campaign,   developed   by   the   Eurasian   Harm   Reduction   Network   (EHRN)   and  

supported   by   the   European   People   Using   Drugs   (EuroPUD).   In   the   scope   of   the   Euro   HRNII   project,   this   initiative   implemented   an   advocacy   campaign   in   6   EU   states,   based   on   the   collection  and  promotion  of  video  testimonials  about  personal  experiences  with  naloxone.      

According  to  this  information,  we  can  conclude  that  “mass  media  messages  can  set  an  agenda   for  and  increase  the  frequency,  depth,  or  both,  of  interpersonal  discussion  about  a  particular   health  issue”  (Wakefield  et  al.,  2010,  p.  1262),  but  they  are  largely  ineffective  if  not  combined   with  a  proximal  intervention.  Also,  it  is  vital  to  carefully  plan  and  test  the  campaign  content   and  format  according  to  the  assessment  of  the  needs  and  resources  of  the  target  groups.      

Additional   challenges   surrounding   mass   media   are   associated   with   their   power   to   greatly   influence  the  public  opinion.  The  nature  of  the  messages  routinely  conveyed  by  them  on  the   topic  of  drug  consumption  and  overdoses  is  certainly  not  ignored  by  the  communities  or  by  the   politicians.  The  media  are  one  of  the  main  sources  of  information  regarding  issues  that  aren’t   part  of  the  publics’  direct  experiences,  which  is  especially  relevant  when  the  theme  mentioned   is  highly  sensitive  -­‐  drug  use  and  drug  deaths;  the  probability  of  generating  messages  marked   by  stigma  is  high.  A  survey  developed  by  IPSOS-­‐MORI  (2007)  (UK)  shows  that  the  individuals   who   report   knowing   something   about   illicit   drugs,   got   their   information   from   the   media   (DrugScope,   2011).   When   depreciating   messages   and   prejudice   regarding   drug   user(s)   and   drug  deaths  are  spread  by  media,  PUD  and  their  families  face  devastating  effects  (e.g.  stigma   can  prevent  their  access  to  treatment;  it  can  invalidate  the  grieve  processes  in  cases  of  drug-­‐ related  deaths;  DrugScope,  2011).  Myths  or  inaccurate  information  about  drug-­‐induced  deaths   in  media,  with  potential  impact  to  PUD,  are  found  in  the  scarce  literature  on  this  topic.  A  study   developed  in  the  UK  shows  that  drug-­‐induced  deaths  tend  to  be  more  extensively  reported  in   the  media   when  ecstasy  is  involved   (when   compared   with   other   substances),  in  spite  of  the   fact   that   the   annual   level   of   mortality   associated   with   this   substance   is   very   low   (UKDPC,   2010).  This  is  an  example  of  a  message  that  is  inaccurately  conveyed,  thus  presenting  the  idea   that  people  who  consume  ecstasy  are  the  ones  at  most  risk  of  an  overdose.  According  to  this   scenario,  some  recent  European  initiatives  invested  in  gathering  evidences  about  the  stigma   conveyed  by  mass  media,  as  well  as  in  the  production  of  guidelines  for  journalists,  in  order  to   tackle  the  myths  present  in  drug-­‐associated  stories.  Some  examples  we’d  like  to  highlight  are   the  work  of  the  UK  Drug  Policy  Commission  –  “Dealing  with  the  stigma  of  drugs:  A  guide  for   journalists”  (UKDPC,  2012)  and  the  one  of  Drug  Scope  (2011)  –  “The  media  guide  to  drugs:  Key   facts  and  figures  for  journalists”.  Although  the  current  indicators  show  that  mass  media  tend   to  fuel  public  indifference  towards  drug  users,  convey  misinformation  about  risks  associated  

with  drug  use  (e.g.  drug-­‐related  deaths),  and  also  contribute  to  the  distinction  between  “good”   and  “bad”  drugs,  some  positive  influence  by  the  projects  aforementioned  is  already  beginning   to  be  noticeable.  Also,  some  encouraging  results  concerning  public  awareness  were  revealed   by  a  British  study:  over  60%  of  national  participants  consider  that  people  with  drug  problems   were  often  stigmatised  by  the  press  (UKDPC,  2010).