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Health and social responses
Information is provided on availability of substitution treatment and of different types of needle and syringe programmes (NSPs), including pharmacy-based programmes.
Overview | Methods and definitions | Tables | Figures | All statistics
Programmes for syringe provision
Access to substitution treatment
Overview
The links below give access to the tables in the bulletin and the 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. See also the side navigation bar for links to all chapters.
Tables
Tables
Retrospective information updates on programmes for syringe provision and on methadone substitution published in the previous Statistical bulletin were made if new information became available.
Summary points
Access to substitution treatment
- Table HSR-1. Year of introduction of substitution treatment with methadone (MMT), high-dosage buprenorphine treatment (HDBT) and heroin-assisted treatment, including trials, provides information on the year in which opioid substitution treatments were introduced in the EU Member States, Croatia and Norway.
Methadone was pioneered in Europe by Sweden, the Netherlands, the UK and Denmark in the late 1960s and beginning of the 1970s, but only in the mid-1980s, an acceleration of the rate at which it became an official treatment modality in other European countries, could be noted. High-dosage buprenorphine treatment, which became available in the first European country 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 is 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-2. Legal framework and practice of substitution treatment initiation, 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 Standard table (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 countries, Croatia and Norway. It should be noted that a distinction between specialised office-based medical doctors and office-based MDs 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-2 also presents which service provider is the main player with regard to treatment initiation in each country.
- Table HSR-3. Estimated number of clients in methadone treatment and of clients receiving any opioid substitution in the EU-27, Croatia, Turkey and Norway, 2005 and 2006.
This table shows the estimated number of clients reported to receive opioid substitution treatment and specifically methadone maintenance treatment in the years 2005 and 2006 for 26 EU Member States, Croatia and Norway (excluding Cyprus, where this type of treatment is not available to this date). As far as possible, treatment in prison and detoxification treatment is not included. It specifies the total number of substitution clients and the number of those receiving methadone treatment in each year. In 2006, 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.
- Figure HSR-1. Number of opioid maintenance treatment clients as a percentage of the estimated number of problem opioid users, 2005–06.
This figure presents the percentage of problem opioid users receiving opioid substitution treatment for those nine countries where recent estimates of the total number of opioid users and clients in substitution treatment were available.
Data indicate that the proportion of problem opioid users receiving substitution treatment in 2005–06 vary considerably between countries, with one out of 20 opioid users in the Slovak Republic receiving such treatment, about one in five in Finland and Greece, and one in four in Norway, while more than every second problem opioid user in the UK (England),and Germany are under substitution treatment. The Czech Republic, Malta and Italy lie in between this range with estimated rates of 35 %, 38 % and 43 % of problem opioid users, respectively. Overall, it is estimated that one in three problem opioid users in the European Union is receiving substitution treatment.
It should, however, be borne in mind that wide confidence intervals in the estimates of problem opioid use mean that comparisons between countries can only be made with caution.
Needle and syringe programmes
- Table HSR-4. Year of introduction of needle and syringe programmes and types of programmes available in 2006, 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 2006.
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 2006, three countries had needle 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-5. Number of syringes provided through needle and syringe programmes 2005–06, provides the total number of syringes exchanged, distributed or sold at specialised syringe provision points in 2005 and 2006. The table includes data on syringes given out by fixed and mobile needle and syringe programme points in prisons and in the community, including through outreach work and peer-distribution, but not vending machines. Syringes given out through pharmacies are included when this is in the framework of a specific, publicly-funded syringe exchange programme. Data on syringes from vending machines and on pharmacy sales are not included.
National substitution registries and other sources of data on substitution clients
| Substitution Treatment National Registry (since 2005). An underestimate, as foreign nationals are not included. | |
| National Centre for Addictions — Register for Substitution Treatment Programmes, Register for Patients on Substitution Maintenance Treatment. | |
| Ústav zdravotnických informací a statistiky CR (Institute of Health Information and Statistics of the Czech Republic) - Substitution Treatment Register; National focal point — Crude estimation of buprenorphine clients (according to distributed quantity of buprenorphine and results of the survey among clients of Prague low-threshold facilities). | |
| National Registry of Drug Users Undergoing Treatment. The Registry contains information of people receiving drug treatment through their county, excluding people in prison and hospitals. | |
| The Federal Opium Monitoring Centre at the Federal Institute for Pharmaceutics and Medical Devices (BfArM) monitors the quantity of delivered narcotics and has been keeping the National Substitution Register since its creation in 2003. The Register is based on a yearly census (1 July). Anonymised individual codes are used but double counting cannot be totally excluded. | |
| Global Fund programme. | |
| Central Treatment List, maintained by the Drug Treatment Centre Board, Trinity Court, Dublin 2. It is a statutory requirement to report any person receiving methadone treatment to the central treatment list. Each client has a unique identifier. Birth certificate and photograph must be provided to the Central Treatment List. Only authorised GPs and pharmacists can dispense methadone for the treatment of opiate dependence. There is a special prescription form. | |
| Data come from licensed methadone substitution units and buprenorphine substitution units, which are the only officially recognised centres that can offer such treatment. The data collection is by an adjusted version of the treatment unit form (TUF A) (<insert link EIB>. The collected information is controlled annually to check internal coherence, as well as congruence across the years. This collection procedure is conducted annually by the Greek Reitox focal point. As far as substitution treatment is concerned, monitoring is also performed by the Organisation Against Drugs, the only agent that has the permission granted by law to establish, operate and supervise substitution treatment programmes. | |
| Registration at regional level (autonomous communities and cities). | |
| OFDT estimate, based on datasets SIAMOIS/InVS. For methodology, see: Cadet-Taïrou, A. et al. (2004), ‘Les traitements de substitution en France: résultats récents 2004’, Tendances, June 2004, No37, http://www.ofdt.fr/ofdtdev/live/publi/tend.html and ‘Estimation du nombre de personnes recevant un traitement de substitution (Subutex 8 mg, Méthadone 60 mg) depuis 1995’, Séries Statistiques, http://www.ofdt.fr/BDD_len/seristat/00028.xhtml | |
| National survey by National Research Council — SIMI®Italia Project. National sampling based on a selected sample of 35994 people, corresponding to around 20% of clients who in 2006 were in treatment at local public services. | |
| High dosage buprenorphine treatment was only implemented in October 2007 in two clinics. | |
| Methadone programme of the State Addiction Agency. State Register of Persons with Drug Dependence and Substance Misuse. | |
| Vilnius Center for Addictive Disorders (VCAD) has a central database on methadone treatment. Healthcare institutions that prescribe methadone are obliged to report about inclusion or discharge of each patient. Private treatment under-reported. | |
| National Substitution Treatment Register to be established within the Directorate of Health. The Register should become operational in the course of 2007. Currently, data on clients in treatment are provided by the Luxembourg Information Network on Drugs and Drug Additions ('réseau luxembourgeois d'information sur les stupéfiants et les toxicomanies', RELIS) and National Health Insurance Union. | |
| Data on MAT centres and their clients is collected in the frame of Methadone Treatment Report 2005 by the specialised outpatient treatment centre of Nyíro Gyula Hospital. | |
| Substance Misuse Outpatient Unit (SMOPU), the centralised substitution unit in Malta. | |
| The National Alcohol and Drugs Information System (LADIS) covering outpatient addiction care and treatment, conducted by the Organisation Care Information Systems (IVZ). Homepage: www.sivz.nl | |
| Register on Substitution Treatment of the Department of Health and Women BMG. Annual analysis of the register on substitution treatment is carried out by the NFP. The data is not complete; experience indicates that not all doctors or services report start of MAT to the register. Reporting obligation for GPs only introduced in March 2007. | |
| National Bureau for Drug Prevention, Poland. | |
| Instituto da Droga e da Toxicodependência, Portugal. | |
| Romanian Monitoring Center for Drugs and Drug Addiction/ Central Statistical Unit, Ministry of Health. | |
| Client documentation at CPTDAs and prison treatment statistics (UIKS Annual report). | |
| General Secretariat of the Board of Ministers for Drug Addiction, Slovakia. | |
| Voluntary and anonymous national drug treatment information system, based at STAKES. | |
| Register of Drug Substitution — units, National Board of Health and Welfare. | |
| UK (England) | National Drug Treatment Monitoring System. |
| UK (N. Ireland) | Northern Ireland Substitute Prescribing Database (SPD). |
| UK (Scotland) | Prescription Information System, Information Services Division, National Services Scotland, NHS Scotland. |
| The Unit for Addiction Medicine, University of Oslo. |
Bulletin tables
Treatment availability
- Table HSR-1. Year of introduction of methadone maintenance treatment (MMT), high-dosage buprenorphine treatment (HDBT) and heroin-assisted treatment, including trials.
- Table HSR-2. Legal framework and practice of substitution treatment initiation.
- Table HSR-3. Estimated number of clients in methadone treatment and of clients receiving any opioid substitution in the EU-27, Croatia, Turkey and Norway, 2005 and 2006.
Needle and syringe availability
- Table HSR-4. Year of introduction of needle and syringe programmes and types of programmes available in 2006.
- Table HSR-5. Number of syringes provided through needle and syringe programmes 2005–06.
Associated graphics
Treatment availability
- Figure HSR-1. Number of opioid maintenance treatment clients as a percentage of the estimated number of problem opioid users, 2005–06.