Health and social responses (HSR)

• Methods and definitions

Overview of the data

The links below give access to the tables in the bulletin and associated graphics in the section dealing with availability of substitution treatment and of needle and syringe programmes, as well as to a description of the methods and definitions used in compiling these data. A brief overview is provided below.

Tables HSR-1 to HSR-5 give information on the provision of syringes through needle and syringe programmes (NSPs) in EU Member States and Norway. Reported are the numbers of syringes distributed, exchanged and sold at different types of syringe provision points, including pharmacies, non-pharmacy-based services and vending machines. Data on the year of introduction of needle and syringe programmes complement the information.

Tables HSR-7 to HSR-9, Table HSR 11 and Figures HSR-1 to HSR-5 provide information on the estimated number of clients receiving methadone and other opioid substitution treatment, the amount of methadone consumed per country, long-term trends in substitution treatment in EU-15 and on the level of coverage of problem opioid users with substitution (in selected countries). Data on the year of introduction of methadone and treatment as well as of heroin-assisted treatment, including trials, are also provided. Complementary information on the legal frameworks and practices of substitution treatment initiation in each country, as well as on national substitution registries and other sources of data on substitution clients are available in Tables HSR-6 and HSR-10, respectively.

Retrospective information updates on programmes for syringe provision and on methadone substitution published in the previous Statistical Bulletin (http://stats06.emcdda.europa.eu/en/page042-en.html) have been made if new information has become available.

References and sources used for the needle and syringe programme information provided in Tables HSR-1 to HSR-5 are given in Table HSR-0.

Summary points

Needle and syringe programmes

The results presented in these tables generally reflect that data on the number of syringes provided are not available to the same extent from all types of syringe provision points in the Member States.

• Table HSR-1 gives the reported number of syringes exchanged, distributed or sold to drug users in 2005, including at vending machines and pharmacy-based needle and syringe programmes in the community. This table provides an overview of the number of points where syringes have been available for distribution, exchange or sale in the countries, including at vending machines and through pharmacy-based needle and syringe programmes. Syringe provision points (or outlets) are defined as individual locations/physically distinct outlets where syringes can be obtained for free, against payment or in exchange against used ones. The table also gives the reported number of syringes provided to drug users at these services in 2005.
• Table HSR-2 provides information on the year in which needle and syringe exchange programmes were introduced in the Member States, from when on they were publicly funded, and which types of needle and syringe programmes were available in 2005. It shows that while needle and syringe distribution at drugs agencies as well as through outreach workers is common, comparatively fewer countries base such programmes at pharmacies or make use of machines to distribute syringes. In 2005, three countries had and syringe programmes in prison. Despite continuous increases over the past years in most countries, differences are still apparent in the coverage of needle and syringe programmes among Member States, which affect data comparability.
• Table HSR-3 provides the numbers of needle and syringe exchange and distribution points, including fixed and mobile outlets that are serviced by drugs agencies, outreach work and peer-distribution. The table also gives the total number of syringes exchanged, distributed or sold at these points from 2002 to 2005. Data from vending machines and from pharmacy-based needle and syringe programmes are not included.
• Table HSR-4 gives information on the number of community pharmacies involved in needle and syringe programmes and on the number of syringes exchanged or distributed to drug users at these pharmacies in 2002 -2005. The table only includes countries where such programmes exist. Where data are not available, the table entry is left empty. While nearly all countries have needle and syringe programmes based in drugs agencies, comparatively few countries make use of pharmacies as outlets for needle and syringe programmes.
• Table HSR-5 shows the reported numbers of syringe vending machines and total numbers of syringes distributed or sold in 2002 – 2005 for those ten countries that have reported the availability of this type of syringe provision.

Access to substitution treatment

• Table HSR-6 shows who is legally allowed to initiate the prescription of opioid substitution treatment and by whom such treatment is predominantly initiated in each country. This table is based on data collected through ST 24 as well as through legal correspondents. It shows who is allowed to initiate the prescription of opioid substitution drugs (methadone and buprenorphine) and on the basis of which law or guideline. Three service providers are presented, namely office-based medical doctors, specialised office-based medical doctors, and doctors working at treatment centres – the latter being allowed to start methadone treatment of opioid users in all European Member States and Norway. It should be noted that a distinction between specialised and non-specialised office-based medical doctors was made, since some countries require medical doctors to be specialised in substance misuse or to undergo a special training in substitution treatment delivery in order to be allowed to initiate this type of treatment. Finally, Table HSR-6 also presents which service provider is the main player with regard to treatment initiation in each country.
• Table HSR-7: 'Estimated number of clients in methadone treatment and of clients receiving any opioid substitution in EU-27 and Norway, 2003 and 2005' and Figure HSR-2: 'Clients in substitution treatment per 100 000 adult population (2003 – 2005)' both show the estimated number of clients in methadone and the total number of clients in opioid substitution treatment for EU Member States and Norway, as well as the ratio per 100 000 adults for 2003 and 2005. This table and graph show the estimated number of clients reported to receive opioid substitution treatment and specifically methadone maintenance treatment in 2003 and 2005 for 26 EU Member States and Norway (excluding Cyprus, where this type of treatment is not available to date). Treatment in prison and detoxification treatment is generally not included. It specifies the total number of substitution clients and the number of those receiving methadone treatment per year. In 2005, further increases in methadone treatment provision can be noted for a number of countries, but in others there is an apparent stabilisation or a decline of the number of treated clients.
• Table HSR-8: 'Year of introduction of substitution treatment with methadone (MMT), high-dosage treatment (HDBT) and heroin-assisted treatment, trials', and Figure HSR-1: 'Year of introduction of methadone maintenance (MMT) and high dosage buprenorphine treatment (HDBT) in 26 EU Member States and Norway' information on the year in which opioid substitution treatments were introduced in the EU Member States and Norway. Methadone was Europe by Sweden, the Netherlands, the UK and Denmark in the late 1960s and early 1970s, but it was only in the mid 1980s that other Member States showed an acceleration of the rate at which it became an official treatment. High dosage , available in the first European Member State in 1996, has been introduced more quickly and is now available in most EU countries. Diamorphine as an option in the treatment of opioid dependence has been available in the UK since the 1920s and since 2007 also in the Netherlands. Trials have been conducted in Germany and Spain and have started in Belgium.
• Table HSR-9 presents data by country on the amount of methadone (in kg) consumed in the years 1992 to 2005 reported to the International Narcotics Control Board. Besides the EU Member States and Norway, data are provided for Switzerland and, for comparative reasons, the totals for the 15 "older" and the 12 "newer" Member States, as well as for EU-27, EU-29 and for the United States of America, as well as the global total amount of methadone consumption are also included in the Table. These statistical data have been extracted from technical reports published by the INCB in 1998, 2000, 2005 and 2007. While methadone is also a medication used for the treatment of pain, the sharp upward trend in its consumption - especially since 2000 – has reached a new record high of 22.5 tons in 2005. According to the analysis of the INCB, this trend is mainly attributable to its growing use in the treatment of opioid addiction.
• Table HSR-10 provides information on existing registries and other data sources on the number of clients in substitution treatment at national level (EU 27 and Norway).
• Table HSR-11 reports on the estimated number of clients in methadone maintenance treatment (MMT) in 27 EU Member States and Norway from 1993 to 2005. This table reports on the estimated number of clients in methadone treatment in EU countries and Norway from 1993 to 2005 according to available historical data. This overview reflects the increasing availability of methadone maintenance substitution treatment in many EU countries.
• Figure HSR-3 presents the percentage of problem opioid users receiving opioid substitution treatment for those countries where recent estimates of the total number of opioid users and clients in substitution treatment were available.
• Figure HSR-4 shows historical trends in the provision of substitution treatment in the EU 15 'old' Member States over thirteen years, based on estimates for the years 1993, 1995, 1997/98, 2001/02, 2003 and 2005.

Page last updated: Tuesday, 20 March 2012